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Huber KL, Stino H, Schlegl T, Steiner I, Nagy G, Niederleithner M, Baumann B, Drexler W, Leitgeb RA, Schmidt-Erfurth U, Schmoll T, Pollreisz A. Microaneurysm detection using high-speed megahertz optical coherence tomography angiography in advanced diabetic retinopathy. Acta Ophthalmol 2024; 102:e687-e695. [PMID: 38126128 DOI: 10.1111/aos.16619] [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: 10/25/2023] [Revised: 11/29/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To compare detection rates of microaneurysms (MAs) on high-speed megahertz optical coherence tomography angiography (MHz-OCTA), fluorescein angiography (FA) and colour fundus photography (CF) in patients with diabetic retinopathy (DR). METHODS For this exploratory cross-sectional study, MHz-OCTA data were acquired with a swept-source OCT prototype (A-scan rate: 1.7 MHz), and FA and CF imaging was performed using Optos® California. MA count was manually evaluated on en face MHz-OCTA/FA/CF images within an extended ETDRS grid. Detectability of MAs visible on FA images was evaluated on corresponding MHz-OCTA and CF images. MA distribution and leakage were correlated with detectability on OCTA and CF imaging. RESULTS 47 eyes with severe DR (n = 12) and proliferative DR (n = 35) were included. MHz-OCTA and CF imaging detected on average 56% and 36% of MAs, respectively. MHz-OCTA detection rate was significantly higher than CF (p < 0.01). The combination of MHz-OCTA and CF leads to an increased detection rate of 70%. There was no statistically significant association between leakage and MA detectability on OCTA (p = 0.13). For CF, the odds of detecting leaking MAs were significantly lower than non-leaking MAs (p = 0.012). Using MHz-OCTA, detection of MAs outside the ETDRS grid was less likely than MAs located within the ETDRS grid (outer ring, p < 0.01; inner ring, p = 0.028). No statistically significant difference between rings was observed for CF measurements. CONCLUSIONS More MAs were detected on MHz-OCTA than on CF imaging. Detection rate was lower for MAs located outside the macular region with MHz-OCTA and for leaking MAs with CF imaging. Combining both non-invasive modalities can improve MA detection.
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Affiliation(s)
- Kim Lien Huber
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Heiko Stino
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Thomas Schlegl
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
| | - Irene Steiner
- Center for Medical Data Science, Institute of Medical Statistics, Medical University of Vienna, Vienna, Austria
| | - Gergely Nagy
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Michael Niederleithner
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
| | - Bernhard Baumann
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
| | - Wolfgang Drexler
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
| | - Rainer A Leitgeb
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Tilman Schmoll
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
- Carl Zeiss Meditec, Inc., Dublin, California, USA
| | - Andreas Pollreisz
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
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Prem Senthil M, Anand S, Chakraborty R, Bordon JE, Constable PA, Brown S, Al-Dasooqi D, Simon S. Exploring the utility of retinal optical coherence tomography as a biomarker for idiopathic intracranial hypertension: a systematic review. J Neurol 2024:10.1007/s00415-024-12481-3. [PMID: 38856724 DOI: 10.1007/s00415-024-12481-3] [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: 04/08/2024] [Revised: 05/24/2024] [Accepted: 05/26/2024] [Indexed: 06/11/2024]
Abstract
This study aimed to examine the existing literature that investigated the effectiveness of optical coherence tomography (OCT) and optical coherence tomography angiography (OCT-A) as a biomarker for idiopathic intracranial hypertension (IIH). Our search was conducted on January 17th, 2024, and included the databases, Medline, Scopus, Embase, Cochrane, Latin American and Caribbean Health Sciences Literature (LILACS), International Standard Randomized Controlled Trial Number (ISRCTN) registry, and the International Clinical Trials Registry Platform (ICTRP). Our final review included 84 articles. In 74 studies, OCT was utilized as the primary ocular imaging method, while OCT-A was employed in two studies including eight studies that utilized both modalities. Overall, the results indicated that IIH patients exhibited significant increases in retinal nerve fiber layer (RNFL) thickness, total retinal and macular thickness, optic nerve head volume, and height, optic disc diameter and area, rim area, and thickness compared to controls. A significant correlation was observed between cerebrospinal fluid (CSF) pressure and OCT parameters including RNFL thickness, total retinal thickness, macular thickness, optic nerve head volume, and optic nerve head height. Interventions aimed at lowering CSF pressure were associated with a substantial improvement in these parameters. Nevertheless, studies comparing peripapillary vessel density using OCT-A between IIH patients and controls yielded conflicting results. Our systematic review supports OCT as a powerful tool to accurately monitor retinal axonal and optic nerve head changes in patients with IIH. Future research is required to determine the utility of OCT-A in IIH.
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Affiliation(s)
- Mallika Prem Senthil
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia.
| | - Saumya Anand
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia
| | - Ranjay Chakraborty
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia
| | - Jose Estevez Bordon
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia
| | - Paul A Constable
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia
| | - Shannon Brown
- Central Library, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Dalia Al-Dasooqi
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia
| | - Simu Simon
- University of Adelaide, Adelaide, South Australia, Australia
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Huang RS, Mihalache A, Popovic MM, Munn C, Balas M, Issa M, Melo IM, Friedman A, Wright T, Yan P, Muni RH. ASSOCIATION OF INTRAVENOUS FLUORESCEIN ANGIOGRAPHY AND ADAPTIVE OPTICS IMAGING IN DIABETIC RETINOPATHY: A Prospective Case Series. Retina 2024; 44:689-699. [PMID: 38011843 DOI: 10.1097/iae.0000000000004012] [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: 11/29/2023]
Abstract
PURPOSE To our knowledge, we present the first case series investigating the relationship between adaptive optics (AO) imaging and intravenous fluorescein angiography (IVFA) parameters in patients with diabetic retinopathy. METHODS Consecutive patients with diabetic retinopathy older than age 18 years presenting to a single center in Toronto, Canada, from 2020 to 2021 were recruited. Adaptive optics was performed with the RTX1 camera (Imagine Eyes, Orsay, France) at retinal eccentricities of 2° and 4°. Intravenous fluorescein angiography was assessed with the artificial intelligence-based RETICAD system to extract blood flow, perfusion, and blood-retinal-barrier (BRB) permeability at the same retinal locations. Correlations between AO and IVFA parameters were calculated using Pearson's correlation coefficient. RESULTS Across nine cases, a significant positive correlation existed between photoreceptor spacing on AO and BRB permeability (r = 0.303, P = 0.027), as well as perfusion (r = 0.272, P = 0.049) on IVFA. When stratified by location, a significant positive correlation between photoreceptor dispersion and both BRB permeability and perfusion (r = 0.770, P = 0.043; r = 0.846, P = 0.034, respectively) was observed. Cone density was also negatively correlated with BRB permeability (r = -0.819, P = 0.046). CONCLUSION Photoreceptor spacing on AO was significantly correlated with BRB permeability and perfusion on IVFA in patients with diabetic retinopathy. Future studies with larger sample sizes are needed to understand the relationship between AO and IVFA parameters in diverse patient populations.
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Affiliation(s)
- Ryan S Huang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Mihalache
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Colyn Munn
- Emagix Inc, Halifax, Nova Scotia, Canada
- Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Balas
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mariam Issa
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Isabela Martins Melo
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Alon Friedman
- Emagix Inc, Halifax, Nova Scotia, Canada
- Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Tom Wright
- Kensington Vision and Research Centre, Kensington Eye Institute, Toronto, Ontario, Canada; and
| | - Peng Yan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Kensington Vision and Research Centre, Kensington Eye Institute, Toronto, Ontario, Canada; and
| | - 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
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Ferrara M, Zheng Y, Romano V. Editorial: Imaging in Ophthalmology. J Clin Med 2022; 11:jcm11185433. [PMID: 36143079 PMCID: PMC9503085 DOI: 10.3390/jcm11185433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Over the last decade, ophthalmology has significantly benefited from advances in vivo non-invasive ophthalmic imaging techniques that play currently a fundamental role in the clinical assessment, diagnosis, management, and monitoring of a wide variety of conditions involving both the anterior and posterior segment [...]
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Affiliation(s)
| | - Yalin Zheng
- Department of Eye and Vision Science, University of Liverpool, Liverpool L69 3BX, UK
- St Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L69 3BX, UK
| | - Vito Romano
- Eye Clinic, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, 25121 Brescia, Italy
- ASST Civil Hospital of Brescia, 25123 Brescia, Italy
- Correspondence:
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Huang L, Li L, Wang M, Zhang D, Song Y. Correlation between ultrawide-field fluorescence contrast results and white blood cell indexes in diabetic retinopathy. BMC Ophthalmol 2022; 22:231. [PMID: 35597915 PMCID: PMC9123654 DOI: 10.1186/s12886-022-02442-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 05/05/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is one of the most common microvascular complications of diabetes. DR involves a state of systemic inflammation, and chronic inflammation can promote microvascular and macrovascular diseases in diabetic patients and accelerate disease progression. Ultrawide-field FFA (UWFA) systems are increasingly being used to examine a wider retina. The aim of this study was to explore the correlation between the different manifestations of retinopathy under UWFA and the systemic indicators of white blood cells in patients with diabetic retinopathy. METHODS This retrospective study included the hospitalized DR patients in the Department of Ophthalmology and Endocrinology of the Affiliated Hospital 2 of Nantong University between January 2016 and March 2019. This study examined the correlations between the UWFA examination results and glycated hemoglobin (HbA1c), routine blood tests,and the neutrophil-to-lymphocyte ratio of patients with clinically diagnosed DR during hospitalization. RESULTS A total of 115 patients with DR (53 females and 62 males) were included (199 eyes: 102 right eyes and 97 left eyes). UWFA revealed that most eyes (77.4%) had grade 4 microvascular leakage, 52.8% had grade 0 capillary non-perfusion area, 59.3% had grade 0 neovascularization, and 92.0% had grade 0 fibrous proliferative membranes. Microvascular leakage was correlated with the NLR (r = 0.186, P = 0.027). Capillary non-perfusion area was correlated with the monocyte ratio (r = 0.144, P = 0.042) and the eosinophil ratio (r = 0.123, P = 0.044). Neovascularization was correlated to the monocyte ratio (r = 0.324, P = 0.018). Finally, the fibrous proliferative membrane was correlated to the monocyte ratio (r = 0.418, P = 0.002). Only the eosinophil ratio was independently associated with proliferative DR (odds ratio = 1.25, 95% confidence interval: 1.04-1.51, P = 0.018). CONCLUSION The results of UWFA imaging in patients with DR are correlated with white blood cell population indexes. The eosinophil ratio was independently associated with proliferative DR.
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Affiliation(s)
- Lili Huang
- Department of Ophthalmology, Affiliated Hospital 2 of Nantong University, Nantong, 226001, People's Republic of China
| | - Lele Li
- Department of Ophthalmology, Affiliated Hospital 2 of Nantong University, Nantong, 226001, People's Republic of China
| | - Min Wang
- Department of Ophthalmology, Affiliated Hospital 2 of Nantong University, Nantong, 226001, People's Republic of China
| | - Dongmei Zhang
- Medical Research Center, Affiliated Hospital 2 of Nantong University, Nantong, 226001, People's Republic of China
| | - Yu Song
- Department of Ophthalmology, Affiliated Hospital 2 of Nantong University, Nantong, 226001, People's Republic of China.
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Chatziralli I, Touhami S, Cicinelli MV, Agapitou C, Dimitriou E, Theodossiadis G, Theodossiadis P. Disentangling the association between retinal non-perfusion and anti-VEGF agents in diabetic retinopathy. Eye (Lond) 2022; 36:692-703. [PMID: 34408316 PMCID: PMC8956693 DOI: 10.1038/s41433-021-01750-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 07/29/2021] [Accepted: 08/06/2021] [Indexed: 02/07/2023] Open
Abstract
Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus (DM) and the leading cause of blindness in patients with DM. In the pathogenesis of DR, chronic hyperglycemia leads to biochemical and structural alterations in retinal blood vessels' wall, resulting in hyperpermeability and non-perfusion. Since vascular endothelial growth factor (VEGF) has been found to play a significant role in the pathogenesis of DR, this review sheds light on the effect of intravitreal anti-VEGF agents on retinal non-perfusion in patients with DR. Based on the existing literature, anti-VEGF agents have been shown to improve DR severity, although they cannot reverse retinal ischemia. The results of the published studies are controversial and differ based on the location of retinal non-perfusion, as well as the imaging modality used to assess retinal non-perfusion. In cases of macular non-perfusion, most of studies showed no change in both fundus fluorescein angiography (FFA) and optical coherence tomography (OCTA) in patients with DR treated with intravitreal anti-VEGF agents, while few studies reported worsening of non-perfusion with enlargement of foveal avascular zone (FAZ). Regarding peripheral ischemia, studies using wide-field-FFA demonstrated an improvement or stability in non-perfusion areas after anti-VEGF treatment. However, the use of wide-field-OCTA revealed no signs of re-perfusion of retinal vessels post anti-VEGF treatment. Further prospective studies with long follow-up and large sample size are still needed to draw solid conclusions.
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Affiliation(s)
- Irini Chatziralli
- grid.5216.00000 0001 2155 08002nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Sara Touhami
- grid.462844.80000 0001 2308 1657Department of Ophthalmology, Reference Center in Rare diseases, DHU Sight Restore, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Maria Vittoria Cicinelli
- grid.15496.3f0000 0001 0439 0892School of Medicine, Vita-Salute San Raffaele University, Milan, Italy ,grid.18887.3e0000000417581884Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chrysa Agapitou
- grid.5216.00000 0001 2155 08002nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Dimitriou
- grid.5216.00000 0001 2155 08002nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - George Theodossiadis
- grid.5216.00000 0001 2155 08002nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Theodossiadis
- grid.5216.00000 0001 2155 08002nd Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
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Sensitivity and specificity of MultiColor imaging in detecting proliferative diabetic retinopathy. Int Ophthalmol 2021; 42:455-467. [PMID: 34698967 PMCID: PMC8545774 DOI: 10.1007/s10792-021-02062-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/21/2021] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the accuracy of MultiColor imaging (MC) compared to fluorescein angiography (FA) in detecting proliferative diabetic retinopathy (PDR) and associated diabetic retinopathy features. METHODS Fifty-nine eyes from 38 PDR patients were included. MC images were reviewed by 2 independent masked graders. A qualitative analysis based on the following features was performed: neovascular complexes (NVC), disc neovascularization (NVD), neovascularization elsewhere (NVE), microaneurysm (MA), intraretinal hemorrhage (IRH), vitreous hemorrhage (VH), preretinal hemorrhage (PRH), fibrosis, hard exudates (HE), epiretinal membrane (ERM), diabetic macular edema (DME), ischemia and laser spots (LS). Measures of diagnostic accuracy compared to FA were determined. RESULTS The sensitivity for the detection of NVC using MC was 95.1%, with a specificity of 40.0%, positive predictive value (PPV) of 92.9% and negative predictive value (NPV) of 50.0%. Sensitivity and specificity were higher in detecting NVD (88.9% and 76.9%) while NVE registered higher PPV (88.9%). MC was highly sensitive in detecting IRH, HE, ERM and LS (100%), MA (98.0%) and fibrosis (95.5%). Highest specificity was found for VH (100.0%), DME (100.0%), PRH (98.1%) and LS (89.5%). The area under the receiver-operating characteristic analysis of MC was excellent in NVD (0.83, 95% confidence interval (CI), 0.71-0.95, p < 0.001), IRH (0.89, 95% CI 0.74-1.00, p < 0.001), VH (0.81, 95% CI 0.60-1.00, p = 0.005) and PRH (0.89, 95% CI 0.68-1.00, p = 0.004) and outstanding in LS detection (0.95, 95% CI 0.87-1.00, p < 0.001). These results are likely due to the contrast and quality of the MC since better discrimination is enabled by the green wavelength. CONCLUSION MC is useful in evaluation of PDR patients and can complement noninvasive imaging. MC detected some PDR features more accurately than FA such as NVD, IRH, VH, PRH, and LS.
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Update on Optical Coherence Tomography and Optical Coherence Tomography Angiography Imaging in Proliferative Diabetic Retinopathy. Diagnostics (Basel) 2021; 11:diagnostics11101869. [PMID: 34679567 PMCID: PMC8535055 DOI: 10.3390/diagnostics11101869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/22/2021] [Accepted: 10/07/2021] [Indexed: 12/29/2022] Open
Abstract
Proliferative diabetic retinopathy (PDR) is a major cause of blindness in diabetic individuals. Optical coherence tomography (OCT) and OCT-angiography (OCTA) are noninvasive imaging techniques useful for the diagnosis and assessment of PDR. We aim to review several recent developments using OCT and discuss their present and potential future applications in the clinical setting. An electronic database search was performed so as to include all studies assessing OCT and/or OCTA findings in PDR patients published from 1 January 2020 to 31 May 2021. Thirty studies were included, and the most recently published data essentially focused on the higher detection rate of neovascularization obtained with widefield-OCT and/or OCTA (WF-OCT/OCTA) and on the increasing quality of retinal imaging with quality levels non-inferior to widefield-fluorescein angiography (WF-FA). There were also significant developments in the study of retinal nonperfusion areas (NPAs) using these techniques and research on the impact of PDR treatment on NPAs and on vascular density. It is becoming increasingly clear that it is critical to use adequate imaging protocols focused on optimized segmentation and maximized imaged retinal area, with ongoing technological development through artificial intelligence and deep learning. These latest findings emphasize the growing applicability and role of noninvasive imaging in managing PDR with the added benefit of avoiding the repetition of invasive conventional FA.
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Kanclerz P, Tuuminen R, Khoramnia R. Imaging Modalities Employed in Diabetic Retinopathy Screening: A Review and Meta-Analysis. Diagnostics (Basel) 2021; 11:diagnostics11101802. [PMID: 34679501 PMCID: PMC8535170 DOI: 10.3390/diagnostics11101802] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Urbanization has caused dramatic changes in lifestyle, and these rapid transitions have led to an increased risk of noncommunicable diseases, such as type 2 diabetes. In terms of cost-effectiveness, screening for diabetic retinopathy is a critical aspect in diabetes management. The aim of this study was to review the imaging modalities employed for retinal examination in diabetic retinopathy screening. METHODS The PubMed and Web of Science databases were the main sources used to investigate the medical literature. An extensive search was performed to identify relevant articles concerning "imaging", "diabetic retinopathy" and "screening" up to 1 June 2021. Imaging techniques were divided into the following: (i) mydriatic fundus photography, (ii) non-mydriatic fundus photography, (iii) smartphone-based imaging, and (iv) ultrawide-field imaging. A meta-analysis was performed to analyze the performance and technical failure rate of each method. RESULTS The technical failure rates for mydriatic and non-mydriatic digital fundus photography, smartphone-based and ultrawide-field imaging were 3.4% (95% CI: 2.3-4.6%), 12.1% (95% CI: 5.4-18.7%), 5.3% (95% CI: 1.5-9.0%) and 2.2% (95% CI: 0.3-4.0%), respectively. The rate was significantly different between all analyzed techniques (p < 0.001), and the overall failure rate was 6.6% (4.9-8.3%; I2 = 97.2%). The publication bias factor for smartphone-based imaging was significantly higher than for mydriatic digital fundus photography and non-mydriatic digital fundus photography (b = -8.61, b = -2.59 and b = -7.03, respectively; p < 0.001). Ultrawide-field imaging studies were excluded from the final sensitivity/specificity analysis, as the total number of patients included was too small. CONCLUSIONS Regardless of the type of the device used, retinal photographs should be taken on eyes with dilated pupils, unless contraindicated, as this setting decreases the rate of ungradable images. Smartphone-based and ultrawide-field imaging may become potential alternative methods for optimized DR screening; however, there is not yet enough evidence for these techniques to displace mydriatic fundus photography.
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Affiliation(s)
- Piotr Kanclerz
- Hygeia Clinic, 80-286 Gdańsk, Poland
- Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland;
- Correspondence: ; Tel./Fax: +48-58-776-4046
| | - Raimo Tuuminen
- Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland;
- Eye Centre, Kymenlaakso Central Hospital, 48100 Kotka, Finland
| | - Ramin Khoramnia
- The David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, 69120 Heidelberg, Germany;
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Willis JR, Ali FS, Argente B, Domalpally A, Gannon J, Gao SS, Grover S, Kanodia P, Russell-Puleri S, Sun D, Thrasher C, Tsougarakis C, Hopkins JJ. Feasibility Study of a Multimodal, Cloud-Based, Diabetic Retinal Screening Program in a Workplace Environment. Transl Vis Sci Technol 2021; 10:20. [PMID: 34111266 PMCID: PMC8131994 DOI: 10.1167/tvst.10.6.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose To evaluate the feasibility of capturing and interpreting retinal images in a workplace environment using a multimodal, cloud-based, diabetic retinal screening program combined with electronic self-reported questionnaires. The burden of diabetic retinopathy (DR) and other retinal conditions, healthcare utilization, and visual function were also assessed. Methods A cross-sectional feasibility study was conducted at the Genentech, Inc., Campus Health Center. Eyes of participants were imaged using ultra-widefield (UWF) color fundus photography (CFP) and spectral-domain optical coherence tomography (SD-OCT). A cloud-based platform was used for the automated, seamless transfer of images to a remote reading center for evaluation for DR and other retinal pathologies. Electronic surveys collected participants’ self-reported medical histories, healthcare utilization, and visual function data. Results Among 100 participants (mean age, 43.9 years; 44% male), 33% of them self-reported diabetes. Eye examinations within the past 12 months were reported by 71% of all participants (n = 71/100) and by 85% (n = 28/33) of those with self-reported diabetes. Among participants with complete screening images from both UWF-CFP and SD-OCT, 20% (n = 6/30) of those with self-reported diabetes and 8.5% (n = 5/59) of participants with no history of diabetes were unaware they had mild/moderate nonproliferative DR. Among all participants, 20% (20/100) had a retinal finding, on either UWF-CFP or SD-OCT, or both, which prompted a referral for further evaluation. Conclusions A retinal screening program deployed via a secure, scalable, and interoperable cloud-based platform was feasible and conveniently integrated into the workplace. Translational Relevance Cloud-based platforms could be used to promote a secure, scalable, and interoperable system for retinal screening in nontraditional environments.
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Affiliation(s)
| | | | | | - Amitha Domalpally
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Simon S Gao
- Genentech, Inc., South San Francisco, CA, USA
| | | | | | | | - Diana Sun
- Genentech, Inc., South San Francisco, CA, USA
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Nagasawa T, Tabuchi H, Masumoto H, Morita S, Niki M, Ohara Z, Yoshizumi Y, Mitamura Y. Accuracy of Diabetic Retinopathy Staging with a Deep Convolutional Neural Network Using Ultra-Wide-Field Fundus Ophthalmoscopy and Optical Coherence Tomography Angiography. J Ophthalmol 2021; 2021:6651175. [PMID: 33884202 PMCID: PMC8041547 DOI: 10.1155/2021/6651175] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/11/2021] [Accepted: 03/26/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The present study aimed to compare the accuracy of diabetic retinopathy (DR) staging with a deep convolutional neural network (DCNN) using two different types of fundus cameras and composite images. METHOD The study included 491 ultra-wide-field fundus ophthalmoscopy and optical coherence tomography angiography (OCTA) images that passed an image-quality review and were graded as no apparent DR (NDR; 169 images), mild nonproliferative DR (NPDR; 76 images), moderate NPDR (54 images), severe NPDR (90 images), and proliferative DR (PDR; 102 images) by three retinal experts by the International Clinical Diabetic Retinopathy Severity Scale. The findings of tests 1 and 2 to identify no apparent diabetic retinopathy (NDR) and PDR, respectively, were then assessed. For each verification, Optos, OCTA, and Optos OCTA imaging scans with DCNN were performed. RESULT The Optos, OCTA, and Optos OCTA imaging test results for comparison between NDR and DR showed mean areas under the curve (AUC) of 0.79, 0.883, and 0.847; sensitivity rates of 80.9%, 83.9%, and 78.6%; and specificity rates of 55%, 71.6%, and 69.8%, respectively. Meanwhile, the Optos, OCTA, and Optos OCTA imaging test results for comparison between NDR and PDR showed mean AUC of 0.981, 0.928, and 0.964; sensitivity rates of 90.2%, 74.5%, and 80.4%; and specificity rates of 97%, 97%, and 96.4%, respectively. CONCLUSION The combination of Optos and OCTA imaging with DCNN could detect DR at desirable levels of accuracy and may be useful in clinical practice and retinal screening. Although the combination of multiple imaging techniques might overcome their individual weaknesses and provide comprehensive imaging, artificial intelligence in classifying multimodal images has not always produced accurate results.
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Affiliation(s)
- Toshihiko Nagasawa
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji 671-1227, Japan
| | - Hitoshi Tabuchi
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji 671-1227, Japan
- Department of Technology and Design Thinking for Medicine, Hiroshima University, Hiroshima 739-8511, Japan
| | - Hiroki Masumoto
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji 671-1227, Japan
| | - Shoji Morita
- Graduate School of Engineering, University of Hyogo, Kobe 657-0013, Japan
| | - Masanori Niki
- Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8851, Japan
| | - Zaigen Ohara
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji 671-1227, Japan
| | - Yuki Yoshizumi
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji 671-1227, Japan
| | - Yoshinori Mitamura
- Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8851, Japan
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Dong Y, Liu Y, Yu J, Qi S, Liu H. Mapping research trends in diabetic retinopathy from 2010 to 2019: A bibliometric analysis. Medicine (Baltimore) 2021; 100:e23981. [PMID: 33545985 PMCID: PMC7837830 DOI: 10.1097/md.0000000000023981] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/26/2020] [Accepted: 11/30/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Although many publications in diabetic retinopathy (DR) have been reported, there is no bibliometric analysis. Purpose: To perform a bibliometric analysis in the field of diabetic retinopathy (DR) research, to characterize the current international status of DR research, to identify the most effective factors involved in this field, and to explore research hotspots in DR research. Methods: Based on the Web of Science Core Collection (WoSCC), a bibliometric analysis was conducted to investigate the publication trends in research related to DR. Knowledge maps were constructed by VOSviewer v.1.6.10 to visualize the publications, the distribution of countries, international collaborations, author productivity, source journals, cited references and keywords, and research hotspots in this field. Results: In total, 11,839 peer-reviewed papers were retrieved on DR from 2010 to 2019, and the annual research output increased with time. The United States ranks highest among countries with the most publications. The most active institution is the University of Melbourne. Wong, TY contributed the largest number of publications in this field. Investigative Ophthalmology & Visual Science was the most prolific journal in DR research. The top-cited references mainly investigated the use of anti-vascular endothelial growth factor (VEGF) medications in the management of DR, and the keywords formed 6 clusters: Discussion: With the improvement of living standard, DR has gradually become one of the important causes of blindness, and has become a hot spot of public health research in many countries. The application of deep learning and artificial intelligence in diabetes screening and anti-VEGF medications in the management of DR have been the research hotspots in recent 10 years. Conclusions: Based on data extracted from the WoSCC, this study provides a broad view of the current status and trends in DR research and may provide clinicians and researchers with insight into DR research and valuable information to identify potential collaborators and partner institutions and better predict their dynamic directions.
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Affiliation(s)
- Yi Dong
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Clinical College of Ophthalmology Tianjin Medical University
| | - Yanli Liu
- Ophthalmology Department, Baodi Clinical College of Tianjin Medical University, Tianjin Baodi Hospital, Tianjin, China
| | - Jianguo Yu
- Ophthalmology Department, Baodi Clinical College of Tianjin Medical University, Tianjin Baodi Hospital, Tianjin, China
| | - Shixin Qi
- Ophthalmology Department, Baodi Clinical College of Tianjin Medical University, Tianjin Baodi Hospital, Tianjin, China
| | - Huijuan Liu
- Ophthalmology Department, Baodi Clinical College of Tianjin Medical University, Tianjin Baodi Hospital, Tianjin, China
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Vaz-Pereira S, Morais-Sarmento T, Esteves Marques R. Optical coherence tomography features of neovascularization in proliferative diabetic retinopathy: a systematic review. Int J Retina Vitreous 2020; 6:26. [PMID: 32612851 PMCID: PMC7322867 DOI: 10.1186/s40942-020-00230-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/21/2020] [Indexed: 01/03/2023] Open
Abstract
Background Diabetic retinopathy (DR) is a leading cause of blindness due to diabetic macular edema (DME) or complications of proliferative diabetic retinopathy (PDR). Optical coherence tomography (OCT) is a noninvasive imaging technique well established for DME but less used to assess neovascularization in PDR. Developments in OCT imaging and the introduction of OCT angiography (OCTA) have shown significant potential in PDR. Objectives To describe the tomographic features of PDR, namely of neovascularization, both of the optic disc (NVD) and elsewhere (NVE), intraretinal microvascular abnormalities (IRMA), retinal nonperfusion areas (NPA), status of the posterior vitreous, vitreoschisis and vitreous and subhyaloid/sub-ILM hemorrhages. Data sources Electronic database search on PubMed and EMBASE, last run on December 19th 2019. Study eligibility criteria, participants and interventions Publications assessing OCT and/or OCTA findings in PDR patients. All study designs were allowed except for case-reports, conference proceedings and letters. Study appraisal Newcastle–Ottawa Scale for observational studies was used for purposes of risk of bias assessment. Results From the 1300 studies identified, 283 proceeded to full-text assessment and 60 were included in this comprehensive review. OCT was useful in detecting NVD and NVE, such as in characterizing disease activity and response to laser and/or anti-VEGF therapies. The absence of posterior vitreous detachment seemed determinant for neovascular growth, with the posterior hyaloid acting as a scaffold. OCTA allowed a more detailed characterization of the neovascular complexes, associated NPA and disease activity, allowing the quantification of neovessel area and flow index. However, changes in OCTA blood flow signal following local therapies did not necessarily correlate with structural regression. Widefield and ultra-widefield OCTA were highly sensitive in the detection of PDR, adding value to disease staging and monitoring. Compared to fluorescein angiography, OCTA was more sensitive in detecting microvascular changes indicating disease progression. Limitations Publication languages were restricted. Most included studies were observational and non-comparative. Risk of bias regarding case representativeness. Conclusions OCT-based retinal imaging technologies are advancing rapidly and the trend is to be noninvasive and wide-field. OCT has proven invaluable in diagnosing, staging and management of proliferative diabetic disease with daily application in clinical and surgical practices.
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Affiliation(s)
- Sara Vaz-Pereira
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Norte, EPE-Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-035 Lisbon, Portugal.,Department of Ophthalmology, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Tiago Morais-Sarmento
- Department of Ophthalmology, Hospital do Espírito Santo de Évora EPE, Évora, Portugal
| | - Raquel Esteves Marques
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Norte, EPE-Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-035 Lisbon, Portugal.,Department of Ophthalmology, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Gramatikov BI. Computer-aided fixation detection using retinal birefringence in multi-modal ophthalmic systems: Computer, electronics, algorithms. Comput Biol Med 2020; 119:103672. [PMID: 32339117 DOI: 10.1016/j.compbiomed.2020.103672] [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: 01/09/2020] [Revised: 02/08/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
Many diagnostic and some therapeutic ophthalmic devices require a reliable complementing method to track the direction of gaze or just to validate fixation of the eye on a presented target. This would allow acquisition of artefact-free robust images of the fovea and the surrounding macula. So far, there have been only few attempts to provide fast and dependable fixation information to an optical imaging system in real time, to guide image acquisition. The author's lab has developed several instruments that detect the location of the fovea using retinal birefringence scanning (RBS), proven to be very effective. Here, an RBS-based fixation detection subsystem is proposed, designed to operate conjointly with a number of ophthalmic imaging technologies. Combining RBS with such technologies is not trivial, because RBS uses polarized light and polarization-sensitive optics, while most other modalities don't. The polarization optics was optimized by means of enhanced computer modeling. Both the electronic hardware and the software were designed for fast and reliable performance. Because many retinal imaging systems are used in pediatric settings, extensive audio-visual circuitry was employed for efficient attention/fixation attraction. The optomechanics has been optimized for robust data acquisition. This computer-aided conjoint system employs true anatomical information from the back of the eye and needs no calibration. The prototype instrument uses a decision-making logic based on four frequencies generated during scanning. The results reveal the applicability of RBS as an adjunct fixation monitoring modality, showing promise to remove the limitation imposed by eye movements upon advanced ophthalmic imaging technologies.
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Affiliation(s)
- Boris I Gramatikov
- Ophthalmic Instrumentation Development Laboratory, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, 21287, USA.
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