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Wolffsohn JS, Berkow D, Chan KY, Chaurasiya SK, Fadel D, Haddad M, Imane T, Jones L, Sheppard AL, Vianya-Estopa M, Walsh K, Woods J, Zeri F, Morgan PB. BCLA CLEAR Presbyopia: Evaluation and diagnosis. Cont Lens Anterior Eye 2024:102156. [PMID: 38641525 DOI: 10.1016/j.clae.2024.102156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
It is important to be able to measure the range of clear focus in clinical practice to advise on presbyopia correction techniques and to optimise the correction power. Both subjective and objective techniques are necessary: subjective techniques (such as patient reported outcome questionnaires and defocus curves) assess the impact of presbyopia on a patient and how the combination of residual objective accommodation and their natural DoF work for them; objective techniques (such as autorefraction, corneal topography and lens imaging) allow the clinician to understand how well a technique is working optically and whether it is the right choice or how adjustments can be made to optimise performance. Techniques to assess visual performance and adverse effects must be carefully conducted to gain a reliable end-point, considering the target size, contrast and illumination. Objective techniques are generally more reliable, can help to explain unexpected subjective results and imaging can be a powerful communication tool with patients. A clear diagnosis, excluding factors such as binocular vision issues or digital eye strain that can also cause similar symptoms, is critical for the patient to understand and adapt to presbyopia. Some corrective options are more permanent, such as implanted inlays / intraocular lenses or laser refractive surgery, so the optics can be trialled with contact lenses in advance (including differences between the eyes) to better communicate with the patient how the optics will work for them so they can make an informed choice.
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Affiliation(s)
- James S Wolffsohn
- School of Optometry, Health and Life Sciences, Aston University, Birmingham, United Kingdom.
| | - David Berkow
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| | - Ka Yin Chan
- Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong
| | - Suraj K Chaurasiya
- Department of Contact Lens and Anterior Segment, CL Gupta Eye Institute, Moradabad, India; Department of Optometry and Vision Science, CL Gupta Eye Institute, Moradabad, India
| | - Daddi Fadel
- Centre for Ocular Research & Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
| | - Mera Haddad
- Faculty of Applied Medical Sciences, Department of Allied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Tarib Imane
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, United States
| | - Lyndon Jones
- Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong; Centre for Ocular Research & Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
| | - Amy L Sheppard
- School of Optometry, Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - Marta Vianya-Estopa
- Vision and Hearing Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
| | - Karen Walsh
- CooperVision Inc., San Ramon, CA, United States
| | - Jill Woods
- Centre for Ocular Research & Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
| | - Fabrizio Zeri
- School of Optometry, Health and Life Sciences, Aston University, Birmingham, United Kingdom; University of Milano-Bicocca, Department of Materials Science, Milan, Italy
| | - Philip B Morgan
- Eurolens Research, Division of Pharmacy and Optometry, University of Manchester, United Kingdom
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Wolffsohn JS. 2022 Glenn A. Fry Award lecture: Enhancing clinical assessment for improved ophthalmic management. Optom Vis Sci 2024; 101:12-24. [PMID: 38350054 DOI: 10.1097/opx.0000000000002102] [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: 02/15/2024] Open
Abstract
ABSTRACT Detailed clinical assessment is critical to allow sensitive evaluation of the eye and its management. As technology advances, these assessment techniques can be adapted and refined to improve the detection of pathological changes of ocular tissue and their impact on visual function. Enhancements in optical medical devices including spectacle, contact, and intraocular lenses have allowed for a better understanding of the mechanism and amelioration of presbyopia and myopia control. Advancements in imaging technology have enabled improved quantification of the tear film and ocular surface, informing diagnosis and treatment strategies. Miniaturized electronics, large processing power, and in-built sensors in smartphones and tablets capacitate more portable assessment tools for clinicians, facilitate self-monitoring and treatment compliance, and aid communication with patients. This article gives an overview of how technology has been used in many areas of eye care to improve assessments and treatment and provides a snapshot of some of my studies validating and using technology to inform better evidence-based patient management.
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Preetam Peraka R, Murthy SI. Role of anterior segment optical coherence tomography in scleral diseases: A review. Semin Ophthalmol 2023; 38:238-247. [PMID: 35996334 DOI: 10.1080/08820538.2022.2112700] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND Scleritis and episcleritis are an overlapping spectrum of diseases and accurate diagnosis is of utmost importance as the treatment and prognosis are vastly different. Predominantly a clinical diagnosis, the challenge lies in those cases with equivocal clinical features. Furthermore, clinical grading of scleritis is subjective and hence is neither very reliable nor reproducible. Existing modalities such as slit lamp examination and clinical photographs in scleritis describe macroanatomy but do not provide details on the microanatomy of the sclera. A recent adjusted algorithm for anterior segment optical coherence tomography (AS-OCT) imaging has improved the ability of this device to aid in the diagnosis of all the major forms of scleritis. PURPOSE To highlight the role of AS-OCT in delineating various anatomical forms of episcleritis and scleritis and explore this tool in monitoring disease course and response to therapy. METHODS A comprehensive literature search was carried out in various medical databases using keywords AS-OCT and scleritis; AS-OCT and episcleritis; anterior segment imaging in scleritis; scleritis and episcleritis; Recent advances in anterior segment imaging. Original articles and novel reports describing the potential role of AS-OCT in the diagnosis and management of scleritis and episcleritis were included. RESULTS After a thorough assessment, it was clear that published literature lacks guidelines for uniform interpretation and also for classification and follow-up in scleritis. We describe a uniform protocol for AS-OCT image acquisition, interpretation of images and list the advantages and limitations. CONCLUSIONS AS-OCT can be used to localize the level of scleral inflammation thus helping in the diagnosis of scleral inflammatory disease. It can be a valuable tool in studying progression.
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Affiliation(s)
- Raghav Preetam Peraka
- Academy of Eye Care Education, L V Prasad Eye Institute, Hyderabad, India
- Department of Cornea, The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Somasheila I Murthy
- Department of Cornea, The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
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Buckhurst PJ, Wolffsohn JS, Davies LN, Naroo SA. Surgical correction of astigmatism during cataract surgery. Clin Exp Optom 2021; 93:409-18. [PMID: 20735787 DOI: 10.1111/j.1444-0938.2010.00515.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Phillip J Buckhurst
- Aston University, Life and Health Sciences, Ophthalmic Research Group, Birmingham, United Kingdom
E‐mail:
| | - James S Wolffsohn
- Aston University, Life and Health Sciences, Ophthalmic Research Group, Birmingham, United Kingdom
E‐mail:
| | - Leon N Davies
- Aston University, Life and Health Sciences, Ophthalmic Research Group, Birmingham, United Kingdom
E‐mail:
| | - Shehzad A Naroo
- Aston University, Life and Health Sciences, Ophthalmic Research Group, Birmingham, United Kingdom
E‐mail:
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Affiliation(s)
- Pammal T Ashwin
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom
| | - Sunil Shah
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom
- Aston University, School of Life and Health Sciences, Ophthalmic Research Group, Birmingham, United Kingdom E‐mail:
| | - James S Wolffsohn
- Aston University, School of Life and Health Sciences, Ophthalmic Research Group, Birmingham, United Kingdom E‐mail:
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Alniemi ST, Amin SR, Sculley L, Bakri SJ. Ultrasound Biomicroscopy in Pseudophakic Patients with Unexplained Recurrent Hyphema or Vitreous Hemorrhage. Semin Ophthalmol 2016; 33:260-264. [PMID: 27960582 DOI: 10.1080/08820538.2016.1228984] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To describe IOL haptic with iris or ciliary body touch on ultrasound biomicroscopy (UBM) in pseudophakic patients with unexplained recurrent hyphema or vitreous hemorrhage. METHODS Retrospective chart review of 10 patients who presented with unexplained recurrent hyphema and or vitreous hemorrhage. RESULTS There were eight posterior chamber intraocular lenses (PCIOL) and two sulcus lenses. Four cases had a history of glaucoma; two cases which had a history of trabeculectomy were found to have some bridging vessels along the sclerostomy requiring argon laser gonioplasty. No preceding trauma or retinal pathology was found. UBM revealed haptic-ciliary body or haptic-iris touch in cases with a PCIOL and haptic-iris touch in both sulcus lens cases. One case with a PCIOL did not reveal any haptic-iris or ciliary body touch and instead displacement of the optic temporally, though haptics remained intracapsular. CONCLUSIONS UBM is a useful tool to evaluate haptic position in pseudophakic patients with unexplained recurrent hyphema and/or vitreous hemorrhage. This is the largest existing series of patients with this clinical entity reported from a single institution.
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Affiliation(s)
- Saba T Alniemi
- a Mayo Clinic Department of Ophthalmology , Rochester , MN , USA
| | - Sejal R Amin
- a Mayo Clinic Department of Ophthalmology , Rochester , MN , USA
| | - Luanne Sculley
- a Mayo Clinic Department of Ophthalmology , Rochester , MN , USA
| | - Sophie J Bakri
- a Mayo Clinic Department of Ophthalmology , Rochester , MN , USA
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Kim HJ, Kim PU, Hyeon MG, Choi Y, Kim J, Kim BM. High-resolution, dual-depth spectral-domain optical coherence tomography with interlaced detection for whole-eye imaging. APPLIED OPTICS 2016; 55:7212-7217. [PMID: 27661354 DOI: 10.1364/ao.55.007212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Dual-depth spectral-domain optical coherence tomography (SD-OCT) enables high-resolution in vivo whole-eye imaging. Two orthogonally polarized beams from a source are focused simultaneously on two axial positions of the anterior segment and the retina. For the detector arm, a 1×2 ultrafast optical switch sequentially delivers two spectral interference signals to a single spectrometer, which extends the in-air axial depth range up to 9.44 mm. An off-pivot complex conjugate removal technique doubles the depth range for all anterior segment imaging. The graphics-processing-unit-based parallel signal processing algorithm supports fast two- and three-dimensional image displays. The obtained high-resolution anterior and retinal images are measured biometrically. The dual-depth SD-OCT system has an axial resolution of ∼6.4 μm in air, and the sensitivity is 91.79 dB at 150 μm from the zero-delay line.
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High resolution iridocorneal angle imaging system by axicon lens assisted gonioscopy. Sci Rep 2016; 6:30844. [PMID: 27471000 PMCID: PMC4965779 DOI: 10.1038/srep30844] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 07/11/2016] [Indexed: 11/08/2022] Open
Abstract
Direct visualization and assessment of the iridocorneal angle (ICA) region with high resolution is important for the clinical evaluation of glaucoma. However, the current clinical imaging systems for ICA do not provide sufficient structural details due to their poor resolution. The key challenges in achieving high quality ICA imaging are its location in the anterior region of the eye and the occurrence of total internal reflection due to refractive index difference between cornea and air. Here, we report an indirect axicon assisted gonioscopy imaging probe with white light illumination. The illustrated results with this probe shows significantly improved visualization of structures in the ICA including TM region, compared to the current available tools. It could reveal critical details of ICA and expected to aid management by providing information that is complementary to angle photography and gonioscopy.
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Abstract
Foreword It gives me pleasure to introduce the 4th edition of the EGS Guidelines. The Third edition proved to be extremely successful, being translated into 7 languages with over 70000 copies being distributed across Europe; it has been downloadable, free, as a pdf file for the past 4 years. As one of the main objectives of the European Glaucoma Society has been to both educate and standardize glaucoma practice within the EU, these guidelines were structured so as to play their part. Glaucoma is a living specialty, with new ideas on causation, mechanisms and treatments constantly appearing. As a number of years have passed since the publication of the last edition, changes in some if not all of these ideas would be expected. For this new edition of the guidelines a number of editorial teams were created, each with responsibility for an area within the specialty; updating where necessary, introducing new diagrams and Flowcharts and ensuring that references were up to date. Each team had writers previously involved with the last edition as well as newer and younger members being co-opted. As soon as specific sections were completed they had further editorial comment to ensure cross referencing and style continuity with other sections. Overall guidance was the responsibility of Anders Heijl and Carlo Traverso. Tribute must be made to the Task Force whose efforts made the timely publication of the new edition possible. Roger Hitchings Chairman of the EGS Foundation www.eugs.org The Guidelines Writers and Contributors Augusto Azuara Blanco Luca Bagnasco Alessandro Bagnis Keith Barton Christoph Baudouin Boel Bengtsson Alain Bron Francesca Cordeiro Barbara Cvenkel Philippe Denis Christoph Faschinger Panayiota Founti Stefano Gandolfi David Garway Heath Francisco Goni Franz Grehn Anders Heijl Roger Hitchings Gabor Hollo Tony Hommer Michele Iester Jost Jonas Yves Lachkar Giorgio Marchini Frances Meier Gibbons Stefano Miglior Marta Misiuk-Hojo Maria Musolino Jean Philippe Nordmann Norbert Pfeiffer Luis Abegao Pinto Luca Rossetti John Salmon Leo Schmetterer Riccardo Scotto Tarek Shaarawy Ingeborg Stalmans Gordana Sunaric Megevand Ernst Tamm John Thygesen Fotis Topouzis Carlo Enrico Traverso Anja Tuulonen Ananth Viswanathan Thierry Zeyen The Guidelines Task Force Luca Bagnasco Anders Heijl Carlo Enrico Traverso Augusto Azuara Blanco Alessandro Bagnis David Garway Heath Michele Iester Yves Lachkar Ingeborg Stalmans Gordana Sunaric Mégevand Fotis Topouzis Anja Tuulonen Ananth Viswanathan The EGS Executive Committee Carlo Enrico Traverso (President) Anja Tuulonen (Vice President) Roger Hitchings (Past President) Anton Hommer (Treasurer) Barbara Cvenkel Julian Garcia Feijoo David Garway Heath Norbert Pfeiffer Ingeborg Stalmans The Board of the European Glaucoma Society Foundation Roger Hitchings (Chair) Carlo E. Traverso (Vice Chair) Franz Grehn Anders Heijl John Thygesen Fotis Topouzis Thierry Zeyen The EGS Committees CME and Certification Gordana Sunaric Mégevand (Chair) Carlo Enrico Traverso (Co-chair) Delivery of Care Anton Hommer (Chair) EU Action Thierry Zeyen (Chair) Carlo E. Traverso (Co-chair) Education John Thygesen (Chair) Fotis Topouzis (Co-chair) Glaucogene Ananth Viswanathan (Chair) Fotis Topouzis (Co-chair) Industry Liaison Roger Hitchings (Chair) Information Technology Ingeborg Stalmans (Chair) Carlo E. Traverso (Co-chair) National Society Liaison Anders Heijl (Chair) Program Planning Fotis Topouzis (Chair) Ingeborg Stalmans (Co-chair) Quality and Outcomes Anja Tuulonen (Chair) Augusto Azuara Blanco (Co-chair) Scientific Franz Grehn (Chair) David Garway Heath (Co-chair)
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Affiliation(s)
- Alireza Mashaghi
- Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Jiaxu Hong
- Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Sunil K Chauhan
- Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Reza Dana
- Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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Lim DH, Kim TH, Chung ES, Chung TY. Measurement of lens density using Scheimpflug imaging system as a screening test in the field of health examination for age-related cataract. Br J Ophthalmol 2014; 99:184-91. [PMID: 25204988 DOI: 10.1136/bjophthalmol-2014-305632] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE To assess Pentacam (Oculus, Wetzlar, Germany) Scheimpflug quantitative images in evaluating lens density and providing objective measurements to suggest optimal time of cataract surgery in the field of health examination. METHODS Two hundred and twenty-nine eyes with age-related cataract were enrolled. Lens density was measured using Pentacam. All Pentacam images were exported to ImageJ (NIH, Bethesda, Maryland, USA) for quantitative analysis. Average lens density (ALD) and nuclear lens density (NLD) were calculated. Lens density was also evaluated by built-in Pentacam Nucleus Staging (PNS) software. Slit-lamp microscopy was performed for cataract grading according to Lens Opacification Classification System III (LOCS III). The best-corrected visual acuity (BCVA) was measured. All measurements were compared between the cataract surgery and non-cataract surgery groups. RESULTS The measurements of Pentacam images significantly correlated with LOCS III for nuclear opalescence (NO) and nuclear colour (NC) grading (p<0.01). Pentacam ImageJ showed higher correlation than PNS. The mean NLD was most highly correlated with NO (r=0.8833) and NC (r=0.6815). The maximum ALD was most highly correlated with cortical opacity (r=0.5381). All Pentacam measurements of lens density and BCVA were significantly different between the cataract surgery and non-surgery groups (p<0.01). The optimised cut-off values to perform cataract surgery for mean NLD and maximum ALD were 26 and 74, respectively (p<0.01). CONCLUSIONS The Pentacam ImageJ method provided objective measurements to evaluate cataracts needing surgery. The method has the potential to be generally applied in the field of health examination and is effective in screening patients with cataract.
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Affiliation(s)
- Dong Hui Lim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea Department of Preventive Medicine, Catholic University School of Medicine, Seoul, Republic of Korea
| | - Tae Hyup Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eui-Sang Chung
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae-Young Chung
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Vélez M, Velásquez LF, Rojas S, Montoya L, Zuluaga K, Balparda K. Capsular block syndrome: a case report and literature review. Clin Ophthalmol 2014; 8:1507-13. [PMID: 25152612 PMCID: PMC4140233 DOI: 10.2147/opth.s67407] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To report the case of a patient who developed late capsular block syndrome and to review the current literature regarding this complication of phacoemulsification procedures. METHODS The literature was reviewed to summarize the diagnosis, classification, use of diagnostic aids, and the current treatments for this complication. RESULTS A 69-year-old patient complained of decreased visual acuity 11 months after undergoing phacoemulsification. She was found to have a secondary myopization. Anterior segment ultrabiomicroscopy confirmed the diagnosis of capsular block syndrome. The patient underwent neodymium-doped yttrium aluminum garnet (Nd:YAG) laser posterior capsulotomy, which resulted in complete resolution of her symptoms. CONCLUSION CAPSULAR BLOCK SYNDROME IS A FAIRLY RARE COMPLICATION OF PHACOEMULSIFICATION PROCEDURES THAT, DEPENDING PRIMARILY ON THE TIMING OF ITS OCCURRENCE FOLLOWING SURGERY, CAN DEVELOP INTO ONE OF THE THREE FOLLOWING POSSIBLE CLINICAL SCENARIOS: intraoperatory, early postoperatory, and late postoperatory. In this patient, Nd:YAG laser capsulotomy was shown to be a safe and effective treatment option for this type of complication.
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Affiliation(s)
- Mauricio Vélez
- Pontifical Bolivarian University, School of Medicine, Medellín, Antioquia, Colombia
| | - Luis F Velásquez
- Pontifical Bolivarian University, School of Medicine, Medellín, Antioquia, Colombia
| | - Sebastián Rojas
- Pontifical Bolivarian University, School of Medicine, Medellín, Antioquia, Colombia
| | - Laura Montoya
- Pontifical Bolivarian University, School of Medicine, Medellín, Antioquia, Colombia
| | - Katherine Zuluaga
- Pontifical Bolivarian University, School of Medicine, Medellín, Antioquia, Colombia
| | - Kepa Balparda
- Pontifical Bolivarian University, School of Medicine, Medellín, Antioquia, Colombia
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Automatic Biometry of the Anterior Segment During Accommodation Imaged by Optical Coherence Tomography. Eye Contact Lens 2014; 40:232-8. [DOI: 10.1097/icl.0000000000000043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Aptel F, Chiquet C, Gimbert A, Romanet JP, Thuret G, Gain P, Campolmi N. Anterior segment biometry using spectral-domain optical coherence tomography. J Refract Surg 2014; 30:354-60. [PMID: 24694582 DOI: 10.3928/1081597x-20140326-01] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 12/03/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the anterior chamber and anterior chamber angle measurements obtained with spectral-domain anterior segment optical coherence tomography (AS-OCT) and time-domain AS-OCT. METHODS The anterior chamber of healthy participants was imaged with spectral-domain AS-OCT (Casia SS-1000; Tomey, Nagoya, Japan) and time-domain AS-OCT (Visante; Carl Zeiss Meditec, Dublin, CA). Central corneal thickness (CCT), anterior chamber depth (ACD), angle opening distance at 500 and 750 μm (AOD 500 and AOD 750), trabecular iris space area at 500 and 750 μm (TISA 500 and TISA 750), and scleral spur angle were measured. The intraclass correlation coefficients (ICCs) were calculated. The Pearson correlation test was used to evaluate the correlation between the measurements and Bland-Altman plots to evaluate the agreement. RESULTS One hundred one eyes of 101 healthy participants were analyzed. Excellent repeatability was found with both devices for CCT, AOD 500, AOD 750, TISA 750, and scleral spur angle (ICC = 0.90 to 0.98 and 0.89 to 0.97, respectively) and excellent to moderate repeatability was found for TISA 500 (ICC = 0.68 to 0.97 and 0.70 to 0.93, respectively). For all parameters, Casia and Visante measurements were significantly correlated (r = 0.76 to 0.98; P < .02). ACD measured with the Casia was significantly larger (mean difference = 0.12 ± 0.08 mm; P < .0001), and the scleral spur angle measured with the Casia was significantly lower (mean difference = 4.85° ± 5.30°; P < .01). There were nonsignificant differences between the devices for the other parameters (P > .06). CONCLUSIONS Both Casia and Visante AS-OCT demonstrate high repeatability. Except for the ACD and scleral spur angles, the two devices show good agreement.
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Srivannaboon S, Chirapapaisan C, Chonpimai P, Koodkaew S. Comparison of ocular biometry and intraocular lens power using a new biometer and a standard biometer. J Cataract Refract Surg 2014; 40:709-15. [PMID: 24656166 DOI: 10.1016/j.jcrs.2013.09.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 09/30/2013] [Accepted: 09/30/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the repeatability and reproducibility of ocular biometry and intraocular lens (IOL) power obtained with a new optical biometer (AL-Scan) and a standard optical biometer (IOLMaster 500). SETTING Siriraj Hospital, Mahidol University, Bangkok, Thailand. DESIGN Prospective comparative study. METHODS Two independent operators measured eyes with cataract using both biometers. The keratometry values, axial length, anterior chamber depth, white-to-white (WTW) corneal diameter, and IOL power calculated using the Holladay 1 formula obtained with each device were recorded. Intraoperator repeatability and interoperator reproducibility of both devices were analyzed using the intraclass correlation coefficient (ICC). The agreement in ocular biometry and IOL power between the 2 devices was evaluated by the Bland-Altman method. RESULTS The study recruited 137 eyes of 81 patients. The repeatability and reproducibility of both devices were high for all ocular biometry measurements (ICC, 0.87-1.00). Except for the WTW corneal diameter (ICC, 0.44), the agreement between the biometers was also high (ICC, 0.98-0.99). The IOL powers calculated by the Holladay 1 formula were similar between the 2 biometers. CONCLUSION The new optical biometer provided excellent repeatability and reproducibility for all ocular biometry. Agreement with the standard optical biometer was good except for the WTW corneal diameter.
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Affiliation(s)
- Sabong Srivannaboon
- From the Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Pratuangsri Chonpimai
- From the Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sunisa Koodkaew
- From the Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Chaudhry IA. Measurement of central corneal thickness in health and disease. Saudi J Ophthalmol 2013; 23:179-80. [PMID: 23960857 DOI: 10.1016/j.sjopt.2009.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Imtiaz A Chaudhry
- Senior Academic Consultant, Oculoplastic and Orbit Division, King Khaled Eye Specialist Hospital, P.O. Box 7191, Riyadh 11462, Saudi Arabia
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Cyclodialysis induced persistent hypotony: surgical management with vitrectomy and endotamponade. Retina 2013; 33:1540-6. [PMID: 23598794 DOI: 10.1097/iae.0b013e3182877a41] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report novel surgical approaches to the management of persistent hypotony after cyclodialysis. METHODS Retrospective review of the medical records of six eyes of six patients with persistent hypotony after traumatic cyclodialysis. The diagnosis accuracy of cyclodialysis was documented by ultrasound biomicroscopy in five patients. The other one underwent an anterior segment optical coherence tomography. The authors performed pars plana vitrectomy and silicone oil-assisted endotamponade in four patients. The remaining eyes underwent a gas tamponade after pars plana vitrectomy. RESULTS Preoperative visual acuity (Snellen scale) ranged from count fingers to 20/50. The patients' visual acuity improved after the surgery. The intraocular pressure ranged from 2 mmHg to 6 mmHg (mean, 3.33 mmHg) before surgery. The authors did achieve an intraocular pressure normalization postoperatively. After surgery, the ciliary body was completely reattached in all cases. A slight angle recession was documented in one eye. CONCLUSION The management of cyclodialysis clefts requires a stepwise approach. In cases where conservative management fails, wide ranges of options have been reported. Based on our results, we consider that silicone oil-assisted or gas-assisted endotamponade, after pars plana vitrectomy, can be an effective alternative approach to the cyclodialysis.
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Du C, Shen M, Li M, Zhu D, Wang MR, Wang J. Anterior segment biometry during accommodation imaged with ultralong scan depth optical coherence tomography. Ophthalmology 2012; 119:2479-85. [PMID: 22902211 DOI: 10.1016/j.ophtha.2012.06.041] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 05/25/2012] [Accepted: 06/25/2012] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To measure by ultralong scan depth optical coherence tomography (UL-OCT) dimensional changes in the anterior segment of human eyes during accommodation. DESIGN Evaluation of diagnostic test or technology. PARTICIPANTS Forty-one right eyes of healthy subjects with a mean age of 34 years (range, 22-41 years) and a mean refraction of -2.5 ± 2.6 diopters were imaged in 2 repeated measurements at minimal and maximal accommodations. METHODS A specially adapted and designed UL-OCT instrument was used to image from the front surface of the cornea to the back surface of the crystalline lens. Custom software corrected the optical distortion of the images and yielded the biometric measurements. The coefficient of repeatability and the intraclass correlation coefficient were calculated to evaluate the repeatability and reliability. MAIN OUTCOME MEASURES Anterior segment parameters and associated repeatability and reliability upon accommodation. The dimensional results included central corneal thickness (CCT), anterior chamber depth and width (ACD, ACW), pupil diameter (PD), lens thickness (LT), anterior segment length (ASL = ACD + LT), lens central position (LCP = ACD + 1/2LT), and horizontal radii of the lens anterior and posterior surface curvatures (LAC, LPC). RESULTS Repeated measurements of each variable within each accommodative state did not differ significantly (P>0.05). The coefficients of repeatability (CORs) and intraclass correlation coefficients for CCT, ACW, ACD, LT, LCP, and ASL were excellent (1.2%- 3.59% and 0.998-0.877, respectively). They were higher for PD (18.90%-21.63% and 0.880-0.874, respectively) and moderate for LAC and LPC (34.86%-42.72% and 0.669-0.251, respectively) in the 2 accommodative states. Compared with minimal accommodation, PD, ACD, LAC, LPC, and LCP decreased and LT and ASL increased significantly at maximal accommodation (P<0.05), whereas CCT and ACW did not change (P>0.05). CONCLUSIONS The UL-OCT measured changes in anterior segment dimensions during accommodation with good repeatability and reliability. During accommodation, the back surface of the lens became steeper as the lens moved forward. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any of the materials discussed in this article.
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Affiliation(s)
- Chixin Du
- Department of Ophthalmology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Dai C, Zhou C, Fan S, Chen Z, Chai X, Ren Q, Jiao S. Optical coherence tomography for whole eye segment imaging. OPTICS EXPRESS 2012; 20:6109-15. [PMID: 22418490 DOI: 10.1364/oe.20.006109] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
We proposed a dual focus dual channel spectral domain optical coherence tomography (SD-OCT) for simultaneous imaging of the whole eye segments from cornea to the retina. By using dual channels the system solved the problem of limited imaging depth of SD-OCT. By using dual focus the system solved the problem of simultaneous light focusing on the anterior segment of the eye and the retina. Dual focusing was achieved by adjusting the collimating lenses so the divergence of the two probing beams was tuned to make them focused at different depth in the eye. We further achieved full range complex (FRC) SD-OCT in one channel to increase the depth range for anterior segment imaging. The system was successfully tested by imaging a human eye in vivo.
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Affiliation(s)
- Cuixia Dai
- School of Biomedical Engineering, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China
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Shields CL, Belinsky I, Romanelli-Gobbi M, Guzman JM, Mazzuca D, Green WR, Bianciotto C, Shields JA. Anterior Segment Optical Coherence Tomography of Conjunctival Nevus. Ophthalmology 2011; 118:915-9. [DOI: 10.1016/j.ophtha.2010.09.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 09/16/2010] [Accepted: 09/17/2010] [Indexed: 11/17/2022] Open
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In vivo 7.1 T magnetic resonance imaging to assess the lens geometry in rabbit eyes 3 years after lens-refilling surgery. J Cataract Refract Surg 2011; 37:749-57. [DOI: 10.1016/j.jcrs.2010.10.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2010] [Revised: 10/19/2010] [Accepted: 10/24/2010] [Indexed: 11/23/2022]
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Kumar DA, Agarwal A, Prakash G, Jacob S, Saravanan Y, Agarwal A. Evaluation of intraocular lens tilt with anterior segment optical coherence tomography. Am J Ophthalmol 2011; 151:406-12.e2. [PMID: 21236406 DOI: 10.1016/j.ajo.2010.09.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2009] [Revised: 09/14/2010] [Accepted: 09/14/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine the ability of anterior segment optical coherence tomography (OCT) to detect intraocular lens (IOL) tilt evaluation in relation to the limbus. DESIGN Observational case series. METHODS The IOL position of 123 eyes of 92 patients was examined with anterior segment OCT (Carl Zeiss Meditec, Dublin, California, USA). All eyes underwent uneventful phacoemulsification with the IOL in the bag. Images were obtained in 4 axes (180 to 0 degrees, 225 to 45 degrees, 315 to 135 degrees, and 270 to 90 degrees). Using MatLab software version 7.1 (Mathworks), the OCT images were analyzed. The distance between the iris margin and the anterior surface of IOL, the slope ratio between IOL and limbus, and the angle (θ; position of IOL with reference to the limbus) were determined and were correlated with the astigmatism and vision. RESULTS The mean slope of the limbus and the IOL in all axes was 0.003 ± 0.09 and -0.002 ± 0.12, respectively. The average slope ratio was 1.1 ± 1 (range, -2.09 to 3.82) and the angle (θ) was 1.52 ± 0.9 degrees (range, 0.04 to 3.6 degrees). The mean ocular residual astigmatism was 0.2379 ± 0.469 diopters. There was no significant correlation of ocular residual astigmatism with slope ratio (r = -0.171; P = .060) and slope angle (r = -0.132; P = .147). There was significant correlation of ocular residual astigmatism with total astigmatism (r=0.602, p=0.000). The mean distances between the iris margin and the anterior surface of IOL at the pupillary plane were 0.80 ± 0.6 mm and 0.83 ± 0.57 mm, respectively. CONCLUSIONS The normal in-the-bag IOL maintains an angle with reference to the limbus and a slope ratio without causing a significant tilt. Anterior segment OCT can be used as an alternative in IOL tilt evaluation by the analysis of its position in relation to the limbus.
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Turuwhenua J. Reconstructing ocular surfaces by Purkinje images using an exact ray approach: estimating IOL decenter and tilt. Ophthalmic Physiol Opt 2010; 30:43-54. [PMID: 20444109 DOI: 10.1111/j.1475-1313.2009.00692.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Recently, an alternate method for recovering the shape of the anterior surface of an intraocular lens (IOL) (by Purkinje images), and capable of returning a Zernike polynomial representation of that surface, was proposed (Ophthal. Physiol Opt., 29, 2009, 80-91). However, in moving toward a clinically applicable method, it is important to estimate parameters such as surface radius, lens tilt and decenter. Previously, radius of curvature (for the anterior surface of an IOL) was estimated by finding the best-fit sphere. A methodology is presented here to recover lens tilt and decenter using this alternate method. The theory is developed and then tested in simulation. An IOL is added to the Navarro eye, and then recovered by assuming: (i) the same 'full eye', and (ii) a reduced two surface version (the 'simplified' eye). A number of decenter and tilt settings are tested, from which root mean squared (RMS) surface errors, best-fit spheres, tilt and decenter values are estimated. Mis-measurement of the axial position of the posterior surface of the IOL is also simulated. The full eye model produces low RMS surface and radii of curvature errors, that increase linearly with axial shift. The error behaviour is not greatly affected by changes in IOL decenter and/or tilt. The simplified eye (n = 1.32 for aqueous) with n = 1.4760 (at lambda = 880 nm) for the IOL, fits the 'full eye' results most consistently. Lens decenter is consistently estimated to within 0.015 mm (for a 1 mm decenter), and tilt <0.15 degrees (for a 5 degree tilt).
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Affiliation(s)
- Jason Turuwhenua
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.
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Kim SK, Kim HM, Song JS. Comparison of internal anterior chamber diameter imaging modalities: 35-MHz ultrasound biomicroscopy, Visante optical coherence tomography, and Pentacam. J Refract Surg 2010; 26:120-6. [PMID: 20163076 DOI: 10.3928/1081597x-20100121-07] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 02/10/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the internal diameter of the anterior chamber among three different imaging modalities: 35-MHz ultrasound biomicroscopy (UBM), Visante optical coherence tomography (OCT), and Pentacam, and to compare the internal diameters with white-to-white (WTW) distance measured by Orbscan. METHODS The internal horizontal anterior chamber diameter was measured in 20 normal eyes using 35-MHz UBM (Optikon), Visante OCT (Carl Zeiss Meditec), and Pentacam (Oculus Inc). The mean horizontal anterior chamber diameters were compared, and the correlations between each pair of two different methods were evaluated. Horizontal WTW distance was measured by Orbscan IIz (Bausch & Lomb-Orbtek Inc) and then correlated with the measurements of internal anterior chamber diameter. RESULTS The mean horizontal anterior chamber diameter was 10.99+/-0.47 mm with UBM, 11.70+/-0.47 mm with OCT, and 11.86+/-0.45 mm with Pentacam. Ultrasound biomicroscopy measurements were significantly different than those of OCT and Pentacam (P<.001 for both). However, no significant difference was found between OCT and Pentacam (P=.19). Regarding the correlations between each pair of two different methods, UBM and OCT showed significant correlation (r=0.848, P<.001), but there was no significant correlation between OCT and Pentacam (r=0.403, P=.078), even though the mean values were similar. In the Bland-Altman plots, the range of agreement was 0.51 mm between OCT and UBM, and 0.99 mm between Pentacam and OCT. CONCLUSIONS Although the internal anterior chamber diameters measured by 35-MHz UBM were significantly smaller than those measured by Visante OCT and Pentacam, the measurements of UBM and Visante OCT showed significant correlation and good agreement with each other. Pentacam showed poor correlation with other measurements.
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Affiliation(s)
- Sang-Kyoon Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
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Comparison of Different Modes in Optical Coherence Tomography and Ultrasound Biomicroscopy in Anterior Chamber Angle Assessment. J Glaucoma 2009; 18:472-8. [DOI: 10.1097/ijg.0b013e31818fb41d] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zhou C, Wang J, Jiao S. Dual channel dual focus optical coherence tomography for imaging accommodation of the eye. OPTICS EXPRESS 2009; 17:8947-55. [PMID: 19466144 PMCID: PMC2718716 DOI: 10.1364/oe.17.008947] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
A dual channel dual focus spectral-domain optical coherence tomography was developed for imaging the accommodation of the eye in real time. The system can provide simultaneous cross-sectional imaging of all the surfaces of the anterior segment of the eye including the cornea, anterior chamber, anterior and posterior surfaces of the crystalline lens. Thus, the modification of the curvatures of the anterior and posterior surfaces of the crystalline lens and the dimensions of the anterior segment of the eye with accommodation can be calculated. The system was successfully tested in imaging accommodation. The preliminary results demonstrated the feasibility of this novel approach.
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Affiliation(s)
- Chuanqing Zhou
- Institute for Laser Medicine and Biophotonics, Shanghai Jiao Tong University School of Life Science and Biotechnology, 800 Dongchuan Road, Shanghai 200240, China
| | - Jianhua Wang
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine 1638 NW 10th Ave. Miami, FL 33136, USA
| | - Shuliang Jiao
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine 1638 NW 10th Ave. Miami, FL 33136, USA
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Jacobs MD. Multiscale systems integration in the eye. WILEY INTERDISCIPLINARY REVIEWS-SYSTEMS BIOLOGY AND MEDICINE 2009; 1:15-27. [DOI: 10.1002/wsbm.29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Marc D. Jacobs
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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Visualization of Changes of the Iris Configuration After Peripheral Laser Iridotomy in Primary Melanin Dispersion Syndrome Using Optical Coherence Tomography. J Glaucoma 2008; 17:569-70. [DOI: 10.1097/ijg.0b013e318168f02c] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW Primary angle closure typically causes acute intraocular pressure rise in the phakic elderly. Alternative diagnoses, however, for which iridotomy is usually ineffective, occur commonly in younger, nonhyperopic, and pseudophakic patients. RECENT FINDINGS High-resolution ultrasonography has advanced our understanding of these entities. Management of platueau iris, present in over half of angle closures with patent iridotomy, may depend on disease stage. Early postoperative pseudophakic patients with myopic shift and narrow angle should be treated with laser capsulotomy for capsular block. Bilateral angle closure is usually due to an offending systemic pharmacologic agent, which must be stopped to resolve the closure. Ciliary body swelling often produces angle closure by blocking the access of aqueous to the anterior chamber, sometimes paradoxically after hypotony. Annular choroidal effusions, difficult to detect without ultrasound, may mimic angle closure. Although cycloplegic and corticosteroid therapy may resolve some entities, pars plana vitrectomy and lensectomy may be necessary to resolve severe ciliary block. We also discuss unique variants of angle closure in patients with retinal disease. SUMMARY Atypical angle closures should always be considered. Careful examination techniques and new technology can detect the mechanisms involved and direct treatment.
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Kim HY, Budenz DL, Lee PS, Feuer WJ, Barton K. Comparison of central corneal thickness using anterior segment optical coherence tomography vs ultrasound pachymetry. Am J Ophthalmol 2008; 145:228-232. [PMID: 18054888 DOI: 10.1016/j.ajo.2007.09.030] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Revised: 09/14/2007] [Accepted: 09/20/2007] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine if there is a systematic difference in central corneal thickness (CCT) measured using anterior segment optical coherence tomography (AS-OCT) as compared with ultrasound pachymetry. DESIGN Prospective observational study. METHODS Consecutive subjects with clinically normal corneas underwent CCT measurement by both ultrasound and AS-OCT while participating in a population-based study in Ghana, West Africa. One eye of each subject was randomly selected for analysis. Two measurements were taken and averaged. Agreement and interobserver variability were also analyzed. RESULTS One hundred and fifty-five subjects of African ethnicity and average age 57 years (standard deviation [SD] 12; range, 40 to 98 years) were included. Measurements by AS-OCT and US were taken a mean of 15 days (maximum, six weeks) apart. The mean (SD) [range] US CCT was 525.3 microm (33.5) [422, 653] and 499.0 microm (32.0) [428, 613] with AS-OCT. Measurements by the two modalities were strongly correlated (r(2) = 0.82; P < .001), and a significant difference was observed between mean US and AS-OCT CCT (SD) [range] of 26.3 microm (14.2) [-63, 12] (P < .001). The width of the limits of agreement was 28 microm, about 6% of the average pachymetry reading. In 50 eyes randomly remeasured with OCT by a second observer, the intraclass correlation coefficient was 0.91. There was a small but significant systematic difference between observers (mean 6.9 microm, SD 10.9 microm), or 1.4% (P < .001), increasing the difference noted above. CONCLUSION There is a reproducible systematic difference between CCT measurements taken with ultrasound and OCT. It is important to note in clinical practice, that measurements acquired by these two modalities are not directly interchangeable.
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Affiliation(s)
- Hanna Y Kim
- Department of Ophthalmology, Stanford University, Stanford, CA, USA
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