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Du Y, Meng J, He W, Qi J, Lu Y, Zhu X. Complications of high myopia: An update from clinical manifestations to underlying mechanisms. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2024; 4:156-163. [PMID: 39036706 PMCID: PMC11260019 DOI: 10.1016/j.aopr.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 06/15/2024] [Accepted: 06/20/2024] [Indexed: 07/23/2024]
Abstract
Background High myopia is one of the major causes of visual impairment and has an ever-increasing prevalence, especially in East Asia. It is characterized by excessive axial elongation, leading to various blinding complications that extend beyond mere refractive errors and persist immovably after refractive surgery, presenting substantial public health challenge. Main text High myopia-related complications include lens pathologies, atrophic and tractional maculopathy, choroidal neovascularization, peripheral retinal degenerations and retinal detachment, and glaucoma and heightened susceptibility to intraocular pressure (IOP) elevation. Pathological lens changes characteristic of high myopia include early cataractogenesis, overgrowth of lens, weakened zonules, and postoperative capsular contraction syndrome, possibly driven by inflammatory pathogenesis, etc. Dome-shaped macula and cilioretinal arteries are two newly identified protective factors for central vision of highly myopic patients. These patients also face risks of open-angle glaucoma and IOP spike following intraocular surgery. Morphologic alternations of optic nerve in high myopia can complicate early glaucoma detection, necessitating comprehensive examinations and close follow-up. Anatomically, thinner trabecular meshwork increases this risk; conversely lamina cribrosa defects may offer a fluid outlet, potentially mitigating the pressure. Notably, anxiety has emerged as the first recognized extra-ocular complication in high myopia, with an underlying inflammatory pathogenesis that connects visual stimulus, blood and brain. Conclusions High myopia induces multiple ocular and potential mental health complications, underscoring the need to develop more effective strategies to improve both physical and emotional well-being of these patients, among which anti-inflammation might possibly represent a promising new target.
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Affiliation(s)
- Yu Du
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Jiaqi Meng
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Wenwen He
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Jiao Qi
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Yi Lu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Xiangjia Zhu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia and Related Eye Diseases, Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
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Baldwin G, Tracy J, Vingopoulos F, Munsell M, Bennett C, Rodriguez JM, Choi H, Garg I, Tandias R, Wescott H, Finn MJ, Razavi P, Bannerman A, Zeng R, Vavvas DG, Husain D, Kim LA, Patel NA, Miller JB. Contrast Sensitivity Better Reflects Wide-Field Swept-Source Optical Coherence Tomography Angiography Vascular Metrics Among Healthy Eyes Compared to Visual Acuity. Ophthalmic Surg Lasers Imaging Retina 2024:1-9. [PMID: 38917397 DOI: 10.3928/23258160-20240411-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the association between widefield swept-source optical coherence tomography angiography (WF SS-OCTA) and visual function in healthy eyes. PATIENTS AND METHODS Fifty-seven eyes of 45 patients were evaluated with visual acuity (VA), contrast sensitivity (CS), and WF SS-OCTA (3 × 3, 6 × 6, and 12 × 12 mm images) on the same day. Mixed-effects multivariable regression analyses were performed. RESULTS Contrast sensitivity metrics, including CS between 6 to 18 cycles per degree (cpd) and area under the logarithm CS function, were significantly associated with vessel density (VD) and vessel skeletonized density (VSD), whereas VA was not. The largest effect size was between CS at 18 cpd and VD (β = 0.41, P = 0.007) and VSD (β = 0.42, P = 0.006) on 12 × 12 mm images. CONCLUSIONS Reduced VSD and VD on WF SSOCTA was significantly associated with decreased CS, whereas VA was not. These results suggest CS could serve as a screening tool for early stage retinal and neurologic disorders. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].
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Zhang W, Yang F, Chen S, Shi T. Peripheral and posterior pole retinal changes in highly myopic Chinese children and adolescents : Retinal changes in Chinese children and adolescents. BMC Ophthalmol 2024; 24:65. [PMID: 38350965 PMCID: PMC10865601 DOI: 10.1186/s12886-024-03328-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/24/2024] [Indexed: 02/15/2024] Open
Abstract
PURPOSE This study was conducted to evaluate the prevalence and related factors of peripheral and posterior pole retinal changes in highly myopic Chinese children and adolescents. METHODS A hospital-based cross-sectional study was designed. A total of 120 subjects with high myopia were recruited and underwent cycloplegic refraction, dilated fundus examination, and optical coherence tomography. A statistical analysis was performed to evaluate the factors associated with peripheral and posterior pole retinal changes. RESULTS The mean spherical equivalent refraction of the subjects was - 8.74 ± 2.86 D, and the mean age was 11.45 ± 3.02 years. Snowflake retinal degeneration (27.5%), white without pressure (27.5%), snail-track degeneration (15%), and lattice degeneration (15%) were the most common peripheral retinal changes, while tessellated fundus (84.17%), optic nerve crescents (78.3%), and posterior staphyloma (11.7%) were the most common posterior changes. Subjects with peripheral changes were significantly older, with thinner choroids (OR = 1.194, 95% CI: 1.045-1.363, p = 0.009; OR = 0.993, 95% CI: 0.987-0.999, p = 0.022, respectively). Optic nerve crescents, tessellated fundus, and posterior scleral staphyloma were all associated with thin choroids (OR = 0.990, 95% CI: 0.983-0.997, p = 0.008; OR = 0.983, 95% CI: 0.974-0.991, p < 0.001; OR = 0.974, 95% CI: 0.960-0.987, p < 0.001, respectively). CONCLUSION A substantial proportion of the subjects had peripheral and posterior retinal changes. An increased risk of retinal changes was associated with high degrees of myopia, long axial lengths, thin choroids, and older ages among 7-16-year-old individuals.
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Affiliation(s)
- Wenli Zhang
- Joint Shantou International Eye Center, Shantou University & the Chinese University of Hong Kong, North Dongxia Road, 515041, Shantou, Guangdong, China
| | - Fan Yang
- Joint Shantou International Eye Center, Shantou University & the Chinese University of Hong Kong, North Dongxia Road, 515041, Shantou, Guangdong, China
| | - Shirong Chen
- Joint Shantou International Eye Center, Shantou University & the Chinese University of Hong Kong, North Dongxia Road, 515041, Shantou, Guangdong, China
| | - Tingkun Shi
- Joint Shantou International Eye Center, Shantou University & the Chinese University of Hong Kong, North Dongxia Road, 515041, Shantou, Guangdong, China.
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Zhang J, Zou H. Insights into artificial intelligence in myopia management: from a data perspective. Graefes Arch Clin Exp Ophthalmol 2024; 262:3-17. [PMID: 37231280 PMCID: PMC10212230 DOI: 10.1007/s00417-023-06101-5] [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: 11/26/2022] [Revised: 03/23/2023] [Accepted: 05/06/2023] [Indexed: 05/27/2023] Open
Abstract
Given the high incidence and prevalence of myopia, the current healthcare system is struggling to handle the task of myopia management, which is worsened by home quarantine during the ongoing COVID-19 pandemic. The utilization of artificial intelligence (AI) in ophthalmology is thriving, yet not enough in myopia. AI can serve as a solution for the myopia pandemic, with application potential in early identification, risk stratification, progression prediction, and timely intervention. The datasets used for developing AI models are the foundation and determine the upper limit of performance. Data generated from clinical practice in managing myopia can be categorized into clinical data and imaging data, and different AI methods can be used for analysis. In this review, we comprehensively review the current application status of AI in myopia with an emphasis on data modalities used for developing AI models. We propose that establishing large public datasets with high quality, enhancing the model's capability of handling multimodal input, and exploring novel data modalities could be of great significance for the further application of AI for myopia.
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Affiliation(s)
- Juzhao Zhang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haidong Zou
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Shanghai Eye Diseases Prevention & Treatment Center, Shanghai Eye Hospital, Shanghai, China.
- National Clinical Research Center for Eye Diseases, Shanghai, China.
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China.
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Maltsev DS, Kulikov AN, Shaimova VA, Burnasheva MA, Vasiliev AS. Spotlight on Lattice Degeneration Imaging Techniques. Clin Ophthalmol 2023; 17:2383-2395. [PMID: 37605766 PMCID: PMC10440085 DOI: 10.2147/opth.s405200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/10/2023] [Indexed: 08/23/2023] Open
Abstract
Lattice degeneration (LD), routinely diagnosed with indirect ophthalmoscopy, is one of the most common and clinically significant peripheral retinal findings. In this review, we have summarized the data on currently available imaging techniques which help to improve diagnosis and our understanding of LD pathogenesis. Ultra-wide field imaging provides reliable color fundus capturing for the primary diagnosis of LD and may also be used as a screening tool. Wide-field imaging can be used for targeted documentation of LD lesions using true colors and with minimal optical distortions. Information on the status of the vitreoretinal interface, including detection of retinal holes, detachments, and vitreous tractions, can be obtained with peripheral structural optical coherence tomography (OCT) or scanning laser ophthalmoscopy in retro-mode. These techniques clarify the associated risks of rhegmatogenous retinal detachment. Fundus autofluorescence can provide details on atrophic changes. However, the risk of retinal detachment by means of this technique requires further investigation. OCT angiography may be successfully performed for some lesions. Taken together, OCT and OCT angiography demonstrate thinning of the choroid, alteration of local choroidal microcirculation, and, in severe lesions, involvement of the sclera. OCT angiography confirms loss of retinal microcirculation within LD lesion, which was previously shown with fluorescein angiography. In conclusion, despite relatively simple primary diagnosis, imaging of LD lesions remains challenging due to their peripheral localization. However, several new strategies, including ultra-wide field imaging, peripheral OCT, and scanning laser ophthalmoscopy, make LD imaging possible on a routine basis, improving diagnosis and understanding of LD pathogenesis.
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Affiliation(s)
- Dmitrii S Maltsev
- Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russia
| | - Alexei N Kulikov
- Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russia
| | - Venera A Shaimova
- Academy of Postgraduate Education of the Federal Scientific and Clinical Center of Specialized Medical Care and Medical Technologies, Moscow, Russia
- “Center Zreniya”, Chelyabinsk, Russia
| | - Maria A Burnasheva
- Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russia
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Qi J, Pan W, Peng T, Zeng L, Li X, Chen Z, Yang Z, Xu H. Higher Circulating Levels of Neutrophils and Basophils Are Linked to Myopic Retinopathy. Int J Mol Sci 2022; 24:ijms24010080. [PMID: 36613520 PMCID: PMC9820571 DOI: 10.3390/ijms24010080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/08/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
This retrospective study investigated circulating immune cell alteration in patients with myopic retinopathy. Blood test results and demographic and ocular information of 392 myopic patients and 129 emmetropia controls who attended Changsha Aier Eye Hospital from May 2017 to April 2022 were used in this study. Compared with emmetropia, the percentages of neutrophils and basophils and neutrophil/lymphocyte ratio were significantly higher in myopic patients, whereas the percentages of monocytes and lymphocytes and the counts of lymphocytes and eosinophils were significantly lower in myopic patients. After adjusting for age and hypertension/diabetes, the difference remained. Interestingly, the platelet counts were significantly lower in myopic patients after the adjustments. Further subgroup analysis using multivariable linear regression showed that higher levels of neutrophils, neutrophil/lymphocyte ratio, and platelet/lymphocyte ratio, lower levels of monocytes, eosinophils, lymphocytes, and platelets, were related to myopic peripheral retinal degeneration (mPRD) and posterior staphyloma (PS). A higher level of basophils was linked to myopic choroidal neovascularization (mCNV). Our results suggest that higher levels of circulating neutrophils and neutrophil/lymphocyte ratio, lower monocytes, eosinophils, lymphocytes, and platelets are related to mild myopic retinopathy. A higher level of circulating basophils is related to the severe form of myopic retinopathy, such as mCNV.
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Affiliation(s)
- Jinyan Qi
- Aier School of Ophthalmology, Central South University, Changsha 410000, China
- Aier Institute of Optometry and Vision Science, Changsha 410000, China
- Hunan Province Optometry Engineering and Technology Research Center, Changsha 410000, China
- Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha 410000, China
| | - Wei Pan
- Aier Institute of Optometry and Vision Science, Changsha 410000, China
- Hunan Province Optometry Engineering and Technology Research Center, Changsha 410000, China
- Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha 410000, China
| | - Ting Peng
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha 410000, China
| | - Ling Zeng
- Aier Institute of Optometry and Vision Science, Changsha 410000, China
- Changsha Aier Eye Hospital, Changsha 410000, China
| | - Xiaoning Li
- Aier Institute of Optometry and Vision Science, Changsha 410000, China
- Hunan Province Optometry Engineering and Technology Research Center, Changsha 410000, China
- Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha 410000, China
- Changsha Aier Eye Hospital, Changsha 410000, China
| | - Zhongping Chen
- Aier School of Ophthalmology, Central South University, Changsha 410000, China
- Changsha Aier Eye Hospital, Changsha 410000, China
| | - Zhikuan Yang
- Aier School of Ophthalmology, Central South University, Changsha 410000, China
- Aier Institute of Optometry and Vision Science, Changsha 410000, China
- Hunan Province Optometry Engineering and Technology Research Center, Changsha 410000, China
- Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha 410000, China
- Aier School of Optometry and Vision Science, Hubei University of Science and Technology, Xianning 437100, China
| | - Heping Xu
- Aier School of Ophthalmology, Central South University, Changsha 410000, China
- Aier Institute of Optometry and Vision Science, Changsha 410000, China
- Hunan Province Optometry Engineering and Technology Research Center, Changsha 410000, China
- Hunan Province International Cooperation Base for Optometry Science and Technology, Changsha 410000, China
- Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast BT9 7BL, UK
- Correspondence: ; Tel.: +44-289097-6463
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Maltsev DS, Kulikov AN, Burnasheva MA. Lattice Degeneration Imaging with Optical Coherence Tomography Angiography. J Curr Ophthalmol 2022; 34:379-383. [PMID: 36644475 PMCID: PMC9832459 DOI: 10.4103/joco.joco_94_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/16/2022] [Accepted: 05/27/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose To describe a series of cases of lattice degeneration of the retina imaged with optical coherence tomography angiography (OCTA). Methods Four eyes of four patients were included and evaluated with green reflectance using a confocal scanning laser ophthalmoscopy and OCTA. In each case, the microcirculation of the retina and choriocapillaris within the lesion, as well as choroidal thickness beneath the lesion, were assessed. Results OCTA showed regional loss of retinal perfusion and rarefication of the choriocapillaris network within the lesion and the presence of venous collectors in the choroid beneath the lesion. The choroid was substantially thinner beneath the lesion compared to the adjacent normal region. Cross-sectional OCT scans showed retinal thinning, vitreal adhesion, atrophic holes, and subretinal fluid within the lesions. Conclusion Lattice degeneration is characterized by significant local changes in retinal and choroidal microcirculation which may play an important role in the pathophysiology of lattice degeneration.
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Affiliation(s)
- Dmitrii S. Maltsev
- Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russia,Address for correspondence: Dmitrii S. Maltsev, Department of Ophthalmology, Military Medical Academy, 21, Botkinskaya Str, St. Petersburg 194044, Russia. E-mail:
| | - Alexei N. Kulikov
- Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russia
| | - Maria A. Burnasheva
- Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russia
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Analysis of White and Dark without Pressure in a Young Myopic Group Based on Ultra-Wide Swept-Source Optical Coherence Tomography Angiography. J Clin Med 2022; 11:jcm11164830. [PMID: 36013068 PMCID: PMC9410463 DOI: 10.3390/jcm11164830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/03/2022] [Accepted: 08/12/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose: This study aimed to investigate the incidence of white without pressure (WWOP) and dark without pressure (DWOP) in a young myopic group based on multimode imaging and to explore the quantitative changes in DWOP based on ultra-wide swept-source optical coherence tomography angiography (SS-OCTA). Methods: A total of 138 patients with high myopia (SE < −6.00 D) were recruited. Examinations, including indirect ophthalmoscope, ultra-wide color fundus photograph, and ultra-wide SS-OCTA, were conducted for each eye. A total of 50 of the 138 patients were selected for further analysis since their DWOP lesions in SS-OCTA could be well quantified. Results: The incidence rates of WWOP and DWOP in the young myopic group were 35.24% and 29.96%, respectively. The patients with a lower spherical equivalent (SE) showed a tendency to have a higher axial length (AL) and higher prevalence of WWOP. Multivariate regression analysis illustrated that a more serious SE and a longer AL were risk factors for both WWOP and DWOP. Eyes with DWOP lesions had lower vessel density (VD) in the whole retina (p < 0.001) and a deep vascular complex (DVC) (p < 0.001), and lower thickness of the outer retina (p < 0.001) compared with healthy counterparts. Conclusion: Ultra-wide SS-OCTA provided new insights into myopic-related peripheral retinal degenerations. DWOP was characterized by thinning of the outer retina and lower perfusion in DVC.
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Oh B, Park UC, Kim BH, Lee EK, Yoon CK, Choe HR, Yeon DY, Yu HG. Role of Ultra-widefield Imaging in the evaluation of Long-term change of highly myopic fundus. Acta Ophthalmol 2022; 100:e977-e985. [PMID: 34403209 DOI: 10.1111/aos.15009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/17/2021] [Accepted: 08/04/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the impact of posterior staphyloma identified using ultra-widefield fundus imaging on the long-term progression of myopic maculopathy in highly myopic patients. METHODS In this observational cohort study, highly myopic patients who were followed up for at least 5 years using ultra-widefield fundus imaging were analysed for fundus abnormalities and the progression of myopic maculopathy based on the International Meta-analysis of Pathologic Myopia classification. RESULTS This study included 390 eyes (210 patients) with the mean follow-up period of 69.2 ± 7.5 months (range, 60-88). Posterior staphyloma was identified in 198 eyes (50.8%) in the baseline ultra-widefield fundus images. The border of staphyloma was not identified within 50° view circle corresponding to conventional fundus photography in 42 eyes (21.2%) with staphyloma, most of that were wide macular type. Progression of myopic maculopathy during follow-up was observed in 202 eyes (51.8%), and eyes with staphyloma were more likely to show progression compared to those without (142/198 [71.7%] versus 60/192 [31.3%]; p < 0.001). In multivariable regression analysis, the presence of posterior staphyloma was an independent risk factor for the progression of myopic maculopathy (p = 0.005). One or more peripheral retinal lesions were observed in 302 eyes (77.4%) and 321 eyes (82.3%) in the baseline and final ultra-widefield fundus images, respectively. CONCLUSION Posterior staphyloma was associated with the long-term progression of myopic maculopathy. With a wider field of view, ultra-widefield fundus imaging is useful for identifying the posterior staphyloma and monitoring the progression of myopic maculopathy in highly myopic patients.
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Affiliation(s)
- Baek‐Lok Oh
- Department of Ophthalmology Seoul National University College of Medicine Seoul Korea
- Retinal Degeneration Research Laboratory Seoul National University Hospital Biomedical Research Institute Seoul Korea
| | - Un Chul Park
- Department of Ophthalmology Seoul National University College of Medicine Seoul Korea
- Retinal Degeneration Research Laboratory Seoul National University Hospital Biomedical Research Institute Seoul Korea
| | - Bo Hee Kim
- Department of Ophthalmology Seoul National University College of Medicine Seoul Korea
- Retinal Degeneration Research Laboratory Seoul National University Hospital Biomedical Research Institute Seoul Korea
| | - Eun Kyoung Lee
- Department of Ophthalmology Seoul National University College of Medicine Seoul Korea
- Retinal Degeneration Research Laboratory Seoul National University Hospital Biomedical Research Institute Seoul Korea
| | - Chang Ki Yoon
- Department of Ophthalmology Seoul National University College of Medicine Seoul Korea
- Retinal Degeneration Research Laboratory Seoul National University Hospital Biomedical Research Institute Seoul Korea
| | - Hye Rim Choe
- Department of Ophthalmology Seoul National University College of Medicine Seoul Korea
- Retinal Degeneration Research Laboratory Seoul National University Hospital Biomedical Research Institute Seoul Korea
| | - Dong Yun Yeon
- Department of Ophthalmology Seoul National University College of Medicine Seoul Korea
- Retinal Degeneration Research Laboratory Seoul National University Hospital Biomedical Research Institute Seoul Korea
| | - Hyeong Gon Yu
- Department of Ophthalmology Seoul National University College of Medicine Seoul Korea
- Retinal Degeneration Research Laboratory Seoul National University Hospital Biomedical Research Institute Seoul Korea
- Seoul National University College of Medicine Interdisciplinary Programs: Stem Cell Biology Seoul Korea
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Zhang W, Shi T, Chen S, Chen H. Subfoveal scleral thickness is associated with peripheral retinal changes in high myopia in children and adolescents. Int Ophthalmol 2022; 42:1595-1604. [PMID: 35091977 DOI: 10.1007/s10792-021-02153-w] [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: 01/29/2021] [Accepted: 12/18/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study aims to identify the risk factors in peripheral retinal changes (PRC) associated with high myopes among children and adolescents. METHODS This is a cross-sectional study on children and adolescents diagnosed with high myopia. The subjects involved underwent a series of ocular examinations, including the dilated fundus examination for PRC and the swept-source optical coherence tomography for foveal retinal, choroidal and scleral thickness measurement. Then, the variables were compared among the eyes with high risk, low risk, and no PRC. Spearman correlation was applied to evaluate the relationship between the parameters and the extent of PRC. Logistic regression was performed to identify the potential risk factors. RESULTS A total of 117 eyes from 117 subjects were recruited. The prevalence of PRC was 57.3% (67 eyes), while that of high-risk PRC was 22.2% (26 eyes). Significant differences were found in the mean subfoveal scleral thickness, spherical equivalent refraction, and axial length among the eyes with high-risk, low-risk, and no PRC (p < 0.01, p < 0.01, p = 0.048, respectively). Compared with spherical equivalent (r = 0.32, p < 0.01) and axial length (r = 0.18, p = 0.05), subfoveal scleral thickness exhibited higher correlation coefficient with PRC (r = - 0.38, p < 0.01). Subfoveal scleral thickness and spherical equivalent refraction were identified as the independent risk factors for PRC and high-risk PRC. CONCLUSION It was demonstrated that there was a correlation between subfoveal scleral thickness and PRC. The eyes with thinner subfoveal scleral thickness carried a higher risk of PRC.
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Affiliation(s)
- Wenli Zhang
- Joint Shantou International Eye Center, Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, Guangdong, 515041, People's Republic of China
| | - Tingkun Shi
- Joint Shantou International Eye Center, Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, Guangdong, 515041, People's Republic of China
| | - Shirong Chen
- Joint Shantou International Eye Center, Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, Guangdong, 515041, People's Republic of China
| | - Haoyu Chen
- Joint Shantou International Eye Center, Shantou University and The Chinese University of Hong Kong, North Dongxia Road, Shantou, Guangdong, 515041, People's Republic of China
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Khatwani N, Makhija S, Ahuja A. Clinical profile and distribution of peripheral retinal changes in myopic population in a hospital-based study in North India. Indian J Ophthalmol 2022; 70:1280-1285. [PMID: 35326034 PMCID: PMC9240558 DOI: 10.4103/ijo.ijo_946_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose To evaluate the prevalence of different types of peripheral retinal changes in a myopic population in North India and correlate them with axial length. Methods This cross-sectional, hospital-based survey included 600 eyes of 300 myopic individuals, aged between 10 and 40 years, attending the outdoor ophthalmology clinic of a tertiary eye care hospital in North India were examined from July 2019 to July 2020. They were divided into mild, moderate, high, and severe myopia according to the spherical equivalent of refraction. Axial length was recorded. Peripheral retinal changes were examined by scleral indentation binocular indirect ophthalmoscopy. Standardized findings considered with their fundus location were lattice degeneration, white without pressure and white with pressure, snail-track degenerations, peripheral chorioretinal atrophy, retinal holes, tears, and detachment. The study was approved by the institutional ethics committee, and all participants provided informed consent. Results Peripheral retinal degenerations were found in almost half (53%) of all myopes included in the study. The most common peripheral retinal degeneration found was lattice degeneration, followed by white without pressure, white with pressure, and chorioretinal atrophy. Most of the peripheral retinal degenerations were seen in the temporal quadrant of the fundus, either superotemporal or inferotemporal. There was a significant positive association between the prevalence of peripheral retinal degeneration with age, increased axial length, and severity of myopia. Conclusion The results of our study indicate the necessity for careful peripheral fundus examinations of all myopes, irrespective of age and degree of myopia, for early diagnosis and better management of visual-threatening complications like retinal detachment.
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Affiliation(s)
- Neelam Khatwani
- Department of Ophthalmology, Sant Parmanand Hospital, Delhi, India
| | - Sandhya Makhija
- Department of Ophthalmology, Sant Parmanand Hospital, Delhi, India
| | - Ashish Ahuja
- Department of Ophthalmology, Sant Parmanand Hospital, Delhi, India
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12
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Aurora A, Aurora A. Commentary: Clinical profile and distribution of peripheral retinal changes in myopic population in a hospital-based study in North India. Indian J Ophthalmol 2022; 70:1286. [PMID: 35326035 PMCID: PMC9240506 DOI: 10.4103/ijo.ijo_532_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Ajay Aurora
- Senior Consultant and Director, Department of Retina, Vitreous and Uvea, Vision Plus Eye Centre, Noida, Uttar Pradesh, India
| | - Arjun Aurora
- Cataract and IOL Fellow, Department of Comprehensive Ophthalmology, Dr Shroff Charity Eye Hospital, New Delhi, India
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13
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Sankaridurg P, Tahhan N, Kandel H, Naduvilath T, Zou H, Frick KD, Marmamula S, Friedman DS, Lamoureux E, Keeffe J, Walline JJ, Fricke TR, Kovai V, Resnikoff S. IMI Impact of Myopia. Invest Ophthalmol Vis Sci 2021; 62:2. [PMID: 33909036 PMCID: PMC8083082 DOI: 10.1167/iovs.62.5.2] [Citation(s) in RCA: 129] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/26/2020] [Indexed: 01/15/2023] Open
Abstract
The global burden of myopia is growing. Myopia affected nearly 30% of the world population in 2020 and this number is expected to rise to 50% by 2050. This review aims to analyze the impact of myopia on individuals and society; summarizing the evidence for recent research on the prevalence of myopia and high myopia, lifetime pathological manifestations of myopia, direct health expenditure, and indirect costs such as lost productivity and reduced quality of life (QOL). The principal trends are a rising prevalence of myopia and high myopia, with a disproportionately greater increase in the prevalence of high myopia. This forecasts a future increase in vision loss due to uncorrected myopia as well as high myopia-related complications such as myopic macular degeneration. QOL is affected for those with uncorrected myopia, high myopia, or complications of high myopia. Overall the current global cost estimates related to direct health expenditure and lost productivity are in the billions. Health expenditure is greater in adults, reflecting the added costs due to myopia-related complications. Unless the current trajectory for the rising prevalence of myopia and high myopia change, the costs will continue to grow. The past few decades have seen the emergence of several novel approaches to prevent and slow myopia. Further work is needed to understand the life-long impact of myopia on an individual and the cost-effectiveness of the various novel approaches in reducing the burden.
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Affiliation(s)
- Padmaja Sankaridurg
- Brien Holden Vision Institute, Sydney, Australia
- School of Optometry and Vision Science, University of New South Wales, New South Wales, Australia
| | - Nina Tahhan
- Brien Holden Vision Institute, Sydney, Australia
- School of Optometry and Vision Science, University of New South Wales, New South Wales, Australia
| | - Himal Kandel
- Save Sight Institute, Sydney Medical School, The University of Sydney, New South Wales, Australia
| | - Thomas Naduvilath
- Brien Holden Vision Institute, Sydney, Australia
- School of Optometry and Vision Science, University of New South Wales, New South Wales, Australia
| | - Haidong Zou
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai, China
| | - Kevin D. Frick
- Johns Hopkins Carey Business School, Baltimore, Maryland, United States
| | - Srinivas Marmamula
- Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - David S. Friedman
- Glaucoma Center of Excellence, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Ecosse Lamoureux
- Duke - NUS Medical School, Singapore; Singapore Eye Research Institute, Singapore
| | - Jill Keeffe
- Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Jeffrey J. Walline
- The Ohio State University College of Optometry, Columbus, Ohio, United States
| | | | - Vilas Kovai
- Health Promotion Service, Population Health, Liverpool Hospital, SWSLHD, Health - New South Wales, New South Wales, Australia
| | - Serge Resnikoff
- Brien Holden Vision Institute, Sydney, Australia
- School of Optometry and Vision Science, University of New South Wales, New South Wales, Australia
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Abstract
Topic: Ultra-widefield (UWF) imaging of the myopic eye. Clinical Relevance: Myopes, and particularly high and pathologic myopes, present a unique challenge in fundoscopic imaging. Critical pathology is often located in the anteriormost portion of the retina, variations in posterior segment contour are difficult to capture in two-dimensional images, and extremes in axial length make simply focusing imaging devices difficult. Methods: We review the evolution of modalities for ophthalmic imaging (color fundus photography [CFP], optical coherence topography [OCT], angiography, artificial intelligence [AI]) to present day UWF technology and its impact on our understanding of myopia. Results: Advances in UWF technology address many of the challenges in fundoscopic imaging of myopes, providing new insights into the structure and function of the myopic eye. UWF CFP improves our ability to detect and document anterior peripheral pathology prevalent in approximately half of all high myopes. UWF OCT better captures the staphylomatous contour of the myopic eye, providing enhanced visualization of the vitreoretinal interface and progressive development of myopic traction maculopathy. UWF angiography highlights the posterior vortex veins, thin choriocapillaris, far peripheral avascularity, and peripheral retinal capillary microaneurysms more prevalent in the myopic eye. Researchers have demonstrated the ability of AI algorithms to predict refractive error, and great potential remains in the use of AI technology for the screening and prevention of myopic disease. Conclusion: We note significant progress in our ability to capture anterior pathology and improved image quality of the posterior segment of high and pathologic myopes. The next jump forward for UWF imaging will be the ability to capture a high quality ora to ora multimodal fundoscopic image in a single scan that will allow for sensitive AI-assisted screening of myopic disease.
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Affiliation(s)
- Cassie A Ludwig
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.,Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Jade Moon
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.,Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Itika Garg
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.,Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - John B Miller
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.,Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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Deng X, Tanumiharjo S, Chen Q, Li S, Lin H, He Y, Jiang J, Zhang J. Myopic retinal changes screening: comparison of sensitivity and specificity among 15 combinations of ultrawide field scanning laser ophthalmoscopy images. Ophthalmic Res 2021; 64:1029-1036. [PMID: 33401267 DOI: 10.1159/000514176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 01/02/2021] [Indexed: 11/19/2022]
Abstract
AIMS To investigate the evaluation indices (diagnostic test accuracy and agreement) of 15 combinations of ultrawide field scanning laser ophthalmoscopy (UWF SLO) images in myopic retinal changes (MRC) screening to determine the combination of imaging that yields the highest evaluation indices in screening MRC. METHODS This is a retrospective study of UWF SLO images obtained from myopes and were analyzed by two retinal specialists independently. 5-field UWF SLO images that included the posterior (B), superior (S), inferior (I), nasal (N) and temporal (T) regions were obtained for analysis and its results used as a reference standard. The evaluation indices of different combinations comprising of one to four fields of the retina were compared to determine the abilities of each combinations screen for MRC. RESULTS UWF SLO images obtained from 823 myopic patients (1646 eyes) were included for the study. Sensitivities ranged from 50.0% to 98.9% (95% confidence interval (CI), 43.8-99.7%); the combinations of B+S+I (97.3%; 95% CI, 94.4-98.8%), B+T+S+I (98.5%; 95% CI, 95.9-99.5%), and B+S+N+I (98.9%; 95% CI, 96.4-99.7%) ranked highest. Furthermore, the combinations of B+S+I, B+T+S+I and B+S+N+I also revealed the highest accuracy (97.7%; 95% CI, 95.1-100.0%, 98.6%; 95% CI, 96.7-100.0%, 98.8%; 95% CI, 96.9-100.0%) and agreement (Kappa = 0.968, 0.980 and 0.980). For the various combinations, specificities were all higher than 99.5% (95% CI, 99.3-100.0%). CONCLUSION In our study, screening combinations of B+S+I, B+T+S+I and B+S+N+I stand out with high-performing optimal evaluation indices. However, when time is limited, B+S+I may be more applicable in primary screening of MRC.
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Affiliation(s)
- Xuan Deng
- Aier School of Ophthalmology, Central South University, Changsha, China
| | - Silvia Tanumiharjo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | | | - Shengnan Li
- Aier School of Ophthalmology, Central South University, Changsha, China
| | - Huimin Lin
- Guangzhou Aier Eye Hospital, Guangzhou, China
| | - Yanqiong He
- Guangzhou Aier Eye Hospital, Guangzhou, China
| | - Junyi Jiang
- Aier Eye Institute, Aier Eye Hospital Group, Changsha, China
| | - Jinglin Zhang
- Aier School of Ophthalmology, Central South University, Changsha, China
- Guangzhou Aier Eye Hospital, Guangzhou, China
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16
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Haarman AEG, Enthoven CA, Tideman JWL, Tedja MS, Verhoeven VJM, Klaver CCW. The Complications of Myopia: A Review and Meta-Analysis. Invest Ophthalmol Vis Sci 2020; 61:49. [PMID: 32347918 PMCID: PMC7401976 DOI: 10.1167/iovs.61.4.49] [Citation(s) in RCA: 241] [Impact Index Per Article: 60.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose To determine the risk between degree of myopia and myopic macular degeneration (MMD), retinal detachment (RD), cataract, open angle glaucoma (OAG), and blindness. Methods A systematic review and meta-analyses of studies published before June 2019 on myopia complications. Odds ratios (OR) per complication and spherical equivalent (SER) degree (low myopia SER < -0.5 to > -3.00 diopter [D]; moderate myopia SER ≤ -3.00 to > -6.00 D; high myopia SER ≤ -6.00 D) were calculated using fixed and random effects models. Results Low, moderate, and high myopia were all associated with increased risks of MMD (OR, 13.57, 95% confidence interval [CI], 6.18-29.79; OR, 72.74, 95% CI, 33.18-159.48; OR, 845.08, 95% CI, 230.05-3104.34, respectively); RD (OR, 3.15, 95% CI, 1.92-5.17; OR, 8.74, 95% CI, 7.28-10.50; OR, 12.62, 95% CI, 6.65-23.94, respectively); posterior subcapsular cataract (OR, 1.56, 95% CI, 1.32-1.84; OR, 2.55, 95% CI, 1.98-3.28; OR, 4.55, 95% CI, 2.66-7.75, respectively); nuclear cataract (OR, 1.79, 95% CI, 1.08-2.97; OR, 2.39, 95% CI, 1.03-5.55; OR, 2.87, 95% CI, 1.43-5.73, respectively); and OAG (OR, 1.59, 95% CI, 1.33-1.91; OR, 2.92, 95% CI, 1.89-4.52 for low and moderate/high myopia, respectively). The risk of visual impairment was strongly related to longer axial length, higher myopia degree, and age older than 60 years (OR, 1.71, 95% CI, 1.07-2.74; OR, 5.54, 95% CI, 3.12-9.85; and OR, 87.63, 95% CI, 34.50-222.58 for low, moderate, and high myopia in participants aged >60 years, respectively). Conclusions Although high myopia carries the highest risk of complications and visual impairment, low and moderate myopia also have considerable risks. These estimates should alert policy makers and health care professionals to make myopia a priority for prevention and treatment.
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17
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Jagadeesh D, Philip K, Fedtke C, Jong M, Ly A, Sankaridurg P. Posterior segment conditions associated with myopia and high myopia. Clin Exp Optom 2020; 103:756-765. [PMID: 32227385 DOI: 10.1111/cxo.13060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 02/13/2020] [Accepted: 02/17/2020] [Indexed: 12/29/2022] Open
Abstract
Myopia, and especially high myopia, is associated with a number of posterior segment changes that are considered to be mostly a consequence of the increased axial elongation. This can result in mechanical strain, attendant vascular changes, stretching and thinning of tissues, and atrophy/deformation of tissues in later or more advanced stages. Such myopia-related changes are observed as changes and/or abnormalities in the vitreous, choroid, retina and peripheral retina, sclera and/or optic disc. Although many of these changes are benign, at times they may be associated with significant vision impairment that either requires active intervention or may suggest future progression of the disease. This review systematically addresses the posterior segment conditions seen in myopic eyes, describes the features associated with the condition and details management pathways.
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Affiliation(s)
- Divya Jagadeesh
- Research and Development Group, Brien Holden Vision Institute, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Krupa Philip
- Research and Development Group, Brien Holden Vision Institute, Sydney, Australia
| | - Cathleen Fedtke
- Research and Development Group, Brien Holden Vision Institute, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Monica Jong
- Research and Development Group, Brien Holden Vision Institute, Sydney, Australia.,Discipline of Optometry and Vision Science, University of Canberra, Canberra, Australia
| | - Angelica Ly
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia.,Centre for Eye Health, Sydney, Australia
| | - Padmaja Sankaridurg
- Research and Development Group, Brien Holden Vision Institute, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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18
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Allon G, Machluf Y, Mezer E, Chaiter Y. Screening for Myopia-Related Retinal Changes Among Teenagers. Ophthalmic Surg Lasers Imaging Retina 2020; 50:e311-e319. [PMID: 31755983 DOI: 10.3928/23258160-20191031-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 06/10/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the relationship between spherical equivalent (SE) refractive error and myopia-related peripheral retinal changes (MPRCs) and to find the optimal cutoff for screening myopic teenagers. PATIENTS AND METHODS The study included 2,286 myopic subjects who had a dilated fundus examination between 1998 and 2011 and SE of -4.0 diopters (D) or higher in both eyes. RESULTS Ninety-five subjects (4.16%) had MPRCs. Two subjects (0.09%) had moderate-to-severe MPRCs. A significant correlation (P < .0001) between SE and MPRC was found. The highest sum of sensitivity (72.63%) and specificity (73.44%) was achieved when a SE of -6.25 D in the more myopic eye was utilized as the cutoff. CONCLUSIONS SE and MPRCs are highly associated. The optimal cutoff to detect MPRC in teenagers is -6.25 D. However, using a SE of -4.0 D as the cutoff may be the practical choice for screening due to the noninvasiveness nature and low cost of the examination. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e311-e319.].
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19
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Li Z, Guo C, Nie D, Lin D, Zhu Y, Chen C, Zhang L, Xu F, Jin C, Zhang X, Xiao H, Zhang K, Zhao L, Yu S, Zhang G, Wang J, Lin H. A deep learning system for identifying lattice degeneration and retinal breaks using ultra-widefield fundus images. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:618. [PMID: 31930019 DOI: 10.21037/atm.2019.11.28] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Lattice degeneration and/or retinal breaks, defined as notable peripheral retinal lesions (NPRLs), are prone to evolving into rhegmatogenous retinal detachment which can cause severe visual loss. However, screening NPRLs is time-consuming and labor-intensive. Therefore, we aimed to develop and evaluate a deep learning (DL) system for automated identifying NPRLs based on ultra-widefield fundus (UWF) images. Methods A total of 5,606 UWF images from 2,566 participants were used to train and verify a DL system. All images were classified by 3 experienced ophthalmologists. The reference standard was determined when an agreement was achieved among all 3 ophthalmologists, or adjudicated by another retinal specialist if disagreements existed. An independent test set of 750 images was applied to verify the performance of 12 DL models trained using 4 different DL algorithms (InceptionResNetV2, InceptionV3, ResNet50, and VGG16) with 3 preprocessing techniques (original, augmented, and histogram-equalized images). Heatmaps were generated to visualize the process of the best DL system in the identification of NPRLs. Results In the test set, the best DL system for identifying NPRLs achieved an area under the curve (AUC) of 0.999 with a sensitivity and specificity of 98.7% and 99.2%, respectively. The best preprocessing method in each algorithm was the application of original image augmentation (average AUC =0.996). The best algorithm in each preprocessing method was InceptionResNetV2 (average AUC =0.996). In the test set, 150 of 154 true-positive cases (97.4%) displayed heatmap visualization in the NPRL regions. Conclusions A DL system has high accuracy in identifying NPRLs based on UWF images. This system may help to prevent the development of rhegmatogenous retinal detachment by early detection of NPRLs.
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Affiliation(s)
- Zhongwen Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Chong Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Danyao Nie
- Shenzhen Ophthalmic Center, Jinan University, Shenzhen 518001, China
| | - Duoru Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Yi Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China.,Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Chuan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China.,Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Li Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Fabao Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Chenjin Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Xiayin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Hui Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Kai Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China.,School of Computer Science and Technology, Xidian University, Xi'an 710071, China
| | - Lanqin Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Shanshan Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Guoming Zhang
- Shenzhen Ophthalmic Center, Jinan University, Shenzhen 518001, China
| | - Jiantao Wang
- Shenzhen Ophthalmic Center, Jinan University, Shenzhen 518001, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
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