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Suh MH, Weinreb RN, Zangwill LM. Optic Disc Microvasculature Dropout in Preperimetric Glaucoma. J Glaucoma 2024; 33:490-498. [PMID: 38619387 DOI: 10.1097/ijg.0000000000002403] [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: 08/14/2023] [Accepted: 02/29/2024] [Indexed: 04/16/2024]
Abstract
PRCIS Optic disc microvasculature dropout (MvD-D) was associated with worse disease severity in pre-perimetric glaucoma. MvD-D was not accompanied by focal lamina cribrosa defect or parapapillary deep-layer microvasculature dropout in 62.3% and 71.0% of eyes, respectively. PURPOSE To investigate factors associated with optic disc microvasculature dropout (MvD-D) in patients with preperimetric primary open angle glaucoma (PPG). METHODS One hundred thirty nine eyes of PPG patients were categorized according to the presence of MvD-D with optical coherence tomography angiography (OCTA). Factors including visual field (VF) mean deviation (MD), retinal nerve fiber layer (RNFL) thickness, focal lamina cribrosa (LC) defect, optic disc hemorrhage (DH), and parapapillary deep-layer microvasculature dropout (MvD-P) were compared between eyes with and without MvD-D. RESULTS MvD-D was observed in 69 PPG eyes (49.6%). Compared with eyes without MvD-D, the ones with MvD-D had a significantly thinner RNFL in all areas except the nasal sector, worse VF MD, and a focal LC defect and MvD-P ( P <0.05): male gender also was more highly prevalent. A considerable number of eyes with MvD-D lacked focal LC defect (62.3% [43/69]) or MvD-P (71.0% [49/69]), while a few eyes without MvD-D had focal LC defect (10.0% [7/70]) or MvD-P (2.9% [2/70]). In a multivariable logistic regression analysis, male gender (odds ratio [OR], 3.96; P <0.001), worse VF MD (OR, 1.44; P =0.019), thinner global RNFL (OR, 1.13; P <0.001), higher prevalence of focal LC defect (OR, 3.71; P =0.014) and MvD-P (OR, 7.85; P <0.001) were significantly associated with MvD-D. CONCLUSIONS MvD-D was related to worse disease severity in patients with PPG, and often was not accompanied by focal LC defect or MvD-P. This suggests that impaired optic disc circulation can be an early sign of glaucoma without noticeable changes in functional or structural features (i.e., VF, focal LC defect, MvD-P).
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Affiliation(s)
- Min Hee Suh
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Robert N Weinreb
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, CA
| | - Linda M Zangwill
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, CA
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Bayraktar S, Hondur G, Şekeroğlu MA, Altaş FB, Yeşilyaprak N, Çevik S, Şen E, Elgin U. The Assessment of Radial Peripapillary Capillary Vessel Density in Adult Children of Patients With Primary Open Angle Glaucoma. J Glaucoma 2024; 33:e43-e48. [PMID: 38129936 DOI: 10.1097/ijg.0000000000002347] [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: 07/01/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023]
Abstract
PRCIS The observed decrease in radial peripapillary capillary vessel density among adult children of individuals with primary open angle glaucoma, in comparison to controls, suggests the possibility of early microvascular alterations in the eyes of these at-risk individuals. PURPOSE To compare the radial peripapillary capillary vessel density (RPCVD) and peripapillary retinal nerve fiber layer (RNFL) thickness values of eyes between healthy adults with a maternal or paternal history of primary open angle glaucoma (POAG) and age-matched healthy controls without a family history of POAG. MATERIALS AND METHODS RPCVD values and RNFL thicknesses in the peripapillary region and 4 quadrants (superior, inferior, nasal, and temporal) were evaluated using optical coherence tomography angiography among 30 adult children of patients with POAG and 30 age-matched healthy controls without a family history of POAG. RESULTS The mean whole image RPCVD (51.6±1.7% vs. 49.8±1.7%, P =0.0006) and average RPCVD (54.7±1.7% vs. 53.2±2.1%, P =0.006) values were significantly lower in the adult children of patients with POAG compared with age-matched healthy controls without a family history of POAG. There was no difference in terms of RNFL thickness values in any region. CONCLUSION Despite having similar RNFL thickness values to the control group, the observation of lower RPCVD in the eyes of adult children of POAG patients may indicate potential early vascular alterations. The result of the present study encourages further longitudinal studies to determine the potential importance of the underlying vascular alterations in these high-risk individuals.
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Affiliation(s)
- Serdar Bayraktar
- The University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Gözde Hondur
- The University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Mehmet Ali Şekeroğlu
- The University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Fatma Büşra Altaş
- The University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Nurtaç Yeşilyaprak
- The University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Seda Çevik
- The University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Emine Şen
- The University of Health Sciences, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
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Hong J, Tan SS, Chua J. Optical coherence tomography angiography in glaucoma. Clin Exp Optom 2024; 107:110-121. [PMID: 38266148 DOI: 10.1080/08164622.2024.2306963] [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: 10/24/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024] Open
Abstract
The use of optical coherence tomography angiography (OCTA) holds significant promise for optometrists in the diagnosis and management of glaucoma. It offers reliable differentiation of glaucomatous eyes from healthy ones and extends monitoring capabilities for advanced cases. OCTA represents a valuable addition to traditional assessment methods, particularly in complex cases. Glaucoma, a major cause of irreversible blindness, is traditionally diagnosed using structural and functional metrics. With growing interest, OCTA is being explored to diagnose, monitor, and manage glaucoma. This review focuses on the application of OCTA in glaucoma patients. A database search was carried out using Embase Elsevier (n = 664), PubMed (n = 574), and Cochrane Central Register of Controlled Trials (n = 19) on 15 August 2023. After deduplication and screening, 272 original papers were included in the narrative review. Inclusion criteria comprised English-language original studies on OCTA use in human glaucoma patients, with or without healthy controls. Exclusion criteria encompassed animal studies, in-vivo/in-vitro research, reviews, and congress abstracts. OCTA has good repeatability and reproducibility. OCTA metrics have good discriminatory power to differentiate glaucomatous eyes from healthy eyes and show strong associations with structural changes and visual field defects. OCTA can extend the monitoring of advanced glaucoma, addressing the 'floor effect' of traditional structural measurements. OCTA metrics can be affected by the choice of OCTA machine, post-image processing algorithms, systemic diseases, and ocular factors. Image artefacts can affect the accuracy of OCTA measurements, and proper scan quality evaluation is crucial to ensure reliable results. Additionally, artificial intelligence techniques offer promise for enhancing the diagnostic accuracy of OCTA by combining data from various retinal layers and regions. OCTA complements traditional methods in assessing glaucoma, especially in challenging cases, providing valuable insights for detection and management. Further research and clinical validation are needed to integrate OCTA into routine practice.
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Affiliation(s)
- Jimmy Hong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Shayne S Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
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Xydaki F, Arribas-Pardo P, Burgos-Blasco B, Garcia-Feijoo J, Mendez-Hernandez C. Peripapillary Vascular Density in Childhood Glaucoma: A Pilot Comparative Study with Age and Sex Matched Healthy Subjects. J Clin Med 2023; 12:6982. [PMID: 38002598 PMCID: PMC10672179 DOI: 10.3390/jcm12226982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
PURPOSE The aim of this study concerns the evaluation of peripapillary vessel indices in childhood glaucoma (CG) and healthy subjects. MATERIAL AND METHODS In this prospective, unicenter, observational cross-sectional study, patients with CG and age and sex-matched healthy subjects were included. We compared retinal nerve fiber layer (RNFL) measurements in optical coherence tomography (OCT), peripapillary vessel density (PVD), and the flux index (FI) of the superficial vascular plexus from OCT angiography (OCT-A) between CG patients and control groups. RESULTS We included 39 patients (68 eyes) with CG and 50 (95 eyes) healthy subjects. The peripapillary RNFL thickness, vessel density, and flux index were significantly lower in the CG group than in the control group. The mean PVD of CG patients was 0.52 ± 0.043%, compared with 0.55 ± 0.014%, p < 0.0001 in healthy subjects. The mean FI was 0.32 ± 0.054 versus 0.37 ± 0.028, p < 0.0001, in CG patients and healthy subjects, respectively. PVD and FI in the superior, inferior, and temporal sectors were significantly lower in CG. The peripapillary RNFL thickness showed a higher area under the ROC curve (AUROC) for discriminating healthy and CG eyes and was significantly different than the PVD (0.797, 95%CI 0.726-0.869; p < 0.0001 vs. 0.664, 95%CI 0.574-0.752; p 0.00037), p 0.012. CONCLUSIONS PVD and FI show lower values in CG and correlate with RNFL thickness measurement but have lower diagnostic ability than RNFL thickness measurement. Our results reveal possible differences in the pathogenesis of microvascular compromise in childhood glaucoma patients.
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Affiliation(s)
- Flora Xydaki
- Department of Inmunology, Opthalmology and ORLIIORC, Complutense University of Madrid, 28040 Madrid, Spain (J.G.-F.)
| | - Paula Arribas-Pardo
- Ophthalmology Department, Central Defense Hospital “Gomez Ulla”, 28047 Madrid, Spain
| | - Barbara Burgos-Blasco
- Department of Inmunology, Opthalmology and ORLIIORC, Complutense University of Madrid, 28040 Madrid, Spain (J.G.-F.)
- Ophthalmology Department, Hospital Clinico San Carlos, Institute of Health Research (IdISSC), 28040 Madrid, Spain
| | - Julian Garcia-Feijoo
- Department of Inmunology, Opthalmology and ORLIIORC, Complutense University of Madrid, 28040 Madrid, Spain (J.G.-F.)
- Ophthalmology Department, Hospital Clinico San Carlos, Institute of Health Research (IdISSC), 28040 Madrid, Spain
| | - Carmen Mendez-Hernandez
- Department of Inmunology, Opthalmology and ORLIIORC, Complutense University of Madrid, 28040 Madrid, Spain (J.G.-F.)
- Ophthalmology Department, Hospital Clinico San Carlos, Institute of Health Research (IdISSC), 28040 Madrid, Spain
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Alasbali T. Current State of Knowledge in Ocular Blood Flow in Glaucoma: A Narrative Review. Clin Ophthalmol 2023; 17:2599-2607. [PMID: 37671333 PMCID: PMC10476666 DOI: 10.2147/opth.s426709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/24/2023] [Indexed: 09/07/2023] Open
Abstract
Glaucoma is a multifactorial disease that is dependent on Intra Ocular Pressure (IOP) and associated with risk factors related to reduced ocular blood flow (OBF). In clinical practice, it is instrumental to update and review the considerable evidence of the current imaging technologies utilized in the investigation of OBF involved in both the onset and progression of glaucoma. Bibliographic databases, including PubMed and Google Scholar, were searched for articles on OBF techniques published between 2018 and 2023 using keywords such as "ocular blood flow", "glaucoma", "invasive ocular blood flow measurement", and "non-invasive ocular blood flow measurement". All types of methodologies were considered, except for editorials, letters to the editor, and animal studies. This review provides comprehensive information on the recent state-of-the-art imaging innovations used to monitor and measure the ocular blood flow in glaucoma.
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Affiliation(s)
- Tariq Alasbali
- Department of Ophthalmology, Faculty of Medicine, College of Medicine, Imam Mohammed Ibn Saud Islamic University, Riyadh, Saudi Arabia
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Jiang D, Yan C, Ge L, Yang C, Huang Y, Chan YK, Chen C, Chen W, Zhou M, Lin B. Metabolomic analysis of aqueous humor reveals potential metabolite biomarkers for differential detection of macular edema. EYE AND VISION (LONDON, ENGLAND) 2023; 10:14. [PMID: 37004107 PMCID: PMC10067239 DOI: 10.1186/s40662-023-00331-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 02/13/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Macular edema (ME) is a major complication of retinal disease with multiple mechanisms involved in its development. This study aimed to investigate the metabolite profile of aqueous humor (AH) in patients with ME of different etiologies and identify potential metabolite biomarkers for early diagnosis of ME. METHODS Samples of AH were collected from 60 patients with ME and 20 age- and sex-matched controls and analyzed by liquid chromatography-mass spectrometry (LC/MS)-based metabolomics. A series of univariate and multivariate statistical analyses were performed to identify differential metabolites and enriched metabolite pathways. RESULTS The metabolic profile of AH differed significantly between ME patients and healthy controls, and differentially expressed metabolites were identified. Pathway analysis revealed that these differentially expressed metabolites are mainly involved in lipid metabolism and amino acid metabolism. Moreover, significant differences were identified in the metabolic composition of AH from patients with ME due to different retinal diseases including age-related macular degeneration (AMD-ME), diabetic retinopathy (DME) and branch retinal vein occlusion (BRVO-ME). In total, 39 and 79 etiology-specific altered metabolites were identified for AMD-ME and DME, respectively. Finally, an AH-derived machine learning-based diagnostic model was developed and successfully validated in the test cohort with an area under the receiver operating characteristic (ROC) curve of 0.79 for AMD-ME, 0.94 for DME and 0.77 for BRVO-ME. CONCLUSIONS Our study illustrates the potential underlying metabolic basis of AH of different etiologies across ME populations. We also identify AH-derived metabolite biomarkers that may improve the differential diagnosis and treatment stratification of ME patients with different etiologies.
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Affiliation(s)
- Dan Jiang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Congcong Yan
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Lina Ge
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Chun Yang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Ying Huang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Yau Kei Chan
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Chonghua Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Wei Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
| | - Meng Zhou
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
| | - Bing Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
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7
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Kooner KS, Angirekula A, Treacher AH, Al-Humimat G, Marzban MF, Chen A, Pradhan R, Tunga N, Wang C, Ahuja P, Zuberi H, Montillo AA. Glaucoma Diagnosis Through the Integration of Optical Coherence Tomography/Angiography and Machine Learning Diagnostic Models. Clin Ophthalmol 2022; 16:2685-2697. [PMID: 36003072 PMCID: PMC9394657 DOI: 10.2147/opth.s367722] [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: 04/21/2022] [Accepted: 06/29/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To establish optical coherence tomography (OCT)/angiography (OCTA) parameter ranges for healthy eyes (HE) and glaucomatous eyes (GE) for a North Texas based population; to develop a machine learning (ML) tool and to identify the most accurate diagnostic parameters for clinical glaucoma diagnosis. Patients and Methods In this retrospective cross-sectional study, we included 1371 eligible eyes, 462 HE and 909 GE (377 ocular hypertension, 160 mild, 156 moderate, 216 severe), from 735 subjects. Demographic data and full OCTA parameters were collected. A Kruskal-Wallis test was used to produce the normative database. Models were trained to solve a two-class problem (HE vs GE) and four-class problem (HE vs mild vs moderate vs severe GE). A rigorous nested, stratified, group, 5×10 fold cross-validation strategy was applied to partition the data. Six ML algorithms were compared using classical and deep learning approaches. Over 2500 ML models were optimized using random search, with performance compared using mean validation accuracy. Final performance was reported on held-out test data using accuracy and F1 score. Decision trees and feature importance were produced for the final model. Results We found differences across glaucoma severities for age, gender, hypertension, Black and Asian race, and all OCTA parameters, except foveal avascular zone area and perimeter (p<0.05). The XGBoost algorithm achieved the highest test performance for both the two-class (F1 score 83.8%; accuracy 83.9%; standard deviation 0.03%) and four-class (F1 score 62.4%; accuracy 71.3%; standard deviation 0.013%) problem. A set of interpretable decision trees provided the most important predictors of the final model; inferior temporal and inferior hemisphere vessel density and peripapillary retinal nerve fiber layer thickness were identified as key diagnostic parameters. Conclusion This study established a normative database for our North Texas based population and created ML tools utilizing OCT/A that may aid clinicians in glaucoma management.
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Affiliation(s)
- Karanjit S Kooner
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA,Department of Ophthalmology, Veteran Affairs North Texas Health Care System Medical Center, Dallas, TX, USA,Correspondence: Karanjit S Kooner, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9057, USA, Tel +1 (214) 648-4733, Fax +1 (214) 648-2270, Email
| | - Ashika Angirekula
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alex H Treacher
- Lyda Hill Department of Bioinformatics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ghadeer Al-Humimat
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA,Department of Ophthalmology, King Hussein Medical Center, Amman, Jordan
| | - Mohamed F Marzban
- Department of Electrical Engineering, University of Texas at Dallas, Dallas, TX, USA
| | - Alyssa Chen
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Roma Pradhan
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nita Tunga
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Chuhan Wang
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Pranati Ahuja
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hafsa Zuberi
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Albert A Montillo
- Lyda Hill Department of Bioinformatics, University of Texas Southwestern Medical Center, Dallas, TX, USA,Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA,Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA,Albert A Montillo, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9057, USA, Email
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Young SL, Jain N, Tatham AJ. The application of advanced imaging techniques in glaucoma. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2101449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Su Ling Young
- Princess Alexandra Eye Pavilion, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Nikhil Jain
- Addenbrooke’s Hospital, Cambridge University Hospitals NHS trust, Cambridge, UK
| | - Andrew J Tatham
- Princess Alexandra Eye Pavilion, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Marques R, Andrade De Jesus D, Barbosa-Breda J, Van Eijgen J, Stalmans I, van Walsum T, Klein S, G Vaz P, Sánchez Brea L. Automatic Segmentation of the Optic Nerve Head Region in Optical Coherence Tomography: A Methodological Review. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 220:106801. [PMID: 35429812 DOI: 10.1016/j.cmpb.2022.106801] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 03/07/2022] [Accepted: 04/01/2022] [Indexed: 06/14/2023]
Abstract
The optic nerve head (ONH) represents the intraocular section of the optic nerve, which is prone to damage by intraocular pressure (IOP). The advent of optical coherence tomography (OCT) has enabled the evaluation of novel ONH parameters, namely the depth and curvature of the lamina cribrosa (LC). Together with the Bruch's membrane minimum-rim-width (BMO-MRW), these seem to be promising ONH parameters for diagnosis and monitoring of retinal diseases such as glaucoma. Nonetheless, these OCT derived biomarkers are mostly extracted through manual segmentation, which is time-consuming and prone to bias, thus limiting their usability in clinical practice. The automatic segmentation of ONH in OCT scans could further improve the current clinical management of glaucoma and other diseases. This review summarizes the current state-of-the-art in automatic segmentation of the ONH in OCT. PubMed and Scopus were used to perform a systematic review. Additional works from other databases (IEEE, Google Scholar and ARVO IOVS) were also included, resulting in a total of 29 reviewed studies. For each algorithm, the methods, the size and type of dataset used for validation, and the respective results were carefully analysed. The results show a lack of consensus regarding the definition of segmented regions, extracted parameters and validation approaches, highlighting the importance and need of standardized methodologies for ONH segmentation. Only with a concrete set of guidelines, these automatic segmentation algorithms will build trust in data-driven segmentation models and be able to enter clinical practice.
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Affiliation(s)
- Rita Marques
- Laboratory for Instrumentation, Biomedical Engineering and Radiation Physics (LIBPhys-UC), Department of Physics, University of Coimbra, Coimbra, Portugal; Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
| | - Danilo Andrade De Jesus
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands.
| | - João Barbosa-Breda
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium; Cardiovascular R&D Center, Faculty of Medicine of the University of Porto, Porto, Portugal; Ophthalmology Department, São João Universitary Hospital Center, Porto, Portugal
| | - Jan Van Eijgen
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium; Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
| | - Ingeborg Stalmans
- Research Group Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium; Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
| | - Theo van Walsum
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
| | - Stefan Klein
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
| | - Pedro G Vaz
- Laboratory for Instrumentation, Biomedical Engineering and Radiation Physics (LIBPhys-UC), Department of Physics, University of Coimbra, Coimbra, Portugal
| | - Luisa Sánchez Brea
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
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Atilgan CU, Goker YS, Hondur G, Kosekahya P, Kocer AM, Citirik M. Evaluation of the radial peripapillary capillary density in unilateral branch retinal vein occlusion and the unaffected fellow eyes. Ther Adv Ophthalmol 2022; 14:25158414221090092. [PMID: 35464343 PMCID: PMC9019368 DOI: 10.1177/25158414221090092] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/09/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Given that unilateral branch retinal vein occlusion (BRVO) and glaucoma share common systemic vascular risk factors, the fellow eyes of patients with BRVO may be at increased risk of glaucoma. Objectives: To analyze the radial peripapillary capillary density (RPCD) in eyes with unilateral BRVO and their unaffected fellow eyes using optical coherence tomography angiography (OCTA). Design: Cross-sectional, prospective study. Methods: The study included 120 eyes of 80 patients: 40 affected eyes of BRVO, 40 fellow eyes of BRVO, and 40 control eyes. The RPCD, retinal nerve fiber layer thickness (RNFLT) were analyzed using OCTA. Results: RPCDs in the whole image, peripapillary region, all the hemispheres, and quadrants were statistically lower in the affected eyes than in both the fellow and control eyes ( p < 0.05 for all). RPCD values in the whole image and the peripapillary region were significantly lower in the fellow eyes than in the control eyes ( p = 0.013, and p = 0.021, respectively). RNFLTs in the peripapillary region, inferior hemisphere and inferior quadrant were significantly lower in the affected eyes than in the control eyes ( p < 0.05 for all). No significant differences were detected between the fellow eyes and the control eyes in term of RNFLT values in any regions ( p > 0.05 for all). Conclusion: Lower RPCD values despite similar RNFLT values were observed in the fellow eyes of patients with unilateral BRVO compared with healthy controls. These results may indicate the shared vascular mechanisms and risk factors that account for the development of BRVO and glaucoma.
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Affiliation(s)
- Cemile Ucgul Atilgan
- Retina Service, Ankara Ulucanlar Eye Training and Research Hospital, Ulucanlar Street, Number: 59, Altindag, 06240 Ankara, Turkey
| | | | - Gozde Hondur
- Ankara Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Pinar Kosekahya
- Ankara Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Ali Mert Kocer
- Ankara Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Mehmet Citirik
- Ankara Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
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Monteiro‐Henriques I, Rocha‐Sousa A, Barbosa‐Breda J. Optical coherence tomography angiography changes in cardiovascular systemic diseases and risk factors: A Review. Acta Ophthalmol 2022; 100:e1-e15. [PMID: 33783129 DOI: 10.1111/aos.14851] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 02/04/2021] [Accepted: 02/27/2021] [Indexed: 02/06/2023]
Abstract
Cardiovascular (CV) disease (CVD) is the main cause of death around the world, and assessing a patient's CV risk factors (CVRF) can play a major role in its prevention. Since it has been shown that retinal vascular alterations may reflect several systemic processes such as CVRF, we conducted a systematic review in order to summarize which ocular microvasculature changes can be found using Optical Coherence Tomography Angiography (OCTA) in patients without ocular diseases and with systemic pathologies/conditions that affect the CV system when compared to healthy subjects. We searched on online databases, namely PubMed, Scopus, Cochrane and Web of Science, and obtained additional studies through citation tracking. Case reports and review articles were excluded. A total of 47 articles were included in our review. We describe that patients with hypertension, diabetes mellitus, kidney disease, preeclampsia, coronary artery disease, carotid artery stenosis and obstructive sleep apnoea syndrome have, in general, lower retinal and choroidal Vessel Density (VD) and Length (VL), as well as an increased foveal avascular zone area and perimeter. Additionally, several characteristics and/or conditions in healthy subjects, such as smoking status, hyper or hypoxia conditions, race, among others, are also related to ocular vascular changes and should be accounted for. We concluded that OCTA could be a useful tool to assess a patient's CV risk profile in a non-invasive way, possibly integrating the diagnostic and prognostic algorithms of the most prevalent CV diseases in the future.
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Affiliation(s)
| | - Amândio Rocha‐Sousa
- Cardiovascular R&D Center Faculty of Medicine of the University of Porto Porto Portugal
- Department of Ophthalmology Centro Hospitalar e Universitário São João Porto Portugal
| | - João Barbosa‐Breda
- Cardiovascular R&D Center Faculty of Medicine of the University of Porto Porto Portugal
- Department of Ophthalmology Centro Hospitalar e Universitário São João Porto Portugal
- Research Group Ophthalmology Department of Neurosciences KULeuven Leuven Belgium
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12
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Ren S, Shen X, Xu J, Li L, Qiu H, Jia H, Wu X, Chen D, Zhao S, Yu B, Gu Y, Dong F. Imaging depth adaptive resolution enhancement for optical coherence tomography via deep neural network with external attention. Phys Med Biol 2021; 66. [PMID: 34464947 DOI: 10.1088/1361-6560/ac2267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/31/2021] [Indexed: 11/11/2022]
Abstract
Optical coherence tomography (OCT) is a promising non-invasive imaging technique that owns many biomedical applications. In this paper, a deep neural network is proposed for enhancing the spatial resolution of OCTen faceimages. Different from the previous reports, the proposed can recover high-resolutionen faceimages from low-resolutionen faceimages at arbitrary imaging depth. This kind of imaging depth adaptive resolution enhancement is achieved through an external attention mechanism, which takes advantage of morphological similarity between the arbitrary-depth and full-depthen faceimages. Firstly, the deep feature maps are extracted by a feature extraction network from the arbitrary-depth and full-depthen faceimages. Secondly, the morphological similarity between the deep feature maps is extracted and utilized to emphasize the features strongly correlated to the vessel structures by using the external attention network. Finally, the SR image is recovered from the enhanced feature map through an up-sampling network. The proposed network is tested on a clinical skin OCT data set and an open-access retinal OCT dataset. The results show that the proposed external attention mechanism can suppress invalid features and enhance significant features in our tasks. For all tests, the proposed SR network outperformed the traditional image interpolation method, e.g. bi-cubic method, and the state-of-the-art image super-resolution networks, e.g. enhanced deep super-resolution network, residual channel attention network, and second-order attention network. The proposed method may increase the quantitative clinical assessment of micro-vascular diseases which is limited by OCT imaging device resolution.
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Affiliation(s)
- Shangjie Ren
- Tianjin Key Laboratory of Process Measurement and Control, School of Electrical and Information Engineering, Tianjin University, Tianjin, 300072, People's Republic of China
| | - Xiongri Shen
- Tianjin Key Laboratory of Process Measurement and Control, School of Electrical and Information Engineering, Tianjin University, Tianjin, 300072, People's Republic of China
| | - Jingjiang Xu
- School of Physics and Optoelectronic Engineering, Foshan University, Foshan, 528000, People's Republic of China
| | - Liang Li
- College of Intelligence and Computing, Tianjin University, Tianjin, 300072, People's Republic of China
| | - Haixia Qiu
- Department of Laser Medicine, the First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Haibo Jia
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, 150081, People's Republic of China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, 150081, People's Republic of China
| | - Xining Wu
- Tianjin Horimed Technology Co., Ltd., Tianjin, 300308, People's Republic of China
| | - Defu Chen
- Institute of Engineering Medicine, Beijing Institute of Technology, Beijing, 100081, People's Republic of China
| | - Shiyong Zhao
- Tianjin Horimed Technology Co., Ltd., Tianjin, 300308, People's Republic of China
| | - Bo Yu
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, 150081, People's Republic of China.,The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, 150081, People's Republic of China
| | - Ying Gu
- Department of Laser Medicine, the First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China.,Precision Laser Medical Diagnosis and Treatment Innovation Unit, Chinese Academy of Medical Sciences, Beijing, 100000, People's Republic of China
| | - Feng Dong
- Tianjin Key Laboratory of Process Measurement and Control, School of Electrical and Information Engineering, Tianjin University, Tianjin, 300072, People's Republic of China
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13
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Retinal Vessel Density Changes on Optical Coherence Tomography Angiography and Predictive Factors in Normal-Tension Glaucoma Treated with Topical Beta-Blocker. Sci Pharm 2021. [DOI: 10.3390/scipharm89030040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Topical antiglaucoma medications may alter the microcirculation in the optic nerve head. We aimed to evaluate the changes in retinal vessel density (VD) on optical coherence tomography angiography (OCTA) in patients with newly diagnosed normal-tension glaucoma (NTG) treated with a topical beta-blocker. (2) Methods: This study included 80 patients diagnosed with NTG not using systemic medication, who received topical carteolol treatment between December 2019 and November 2020. We studied the changes in the OCTA VD/signal strength index (SSI) after the 6-month treatment period and determined the predictive factors affecting the changes in VD/SSI. (3) Results: After the 6-month treatment period, the peripapillary VD increased in 40 patients but decreased in the other 40 patients. The univariate and multivariate analyses revealed that old age and hypertension were significant factors associated with a VD/SSI decrease after carteolol treatment. Moreover, high baseline peripapillary, superficial, and deep macular VDs were significantly associated with the VD decrease after carteolol treatment. (4) Conclusions: Carteolol treatment could increase or decrease the VD in patients with NTG. The baseline VD, age, and hypertension could affect these VD changes. Patients with NTG and higher baseline peripapillary or macular VD, older age, and hypertension are more likely to have a decreased VD after carteolol treatment.
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14
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Lin YH, Su WW, Huang SM, Chuang LH, Chen LC. Optical Coherence Tomography Angiography Vessel Density Changes in Normal-tension Glaucoma Treated With Carteolol, Brimonidine, or Dorzolamide. J Glaucoma 2021; 30:690-696. [PMID: 33927152 DOI: 10.1097/ijg.0000000000001859] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/06/2021] [Indexed: 11/26/2022]
Abstract
PRECIS In patients with normal-tension glaucoma (NTG), topical dorzolamide might enhance the vessel density (VD), topical carteolol decreased the VD in the inferior-temporal peripapillary retina, whereas topical brimonidine did not change the VD. PURPOSE Topical antiglaucoma medications may improve ocular perfusion pressure or microcirculation in the optic nerve head. The study evaluated responses of retinal VD to topical carteolol, brimonidine, and dorzolamide in NTG using optical coherence tomography angiography. PATIENTS AND METHODS This is a retrospective, nonrandomized, comparative study. The study included 131 individuals (77 men, 54 women) diagnosed with NTG, without systemic medication use, who visited the glaucoma clinic of Chang Gung Memorial Hospital, Taiwan, between January 2019 and May 2020. If both eyes were diagnosed with NTG, only the right eye was included. Of these, there were 80 carteolol-treated eyes, 27 brimonidine-treated eyes, and 24 dorzolamide-treated eyes. We studied the response of optical coherence tomography angiography parameters and retinal nerve fiber layer (RNFL) thickness to drugs, 6 months after treatment. RESULTS In dorzolamide-treated eyes, increases in the peripapillary superficial retinal VD, especially in the superior-nasal area, were significant; however, no RNFL thickness changes were observed. In contrast, the superficial retinal VD decreased at the inferior-temporal peripapillary area, and RNFL thickness decreased in the inferior-nasal peripapillary area of carteolol-treated eyes. Finally, in brimonidine-treated eyes, changes in either VD parameters or RNFL thickness were not significant. CONCLUSIONS Topical dorzolamide possibly enhanced the VD of the peripapillary retina in NTG eyes. On the contrary, topical carteolol possibly decreased VD in the inferior-temporal peripapillary retina. Finally, in cases treated with topical brimonidine, peripapillary microcirculation remained unchanged. The study shows preliminary results and future large-scale studies are needed to confirm findings.
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Affiliation(s)
- Yun-Hsuan Lin
- Department of Electro-Optical Engineering, National Taipei University of Technology, Taipei
- Departments of Ophthalmology
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Wen Su
- Departments of Ophthalmology
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Ming Huang
- Radiation Oncology, Chang Gung Memorial Hospital, Keelung
- Radiation Oncology, Chang Gung Memorial Hospital, Linkou
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lan-Hsin Chuang
- Departments of Ophthalmology
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lung-Chien Chen
- Department of Electro-Optical Engineering, National Taipei University of Technology, Taipei
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15
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Naranjo-Bonilla P, Muñoz-Villanueva MC, Giménez-Gómez R, Jurado-Gámez B. Retinal and choroidal thickness measurements in obstructive sleep apnea: impacts of continuous positive airway pressure treatment. Graefes Arch Clin Exp Ophthalmol 2021; 259:3381-3393. [PMID: 34296347 DOI: 10.1007/s00417-021-05322-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/01/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To examine retinal and choroidal thicknesses in individuals with obstructive sleep apnea (OSA) and determine the impacts of continuous positive airway pressure (CPAP) treatment. METHODS Prospective follow-up study conducted at a university hospital. 40 patients with OSA, 28 treated with CPAP, and 12 untreated, were enrolled immediately after diagnosis and graded according to the apnea hypopnea index (AHI) determined in an overnight polysomnography. Inclusion criteria were a new diagnosis of OSA and CPAP indicated. Participants underwent a full ophthalmologic examination including optical coherence tomography (OCT) at the peripapillary, macular, and choroidal levels and the same examination 3 months later. Outcome measures were peripapillary retinal nerve fiber layer (RNFL), total retinal (TRT), retinal ganglion cell layer (RGCL), inner plexiform layer (IPL), photoreceptor layer (PL), and choroidal thicknesses. RESULTS At 3 months, RGCL thickness was reduced at the inner nasal macula segment in the no-CPAP group (P = 0.016). In + CPAP, increases were produced in RNFL thickness (5/6 segments) and TRT (7/ 9 segments), while choroidal thinning was observed temporally (P = 0.003). At baseline, positive correlation was detected between choroidal thickness and AHI (r = 0.352, P = 0.005) and between IPL thickness (7/9 segments) and AHI (r = 0.414, P < 0.001). CONCLUSIONS Initial retinal and choroidal thickening was followed by RGCL thinning over 3 months. In patients receiving CPAP, we observed no thinning of any retinal layer and normalization of choroidal thickness.
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Affiliation(s)
- P Naranjo-Bonilla
- Ophthalmology Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain. .,Ophthalmology Department, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain. .,, Cordoba, Spain.
| | | | - R Giménez-Gómez
- Ophthalmology Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain.,Ophthalmology Department, Hospital Universitario Reina Sofía, Cordoba, Spain
| | - B Jurado-Gámez
- Respiratory Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain.,Respiratory Department, Hospital Universitario Reina Sofía, Cordoba, Spain
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16
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Bakker E, Dikland FA, van Bakel R, Andrade De Jesus D, Sánchez Brea L, Klein S, van Walsum T, Rossant F, Farías DC, Grieve K, Paques M. Adaptive optics ophthalmoscopy: a systematic review of vascular biomarkers. Surv Ophthalmol 2021; 67:369-387. [PMID: 34090882 DOI: 10.1016/j.survophthal.2021.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 05/17/2021] [Accepted: 05/24/2021] [Indexed: 12/28/2022]
Abstract
Retinal vascular diseases are a leading cause for blindness and partial sight certifications. By applying adaptive optics (AO) to conventional imaging modalities, the microstructures of the retinal vasculature can be observed with high spatial resolution, hence offering a unique opportunity for the exploration of the human microcirculation. The objective of this systematic review is to describe the current state of retinal vascular biomarkers imaged by AO flood illumination ophthalmoscopy (FIO) and AO scanning laser ophthalmoscopy (SLO). A literature research was conducted in the PubMed and Scopus databases on July 9, 2020. From 217 screened studies, 42 were eligible for this review. All studies underwent a quality check regarding their content. A meta-analysis was performed for the biomarkers reported for the same pathology in at least three studies using the same modality. The most frequently studied vascular biomarkers were the inner diameter (ID), outer diameter (OD), parietal thickness (PT), wall cross-sectional area (WCSA), and wall-to-lumen ratio (WLR). The applicability of AO vascular biomarkers has been mostly explored in systemic hypertension using AO FIO and in diabetes using AO SLO. The result of the meta-analysis for hypertensive patients showed that WLR, PT, and ID were significantly different when compared to healthy controls, while WCSA was not (P < 0.001, P = 0.002, P < 0.001, and P = 0.070, respectively). The presented review shows that, although a substantial number of retinal vascular biomarkers have been explored in AO en face imaging, further clinical research and standardization of procedures is needed to validate such biomarkers for the longitudinal monitoring of arterial hypertension and other diseases.
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Affiliation(s)
- Elise Bakker
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands; Clinical Technology, Delft University of Technology, Delft, The Netherlands
| | - Felix Anne Dikland
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands; Clinical Technology, Delft University of Technology, Delft, The Netherlands
| | - Roan van Bakel
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands; Clinical Technology, Delft University of Technology, Delft, The Netherlands
| | - Danilo Andrade De Jesus
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
| | - Luisa Sánchez Brea
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Stefan Klein
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Theo van Walsum
- Biomedical Imaging Group Rotterdam, Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Florence Rossant
- ISEP, Institut Supérieur d'Electronique de Paris, Issy-les-Moulineaux, France
| | - Daniela Castro Farías
- Paris Eye Imaging Group, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, INSERM-DHOS Clinical Investigation Center, Paris, France
| | - Kate Grieve
- Paris Eye Imaging Group, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, INSERM-DHOS Clinical Investigation Center, Paris, France
| | - Michel Paques
- Paris Eye Imaging Group, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, INSERM-DHOS Clinical Investigation Center, Paris, France
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17
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Nie L, Xu J, Fu L, Ye Y, Chan YK, Li T, Pan W, Lu P. Changes in circumpapillary retinal vessel density after acute primary angle closure episode via OCT angiography. Int Ophthalmol 2021; 41:2389-2397. [PMID: 33948808 DOI: 10.1007/s10792-021-01793-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the changes and evaluate the diagnosis value of circumpapillary vessel density (VD) in cases of acute primary angle closure (APAC). DESIGN Case-control study. METHODS APAC patients with a history of unilateral acute attack were enrolled. The eyes with acute episode constituted the case group while the contralateral eyes without attack consisted of the control group. Ophthalmic examinations including slit-lamp examination, best-corrected visual acuity, intraocular pressure and visual field were carried out. Retinal nerve fiber layer (RNFL), macular ganglion cell complex (GCC) were measured by spectral-domain optical coherence tomography, while VD was assessed by optical coherence tomography angiography. RESULTS The whole en face image vessel density (wiVD), circumpapillary vessel density (cpVD) and inside disk VD for both all vessels and capillary were all significantly lower in the APAC eyes compared to the fellow eyes (P < 0.01 for all). In APAC eyes, the wiVD, inside disk VD and cpVD both for all vessels and capillary were all positively correlated with RNFL and GCC thicknesses but negatively correlated with the mean deviation (MD), pattern standard deviation (PSD) and the duration of acute attack (all P < 0.01). From the ROC curve, the cpVDcap, wiVDcap, cpVDall and wiVDall all showed comparable diagnostic ability with RNFL, GCC and MD to differentiate eyes with APAC from the fellow eyes (all P > 0.05). The inside disk VDcap and VDall demonstrated significant lower diagnostic ability than the cpVDcap, wiVDcap, cpVDall and wiVDall (all P < 0.001). CONCLUSIONS In APAC eyes, circumpapillary VD decreased significantly compared with the fellow unaffected eyes. They were significantly correlated with thicknesses of RNFL and GCC, and visual field MD and PSD in the APAC eyes. The patients with longer duration of acute attack were more likely to have lower cpVD. For APAC, the diagnostic ability of wiVD and cpVD was similar with RNFL, GCC and MD and was higher than inside disk VD.
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Affiliation(s)
- Li Nie
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China.,Department of Glaucoma, Affiliated Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Hangzhou, 310000, Zhejiang, China
| | - Jiawen Xu
- Department of Glaucoma, Affiliated Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Hangzhou, 310000, Zhejiang, China
| | - Lin Fu
- Department of Glaucoma, Affiliated Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Hangzhou, 310000, Zhejiang, China
| | - Yufeng Ye
- Department of Glaucoma, Affiliated Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Hangzhou, 310000, Zhejiang, China
| | - Yau Kei Chan
- Department of Ophthalmology, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Tiankun Li
- Department of Glaucoma, Affiliated Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Hangzhou, 310000, Zhejiang, China
| | - Weihua Pan
- Department of Glaucoma, Affiliated Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Hangzhou, 310000, Zhejiang, China
| | - Peirong Lu
- Department of Ophthalmology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China.
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18
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Koutropoulou N, Panos GD. The diagnostic value of Optical Coherence Tomography Angiography in glaucoma. Curr Med Imaging 2021; 17:1179-1182. [PMID: 33845726 DOI: 10.2174/1573405617666210412141244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/21/2021] [Accepted: 02/26/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Nikolitsa Koutropoulou
- Department of Ophthalmology, Northampton General Hospital NHS Trust, Northampton. United Kingdom
| | - Georgios D Panos
- Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham. United Kingdom
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19
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Optical Coherence Tomography Imaging of the Lamina Cribrosa: Structural Biomarkers in Nonglaucomatous Diseases. J Ophthalmol 2021; 2021:8844614. [PMID: 33680508 PMCID: PMC7910045 DOI: 10.1155/2021/8844614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/28/2021] [Accepted: 02/05/2021] [Indexed: 12/13/2022] Open
Abstract
The lamina cribrosa (LC) is an active structure that responds to the strain by changing its morphology. Abnormal changes in LC morphology are usually associated with, and indicative of, certain pathologies such as glaucoma, intraocular hypertension, and myopia. Recent developments in optical coherence tomography (OCT) have enabled detailed in vivo studies about the architectural characteristics of the LC. Structural characteristics of the LC have been widely explored in glaucoma management. However, information about which LC biomarkers could be useful for the diagnosis, and follow-up, of other diseases besides glaucoma is scarce. Hence, this literature review aims to summarize the role of the LC in nonophthalmic and ophthalmic diseases other than glaucoma. PubMed was used to perform a systematic review on the LC features that can be extracted from OCT images. All imaging features are presented and discussed in terms of their importance and applicability in clinical practice. A total of 56 studies were included in this review. Overall, LC depth (LCD) and thickness (LCT) have been the most studied features, appearing in 75% and 45% of the included studies, respectively. These biomarkers were followed by the prelaminar tissue thickness (21%), LC curvature index (5.4%), LC global shape index (3.6%), LC defects (3.6%), and LC strains/deformations (1.8%). Overall, the disease groups showed a thinner LC (smaller LCT) and a deeper ONH cup (larger LCD), with some exceptions. A large variability between approaches used to compute LC biomarkers has been observed, highlighting the importance of having automated and standardized methodologies in LC analysis. Moreover, further studies are needed to identify the pathologies where LC features have a diagnostic and/or prognostic value.
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20
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Andrade De Jesus D, Sánchez Brea L, Barbosa Breda J, Fokkinga E, Ederveen V, Borren N, Bekkers A, Pircher M, Stalmans I, Klein S, van Walsum T. OCTA Multilayer and Multisector Peripapillary Microvascular Modeling for Diagnosing and Staging of Glaucoma. Transl Vis Sci Technol 2020; 9:58. [PMID: 33224631 PMCID: PMC7674004 DOI: 10.1167/tvst.9.2.58] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 10/01/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose To develop and assess an automatic procedure for classifying and staging glaucomatous vascular damage based on optical coherence tomography angiography (OCTA) imaging. Methods OCTA scans (Zeiss Cirrus 5000 HD-OCT) from a random eye of 39 healthy subjects and 82 glaucoma patients were used to develop a new classification algorithm based on multilayer and multisector information. The averaged circumpapillary retinal nerve fiber layer (RNFL) thickness was also collected. Three models, support vector machine (SVM), random forest (RF), and gradient boosting (xGB), were developed and optimized for classifying between healthy and glaucoma patients, primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG), and glaucoma severity groups. Results All the models, the SVM (area under the receiver operating characteristic [AUROC] 0.89 ± 0.06), the RF (AUROC 0.86 ± 0.06), and the xGB (AUROC 0.85 ± 0.07), with 26, 22, and 29 vascular features obtained after feature selection, respectively, presented a similar performance to the RNFL thickness (AUROC 0.85± 0.06) in classifying healthy and glaucoma patients. The superficial vascular plexus was the most informative layer with the infero temporal sector as the most discriminative region of interest. No significant differentiation was obtained in discriminating the POAG from the NTG group. The xGB model, after feature selection, presented the best performance in classifying the severity groups (AUROC 0.76± 0.06), outperforming the RNFL (AUROC 0.67± 0.06). Conclusions OCTA multilayer and multisector information has similar performance to RNFL for glaucoma diagnosis, but it has an added value for glaucoma severity classification, showing promising results for staging glaucoma progression. Translational Relevance OCTA, in its current stage, has the potential to be used in clinical practice as a complementary imaging technique in glaucoma management.
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Affiliation(s)
- Danilo Andrade De Jesus
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Luisa Sánchez Brea
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - João Barbosa Breda
- Research Group of Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Ella Fokkinga
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.,Delft University of Technology, Delft, The Netherlands
| | - Vera Ederveen
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.,Delft University of Technology, Delft, The Netherlands
| | - Noor Borren
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.,Delft University of Technology, Delft, The Netherlands
| | - Amerens Bekkers
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.,Delft University of Technology, Delft, The Netherlands
| | - Michael Pircher
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Ingeborg Stalmans
- Research Group of Ophthalmology, Department of Neurosciences, KU Leuven, Leuven, Belgium.,Ophthalmology Department, University Hospitals Leuven, Leuven, Belgium
| | - Stefan Klein
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Theo van Walsum
- Biomedical Imaging Group Rotterdam, Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
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Asanad S, Mohammed I, Sadun AA, Saeedi OJ. OCTA in neurodegenerative optic neuropathies: emerging biomarkers at the eye-brain interface. Ther Adv Ophthalmol 2020; 12:2515841420950508. [PMID: 32923939 PMCID: PMC7457690 DOI: 10.1177/2515841420950508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 07/13/2020] [Indexed: 12/22/2022] Open
Abstract
OCTA imaging in optic neuropathies.
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Affiliation(s)
- Samuel Asanad
- Department of Ophthalmology and Visual Sciences, University of Maryland Eye Associates, University of Maryland Medical Center and University of Maryland School of Medicine, 419 W. Redwood St., Baltimore, MD 21201, USA
| | - Isa Mohammed
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alfredo A Sadun
- Doheny Eye Center, Los Angeles, CA, USA; Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Osamah J Saeedi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
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Microvascular damage assessed by OCT Angiography for glaucoma diagnosis: a systematic review of the most discriminative regions. Acta Ophthalmol 2020; 98:572. [PMID: 32816404 PMCID: PMC8097601 DOI: 10.1111/aos.14481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/01/2020] [Indexed: 01/14/2023]
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Girard MJA, Schmetterer L. Artificial intelligence and deep learning in glaucoma: Current state and future prospects. PROGRESS IN BRAIN RESEARCH 2020; 257:37-64. [PMID: 32988472 DOI: 10.1016/bs.pbr.2020.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Over the past few years, there has been an unprecedented and tremendous excitement for artificial intelligence (AI) research in the field of Ophthalmology; this has naturally been translated to glaucoma-a progressive optic neuropathy characterized by retinal ganglion cell axon loss and associated visual field defects. In this review, we aim to discuss how AI may have a unique opportunity to tackle the many challenges faced in the glaucoma clinic. This is because glaucoma remains poorly understood with difficulties in providing early diagnosis and prognosis accurately and in a timely fashion. In the short term, AI could also become a game changer by paving the way for the first cost-effective glaucoma screening campaigns. While there are undeniable technical and clinical challenges ahead, and more so than for other ophthalmic disorders whereby AI is already booming, we strongly believe that glaucoma specialists should embrace AI as a companion to their practice. Finally, this review will also remind ourselves that glaucoma is a complex group of disorders with a multitude of physiological manifestations that cannot yet be observed clinically. AI in glaucoma is here to stay, but it will not be the only tool to solve glaucoma.
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Affiliation(s)
- Michaël J A Girard
- Ophthalmic Engineering & Innovation Laboratory (OEIL), Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
| | - Leopold Schmetterer
- Ocular Imaging, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore; School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore; SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore; Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria; Institute of Clinical and Experimental Ophthalmology, Basel, Switzerland.
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Zabel K, Zabel P, Kaluzna M, Lamkowski A, Jaworski D, Wietlicka-Piszcz M, Kaluzny JJ. Correlation of retinal sensitivity in microperimetry with vascular density in optical coherence tomography angiography in primary open-angle glaucoma. PLoS One 2020; 15:e0235571. [PMID: 32628706 PMCID: PMC7337279 DOI: 10.1371/journal.pone.0235571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/17/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose To evaluate the correlation between retinal sensitivity in microperimetry (MP) with vessel density (VD) using optical coherence tomography angiography (OCTA) in primary open-angle glaucoma (POAG). Methods We enrolled 30 participants (52 eyes) with POAG and 15 participants (23 eyes) in the healthy control group. All participants were examined for retinal structure using OCTA to assess VD and Spectral domain OCT (SD-OCT) to assess ganglion cell complex (GCC) and peripapillary retinal nerve fiber layer (pRNFL) thickness. Retinal sensitivity was tested with MP and standard automatic perimetry (SAP). Results The VD in moderate/severe POAG was lower than that in mild POAG and healthy control in the macular superficial vascular plexus (SVP) (38.7±6.3% vs. 42.9±5.2%, 49.7±2.6% respectively, P<0.001) and peripapillary radial peripapillary capillaries (pRPC) (36.4±5.7% vs. 43.6±6.6%, 49.1±2.4% respectively, P<0.001). The Pearson’s correlations between function-structure parameters were strongest with MP average sensitivity threshold and SVP VD in the area of whole macula (r = 0.68); followed by SAP mean deviation (MD) and pRNFL thickness (r = 0.63); SAP MD and pRPC VD (r = 0.59) and MP average threshold and GCC thickness (r = 0.54). We found the AUROCs for discriminating between glaucomatous and healthy eyes were highest for structural parameters as follows: pRNFL (0.94), macular SVP whole (0.92), pRPC (0.92) and GCC (0.91). Pairwise comparison of the above parameters showed no difference (P>0.05). Conclusion The relationship between microvascular damage in the macular SVP whole and the decrease of MP average sensitivity threshold is stronger than the pRNFL thickness measurements and SAP parameters. OCTA and MP techniques are valuable methods that allow clinically monitor structural and functional changes in glaucomatous eyes.
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Affiliation(s)
- Katarzyna Zabel
- Department of Sensory Organ Studies, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
- Oftalmika Eye Hospital, Bydgoszcz, Poland
- Department of Ophthalmology, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
- * E-mail:
| | - Przemyslaw Zabel
- Department of Sensory Organ Studies, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
- Oftalmika Eye Hospital, Bydgoszcz, Poland
- Department of Ophthalmology, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | | | | | | | - Magdalena Wietlicka-Piszcz
- Department of Biostatistics and Biomedical Systems Theory, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Jakub J. Kaluzny
- Department of Sensory Organ Studies, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
- Oftalmika Eye Hospital, Bydgoszcz, Poland
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Advanced vascular examinations of the retina and optic nerve head in glaucoma. PROGRESS IN BRAIN RESEARCH 2020; 257:77-83. [DOI: 10.1016/bs.pbr.2020.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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