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Kong X, Ho A, Munoz B, West S, Strauss RW, Jha A, Ervin A, Buzas J, Singh M, Hu Z, Cheetham J, Ip M, Scholl HPN. Reproducibility of Measurements of Retinal Structural Parameters Using Optical Coherence Tomography in Stargardt Disease. Transl Vis Sci Technol 2019; 8:46. [PMID: 31259091 PMCID: PMC6590092 DOI: 10.1167/tvst.8.3.46] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 04/03/2019] [Indexed: 02/06/2023] Open
Abstract
Purpose To assess the reproducibility of retinal measurements from optical coherence tomography (OCT) in ABCA4-related Stargardt disease (STGD1). Methods The international multicenter Progression of Atrophy Secondary to Stargardt Disease (ProgStar) Study enrolled 259 STGD1 patients. OCT images were graded by the study reading center (RC). Semiautomatic segmentation with manual adjustments was used to segment the layers of retinal pigmentation epithelium, outer segments, inner segments (ISs), outer nuclear layer (ONL), inner retina, and the total retina (TR). The images were overlaid to the Early Treatment Diabetic Retinopathy Study (ETDRS) grid. For each layer, the thickness and the intact area of the ETDRS central subfield, inner ring, and outer ring were recorded, respectively. A different set of RC graders regraded 30 independent ProgStar images to evaluate measurement reproducibility. Reproducibility was assessed graphically and using statistics including intraclass correlation (ICC) and relative absolute difference (RAD). Results Across all layers, measurements of the ETDRS central subfield had low ICC and/or large RAD. The outer-ring region was not fully captured in some images. For inner ring, good reproducibility was observed for intact area in the IS (ICC = 0.99, RAD = 4%), thicknesses of the ONL (ICC = 0.93, RAD = 6%), and TR (ICC = 0.99, RAD = 1%). Conclusions STGD1's complex morphology made outer retina segmentation challenging. Measurements of the inner ring, including the intact area of IS (i.e., the ellipsoid zone [EZ]) and ONL and TR thicknesses, had good reproducibility and showed anatomical impairment. Translational Relevance ONL and TR thicknesses and the EZ intact area in the ETDRS inner ring hold potential as structural endpoints for STGD1 trials. Structure-function relationships need to be further established.
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Affiliation(s)
- Xiangrong Kong
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Alexander Ho
- Doheny Eye Institute, David Geffen School of Medicine at University of California Los Angeles, CA, USA
| | - Beatriz Munoz
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Sheila West
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Rupert W Strauss
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA.,Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, University College London, London, UK.,Department of Ophthalmology, Johannes Kepler University Clinic Linz, Linz, Austria.,Department of Ophthalmology, Medical University Graz, Graz, Austria
| | - Anamika Jha
- Doheny Eye Institute, David Geffen School of Medicine at University of California Los Angeles, CA, USA
| | - Ann Ervin
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jeff Buzas
- Department of Statistics, University of Vermont, Burlington, VM, USA
| | - Mandeep Singh
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Zhihong Hu
- Doheny Eye Institute, David Geffen School of Medicine at University of California Los Angeles, CA, USA
| | | | - Michael Ip
- Doheny Eye Institute, David Geffen School of Medicine at University of California Los Angeles, CA, USA
| | - Hendrik P N Scholl
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA.,Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland.,Department of Ophthalmology, University of Basel, Basel, Switzerland
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Stereotactic radiotherapy for wet age-related macular degeneration (INTREPID): influence of baseline characteristics on clinical response. Retina 2015; 35:194-204. [PMID: 25102198 DOI: 10.1097/iae.0000000000000283] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine which patients respond best to stereotactic radiotherapy (SRT) for neovascular age-related macular degeneration. METHODS Participants (n = 230) receiving intravitreal anti-vascular endothelial growth factor injections for neovascular age-related macular degeneration enrolled in a randomized, double-masked sham-controlled trial comparing 16 Gray, 24 Gray, or Sham SRT. In a post hoc analysis, participants were grouped according to their baseline characteristics, to determine if these influenced SRT efficacy. RESULTS At 52 weeks, SRT was most effective for lesions ≤4 mm in greatest linear dimension and with a macular volume greater than the median value of 7.4 mm. For 26% of the participants with both these characteristics, SRT resulted in 55% fewer ranibizumab injections (2.08 vs. 4.60; P = 0.0002), a mean visual acuity change that was 5.33 letters superior to sham (+2.18 vs. -3.15 letters; P = 0.0284), and a 71.1-μm greater reduction in mean central subfield thickness (-122.6 vs. -51.5 μm; P = 0.027). Other features associated with a positive response to SRT included pigment epithelial detachment and the absence of fibrosis. CONCLUSION Stereotactic radiotherapy is most effective for neovascular age-related macular degeneration lesions that are actively leaking at the time of treatment, and no larger than the 4-mm treatment zone.
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Hodzic-Hadzibegovic D, Sander BA, Lund-Andersen H. Diabetic macular oedema quantified with spectral-domain optical coherence tomography--evaluation of boundary line artefacts and the effect on retinal thickness. Acta Ophthalmol 2015; 93:74-82. [PMID: 25042850 DOI: 10.1111/aos.12494] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 06/02/2014] [Indexed: 12/21/2022]
Abstract
PURPOSE To characterize frequency, morphological cause and time-dependent change of boundary line artefacts in optical coherence tomography (OCT) examinations of centre-involved diabetic macular oedema (ciDME) patients who underwent ranibizumab treatment with 1-year follow-up and to evaluate the impact of artefacts on retinal thickness. METHODS One hundred and fourteen patients were examined with radial scan protocol by Topcon 3D OCT at baseline, 3 and 12 months. All B scans from all visits were examined for boundary line artefacts (artefacts) and were stratified by morphological element causing artefacts including hard exudates (HE), epiretinal membranes (ERM), optical opacities and serous detachments. Boundary line artefacts were manually corrected and the corrected central subfield thickness (CST) and macular volume were compared with automated values. Data were compared with a repeatability coefficient of 25 μm. RESULTS Boundary line artefacts were found in 51.8% of the total 342 OCT examinations and in 25.5% of the total 2052 B scans. Morphological elements that caused artefacts in the total 2052 B scans were HE (10.6%), ERM (10.3%), optical opacities (4.4%), serous detachments (1.7%) and others (1.2%). The number of artefacts due to HE decreased significantly (p = 0.0005), and the number of artefacts due to ERM were unchanged (p = 0.087) during 12 months. In OCT examinations with artefacts caused by HE, manually corrected CST was statistically significant higher than automated value at baseline and 3 months. For ERM, manually corrected CST was statistically significant lower than automated value at baseline and 12 months. CONCLUSION Boundary line artefacts in OCT examinations of ciDME patients using Topcon 3D OCT occur in 51.8%. In situation of boundary line artefacts in centre 1-mm area every fourth OCT examination has a change in CST beyond 25 μm.
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Affiliation(s)
- Delila Hodzic-Hadzibegovic
- Department of Ophthalmology; Glostrup Hospital; University of Copenhagen; Glostrup Denmark
- Faculty of Health Sciences; University of Copenhagen; Copenhagen Denmark
| | - Birgit A. Sander
- Department of Ophthalmology; Glostrup Hospital; University of Copenhagen; Glostrup Denmark
| | - Henrik Lund-Andersen
- Department of Ophthalmology; Glostrup Hospital; University of Copenhagen; Glostrup Denmark
- Faculty of Health Sciences; University of Copenhagen; Copenhagen Denmark
- Steno Diabetes Center; Gentofte Denmark
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Zhu M, Chew JK, Broadhead GK, Luo K, Joachim N, Hong T, Syed A, Chang AA. Intravitreal Ranibizumab for neovascular Age-related macular degeneration in clinical practice: five-year treatment outcomes. Graefes Arch Clin Exp Ophthalmol 2014; 253:1217-25. [PMID: 25205618 DOI: 10.1007/s00417-014-2799-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 07/09/2014] [Accepted: 08/07/2014] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents are the established standard of care for neovascular age-related macular degeneration (nAMD). However, data on long-term outcomes of this therapy are limited. The purpose of this study was to assess the visual and anatomical outcomes and safety profile of intravitreal ranibizumab in treating nAMD over a period of five years. METHODS 208 patients (208 eyes) were included in this retrospective case series study. Intervention was an "as-needed" treatment model. Visual acuity (VA), central macular thickness (CMT), ophthalmic examination, and adverse events (AEs) were assessed in each visit. Snellen VA was converted to Early Treatment Diabetic Retinopathy Study letters for analysis. RESULTS The average VA improved by 1.9 letters after one year (p = 0.017), and decreased by 2.4 letters over five years of treatment (p = 0.043). At the end of year five, 11.1 % of patients (23/208) had improved VA by more than 15 letters and 68.8 % (143/208) had VA improvement or loss less than or equal to 15 letters, while 20.2 % of patients (42/208) had a loss of more than 15 letters. Patients with VA of less than 35 letters at baseline showed significant VA improvement after five years of treatment. There was a positive relationship between injection numbers and VA improvement over the five-year period, after adjusting for age and baseline VA (p < 0.0005). Mean CMT decreased by 28.3 μm (p < 0.0005) over five years. Ocular AEs, serious adverse events (SAEs), and systemic SAEs occurred in 4.6 %, 0.48 %, and 2 % of patients, respectively, during the follow-up period. CONCLUSIONS The use of intravitreal ranibizumab in an as-needed treatment regimen over a five-year period was effective in maintaining vision in patients with nAMD and in reducing macular thickness, with a relatively low rate of adverse and serious adverse events.
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Affiliation(s)
- Meidong Zhu
- Sydney Institute of Vision Science, Level 13, 187 Macquarie Street, Sydney, 2000, Australia
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Uji A, Murakami T, Unoki N, Ogino K, Nishijima K, Yoshitake S, Dodo Y, Yoshimura N. Parallelism as a novel marker for structural integrity of retinal layers in optical coherence tomographic images in eyes with epiretinal membrane. Am J Ophthalmol 2014; 157:227-236.e4. [PMID: 24139623 DOI: 10.1016/j.ajo.2013.09.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 08/31/2013] [Accepted: 09/03/2013] [Indexed: 11/16/2022]
Abstract
PURPOSE To propose a new parameter, "Parallelism," to evaluate retinal layer integrity on spectral-domain optical coherence tomography (SDOCT), and to investigate the association between parallelism and visual function in eyes with idiopathic epiretinal membrane (ERM). DESIGN Retrospective, observational evaluation of a diagnostic test. METHODS We evaluated a consecutive series of 57 eyes of 57 patients with ERM and 30 healthy eyes of 30 volunteers for whom M-CHARTS testing and SDOCT were performed on the same day. OCT images were skeletonized, and the orientation of segmented lines in the image was termed "Parallelism" and was expressed as a value ranging from 0-1 and increasing as the retinal layers ran more parallel with each other. The relationships between parallelism and visual acuity and between parallelism and metamorphopsia score were evaluated. RESULTS In normal eyes, parallelism was nearly homogeneous and varied slightly with the location. Parallelism in eyes with ERM was significantly lower than that in normal eyes. In the horizontal and vertical scans, parallelism was significantly correlated with visual acuity, horizontal metamorphopsia score, and vertical metamorphopsia score. Parallelism of the center (1 mm) in the horizontal scan was strongly correlated with horizontal metamorphopsia score (R = -0.632; P < .0001). Significant negative correlation was found between parallelism and retinal thickness both in horizontal and vertical scans. CONCLUSIONS Parallelism was significantly lower in eyes with ERM than in normal eyes, and correlated strongly with metamorphopsia and visual acuity in eyes with ERM.
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Affiliation(s)
- Akihito Uji
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Tomoaki Murakami
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Noriyuki Unoki
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ken Ogino
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuaki Nishijima
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shin Yoshitake
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoko Dodo
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Nagahisa Yoshimura
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Penha FM, Gregori G, Yehoshua Z, Feuer WJ, Rosenfeld PJ. Identifying the boundaries of retinal pigment epithelial detachments using two spectral-domain optical coherence tomography instruments. Ophthalmic Surg Lasers Imaging Retina 2013; 44:10-6. [PMID: 23410807 DOI: 10.3928/23258160-20121221-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 12/15/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare two spectral-domain optical coherence tomography (SD-OCT) instruments in identifying the boundaries of retinal pigment epithelium detachment (PED). PATIENTS AND METHODS 27 eyes were scanned with Cirrus and Spectralis SD-OCT instruments during a single visit. Two Cirrus scan patterns were used: the 512 × 128 and 200 × 200 covering a 6 × 6 mm (20° × 20°) area. The Spectralis scan pattern consisted of seven B-scans, averaged 51 times, covering a 30° × 5° area. The main outcome measures were the retinal thickness at the foveal center and the number of segmentation failures on the central B-scan. RESULTS The Spectralis algorithm failed to follow the proper retinal contour in 25 eyes (92.6%), while the segmentation on the Cirrus instrument was successful in every central B-scan. Spectralis yielded greater retinal thickness measurements in all cases, and the average difference between Cirrus and Spectralis was 139 μm (P < .001). The intraclass correlation coefficient between the two Cirrus scan patterns was 0.998, and Cirrus versus Spectralis was 0.21. CONCLUSIONS The Cirrus SD-OCT instrument identifies the appropriate segmentation boundaries in the presence PED. The Spectralis SD-OCT algorithm was unreliable in segmenting PEDs, leading to inaccurate retinal thickness measurements unless manual adjustments were performed.
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Affiliation(s)
- Fernando M Penha
- Bascom Palmer Eye Institute, 900 NW 17th St., Miami, FL 33136, USA.
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Sadiq MA, Rashid A, Channa R, Hatef E, Do DV, Nguyen QD, Sepah YJ. Reliability and reproducibility of spectral and time domain optical coherence tomography images before and after correction for patients with age-related macular degeneration. F1000Res 2013; 2:131. [PMID: 26097682 PMCID: PMC4457115 DOI: 10.12688/f1000research.2-131.v2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2015] [Indexed: 11/20/2022] Open
Abstract
Purpose: To evaluate the reproducibility and reliability of optical coherence tomography scans obtained using the time domain (TD-OCT) Stratus
TM OCT, and the Spectral Domain (SD-OCT) Spectralis
TM and Cirrus
TM OCT devices before and after manual correction in eyes with either Neovascular (NV-AMD) or Non-Neovascular (NNV-AMD) age-related macular degeneration. Design: Prospective observational study. Methods: Setting: University-based retina practice. Patients: Thirty-six patients (50 eyes) with NV-AMD or NNV-AMD. Procedure: OCT scans were taken simultaneously using one TD-OCT and two SD-OCT devices. Main Outcome Measures: Macular thickness measurements were assessed before and after correction of the algorithm by constructing Bland-Altman plots for agreement and calculating intraclass correlation coefficients (ICCs) and coefficients of repeatability (COR) to evaluate intraclass repeatability. Results: Spectralis had the highest number of images needing manual correction. All machines had high ICCs, with Spectralis having the highest. Also, Bland-Altman plots indicated that there was low agreement between Cirrus™ and Stratus™, Spectralis™ and Stratus™, while there was good agreement between the Cirrus™ and Spectralis™. The CORs were lowest for Spectralis
TM and similar and higher for Cirrus
TM and Stratus
TM. Agreement, CORs, and ICCs generally improved after manual correction, but only minimally. Conclusion: Agreement is low between devices, except between both SD-OCT machines. Manual correction tends to improve results.
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Affiliation(s)
- Mohammad A Sadiq
- Ocular Imaging Research and Reading Center (OIRRC), Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Aymen Rashid
- Ocular Imaging Research and Reading Center (OIRRC), Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Roomasa Channa
- Ocular Imaging Research and Reading Center (OIRRC), Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Elham Hatef
- Ocular Imaging Research and Reading Center (OIRRC), Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Diana V Do
- Ocular Imaging Research and Reading Center (OIRRC), Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Quan Dong Nguyen
- Ocular Imaging Research and Reading Center (OIRRC), Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Yasir J Sepah
- Ocular Imaging Research and Reading Center (OIRRC), Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, 68198, USA
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Siegel RA, Dreznik A, Mimouni K, Bor E, Weinberger D, Bourla DH. Intravitreal Bevacizumab Treatment for Macular Edema due to Branch Retinal Vein Occlusion in a Clinical Setting. Curr Eye Res 2012; 37:823-9. [DOI: 10.3109/02713683.2012.678542] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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