1
|
Servillo A, Sacconi R, Oldoni G, Barlocci E, Tombolini B, Battista M, Fantaguzzi F, Rissotto F, Mularoni C, Parravano M, Zucchiatti I, Querques L, Bandello F, Querques G. Advancements in Imaging and Therapeutic Options for Dry Age-Related Macular Degeneration and Geographic Atrophy. Ophthalmol Ther 2024:10.1007/s40123-024-00970-7. [PMID: 38833127 DOI: 10.1007/s40123-024-00970-7] [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: 03/22/2024] [Accepted: 05/13/2024] [Indexed: 06/06/2024] Open
Abstract
Age-related macular degeneration (AMD) is a leading cause of vision loss in the elderly, with dry AMD (d-AMD) leading to geographic atrophy (GA) and significant visual impairment. Multimodal imaging plays a crucial role in d-AMD diagnosis and management, allowing for detailed classification of patient phenotypes and aiding in treatment planning and prognosis determination. Treatment approaches for d-AMD have recently witnessed profound change with the development of specific drugs targeting the complement cascade, with the first anticomplement agents recently approved for GA treatment. Additionally, emerging strategies such as gene therapy and laser treatments may offer potential benefits, though further research is needed to fully establish their efficacy. However, the lack of effective therapies capable of restoring damaged retinal cells remains a major challenge. In the future, genetic treatments aimed at preventing the progression of d-AMD may emerge as a powerful approach. Currently, however, their development is still in the early stages.
Collapse
Affiliation(s)
- Andrea Servillo
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Riccardo Sacconi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Gloria Oldoni
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Eugenio Barlocci
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Beatrice Tombolini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Marco Battista
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Federico Fantaguzzi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Federico Rissotto
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Cecilia Mularoni
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | | | - Ilaria Zucchiatti
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Lea Querques
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Giuseppe Querques
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| |
Collapse
|
2
|
Vallino V, Berni A, Coletto A, Serafino S, Bandello F, Reibaldi M, Borrelli E. Structural OCT and OCT angiography biomarkers associated with the development and progression of geographic atrophy in AMD. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06497-8. [PMID: 38689123 DOI: 10.1007/s00417-024-06497-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/12/2024] [Accepted: 04/25/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Geographic atrophy (GA) is an advanced, irreversible, and progressive form of age-related macular degeneration (AMD). Structural optical coherence tomography (OCT) and OCT angiography (OCTA) have been largely used to characterize this stage of AMD and, more importantly, to define biomarkers associated with the development and progression of GA in AMD. METHODS Articles pertaining to OCT and OCTA biomarkers related to the development and progression of GA with relevant key words were used to search in PubMed, Researchgate, and Google Scholar. The articles were selected based on their relevance, reliability, publication year, published journal, and accessibility. RESULTS Previous reports have highlighted various OCT and OCTA biomarkers linked to the onset and advancement of GA. These biomarkers encompass characteristics such as the size, volume, and subtype of drusen, the presence of hyperreflective foci, basal laminar deposits, incomplete retinal pigment epithelium and outer retinal atrophy (iRORA), persistent choroidal hypertransmission defects, and the existence of subretinal drusenoid deposits (also referred to as reticular pseudodrusen). Moreover, biomarkers associated with the progression of GA include thinning of the outer retina, photoreceptor degradation, the distance between retinal pigment epithelium and Bruch's membrane, and choriocapillaris loss. CONCLUSION The advent of novel treatment strategies for GA underscores the heightened need for prompt diagnosis and precise monitoring of individuals with this condition. The utilization of structural OCT and OCTA becomes essential for identifying distinct biomarkers associated with the initiation and progression of GA.
Collapse
Affiliation(s)
- Veronica Vallino
- Department of Surgical Sciences, University of Turin, Corso Dogliotti 14, Turin, Italy
- Department of Ophthalmology, "City of Health and Science" Hospital, Turin, Italy
| | - Alessandro Berni
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Coletto
- Department of Surgical Sciences, University of Turin, Corso Dogliotti 14, Turin, Italy
- Department of Ophthalmology, "City of Health and Science" Hospital, Turin, Italy
| | - Sonia Serafino
- Department of Surgical Sciences, University of Turin, Corso Dogliotti 14, Turin, Italy
- Department of Ophthalmology, "City of Health and Science" Hospital, Turin, Italy
| | - Francesco Bandello
- Vita-Salute San Raffaele University Milan, Milan, Italy
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michele Reibaldi
- Department of Surgical Sciences, University of Turin, Corso Dogliotti 14, Turin, Italy
- Department of Ophthalmology, "City of Health and Science" Hospital, Turin, Italy
| | - Enrico Borrelli
- Department of Surgical Sciences, University of Turin, Corso Dogliotti 14, Turin, Italy.
- Department of Ophthalmology, "City of Health and Science" Hospital, Turin, Italy.
| |
Collapse
|
3
|
Mauschitz MM, Zeller M, Sagar P, Biswal S, Guzman G, Terheyden JH, Meyer CH, Holz FG, Heinz C, Pleyer U, Finger RP, Wintergerst MWM. Fundus Autofluorescence in Posterior and Panuveitis-An Under-Estimated Imaging Technique: A Review and Case Series. Biomolecules 2024; 14:515. [PMID: 38785922 PMCID: PMC11118036 DOI: 10.3390/biom14050515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/22/2024] [Accepted: 02/25/2024] [Indexed: 05/25/2024] Open
Abstract
Fundus autofluorescence (FAF) is a prompt and non-invasive imaging modality helpful in detecting pathological abnormalities within the retina and the choroid. This narrative review and case series provides an overview on the current application of FAF in posterior and panuveitis. The literature was reviewed for articles on lesion characteristics on FAF of specific posterior and panuveitis entities as well as benefits and limitations of FAF for diagnosing and monitoring disease. FAF characteristics are described for non-infectious and infectious uveitis forms as well as masquerade syndromes. Dependent on the uveitis entity, FAF is of diagnostic value in detecting disease and following the clinical course. Currently available FAF modalities which differ in excitation wavelengths can provide different pathological insights depending on disease entity and activity. Further studies on the comparison of FAF modalities and their individual value for uveitis diagnosis and monitoring are warranted.
Collapse
Affiliation(s)
- Matthias M. Mauschitz
- Department of Ophthalmology, University Hospital Bonn, University of Bonn, 53127 Bonn, Germany
| | - Markus Zeller
- Department of Ophthalmology, University Hospital Bonn, University of Bonn, 53127 Bonn, Germany
| | - Pradeep Sagar
- Sankara Academy of Vision, Sankara Eye Hospital Shimoga, Shimoga 577202, India; (P.S.)
| | - Suchitra Biswal
- Sankara Academy of Vision, Sankara Eye Hospital Shimoga, Shimoga 577202, India; (P.S.)
| | - Gabriela Guzman
- Department of Ophthalmology, University Hospital Bonn, University of Bonn, 53127 Bonn, Germany
| | - Jan H. Terheyden
- Department of Ophthalmology, University Hospital Bonn, University of Bonn, 53127 Bonn, Germany
| | - Carsten H. Meyer
- Augenzentrum Grischun, 7000 Chur, Switzerland
- Department of Ophthalmology, Philipps University, 35037 Marburg, Germany
| | - Frank G. Holz
- Department of Ophthalmology, University Hospital Bonn, University of Bonn, 53127 Bonn, Germany
| | - Carsten Heinz
- Department of Ophthalmology, St. Franziskus-Hospital Muenster, 48145 Muenster, Germany;
- Department of Ophthalmology, University Duisburg-Essen, 45122 Essen, Germany
| | - Uwe Pleyer
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany;
- Department of Ophthalmology, Berlin and Berlin Institute of Health, 13353 Berlin, Germany
| | - Robert P. Finger
- Department of Ophthalmology, University Medical Center Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Maximilian W. M. Wintergerst
- Department of Ophthalmology, University Hospital Bonn, University of Bonn, 53127 Bonn, Germany
- Augenzentrum Grischun, 7000 Chur, Switzerland
| |
Collapse
|
4
|
Berlin A, Fischer NA, Clark ME, Kar D, Swain TA, Martindale RM, McGwin G, Crosson JN, Sloan KR, Owsley C, Curcio CA. Quantitative Autofluorescence at AMD's Beginnings Highlights Retinal Topography and Grading System Differences: ALSTAR2 Baseline. Ophthalmologica 2024:1-13. [PMID: 38599207 DOI: 10.1159/000538696] [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: 11/28/2023] [Accepted: 03/24/2024] [Indexed: 04/12/2024]
Abstract
INTRODUCTION The aims of the study were to describe baseline quantitative (short-wavelength) autofluorescence (qAF) findings in a large pseudophakic cohort at age-related macular degeneration (AMD)'s beginnings and to assess qAF8 as an outcome measure and evaluate Age-Related Eye Disease Study (AREDS) and Beckman grading systems. METHODS In the ALSTAR2 baseline cohort (NCT04112667), 346 pseudophakic eyes of 188 persons (74.0 ± 5.5 years) were classified as normal (N = 160 by AREDS, 158 by Beckman), early AMD (eAMD) (N = 104, 66), and intermediate AMD (iAMD) (N = 82, 122). Groups were compared via mean qAF intensities in a 6°-8° annulus (qAF8) and maps of differences between observations and the overall mean, divided by standard deviation (Z-score). RESULTS qAF8 did not differ significantly among diagnostic groups by either stratification (p = 0.0869 AREDS; p = 0.0569 by Beckman). Notably, 45 eyes considered eAMD by AREDS became iAMD by Beckman. For AREDS-stratified eyes, Z-score maps showed higher centrally located qAF for normal, near the mean in eAMD, and lower values for iAMD. Maps deviated from this pattern for Beckman-stratified eyes. CONCLUSIONS In a large sample of pseudophakic eyes, qAF8 does not differ overall from normal aging to iAMD but also does not capture the earliest AMD activity in the macula lutea. AREDS classification gives results more consistent with a slow decline in histologic autofluorescence than Beckman classification.
Collapse
Affiliation(s)
- Andreas Berlin
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA,
- University Hospital Würzburg, Würzburg, Germany,
| | - Nathan A Fischer
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Retina Consultants of Alabama, Birmingham, Alabama, USA
| | - Mark E Clark
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Deepayan Kar
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Thomas A Swain
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Richard M Martindale
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Retina Consultants of Alabama, Birmingham, Alabama, USA
| | - Gerald McGwin
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jason N Crosson
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Retina Consultants of Alabama, Birmingham, Alabama, USA
| | - Kenneth R Sloan
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Cynthia Owsley
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christine A Curcio
- Department of Ophthalmology and Visual Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
5
|
Różanowska MB. Lipofuscin, Its Origin, Properties, and Contribution to Retinal Fluorescence as a Potential Biomarker of Oxidative Damage to the Retina. Antioxidants (Basel) 2023; 12:2111. [PMID: 38136230 PMCID: PMC10740933 DOI: 10.3390/antiox12122111] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/05/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023] Open
Abstract
Lipofuscin accumulates with age as intracellular fluorescent granules originating from incomplete lysosomal digestion of phagocytosed and autophagocytosed material. The purpose of this review is to provide an update on the current understanding of the role of oxidative stress and/or lysosomal dysfunction in lipofuscin accumulation and its consequences, particularly for retinal pigment epithelium (RPE). Next, the fluorescence of lipofuscin, spectral changes induced by oxidation, and its contribution to retinal fluorescence are discussed. This is followed by reviewing recent developments in fluorescence imaging of the retina and the current evidence on the prognostic value of retinal fluorescence for the progression of age-related macular degeneration (AMD), the major blinding disease affecting elderly people in developed countries. The evidence of lipofuscin oxidation in vivo and the evidence of increased oxidative damage in AMD retina ex vivo lead to the conclusion that imaging of spectral characteristics of lipofuscin fluorescence may serve as a useful biomarker of oxidative damage, which can be helpful in assessing the efficacy of potential antioxidant therapies in retinal degenerations associated with accumulation of lipofuscin and increased oxidative stress. Finally, amendments to currently used fluorescence imaging instruments are suggested to be more sensitive and specific for imaging spectral characteristics of lipofuscin fluorescence.
Collapse
Affiliation(s)
- Małgorzata B. Różanowska
- School of Optometry and Vision Sciences, College of Biomedical and Life Sciences, Cardiff University, Maindy Road, Cardiff CF24 4HQ, Wales, UK;
- Cardiff Institute for Tissue Engineering and Repair (CITER), Redwood Building, King Edward VII Avenue, Cardiff CF10 3NB, Wales, UK
| |
Collapse
|
6
|
Sarao V, Veritti D, De Nardin A, Misciagna M, Foresti G, Lanzetta P. Explainable artificial intelligence model for the detection of geographic atrophy using colour retinal photographs. BMJ Open Ophthalmol 2023; 8:e001411. [PMID: 38057106 PMCID: PMC10711821 DOI: 10.1136/bmjophth-2023-001411] [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: 07/21/2023] [Accepted: 11/22/2023] [Indexed: 12/08/2023] Open
Abstract
OBJECTIVE To develop and validate an explainable artificial intelligence (AI) model for detecting geographic atrophy (GA) via colour retinal photographs. METHODS AND ANALYSIS We conducted a prospective study where colour fundus images were collected from healthy individuals and patients with retinal diseases using an automated imaging system. All images were categorised into three classes: healthy, GA and other retinal diseases, by two experienced retinologists. Simultaneously, an explainable learning model using class activation mapping techniques categorised each image into one of the three classes. The AI system's performance was then compared with manual evaluations. RESULTS A total of 540 colour retinal photographs were collected. Data was divided such that 300 images from each class trained the AI model, 120 for validation and 120 for performance testing. In distinguishing between GA and healthy eyes, the model demonstrated a sensitivity of 100%, specificity of 97.5% and an overall diagnostic accuracy of 98.4%. Performance metrics like area under the receiver operating characteristic (AUC-ROC, 0.988) and the precision-recall (AUC-PR, 0.952) curves reinforced the model's robust achievement. When differentiating GA from other retinal conditions, the model preserved a diagnostic accuracy of 96.8%, a precision of 90.9% and a recall of 100%, leading to an F1-score of 0.952. The AUC-ROC and AUC-PR scores were 0.975 and 0.909, respectively. CONCLUSIONS Our explainable AI model exhibits excellent performance in detecting GA using colour retinal images. With its high sensitivity, specificity and overall diagnostic accuracy, the AI model stands as a powerful tool for the automated diagnosis of GA.
Collapse
Affiliation(s)
- Valentina Sarao
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare (IEMO), Udine, Italy
| | - Daniele Veritti
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
| | - Axel De Nardin
- Department of Mathematics, Computer Science and Physics, University of Udine, Udine, Italy
| | - Micaela Misciagna
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
| | - Gianluca Foresti
- Department of Mathematics, Computer Science and Physics, University of Udine, Udine, Italy
| | - Paolo Lanzetta
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare (IEMO), Udine, Italy
| |
Collapse
|
7
|
Hammer M, Simon R, Meller D, Klemm M. Combining fluorescence lifetime with spectral information in fluorescence lifetime imaging ophthalmoscopy (FLIO). BIOMEDICAL OPTICS EXPRESS 2022; 13:5483-5494. [PMID: 36425633 PMCID: PMC9664887 DOI: 10.1364/boe.457946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 06/01/2023]
Abstract
Fluorescence lifetime imaging ophthalmoscopy (FLIO) provides information on fluorescence lifetimes in two spectral channels as well as the peak emission wavelength (PEW) of the fluorescence. Here, we combine these measures in an integral three-dimensional lifetime-PEW metric vector and determine a normal range for this vector from measurements in young healthy subjects. While for these control subjects 97 (±8) % (median (interquartile range)) of all para-macular pixels were covered by this normal vector range, it was 67 (±55) % for the elderly healthy, 38 (±43) % for age-related macular degeneration (AMD)-suspect subjects, and only 6 (±4) % for AMD patients. The vectors were significantly different for retinal pigment epithelium (RPE) lesions in AMD patients from that of non-affected tissue (p < 0.001). Lifetime- PEW plots allowed to identify possibly pathologic fundus areas by fluorescence parameters outside a 95% quantile per subject. In a patient follow-up, changes in fluorescence parameters could be traced in the lifetime-PEW metric, showing their change over disease progression.
Collapse
Affiliation(s)
- Martin Hammer
- Department of Ophthalmology, University Hospital Jena, Jena, Germany
- Center for Medical Optics and Photonics, Univ. of Jena, Jena, Germany
| | - Rowena Simon
- Department of Ophthalmology, University Hospital Jena, Jena, Germany
| | - Daniel Meller
- Department of Ophthalmology, University Hospital Jena, Jena, Germany
| | - Matthias Klemm
- Institute of Biomedical Engineering and Informatics, Technical Univ. Ilmenau, Ilmenau, Germany
| |
Collapse
|
8
|
Spectrally resolved autofluorescence imaging in posterior uveitis. Sci Rep 2022; 12:14337. [PMID: 36038591 PMCID: PMC9424200 DOI: 10.1038/s41598-022-18048-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 08/04/2022] [Indexed: 11/10/2022] Open
Abstract
Clinical discrimination of posterior uveitis entities remains a challenge. This exploratory, cross-sectional study investigated the green (GEFC) and red emission fluorescent components (REFC) of retinal and choroidal lesions in posterior uveitis to facilitate discrimination of the different entities. Eyes were imaged by color fundus photography, spectrally resolved fundus autofluorescence (Color-FAF) and optical coherence tomography. Retinal/choroidal lesions’ intensities of GEFC (500–560 nm) and REFC (560–700 nm) were determined, and intensity-normalized Color-FAF images were compared for birdshot chorioretinopathy, ocular sarcoidosis, acute posterior multifocal placoid pigment epitheliopathy (APMPPE), and punctate inner choroidopathy (PIC). Multivariable regression analyses were performed to reveal possible confounders. 76 eyes of 45 patients were included with a total of 845 lesions. Mean GEFC/REFC ratios were 0.82 ± 0.10, 0.92 ± 0.11, 0.86 ± 0.10, and 1.09 ± 0.19 for birdshot chorioretinopathy, sarcoidosis, APMPPE, and PIC lesions, respectively, and were significantly different in repeated measures ANOVA (p < 0.0001). Non-pigmented retinal/choroidal lesions, macular neovascularizations, and fundus areas of choroidal thinning featured predominantly GEFC, and pigmented retinal lesions predominantly REFC. Color-FAF imaging revealed involvement of both, short- and long-wavelength emission fluorophores in posterior uveitis. The GEFC/REFC ratio of retinal and choroidal lesions was significantly different between distinct subgroups. Hence, this novel imaging biomarker could aid diagnosis and differentiation of posterior uveitis entities.
Collapse
|
9
|
Shin Y, Cho H, Shin YU, Seong M, Choi JW, Lee WJ. Comparison between Deep-Learning-Based Ultra-Wide-Field Fundus Imaging and True-Colour Confocal Scanning for Diagnosing Glaucoma. J Clin Med 2022; 11:jcm11113168. [PMID: 35683577 PMCID: PMC9181263 DOI: 10.3390/jcm11113168] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/25/2022] [Accepted: 06/01/2022] [Indexed: 02/05/2023] Open
Abstract
In this retrospective, comparative study, we evaluated and compared the performance of two confocal imaging modalities in detecting glaucoma based on a deep learning (DL) classifier: ultra-wide-field (UWF) fundus imaging and true-colour confocal scanning. A total of 777 eyes, including 273 normal control eyes and 504 glaucomatous eyes, were tested. A convolutional neural network was used for each true-colour confocal scan (Eidon AF™, CenterVue, Padova, Italy) and UWF fundus image (Optomap™, Optos PLC, Dunfermline, UK) to detect glaucoma. The diagnostic model was trained using 545 training and 232 test images. The presence of glaucoma was determined, and the accuracy and area under the receiver operating characteristic curve (AUC) metrics were assessed for diagnostic power comparison. DL-based UWF fundus imaging achieved an AUC of 0.904 (95% confidence interval (CI): 0.861−0.937) and accuracy of 83.62%. In contrast, DL-based true-colour confocal scanning achieved an AUC of 0.868 (95% CI: 0.824−0.912) and accuracy of 81.46%. Both DL-based confocal imaging modalities showed no significant differences in their ability to diagnose glaucoma (p = 0.135) and were comparable to the traditional optical coherence tomography parameter-based methods (all p > 0.005). Therefore, using a DL-based algorithm on true-colour confocal scanning and UWF fundus imaging, we confirmed that both confocal fundus imaging techniques had high value in diagnosing glaucoma.
Collapse
Affiliation(s)
- Younji Shin
- Department of Electrical Engineering, Hanyang University, Seoul 04763, Korea;
| | - Hyunsoo Cho
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul 04763, Korea; (H.C.); (Y.U.S.); (M.S.)
| | - Yong Un Shin
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul 04763, Korea; (H.C.); (Y.U.S.); (M.S.)
| | - Mincheol Seong
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul 04763, Korea; (H.C.); (Y.U.S.); (M.S.)
| | - Jun Won Choi
- Department of Electrical Engineering, Hanyang University, Seoul 04763, Korea;
- Correspondence: (J.W.C.); (W.J.L.); Tel.: +82-2-2290-2316 (J.W.C.); +82-2-2290-8570 (W.J.L.)
| | - Won June Lee
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul 04763, Korea; (H.C.); (Y.U.S.); (M.S.)
- Correspondence: (J.W.C.); (W.J.L.); Tel.: +82-2-2290-2316 (J.W.C.); +82-2-2290-8570 (W.J.L.)
| |
Collapse
|
10
|
Daich Varela M, Esener B, Hashem SA, Cabral de Guimaraes TA, Georgiou M, Michaelides M. Structural evaluation in inherited retinal diseases. Br J Ophthalmol 2021; 105:1623-1631. [PMID: 33980508 PMCID: PMC8639906 DOI: 10.1136/bjophthalmol-2021-319228] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/07/2021] [Accepted: 04/21/2021] [Indexed: 12/20/2022]
Abstract
Ophthalmic genetics is a field that has been rapidly evolving over the last decade, mainly due to the flourishing of translational medicine for inherited retinal diseases (IRD). In this review, we will address the different methods by which retinal structure can be objectively and accurately assessed in IRD. We review standard-of-care imaging for these patients: colour fundus photography, fundus autofluorescence imaging and optical coherence tomography (OCT), as well as higher-resolution and/or newer technologies including OCT angiography, adaptive optics imaging, fundus imaging using a range of wavelengths, magnetic resonance imaging, laser speckle flowgraphy and retinal oximetry, illustrating their utility using paradigm genotypes with on-going therapeutic efforts/trials.
Collapse
Affiliation(s)
- Malena Daich Varela
- Moorfields Eye Hospital City Road Campus, London, UK
- UCL Institute of Ophthalmology, University College London, London, UK
| | - Burak Esener
- Department of Ophthalmology, Inonu University School of Medicine, Malatya, Turkey
| | - Shaima A Hashem
- Moorfields Eye Hospital City Road Campus, London, UK
- UCL Institute of Ophthalmology, University College London, London, UK
| | | | - Michalis Georgiou
- Moorfields Eye Hospital City Road Campus, London, UK
- UCL Institute of Ophthalmology, University College London, London, UK
| | - Michel Michaelides
- Moorfields Eye Hospital City Road Campus, London, UK
- UCL Institute of Ophthalmology, University College London, London, UK
| |
Collapse
|
11
|
Schultz R, Schwanengel L, Klemm M, Meller D, Hammer M. Spectral fundus autofluorescence peak emission wavelength in ageing and AMD. Acta Ophthalmol 2021; 100:e1223-e1231. [PMID: 34850573 DOI: 10.1111/aos.15070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/26/2021] [Accepted: 11/19/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE To investigate the spectral characteristics of fundus autofluorescence (FAF) in AMD patients and controls. METHODS Fundus autofluorescence spectral characteristics was described by the peak emission wavelength (PEW) of the spectra. Peak emission wavelength (PEW) was derived from the ratio of FAF recordings in two spectral channels at 500-560 nm and 560-720 nm by fluorescence lifetime imaging ophthalmoscopy. The ratio of FAF intensity in both channels was related to PEW by a calibration procedure. Peak emission wavelength (PEW) measurements were done in 44 young (mean age: 24.0 ± 3.8 years) and 18 elderly (mean age: 67.5 ± 10.2 years) healthy subjects as well as 63 patients with AMD (mean age: 74.0 ± 7.3 years) in each pixel of a 30° imaging field. The values were averaged over the central area, the inner and the outer ring of the ETDRS grid. RESULTS There was no significant difference between PEW in young and elderly controls. However, PEW was significantly shorter in AMD patients (ETDRS grid centre: 571 ± 26 nm versus 599 ± 17 nm for elderly controls, inner ring: 596 ± 17 nm versus 611 ± 11 nm, outer ring: 602 ± 16 nm versus 614 ± 11 nm). After a mean follow-up time of 50.8 ± 10.8 months, the PEW in the patients decreased significantly by 9 ± 19 nm in the inner ring of the grid. Patients, showing progression to atrophic AMD in the follow up, had significantly (p ≤ 0.018) shorter PEW at baseline than non-progressing patients. CONCLUSIONS Peak emission wavelength (PEW) is related to AMD pathology and might be a diagnostic marker in AMD. Possibly, a short PEW can predict progression to retinal and/or pigment epithelium atrophy.
Collapse
Affiliation(s)
- Rowena Schultz
- Department of Ophthalmology University Hospital Jena Jena Germany
| | | | - Matthias Klemm
- Institute of Biomedical Engineering and Informatics Technical Univ. Ilmenau Ilmenau Germany
| | - Daniel Meller
- Department of Ophthalmology University Hospital Jena Jena Germany
| | - Martin Hammer
- Department of Ophthalmology University Hospital Jena Jena Germany
- Center for Medical Optics and Photonics Univ. of Jena Jena Germany
| |
Collapse
|
12
|
Vujosevic S, Toma C, Sarao V, Veritti D, Brambilla M, Muraca A, De Cillà S, Villani E, Nucci P, Lanzetta P. Color Fundus Autofluorescence to Determine Activity of Macular Neovascularization in Age-Related Macular Degeneration. Transl Vis Sci Technol 2021; 10:33. [PMID: 34003918 PMCID: PMC7910646 DOI: 10.1167/tvst.10.2.33] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate with color fundus autofluorescence (FAF) different lesion components of macular neovascularization (MNV) secondary to age-related macular degeneration (AMD) and to assess its activity. Methods In total, 137 eyes (102 patients) with MNV underwent a complete eye examination, including color fundus photography, optical coherence tomography (OCT), OCT angiography, and confocal color FAF, with an excitation wavelength at 450 nm. Each image was imported into a custom-image analysis software for quantitative estimation of emission wavelength and green and red emission fluorescence (GEFC/REFC) intensity, considering both single components of neovascular AMD and different MNV types (type 1 and type 2 MNV, active and inactive MNV). Results Subretinal fluid (SRF) had significantly higher values of GEFC (P = 0.008 and P = 0.0004) and REFC intensity (P = 0.005 and P = 0.0003) versus fibrosis and atrophy. The emission wavelength from SRF was lower compared to atrophy (P = 0.024) but not to fibrosis (P = 0.46). No significant differences were detected between type 1 and 2 MNV. Considering active versus inactive MNVs, a difference was detected for all evaluated parameters (P < 0.001). Mean FAF wavelength of both MNV with SRF and intraretinal fluid (IRF) was lower versus inactive MNV (P < 0.001 and P = 0.005). MNV with SRF (P < 0.001) had higher values of GEFC and REFC versus inactive MNV (P < 0.001). MNV with IRF had higher values of GEFC versus inactive MNV (P = 0.05). Conclusions Quantitative color FAF can differentiate active versus inactive MNV, whereas no differences were found between type 1 and type 2 MNV. If these data can be further confirmed, color FAF may be useful for automatic detection of active MNV in AMD and as a guide for treatment. Translational Relevance Automatic quantitative evaluation of green and red emission components of FAF in AMD can help determine the activity of MNV and guide the treatment.
Collapse
Affiliation(s)
- Stela Vujosevic
- Eye Clinic IRCCS MultiMedica, Milan, Italy.,University Hospital Maggiore della Carità, Eye Clinic, Novara, Italy
| | - Caterina Toma
- University Hospital Maggiore della Carità, Eye Clinic, Novara, Italy
| | - Valentina Sarao
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy.,Istituto Europeo di Microchirurgia Oculare-IEMO, Udine, Italy
| | - Daniele Veritti
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
| | - Marco Brambilla
- Department of Medical Physics, University Hospital Maggiore Della Carità, Novara, Italy
| | - Andrea Muraca
- University Hospital Maggiore della Carità, Eye Clinic, Novara, Italy
| | - Stefano De Cillà
- University Hospital Maggiore della Carità, Eye Clinic, Novara, Italy.,Department of Health Sciences, University East Piedmont "A. Avogadro," Novara, Italy
| | - Edoardo Villani
- Eye Clinic IRCCS MultiMedica, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paolo Nucci
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paolo Lanzetta
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy.,Istituto Europeo di Microchirurgia Oculare-IEMO, Udine, Italy
| |
Collapse
|
13
|
Ocular Imaging for Enhancing the Understanding, Assessment, and Management of Age-Related Macular Degeneration. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1256:33-66. [PMID: 33847997 DOI: 10.1007/978-3-030-66014-7_2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Age-related macular degeneration (AMD) is a progressive neuro-retinal disease and the leading cause of central vision loss among elderly individuals in the developed countries. Modern ocular imaging technologies constitute an essential component of the evaluation of these patients and have contributed extensively to our understanding of the disease. A challenge with any review of ocular imaging technologies is the rapid pace of progress and evolution of these instruments. Nonetheless, for proper and optimal use of these technologies, it is essential for the user to understand the technical principles underlying the imaging modality and their role in assessing the disease in various settings. Indeed, AMD, like many other retinal diseases, benefits from a multimodal imaging approach to optimally characterize the disease. In this chapter, we will review the various imaging technologies currently used in the assessment and management of AMD.
Collapse
|
14
|
Vujosevic S, Toma C, Nucci P, Brambilla M, De Cillà S. Quantitative Color Fundus Autofluorescence in Patients with Diabetes Mellitus. J Clin Med 2020; 10:E48. [PMID: 33375699 PMCID: PMC7796312 DOI: 10.3390/jcm10010048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/07/2020] [Accepted: 12/19/2020] [Indexed: 01/09/2023] Open
Abstract
A new short wavelength confocal blue-light 450 nm-fundus autofluorescence (color-FAF) allows for visualization of minor fluorophores (e.g., advanced glycation end products, AGEs), besides lipofuscin. The aim of the present pilot study was to quantitatively evaluate color-FAF in patients with diabetes mellitus (DM) and to correlate these data with different stages of retinal disease severity. Optical coherence tomography and color-FAF images of 193 patients/eyes and 18 controls were analyzed using a custom software for quantification of the long (red) and short (green) wavelength components of the emission spectrum (REFC/GEFC). Measurements were performed in nine quadrants of the 6-mm ETDRS macular grid. Foveal GEFC and REFC intensities were higher in patients with DM compared to controls (p = 0.015 and p = 0.006 respectively) and in eyes with center involving diabetic macular edema (DME) compared to eyes without DME (p < 0.001). A positive correlation was found between GEFC and REFC intensities and central retinal thickness, r = 0.37 (p < 0.001) and r = 0.42 (p < 0.001), respectively. No differences were found in color-FAF among different DR severity groups. Quantitative color-FAF could become helpful for the metabolic evaluation of retina in patients with DM and in DME; however, further histologic and immunohistochemical studies on distribution of different retinal fluorophores in DM are needed to better understand its role.
Collapse
Affiliation(s)
- Stela Vujosevic
- Eye Clinic, IRCCS MultiMedica, 20123 Milan, Italy
- University Hospital Maggiore della Carità, Eye Clinic, 28100 Novara, Italy; (C.T.); (S.D.C.)
| | - Caterina Toma
- University Hospital Maggiore della Carità, Eye Clinic, 28100 Novara, Italy; (C.T.); (S.D.C.)
| | - Paolo Nucci
- Department of Clinical Sciences and Community Health, University of Milan, 20123 Milan, Italy;
| | - Marco Brambilla
- Department of Medical Physics, University Hospital Maggiore della Carità, 28100 Novara, Italy;
| | - Stefano De Cillà
- University Hospital Maggiore della Carità, Eye Clinic, 28100 Novara, Italy; (C.T.); (S.D.C.)
- Department of Health Sciences, University East Piedmont “A. Avogadro”, 28100 Novara, Italy
| |
Collapse
|
15
|
Borrelli E, Querques L, Lattanzio R, Cavalleri M, Grazioli Moretti A, Di Biase C, Signorino A, Gelormini F, Sacconi R, Bandello F, Querques G. Nonmydriatic widefield retinal imaging with an automatic white LED confocal imaging system compared with dilated ophthalmoscopy in screening for diabetic retinopathy. Acta Diabetol 2020; 57:1043-1047. [PMID: 32246268 DOI: 10.1007/s00592-020-01520-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/17/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE To compare nonmydriatic montage widefield images with dilated fundus ophthalmoscopy for determining diabetic retinopathy (DR) severity. MATERIALS AND METHODS In this prospective, observational, cross-sectional study, patients with a previous diagnosis of diabetes and without history of diabetes-associated ocular disease were screened for DR. Montage widefield imaging was obtained with a system that combines confocal technology with white-light emitting diode (LED) illumination (DRSplus, Centervue, Padua, Italy). Dilated fundus examination was performed by a retina specialist. RESULTS Thirty-seven eyes (20 patients, 8 females) were finally included in the analysis. Mean age of the patients enrolled was 58.0 ± 11.6 years [range 31-80 years]. The level of DR identified on montage widefield images agreed exactly with indirect ophthalmoscopy in 97.3% (36) of eyes and was within 1 step in 100% (37) of eyes. Cohen's kappa coefficient (κ) was 0.96, this suggesting an almost perfect agreement between the two modalities in DR screening. Nonmydriatic montage widefield imaging acquisition time was significantly shorter than that of dilated clinical examination (p = 0.010). CONCLUSION Nonmydriatic montage widefield images were compared favorably with dilated fundus examination in defining DR severity; however, they are acquired more rapidly.
Collapse
Affiliation(s)
- Enrico Borrelli
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute, University Vita-Salute, Via Olgettina 60, Milan, Italy
| | - Lea Querques
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute, University Vita-Salute, Via Olgettina 60, Milan, Italy
| | - Rosangela Lattanzio
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute, University Vita-Salute, Via Olgettina 60, Milan, Italy
| | - Michele Cavalleri
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute, University Vita-Salute, Via Olgettina 60, Milan, Italy
| | - Alessio Grazioli Moretti
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute, University Vita-Salute, Via Olgettina 60, Milan, Italy
| | - Carlo Di Biase
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute, University Vita-Salute, Via Olgettina 60, Milan, Italy
| | - Alberto Signorino
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute, University Vita-Salute, Via Olgettina 60, Milan, Italy
| | - Francesco Gelormini
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute, University Vita-Salute, Via Olgettina 60, Milan, Italy
| | - Riccardo Sacconi
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute, University Vita-Salute, Via Olgettina 60, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute, University Vita-Salute, Via Olgettina 60, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute, University Vita-Salute, Via Olgettina 60, Milan, Italy.
| |
Collapse
|
16
|
Schmitz-Valckenberg S, Pfau M, Fleckenstein M, Staurenghi G, Sparrow JR, Bindewald-Wittich A, Spaide RF, Wolf S, Sadda SR, Holz FG. Fundus autofluorescence imaging. Prog Retin Eye Res 2020; 81:100893. [PMID: 32758681 DOI: 10.1016/j.preteyeres.2020.100893] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/20/2020] [Accepted: 07/25/2020] [Indexed: 12/20/2022]
Abstract
Fundus autofluorescence (FAF) imaging is an in vivo imaging method that allows for topographic mapping of naturally or pathologically occurring intrinsic fluorophores of the ocular fundus. The dominant sources are fluorophores accumulating as lipofuscin in lysosomal storage bodies in postmitotic retinal pigment epithelium cells as well as other fluorophores that may occur with disease in the outer retina and subretinal space. Photopigments of the photoreceptor outer segments as well as macular pigment and melanin at the fovea and parafovea may act as filters of the excitation light. FAF imaging has been shown to be useful with regard to understanding of pathophysiological mechanisms, diagnostics, phenotype-genotype correlation, identification of prognostic markers for disease progression, and novel outcome parameters to assess efficacy of interventional strategies in chorio-retinal diseases. More recently, the spectrum of FAF imaging has been expanded with increasing use of green in addition to blue FAF, introduction of spectrally-resolved FAF, near-infrared FAF, quantitative FAF imaging and fluorescence life time imaging (FLIO). This article gives an overview of basic principles, FAF findings in various retinal diseases and an update on recent developments.
Collapse
Affiliation(s)
- Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany; John A. Moran Eye Center, University of Utah, Salt Lake City, USA
| | - Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany; Department of Biomedical Data Science, Stanford University, USA
| | | | - Giovanni Staurenghi
- Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital University of Milan, Italy
| | - Janet R Sparrow
- Departments of Ophthalmology and Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Almut Bindewald-Wittich
- Department of Ophthalmology, University of Bonn, Bonn, Germany; Augenheilkunde Heidenheim MVZ, Heidenheim, Germany
| | - Richard F Spaide
- Vitreous Retina Macula Consultants of New York, New York, NY, USA
| | - Sebastian Wolf
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Srinivas R Sadda
- Doheny Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany.
| |
Collapse
|
17
|
Spectrally Resolved Fundus Autofluorescence in Healthy Eyes: Repeatability and Topographical Analysis of the Green-Emitting Fluorophores. J Clin Med 2020; 9:jcm9082388. [PMID: 32726903 PMCID: PMC7464110 DOI: 10.3390/jcm9082388] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 12/03/2022] Open
Abstract
The aim of this study was to report normal measurements of green-emitting fluorophores in the macula of healthy young individuals and to assess the repeatability of these quantitative metrics. To do so, healthy young volunteers were imaged twice (7 ± 3 days apart) using a confocal blue-light fundus autofluorescence (FAF) device with a shorter excitation wavelength (peak at 450 nm) and the capability for separately detecting the red and green components of the emission spectrum. The main outcome measure was the percentage of area occupied by green-emitting fluorophores in the macula. In addition, this measure was performed in separate regions providing a topographical assessment in the foveal, parafoveal and perifoveal regions. Furthermore, the level of agreement between repeated measurements was evaluated. Thirty eyes from 30 healthy volunteers were included in this analysis. Mean age was 26.2 ± 2.8 years (median: 25.0 years; range: 23.0–32.0 years). Median (interquartile range—IQR) area occupied by green-emitting fluorophores was 3.6% (1.9–4.7%) in the macular region. In the topographical analysis, this percentage was higher in the foveal area (median = 33.3%, IQR = 21.9–41.2%), as compared with both the parafoveal (median = 5.3%; IQR = 2.4–8.1%; p < 0.0001) and perifoveal (median = 0.5%, IQR = 0.2–0.8%; p < 0.0001) regions. The coefficient of variation (CV; ranging from 1.1% to 1.7% in the analyzed regions) and the intraclass correlation coefficient (ICC; ranging from 0.93 to 0.97) indicated high levels of repeatability. In conclusion, the assessment of green-emitting fluorophores is repeatable. The distribution of these fluorophores is highest in the foveal region. Assuming that flavin adenine dinucleotide (FAD) emits in the green autofluorescence spectrum, this variability could be secondary to an increased quantity of mitochondria in the foveal region.
Collapse
|
18
|
Reviewing the Role of Ultra-Widefield Imaging in Inherited Retinal Dystrophies. Ophthalmol Ther 2020; 9:249-263. [PMID: 32141037 PMCID: PMC7196101 DOI: 10.1007/s40123-020-00241-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Indexed: 11/28/2022] Open
Abstract
Inherited retinal dystrophies (IRD) are a heterogeneous group of rare chronic disorders caused by genetically determined degeneration of photoreceptors and retinal pigment epithelium cells. Ultra-widefield (UWF) imaging is a useful diagnostic tool for evaluating retinal integrity in IRD, including Stargardt disease, retinitis pigmentosa, cone dystrophies, and Best vitelliform dystrophy. Color or pseudocolor and fundus autofluorescence images obtained with UWF provide previously unavailable information on the retinal periphery, which correlates well with visual field measurement or electroretinogram. Despite unavoidable artifacts of the UWF device, the feasibility of investigations in infants and in patients with poor fixation makes UWF imaging a precious resource in the diagnostic armamentarium for IRD.
Collapse
|
19
|
|
20
|
A comparison between a white LED confocal imaging system and a conventional flash fundus camera using chromaticity analysis. BMC Ophthalmol 2019; 19:231. [PMID: 31744471 PMCID: PMC6862837 DOI: 10.1186/s12886-019-1241-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 11/06/2019] [Indexed: 01/25/2023] Open
Abstract
Background Conventional flash fundus cameras capture color images that are oversaturated in the red channel and washed out in the green and blue channels, resulting in a retinal picture that often looks flat and reddish. A white LED confocal device was recently introduced to provide a high-quality retinal image with enhanced color fidelity. In this study, we aimed to evaluate the color rendering properties of the white LED confocal system and compare them to those of a conventional flash fundus camera through chromaticity analysis. Methods A white LED confocal device (Eidon, Centervue, Padova, Italy) and a traditional flash fundus camera (TRC-NW8, Topcon Corporation, Tokyo, Japan) were used to capture fundus images. Color images were evaluated with respect to chromaticity. Analysis was performed according to the image color signature. The color signature of an image was defined as the distribution of its pixels in the rgb chromaticity space. The descriptors used for the analysis are the average and variability of the barycenter positions, the average of the variability and the number of unique colors (NUC) of all signatures. Results Two hundred thirty-three color photographs were acquired with each retinal camera. The images acquired by the confocal white LED device demonstrated an average barycenter position (rgb = [0.448, 0.328, 0.224]) closer to the center of the chromaticity space, while the conventional fundus camera provides images with a clear shift toward red at the expense of the blue and green channels (rgb = [0.574, 0.278, 0.148] (p < 0.001). The variability of the barycenter positions was higher in the white LED confocal system than in the conventional fundus camera. The average variability of the distributions was higher (0.003 ± 0.007, p < 0.001) in the Eidon images compared to the Topcon camera, indicating a greater richness of color. The NUC percentage was higher for the white LED confocal device than for the conventional flash fundus camera (0.071% versus 0.025%, p < 0.001). Conclusions Eidon provides more-balanced color images, with a wider richness of color content, compared to a conventional flash fundus camera. The overall higher chromaticity of Eidon may provide benefits in terms of discriminative power and diagnostic accuracy.
Collapse
|
21
|
Turski C, Holz F, Brinkmann C. Inter-Device Comparison of Blue-Light Autofluorescence in Optic Disc Drusen. Ophthalmologica 2019; 243:110-119. [DOI: 10.1159/000501860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 07/01/2019] [Indexed: 11/19/2022]
|
22
|
Dysli C, Müller PL, Birtel J, Holz FG, Herrmann P. Spectrally Resolved Fundus Autofluorescence in ABCA4-Related Retinopathy. ACTA ACUST UNITED AC 2019; 60:274-281. [DOI: 10.1167/iovs.18-25755] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Chantal Dysli
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- Department of Ophthalmology and Department of Clinical Research, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Philipp L. Müller
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- Center for Rare Diseases, University of Bonn, Bonn, Germany
| | - Johannes Birtel
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- Center for Rare Diseases, University of Bonn, Bonn, Germany
| | - Frank G. Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- Center for Rare Diseases, University of Bonn, Bonn, Germany
| | - Philipp Herrmann
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- Center for Rare Diseases, University of Bonn, Bonn, Germany
| |
Collapse
|
23
|
Garrity ST, Sarraf D, Freund KB, Sadda SR. Multimodal Imaging of Nonneovascular Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2018; 59:AMD48-AMD64. [PMID: 30025107 DOI: 10.1167/iovs.18-24158] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Nonneovascular (dry) AMD is a retinal disease with potential for significant central visual impairment. The hallmarks of this disease are macular drusen, RPE alterations, and geographic atrophy (GA). Classification schemes for nonneovascular AMD have evolved over the years as major advances in retinal imaging have enabled a greater understanding of disease pathophysiology. The original classifications of nonneovascular AMD were based on color fundus photography (CFP), while more modern schemes rely on a multimodal imaging approach. Effective diagnosis and management of nonneovascular AMD requires a thorough understanding of its multimodal imaging features as detailed in this review. Future imaging modalities and imaging biomarkers that may aid in diagnosis and management are also discussed.
Collapse
Affiliation(s)
- Sean T Garrity
- Stein Eye Institute, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States
| | - David Sarraf
- Stein Eye Institute, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States.,Greater Los Angeles VA Healthcare Center, Los Angeles, California, United States
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, United States.,Department of Ophthalmology, New York University School of Medicine, New York, New York, United States
| | - Srinivas R Sadda
- Doheny Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States
| |
Collapse
|
24
|
Borrelli E, Nittala MG, Abdelfattah NS, Lei J, Hariri AH, Shi Y, Fan W, Cozzi M, Sarao V, Lanzetta P, Staurenghi G, Sadda SR. Comparison of short-wavelength blue-light autofluorescence and conventional blue-light autofluorescence in geographic atrophy. Br J Ophthalmol 2018; 103:bjophthalmol-2018-311849. [PMID: 29871967 PMCID: PMC6709768 DOI: 10.1136/bjophthalmol-2018-311849] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/15/2018] [Accepted: 05/22/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND/AIMS To systematically compare the intermodality and inter-reader agreement for two blue-light confocal fundus autofluorescence (FAF) systems. METHODS Thirty eyes (21 patients) with a diagnosis of geographic atrophy (GA) were enrolled. Eyes were imaged using two confocal blue-light FAF devices: (1) Spectralis device with a 488 nm excitation wavelength (488-FAF); (2) EIDON device with 450 nm excitation wavelength and the capability for 'colour' FAF imaging including both the individual red and green components of the emission spectrum. Furthermore, a third imaging modality (450-RF image) isolating and highlighting the red emission fluorescence component (REFC) was obtained and graded. Each image was graded by two readers to assess inter-reader variability and a single image for each modality was used to assess the intermodality variability. RESULTS The 95% coefficient of repeatability (1.35 mm2 for the 488-FAF-based grading, 8.13 mm2 for the 450-FAF-based grading and 1.08 mm2 for the 450-RF-based grading), the coefficient of variation (1.11 for 488-FAF, 2.05 for 450-FAF, 0.92 for 450-RF) and the intraclass correlation coefficient (0.994 for 488-FAF, 0.711 for 450-FAF, 0.997 for 450-RF) indicated that 450-FAF-based and 450-RF-based grading have the lowest and highest inter-reader agreements, respectively. The GA area was larger for 488-FAF images (median (IQR) 2.1 mm2 (0.8-6.4 mm2)) than for 450-FAF images (median (IQR) 1.0 mm2 (0.3-4.3 mm2); p<0.0001). There was no significant difference in lesion area measurement between 488-FAF-based and 450-RF-based grading (median (IQR) 2.6 mm2 (0.8-6.8 mm2); p=1.0). CONCLUSION The isolation of the REFC from the 450-FAF images allowed for a reproducible quantification of GA. This assessment had good comparability with that obtained with 488-FAF images.
Collapse
Affiliation(s)
- Enrico Borrelli
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Medicine and Science of Ageing, Ophthalmology Clinic, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Muneeswar Gupta Nittala
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Nizar Saleh Abdelfattah
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jianqin Lei
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Amir H Hariri
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Yue Shi
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Wenying Fan
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Mariano Cozzi
- Department of Medicine and Ophthalmology, University of Udine Piazzale S. Maria della Misericordia, Udine, Italy
| | - Valentina Sarao
- Istituto Europeo di Microchirurgia Oculare-IEMO, Udine, Italy
- Eye Clinic, Department of Biomedical and Clinical Science 'Luigi Sacco', Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Paolo Lanzetta
- Istituto Europeo di Microchirurgia Oculare-IEMO, Udine, Italy
- Eye Clinic, Department of Biomedical and Clinical Science 'Luigi Sacco', Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Giovanni Staurenghi
- Department of Medicine and Ophthalmology, University of Udine Piazzale S. Maria della Misericordia, Udine, Italy
| | - SriniVas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| |
Collapse
|
25
|
Abstract
Retinal imaging has undergone a revolution in the past 50 years to allow for better understanding of the eye in health and disease. Significant improvements have occurred both in hardware such as lasers and optics in addition to software image analysis. Optical imaging modalities include optical coherence tomography (OCT), OCT angiography (OCTA), photoacoustic microscopy (PAM), scanning laser ophthalmoscopy (SLO), adaptive optics (AO), fundus autofluorescence (FAF), and molecular imaging (MI). These imaging modalities have enabled improved visualization of retinal pathophysiology and have had a substantial impact on basic and translational medical research. These improvements in technology have translated into early disease detection, more accurate diagnosis, and improved management of numerous chorioretinal diseases. This article summarizes recent advances and applications of retinal optical imaging techniques, discusses current clinical challenges, and predicts future directions in retinal optical imaging.
Collapse
Affiliation(s)
- Yanxiu Li
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI 48105, USA
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Xiaobo Xia
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yannis M. Paulus
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI 48105, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48015, USA
- Correspondence: ; Tel.: +1-734-232-8105; Fax: +1-734-936-3815
| |
Collapse
|