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Prem Senthil M, Anand S, Chakraborty R, Bordon JE, Constable PA, Brown S, Al-Dasooqi D, Simon S. Exploring the utility of retinal optical coherence tomography as a biomarker for idiopathic intracranial hypertension: a systematic review. J Neurol 2024; 271:4769-4793. [PMID: 38856724 PMCID: PMC11319609 DOI: 10.1007/s00415-024-12481-3] [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: 04/08/2024] [Revised: 05/24/2024] [Accepted: 05/26/2024] [Indexed: 06/11/2024]
Abstract
This study aimed to examine the existing literature that investigated the effectiveness of optical coherence tomography (OCT) and optical coherence tomography angiography (OCT-A) as a biomarker for idiopathic intracranial hypertension (IIH). Our search was conducted on January 17th, 2024, and included the databases, Medline, Scopus, Embase, Cochrane, Latin American and Caribbean Health Sciences Literature (LILACS), International Standard Randomized Controlled Trial Number (ISRCTN) registry, and the International Clinical Trials Registry Platform (ICTRP). Our final review included 84 articles. In 74 studies, OCT was utilized as the primary ocular imaging method, while OCT-A was employed in two studies including eight studies that utilized both modalities. Overall, the results indicated that IIH patients exhibited significant increases in retinal nerve fiber layer (RNFL) thickness, total retinal and macular thickness, optic nerve head volume, and height, optic disc diameter and area, rim area, and thickness compared to controls. A significant correlation was observed between cerebrospinal fluid (CSF) pressure and OCT parameters including RNFL thickness, total retinal thickness, macular thickness, optic nerve head volume, and optic nerve head height. Interventions aimed at lowering CSF pressure were associated with a substantial improvement in these parameters. Nevertheless, studies comparing peripapillary vessel density using OCT-A between IIH patients and controls yielded conflicting results. Our systematic review supports OCT as a powerful tool to accurately monitor retinal axonal and optic nerve head changes in patients with IIH. Future research is required to determine the utility of OCT-A in IIH.
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Affiliation(s)
- Mallika Prem Senthil
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia.
| | - Saumya Anand
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia
| | - Ranjay Chakraborty
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia
| | - Jose Estevez Bordon
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia
| | - Paul A Constable
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia
| | - Shannon Brown
- Central Library, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Dalia Al-Dasooqi
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Bedford Park, Adelaide, South Australia, 5042, Australia
| | - Simu Simon
- University of Adelaide, Adelaide, South Australia, Australia
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Majmudar TV, Moss HE, Avery RA. Which OCT Measure of the Optic Nerve Head Improves Fastest? Towards Optimizing Early Detection of Resolving Papilledema in Children. Transl Vis Sci Technol 2024; 13:12. [PMID: 38224329 PMCID: PMC10793388 DOI: 10.1167/tvst.13.1.12] [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: 08/31/2023] [Accepted: 11/30/2023] [Indexed: 01/16/2024] Open
Abstract
Purpose Optical coherence tomography (OCT) has been used to monitor papilledema. This study aims to determine which OCT-derived measures of the optic nerve head (ONH) detect resolving papilledema in children faster than standard OCT measures. Methods Children (≤18 years of age) with papilledema who completed optic nerve SD-OCT pretreatment and had evidence of treatment response on one or more follow-up OCTs within 4 months were included. Standard (mean circumpapillary retinal nerve fiber layer [cpRNFL] thickness), device-derived (per-quadrant cpRNFL) and custom (ONH height, maximum Bruch's membrane displacement [BMD], ONH volume [ONHV], and BMD volume) OCT measures were calculated. Per-eye generalized estimating equations (GEEs) modelled changes in device-derived and custom measures as a function of mean cpRNFL to identify those measures that resolved faster during early (0-2 months) follow-up. Mean cpRNFL coefficients of greater than 1 indicated faster resolving papilledema. Results We included 52 eyes of 29 children (mean age, 12.8 years; 72.4% female). In analysis of early follow-up visits (38 eyes from 22 children), nasal cpRNFL and maximum BMD in each quadrant resolved faster than mean cpRNFL (GEE coefficients range, 1.14-3.37). Inferior cpRNFL, superior, nasal, and inferior ONH heights and ONHV resolved slower than mean cpRNFL (GEE coefficients range, 0.67-0.87). Conclusions Nasal cpRNFL is a promising device-derived OCT measure for the early detection of resolving papilledema in children compared with mean cpRNFL. Maximum BMD, a custom measure, also shows promise, but its calculation has not yet been incorporated into commercial OCT devices. Translational Relevance This study guides the optimal use of OCT in capturing resolving papilledema in children.
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Affiliation(s)
| | - Heather E. Moss
- Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA, USA
| | - Robert A. Avery
- Divison of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Ophthalmology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Can Lumbar Puncture Be Safely Deferred in Patients With Mild Presumed Idiopathic Intracranial Hypertension? J Neuroophthalmol 2022; 42:505-508. [PMID: 34860748 DOI: 10.1097/wno.0000000000001411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Lumbar puncture (LP) is considered an essential component of the diagnosis of idiopathic intracranial hypertension (IIH) and ruling out IIH mimics, such as meningeal inflammation and neoplastic disease. Such mimics are unlikely in patients who are systemically well and fit the clinical demographic of IIH. It is important to take into account the risks of performing a LP as patients commonly experience mild adverse effects and infrequently more serious ones including psychological distress. LP can also be difficult to obtain in some health care settings, requiring inpatient admission. We examined the clinical course of a subset of presumed patients with IIH with mild vision loss and papilledema to determine whether LP can be safely deferred in this group. METHODS This was a retrospective study looking at the clinical characteristics, final visual outcome, and diagnosis of patients with presumed IIH and papilledema determined by clinical examination who did not undergo LP. The inclusion criteria included i) no symptoms suspicious for systemic infectious/neoplastic/inflammatory processes, ii) no secondary causes of raised intracranial pressure seen on magnetic resonance imaging/magnetic resonance venography, iii) optical coherence tomography (OCT)-RNFL thickness ≤300 µm, and iv) automated mean deviation (MD) ≤ -5.00 dB v) at least one follow-up visit. RESULTS A total of 132 eyes of 68 patients (66 female and 2 male) were included in the study. The mean ± SD age was 31.4 ± 10.2 years, and body mass index was 35.1 ± 6.8 kg/m 2 . Systemic symptoms included headache (n = 47), pulsatile tinnitus (n = 28), transient visual obscurations (n = 10), and diplopia (n = 2). Presenting logarithm of the minimum angle of resolution visual acuity was 0.020 ± 0.090, automated MD was -2.23 ± 1.38 dB, and OCT RNFL thickness was 150.8 ± 48.4 µm. Patients were followed for a mean number of 63.3 ± 78.3 weeks. No additional cause of intracranial hypertension was discovered, and all patients remained systemically well. Two patients were started on acetazolamide, and 31 patients lost at least some weight. There was a significant improvement in the automated MD (-1.73 ± 1.74 dB; P < 0.001) and OCT RNFL thickness (128.1 ± 38.6 µm; P < 0.001) at final follow-up. Seventy-six eyes of 38 patients were considered to have resolved papilledema at the final follow-up. CONCLUSIONS Some patients with presumed IIH may not be able to undergo LP because of patient factors such as refusal, failed attempts, or the environment in which neuro-ophthalmologists practice. This study suggests that it may be acceptable to defer LP for patients with suspected IIH who are under the care of a neuro-ophthalmologist with experience in diagnosing and managing IIH. These patients should be systemically well, in a typical demographic for IIH patients, have mild optic disc edema, and preserved visual function. Patients should be informed about the controversial nature of this decision.
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Pardon LP, Ferguson CR, Laurie SS. The Enigma of the Posterior Displacement of the Bruch Membrane Opening During Spaceflight—Reply. JAMA Ophthalmol 2022; 140:1029-1030. [DOI: 10.1001/jamaophthalmol.2022.3634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Pardon LP, Macias BR, Ferguson CR, Greenwald SH, Ploutz-Snyder R, Alferova IV, Ebert D, Dulchavsky SA, Hargens AR, Stenger MB, Laurie SS. Changes in Optic Nerve Head and Retinal Morphology During Spaceflight and Acute Fluid Shift Reversal. JAMA Ophthalmol 2022; 140:763-770. [PMID: 35708665 DOI: 10.1001/jamaophthalmol.2022.1946] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Importance Countermeasures that reverse the headward fluid shift experienced in weightlessness have the potential to mitigate spaceflight-associated neuro-ocular syndrome. This study investigated whether use of the countermeasure lower-body negative pressure during spaceflight was associated with changes in ocular structure. Objective To determine whether changes to the optic nerve head and retina during spaceflight can be mitigated by brief in-flight application of 25-mm Hg lower-body negative pressure. Design, Setting, and Participants In the National Aeronautics and Space Administration's "Fluid Shifts Study," a prospective cohort study, optical coherence tomography scans of the optic nerve head and macula were obtained from US and international crew members before flight, in-flight, and up to 180 days after return to Earth. In-flight scans were obtained both under normal weightless conditions and 10 to 20 minutes into lower-body negative pressure exposure. Preflight and postflight data were collected in the seated, supine, and head-down tilt postures. Crew members completed 6- to 12-month missions that took place on the International Space Station. Data were analyzed from 2016 to 2021. Interventions or Exposures Spaceflight and lower-body negative pressure. Main Outcomes and Measures Changes in minimum rim width, optic cup volume, Bruch membrane opening height, peripapillary total retinal thickness, and macular thickness. Results Mean (SD) flight duration for the 14 crew members (mean [SD] age, 45 [6] years; 11 male crew members [79%]) was 214 (72) days. Ocular changes on flight day 150, as compared with preflight seated, included an increase in minimum rim width (33.8 μm; 95% CI, 27.9-39.7 μm; P < .001), decrease in cup volume (0.038 mm3; 95% CI, 0.030-0.046 mm3; P < .001), posterior displacement of Bruch membrane opening (-9.0 μm; 95% CI, -15.7 to -2.2 μm; P = .009), and decrease in macular thickness (fovea to 500 μm, 5.1 μm; 95% CI, 3.5-6.8 μm; P < .001). Brief exposure to lower-body negative pressure did not affect these parameters. Conclusions and Relevance Results of this cohort study suggest that peripapillary tissue thickening, decreased cup volume, and mild central macular thinning were associated with long-duration spaceflight. Acute exposure to 25-mm Hg lower-body negative pressure did not alter optic nerve head or retinal morphology, suggesting that longer durations of a fluid shift reversal may be needed to mitigate spaceflight-induced changes and/or other factors are involved.
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Affiliation(s)
| | - Brandon R Macias
- National Aeronautics and Space Administration Johnson Space Center, Houston, Texas
| | | | | | | | - Irina V Alferova
- Russian Federation State Research Center Institute of Biomedical Problems, Russian Academy of Sciences, Moscow, Russia
| | | | | | - Alan R Hargens
- Department of Orthopedic Surgery, UC San Diego Medical Center, University of California, San Diego
| | - Michael B Stenger
- National Aeronautics and Space Administration Johnson Space Center, Houston, Texas
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Banerjee M, Phuljhele S, Saluja G, Kumar P, Saxena R, Sharma P, Vibha D, Pandit AK. Optical coherence tomography features and correlation of functional and structural parameters in patients of idiopathic intracranial hypertension. Indian J Ophthalmol 2022; 70:1343-1349. [PMID: 35326052 PMCID: PMC9240538 DOI: 10.4103/ijo.ijo_2103_21] [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] [Indexed: 11/10/2022] Open
Abstract
Purpose: To determine the correlation between functional parameters and optical coherence tomography (OCT) features in patients of idiopathic intracranial hypertension (IIH). Methods: A prospective observational study in early and established cases of papilledema in IIH presenting from December 2017 to February 2019. Functional parameters (visual acuity, contrast sensitivity, mean deviation, VER, and MfERG) and structural parameters (RNFL, GCL-IPL, and optic disc height) were measured at baseline and every 6 weeks for 6 months. Results: At baseline, average RNFL had a moderate negative correlation with mean deviation (r = −0.45; P = 0.0007) and a positive correlation with logMAR visual acuity (r = 0.18; P = 0.17). On the contrary, baseline GCL and logMAR visual acuity had a negative correlation (r = −0.4, P = 0.02). Optic disc height (ODH) had a negative correlation with visual field mean deviation (r = −0.046; P = 0.0005). At 6 months, ODH and GCL-IPL complex had a statistically significant correlation with functional parameters. However, RNFL values did not show any significant correlation with any of the functional parameters. Baseline GCL-IPL and optic disc height values had a moderate and significant correlation with final functional parameters. However, RNFL did not show any correlation with final functional parameters. Correlation between GCL-IPL thickness at 6 weeks and final functional parameters were stronger than that with baseline GCL values Conclusion: In the setting of severe papilledema, RNFL can misguide the prognosis. GCL-IPL can be a valuable tool for an objective evaluation of the integrity of the optic nerve in IIH and ODH may be used as an alternative or in combination with GCL-IPL in these cases.
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Affiliation(s)
- Mousumi Banerjee
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Swati Phuljhele
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Gunjan Saluja
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Pawan Kumar
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Rohit Saxena
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Pradeep Sharma
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Deepti Vibha
- Department of Neurology, AIIMS, New Delhi, India
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Jacobsen HH, Jørstad ØK, Moe MC, Petrovski G, Pripp AH, Sandell T, Eide PK. Noninvasive Estimation of Pulsatile and Static Intracranial Pressure by Optical Coherence Tomography. Transl Vis Sci Technol 2022; 11:31. [PMID: 35050344 PMCID: PMC8787623 DOI: 10.1167/tvst.11.1.31] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To explore the ability of optical coherence tomography (OCT) to noninvasively estimate pulsatile and static intracranial pressure (ICP). Methods An OCT examination was performed in patients who underwent continuous overnight monitoring of the pulsatile and static ICP for diagnostic purpose. We included two patient groups, patients with idiopathic intracranial hypertension (IIH; n = 20) and patients with no verified cerebrospinal fluid disturbances (reference; n = 12). Several OCT parameters were acquired using spectral-domain OCT (RS-3000 Advance; NIDEK, Singapore). The ICP measurements were obtained using a parenchymal sensor (Codman ICP MicroSensor; Johnson & Johnson, Raynham, MA, USA). The pulsatile ICP was determined as the mean ICP wave amplitude (MWA), and the static ICP was determined as the mean ICP. Results The peripapillary Bruch's membrane angle (pBA) and the optic nerve head height (ONHH) differed between the IIH and reference groups and correlated with both MWA and mean ICP. Both OCT parameters predicted elevated MWA. Area under the curve and cutoffs were 0.82 (95% confidence interval [CI], 0.66–0.98) and -0.65° (sensitivity/specificity; 0.75/0.92) for pBA and 0.84 (95% CI, 0.70–0.99) and 405 µm (0.88/0.67) for ONHH. Adjusting for age and body mass index resulted in nonsignificant predictive values for mean ICP, whereas the predictive value for MWA remained significant. Conclusions This study provides evidence that the OCT parameters pBA and ONHH noninvasively can predict elevated pulsatile ICP, represented by the MWA. Translational Relevance OCT shows promise as a method for noninvasive estimation of ICP.
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Affiliation(s)
- Henrik Holvin Jacobsen
- Department of Ophthalmology, Oslo University Hospital-Ullevål, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Øystein Kalsnes Jørstad
- Department of Ophthalmology, Oslo University Hospital-Ullevål, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Morten C Moe
- Department of Ophthalmology, Oslo University Hospital-Ullevål, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Goran Petrovski
- Department of Ophthalmology, Oslo University Hospital-Ullevål, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Ophthalmology, University of Split School of Medicine, Split, Croatia
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Tiril Sandell
- Department of Ophthalmology, Oslo University Hospital-Ullevål, Oslo, Norway.,Department of Ophthalmology, Vestre Viken Hospital, Drammen, Norway
| | - Per Kristian Eide
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway
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Kaya FS, Arici C. Assessment of peripapillary choroidal thicknesses and optic disc diameters in idiopathic intracranial hypertension. CANADIAN JOURNAL OF OPHTHALMOLOGY 2021; 58:212-218. [PMID: 34919841 DOI: 10.1016/j.jcjo.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 10/27/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the peripapillary choroidal thickness and optic disc diameter changes in the eyes of patients who had idiopathic intracranial hypertension (IIH) when they had swollen discs and after resolution of the papilledema. DESIGN This is an observational, cross-sectional study. Optical coherence tomography was performed on both eyes of patients with IIH, who had been divided into 2 groups: 18 patients with acute papilledema and 25 patients with resolved papilledema. Twenty healthy participants were also enrolled in this study. METHODS In this observational, cross-sectional study, the thickness of the retinal nerve fibre layer, the peripapillary choroidal thickness (PCT), the ganglion cell complex thickness, and the optic disc diameters were measured using optical coherence tomography. RESULTS In the resolved-papilledema subgroup, PCT in all quadrants was significantly lower than in the control group (p < 0.001 for each). In the acute-papilledema subgroup, PCT in the temporal, inferior, and superior quadrants was significantly less than in the control eyes (p < 0.001, p = 0.003, p = 0.049, respectively). The disc diameters in the vertical and horizontal planes were also significantly larger in the acute-papilledema eyes than in the control eyes and in the resolved papilledema eyes (p < 0.001 for each). CONCLUSION PCT decreases both at the acute and chronic stages of IIH, and optic disc diameter increases in patients with IIH who have swollen discs.
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Affiliation(s)
- Fatma Selin Kaya
- Department of Ophthalmology, Başakşehir Çam ve Sakura City Hospital, Başakşehir, Istanbul, Turkey.
| | - Ceyhun Arici
- Department of Ophthalmology, Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
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Abstract
Purpose of review Optic nerve head elevation can be associated with vision loss. This review provides an update regarding key features of optic disc drusen (ODD) compared with papilledema from increased intracranial pressure and optic disc edema from other causes. Recent findings Clinical history and funduscopic examination are not sufficient to correctly diagnose different causes of optic nerve head elevation. Multimodal ophthalmic imaging is noninvasive and should be used as first-line diagnostic testing to distinguish optic disc edema or papilledema from pseudoedema. Advanced ophthalmic imaging, including enhanced depth imaging optical coherence tomography (EDI-OCT) and autofluorescence imaging, can visualize ODD at high resolution and determine whether there is optic disc edema. OCT angiography does not require contrast and can rapidly visualize papillary, peripapillary, and macular microvasculature and identify important vascular biomarker of ischemia and, potentially, visual prognosis. Summary Multimodal ophthalmic imaging can help in the diagnosis of ODD and optic disc edema and identify patients at high risk of vision loss and neurological issues in order to ensure appropriate diagnosis and treatment.
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Legocki AT, Moshiri Y, Zepeda EM, Gillette TB, Shariff A, Grant LE, Ding L, Lee AY, Lee CS, Tarczy-Hornoch K, Cabrera MT. Dome-shaped macula in premature infants visualized by handheld spectral-domain optical coherence tomography. J AAPOS 2021; 25:153.e1-153.e6. [PMID: 34044111 PMCID: PMC8328941 DOI: 10.1016/j.jaapos.2020.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/07/2020] [Accepted: 12/19/2020] [Indexed: 10/21/2022]
Abstract
PURPOSE To describe dome-shaped macula and associated clinical findings in premature infants. METHODS This prospective, observational cohort study included a consecutive sample of premature infants screened for retinopathy of prematurity (ROP) with 9-month follow-up. Handheld spectral domain optical coherence tomography (SD-OCT) was performed at the time of ROP screening. Images were assessed for dome-shaped macula, cystoid macular edema, epiretinal membrane, vitreous bands, and punctate hyperreflective vitreous opacities. Dome height measurements were performed in a subset of images. Teller visual acuity and cycloplegic refraction were performed at an adjusted age of 8-10 months. RESULTS Of 37 infants (74 eyes; 49% male; mean gestational age 27.8 ± 3.2 weeks; mean birth weight 949 ± 284 g), 24/37 (65%) demonstrated dome-shaped macula in at least one eye (13 both eyes, 5 right eye only, and 6 left eye only). Of the 74 eyes, 26 (35%) could be reliably measured, with a mean dome height of 139.0 ± 72.3 μm (range, 54-369 μm). Presence of dome-shaped macula was associated with a diagnosis of ROP (P = 0.02; OR, 3.03; 95% CI, 1.18-7.82) and pre-plus or plus disease (P = 0.02; OR, 4.20; 95% CI, 1.05-16.78). Infants with dome-shaped macula had lower birth weight compared with those without (877 vs 1081 g; P = 0.04). No associations with other demographics, OCT findings, and 9-month refractive outcomes were found. CONCLUSIONS Dome-shaped macula was frequently identified by handheld SD-OCT in premature infants, especially those with lower birth weight and severe ROP. The long-term clinical significance of this finding is unknown.
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Affiliation(s)
- Alex T Legocki
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Yasman Moshiri
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Emily M Zepeda
- Department of Ophthalmology, Dean McGee Eye Institute, Oklahoma City, Oklahoma
| | - Thomas B Gillette
- Department of Ophthalmology, University of South Florida Eye Institute, Tampa, Florida
| | - Ayesha Shariff
- Department of Ophthalmology, Case Western Reserve University, Cleveland, Ohio
| | - Laura E Grant
- Department of Ophthalmology, Henry Ford Hospital, Detroit, Michigan
| | - Leona Ding
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Kristina Tarczy-Hornoch
- Department of Ophthalmology, University of Washington, Seattle, Washington; Department of Ophthalmology, Seattle Children's Hospital, Seattle, Washington
| | - Michelle T Cabrera
- Department of Ophthalmology, University of Washington, Seattle, Washington; Department of Ophthalmology, Seattle Children's Hospital, Seattle, Washington.
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McNabb RP, Liu AS, Gospe SM, El-Dairi M, Meekins LC, James C, Vann RR, Izatt JA, Kuo AN. QUANTITATIVE TOPOGRAPHIC CURVATURE MAPS OF THE POSTERIOR EYE UTILIZING OPTICAL COHERENCE TOMOGRAPHY. Retina 2021; 41:804-811. [PMID: 32568982 PMCID: PMC7744428 DOI: 10.1097/iae.0000000000002897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Deformations of the retina such as staphylomas in myopia or scleral flattening in high intracranial pressure can be challenging to quantify with en face imaging. We describe an optical coherence tomography-based method for the generation of quantitative posterior eye topography maps in normal and pathologic eyes. METHODS Using "whole eye" optical coherence tomography, we corrected for subjects' optical distortions to generate spatially accurate posterior eye optical coherence tomography volumes and created local curvature (KM, mm-1) topography maps for each consented subject. We imaged nine subjects, three normal, two with myopic degeneration, and four with papilledema including one that was imaged longitudinally. RESULTS Normal subjects mean temporal KM was 0.0923 mm-1, nasal KM was 0.0927 mm-1, and KM local variability was 0.0162 mm-1. In myopic degeneration, subjects KM local variability was higher at 0.0836 mm-1. In papilledema subjects nasal KM was flatter compared with temporal KM (0.0709 vs. 0.0885 mm-1). Mean intrasession KM repeatability for all subjects was 0.0036 mm-1. CONCLUSION We have developed an optical coherence tomography based method for quantitative posterior eye topography that offers the ability to analyze local curvature with micron scale resolution and offers the potential to help clinicians and researchers characterize subtle, local retinal deformations earlier in patients and follow their development over time.
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Affiliation(s)
- Ryan P. McNabb
- Department of Ophthalmology, Duke University Medical Center, Durham, NC 27710
| | - Alice S. Liu
- Department of Ophthalmology, Duke University Medical Center, Durham, NC 27710
| | - Sidney M. Gospe
- Department of Ophthalmology, Duke University Medical Center, Durham, NC 27710
| | - Mays El-Dairi
- Department of Ophthalmology, Duke University Medical Center, Durham, NC 27710
| | - Landon C. Meekins
- Department of Ophthalmology, Duke University Medical Center, Durham, NC 27710
| | - Charlene James
- Department of Ophthalmology, Duke University Medical Center, Durham, NC 27710
| | - Robin R. Vann
- Department of Ophthalmology, Duke University Medical Center, Durham, NC 27710
| | - Joseph A. Izatt
- Department of Ophthalmology, Duke University Medical Center, Durham, NC 27710
- Department of Biomedical Engineering; Duke University; Durham, NC 27708
| | - Anthony N. Kuo
- Department of Ophthalmology, Duke University Medical Center, Durham, NC 27710
- Department of Biomedical Engineering; Duke University; Durham, NC 27708
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Sibony PA, Kupersmith MJ, Kardon RH. Optical Coherence Tomography Neuro-Toolbox for the Diagnosis and Management of Papilledema, Optic Disc Edema, and Pseudopapilledema. J Neuroophthalmol 2021; 41:77-92. [PMID: 32909979 PMCID: PMC7882012 DOI: 10.1097/wno.0000000000001078] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Distinguishing optic disc edema from pseudopapilledema is a common, sometimes challenging clinical problem. Advances in spectral-domain optical coherence tomography (SD-OCT) of the optic nerve head (ONH) has proven to be a cost effective, noninvasive, outpatient procedure that may help. At its core are tools that quantify the thickness of the retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GC-IPL). The SD-OCT also provides a set of tools that may be qualitatively interpreted in the same way that we read an MRI. They include the transverse axial, en face, and circular tomogram. Our goal is to describe a practical office-based set of tools using SD-OCT in the diagnosis and monitoring of papilledema, optic disc edema, and pseudopapilledema. EVIDENCE ACQUISITION Searches on PubMed were performed using combinations of the following key words: OCT, papilledema, pseudopapilledema, optic disc drusen, retinal folds (RF), and choroidal folds (CF). RESULTS The principal elements of SD-OCT analysis of the ONH are the RNFL and GC-IPL thickness; however, these metrics have limitations when swelling is severe. Qualitative interpretation of the transverse axial SD-OCT aids in assessing peripapillary shape that may help distinguish papilledema from pseudopapilledema, evaluate atypical optic neuropathies, diagnose shunt failures, and identify outer RF and CF. There is a consensus that the SD-OCT is the most sensitive way of identifying buried optic disc drusen. En face SD-OCT is especially effective at detecting peripapillary wrinkles and outer retinal creases, both of which are common and distinctive signs of optic disc edema that rule out pseudopapilledema. Mechanically stressing the ONH in the adducted eye position, in patients with papilledema, may expose folds and peripapillary deformations that may not be evident in primary position. We also discuss how to optimize the acquisition and registration of SD-OCT images. CONCLUSIONS The SD-OCT is not a substitute for a complete history and a careful examination. It is, however, a convenient ancillary test that aids in the diagnosis and management of papilledema, optic disc edema, and pseudopapilledema. It is particularly helpful in monitoring changes over the course of time and distinguishing low-grade papilledema from buried drusen. The application of the SD-OCT toolbox depends on optimizing the acquisition of images, understanding its limitations, recognizing common artifacts, and accurately interpreting images in the context of both history and clinical findings.
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Affiliation(s)
- Patrick A Sibony
- Department Ophthalmology (PAS), State University of New York at Stony Brook, Stony Brook, New York; Departments of Neurology, Ophthalmology, Neurosurgery (MJK), Icahn School of Medicine at Mount Sinai and New York Eye and Ear Infirmary, New York, New York; Department of Ophthalmology and Visual Sciences (RHK), the University of Iowa, Iowa City, Iowa; and Center for the Prevention and Treatment of Visual Loss (RHK), Iowa City VA Health Care System, Iowa City, Iowa
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Bingöl Kızıltunç P, Atilla H. A novel biomarker for increased intracranial pressure in idiopathic intracranial hypertension. Jpn J Ophthalmol 2021; 65:416-422. [PMID: 33420540 DOI: 10.1007/s10384-020-00807-3] [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: 03/28/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Changes in optic disc and peripapillary structures associated with optic nerve edema in idiopathic intracranial hypertension (IIH), can be evaluated with spectral domain optical coherence tomography (SD-OCT). We aimed to evaluate the association between increased cerebrospinal fluid (CSF) opening pressure and changes in peripapillary structures detected by SD-OCT and to determine whether these changes can be used to assess the changes in CSF pressure without performing lumbar puncture (LP). STUDY DESIGN Retrospective study METHODS: We included 54 eyes of 28 patients with bilateral papilledema who had peripapillary SD-OCT imaging within 24 h before the LP. Correlation between CSF pressure and peripapillary OCT parameters including maximal retinal thickness, maximal anterior retinal projection, maximal retinal nerve fiber layer (RNFL) thickness and Bruch membrane opening (BMO) was evaluated. RESULTS Bruch Membrane opening and maximal RNFL thickness were significantly higher in patients with increased CSF pressure. There exist correlations between CSF pressure and BMO, maximal RNFL thickness and maximal retinal thickness. (Spearman's Rho: 0.791, 0.482 and 0.297, p < 0.001, < 0.001 and 0.029, respectively) The cut off value of BMO for the prediction of increased CSF pressure was 1785 µm, with a sensitivity of 78.8% and a specificity of 81%. The cut off value for maximal RNFL thickness was 174 µm, with a sensitivity of 75.8% and a specificity of 61.9%. CONCLUSION Bruch membrane opening and maximal RNFL thickness can give an idea about increased CSF pressure values in IIH patients. Thus SD-OCT can be used to detect CSF pressure changes in these patients.
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Affiliation(s)
| | - Huban Atilla
- Department of Ophthalmology, Ankara University School of Medicine, Ankara, Turkey
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14
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Minakaran N, de Carvalho ER, Petzold A, Wong SH. Optical coherence tomography (OCT) in neuro-ophthalmology. Eye (Lond) 2021; 35:17-32. [PMID: 33239763 PMCID: PMC7852683 DOI: 10.1038/s41433-020-01288-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 10/30/2020] [Accepted: 11/04/2020] [Indexed: 01/01/2023] Open
Abstract
Optical coherence tomography (OCT) is a non-invasive medical imaging technology that is playing an increasing role in the routine assessment and management of patients with neuro-ophthalmic conditions. Its ability to characterise the optic nerve head, peripapillary retinal nerve fibre layer and cellular layers of the macula including the ganglion cell layer enables qualitative and quantitative assessment of optic nerve disease. In this review, we discuss technical features of OCT and OCT-based imaging techniques in the neuro-ophthalmic context, potential pitfalls to be aware of, and specific applications in more common neuro-ophthalmic conditions including demyelinating, inflammatory, ischaemic and compressive optic neuropathies, optic disc drusen and raised intracranial pressure. We also review emerging applications of OCT angiography within neuro-ophthalmology.
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Affiliation(s)
- Neda Minakaran
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.
| | - Emanuel R de Carvalho
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Department of Ophthalmology, University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Axel Petzold
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Neuro-ophthalmology Expertise Centre, University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- UCL Institute of Neurology, Queen Square, London, UK
| | - Sui H Wong
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Guys and St Thomas' NHS Foundation Trust, London, UK
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15
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Lo C, Vuong LN, Micieli JA. Recent advances and future directions on the use of optical coherence tomography in neuro-ophthalmology. Taiwan J Ophthalmol 2021; 11:3-15. [PMID: 33767951 PMCID: PMC7971436 DOI: 10.4103/tjo.tjo_76_20] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/26/2020] [Indexed: 12/12/2022] Open
Abstract
Optical coherence tomography (OCT) is a noninvasive imaging technique used to qualitatively and quantitatively analyze various layers of the retina. OCT of the retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) is particularly useful in neuro-ophthalmology for the evaluation of patients with optic neuropathies and retrochiasmal visual pathway disorders. OCT allows for an objective quantification of edema and atrophy of the RNFL and GCIPL, which may be evident before obvious clinical signs and visual dysfunction develop. Enhanced depth imaging OCT allows for visualization of deep structures of the optic nerve and has emerged as the gold standard for the detection of optic disc drusen. In the evaluation of compressive optic neuropathies, OCT RNFL and GCIPL thicknesses have been established as the most important visual prognostic factor. There is increasing evidence that inclusion of OCT as part of the diagnostic criteria for multiple sclerosis (MS) increases its sensitivity. Moreover, OCT of the RNFL and GCIPL may be helpful in the early detection and monitoring the treatment of conditions such as MS and Alzheimer's disease. OCT is an important aspect of the neuro-ophthalmologic assessment and its use is likely to increase moving forward.
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Affiliation(s)
- Cody Lo
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Laurel N. Vuong
- The New England Eye Center, Tufts Medical Center, Boston, MA, USA
| | - Jonathan A. Micieli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
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Optic Nerve Head and Macular Optical Coherence Tomography Measurements in Papilledema Compared With Pseudopapilledema. J Neuroophthalmol 2020; 39:28-34. [PMID: 29474199 DOI: 10.1097/wno.0000000000000641] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To compare macular and optic nerve head optical coherence tomography (OCT) measurements in mild to moderate papilledema and pseudopapilledema. METHODS One hundred nineteen eyes of 61 patients with mild to moderate papilledema, 84 eyes of 48 patients with pseudopapilledema, and 60 eyes of 60 healthy normal individuals were enrolled in this cross-sectional study. Using Spectralis SD-OCT, macular scans with macular ganglion cell-inner plexiform layer (GCIPL) and macular retinal nerve fiber layer (RNFL) segmentation were performed and divided into 2 regions (inner and outer, with a diameter of 3 and 6 mm, respectively); in addition, Bruch membrane opening (BMO) area and peripapillary RNFL thickness were obtained. RESULTS BMO area was similar in papilledema (1.83 ± 0.34 mm), pseudopapilledema (1.85 ± 0.37 mm), and controls (1.85 ± 0.32 mm). Average inner region macular GCIPL thickness in the papilledema, pseudopapilledema, and control groups was 87.2 ± 14.4 μm, 90.8 ± 6.1 μm, and 91.2 ± 9.8 μm, respectively (P > 0.05). Outer temporal region macular GCIPL was significantly thinner in the papilledema group compared with control group (P = 0.01). By contrast, outer inferior and outer nasal macular RNFL sectors were significantly thicker in the papilledema group compared with control groups (P = 0.01 and P < 0.01, respectively). Those measures were not different between pseudopapilledema and control eyes. CONCLUSIONS In papilledema eyes, outer temporal region macular GCIPL thickness decreased and outer inferior and outer nasal macular RNFL sectors thickness increased compared with the control group. These changes were not observed in the pseudopapilledema group.
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17
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Pazos M, Biarnés M, Blasco-Alberto A, Dyrda A, Luque-Fernández MÁ, Gómez A, Mora C, Milla E, Muniesa M, Antón A, Díaz-Alemán VT. SD-OCT peripapillary nerve fibre layer and ganglion cell complex parameters in glaucoma: principal component analysis. Br J Ophthalmol 2020; 105:496-501. [PMID: 32493759 DOI: 10.1136/bjophthalmol-2020-316296] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/13/2020] [Accepted: 05/10/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND/AIMS To identify objective glaucoma-related structural features based on peripapillary (p) and macular (m) spectral domain optical coherence tomography (SD-OCT) parameters and assess their discriminative ability between healthy and glaucoma patients. METHODS Two hundred and sixty eyes (91 controls and 169 glaucoma) were included in this prospective study. After a complete examination, all participants underwent the posterior pole and the peripapillary retinal nerve fibre layer (pRNFL) protocols of the Spectralis SD-OCT. Principal component analysis (PCA), a data reduction method, was applied to identify and characterise the main information provided by the ganglion cell complex (GCC). The discriminative ability between healthy and glaucomatous eyes of the first principal components (PCs) was compared with that of conventional SD-OCT parameters (pRNFL, macular RNFL (mRNFL), macular ganglion cell layer (mGCL)and macular inner plexiform layer (mIPL)) using 10-fold cross-validated areas under the curve (AUC). RESULTS The first PC explained 58% of the total information contained in the GCC and the pRNFL parameters and was the result of a general combination of almost all variables studied (diffuse distribution). Other PCs were driven mainly by pRNFL and mRNFL measurements. PCs and pRNFL had similar AUC (0.95 vs 0.96, p=0.88), and outperformed the other structural measurements: mRNFL (0.91, p=0.002), mGCL (0.92, p=0.02) and mIPL (0.92, p=0.0001). CONCLUSIONS PCA identified a diffuse representation of the papillary and macular SD-OCT parameters as the most important PC to summarise structural data in healthy and glaucomatous eyes. PCs and pRNFL parameters showed the greatest discriminative ability between healthy and glaucoma cases.
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Affiliation(s)
- Marta Pazos
- Institut Clínic d'Oftalmologia, Hospital Clínic de Barcelona. Universitat de Barcelona, Barcelona, Spain .,Institut de la Màcula, Barcelona Macula Foundation (Hospital Quirón-Teknon), Barcelona, Spain
| | - Marc Biarnés
- Institut de la Màcula, Barcelona Macula Foundation (Hospital Quirón-Teknon), Barcelona, Spain
| | - Andrés Blasco-Alberto
- Ophthalmology, Hospital Universitario de Canarias, Universidad de la Laguna, Tenerife, Spain
| | - Agnieszka Dyrda
- Glaucoma and Research, Institut Català de Retina, Barcelona, Spain
| | - Miguel Ángel Luque-Fernández
- Non-communicable Disease and Cancer Epidemiology Group, Biomedical Research Institute of Granada (ibs.GRANADA), Granada, Spain.,Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Alicia Gómez
- Glaucoma and Research, Institut Català de Retina, Barcelona, Spain
| | - Clara Mora
- Ophthalmology, Hospital de l'Esperança-Parc de Salut Mar, Barcelona, Spain
| | - Elena Milla
- Institut Clínic d'Oftalmologia, Hospital Clínic de Barcelona. Universitat de Barcelona, Barcelona, Spain
| | - MªJesús Muniesa
- Institut Clínic d'Oftalmologia, Hospital Clínic de Barcelona. Universitat de Barcelona, Barcelona, Spain
| | - Alfonso Antón
- Glaucoma and Research, Institut Català de Retina, Barcelona, Spain.,Ophthalmology, Hospital de l'Esperança-Parc de Salut Mar, Barcelona, Spain.,Ophthalmology, Universitat Internacional de Catalunya Facultat de Medicina i Ciències de la Salut, Sant Cugat del Valles, Spain
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The Effect of Acetazolamide and Weight Loss on Intraocular Pressure in Idiopathic Intracranial Hypertension Patients. J Glaucoma 2020; 28:352-356. [PMID: 30624392 DOI: 10.1097/ijg.0000000000001189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Acetazolamide (ACZ) lowers intraocular pressure (IOP), acutely in normal eyes and both acutely and chronically in eyes with glaucoma, and cerebrospinal fluid pressure (CSFp), chronically in patients with idiopathic intracranial hypertension (IIH). We hypothesize chronic daily ACZ would significantly reduce IOP and contribute to a translaminar pressure gradient change reflected by alteration in the CSFp-IOP difference and the deformation of the neural canal in patients with IIH and no glaucoma. PATIENTS AND METHODS Before randomization to ACZ or placebo treatment for 6 months, 165 participants in the IIH Treatment Trial had evaluations that included Goldmann applanation, CSFp measurement, and optical coherence tomography determination of the neural canal deformation. These measures were repeated at the 6-month outcome. RESULTS The IOP was not significantly decreased from baseline at 1, 3, or 6 months in eyes in both treatment groups. At month 6, the amount of ACZ or weight modification did not correlate with any IOP change. The 6-month mean change in neural canal deformation was 0.96 and -0.04 (P=0.001) and in CSFp was -128 and -38 mm H2O (P=0.001), but CSFp-IOP difference change was not significant, in the ACZ and placebo groups, respectively. CONCLUSIONS ACZ does not reduce the IOP in eyes without glaucoma but does decrease the pathologic elevated CSFp, providing evidence that normal systems can compensate for chronic medication effects. The CSFp-IOP is not a direct marker of translaminar pressure gradient and the ACZ normalization of the neural canal deformation appears due to CSFp reduction alone.
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Islam MS, Wang JK, Johnson SS, Thurtell MJ, Kardon RH, Garvin MK. A Deep-Learning Approach for Automated OCT En-Face Retinal Vessel Segmentation in Cases of Optic Disc Swelling Using Multiple En-Face Images as Input. Transl Vis Sci Technol 2020; 9:17. [PMID: 32821471 PMCID: PMC7401896 DOI: 10.1167/tvst.9.2.17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/29/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose In cases of optic disc swelling, segmentation of projected retinal blood vessels from optical coherence tomography (OCT) volumes is challenging due to swelling-based shadowing artifacts. Based on our hypothesis that simultaneously considering vessel information from multiple projected retinal layers can substantially increase vessel visibility, in this work, we propose a deep-learning-based approach to segment vessels involving the simultaneous use of three OCT en-face images as input. Methods A human expert vessel tracing combining information from OCT en-face images of the retinal pigment epithelium (RPE), inner retina, and total retina as well as a registered fundus image served as the reference standard. The deep neural network was trained from the imaging data from 18 patients with optic disc swelling to output a vessel probability map from three OCT en-face input images. The vessels from the OCT en-face images were also manually traced in three separate stages to compare with the performance of the proposed approach. Results On an independent volume-matched test set of 18 patients, the proposed deep-learning-based approach outperformed the three OCT-based manual tracing stages. The manual tracing based on three OCT en-face images also outperformed the manual tracing using only the traditional RPE en-face image. Conclusions In cases of optic disc swelling, use of multiple en-face images enables better vessel segmentation when compared with the traditional use of a single en-face image. Translational Relevance Improved vessel segmentation approaches in cases of optic disc swelling can be used as features for an improved assessment of the severity and cause of the swelling.
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Affiliation(s)
- Mohammad Shafkat Islam
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, USA
| | - Jui-Kai Wang
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, USA
- Iowa City VA Health Care System and Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, IA, USA
| | - Samuel S. Johnson
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, USA
| | - Matthew J. Thurtell
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
| | - Randy H. Kardon
- Iowa City VA Health Care System and Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, IA, USA
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
| | - Mona K. Garvin
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, IA, USA
- Iowa City VA Health Care System and Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, IA, USA
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20
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Malhotra K, Padungkiatsagul T, Moss HE. Optical coherence tomography use in idiopathic intracranial hypertension. ANNALS OF EYE SCIENCE 2020; 5:7. [PMID: 32405617 PMCID: PMC7220123 DOI: 10.21037/aes.2019.12.06] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Idiopathic intracranial hypertension (IIH) is a condition in which elevated pressure in the cerebrospinal fluid can lead to optic nerve head (ONH) dysfunction and subsequent visual impairment. Physicians are currently limited in their ability to monitor and manage this condition, as clinical symptoms and exam findings are often delayed in response to changes in intracranial pressure. In order to find other biomarkers of disease, researchers are using imaging modalities such as optical coherence tomography (OCT) to observe microscopic changes in the eye in this condition. OCT can create 2-dimensional and 3-dimensional high definition images of the retina of the ONH and has been used to study various conditions such as glaucoma and multiple sclerosis. Numerous studies have used OCT in IIH as well, and they have shown that certain retinal layers and the ONH change in thickness and shape in both the short and long term with intracranial pressure changes. OCT is a promising modality for clinical and scientific evaluation of IIH as it is a noninvasive and practical tool to obtain in depth images. This review will discuss how OCT can be used to assess a patient with IIH, both before and after treatment, along with its limitations and future applications.
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Affiliation(s)
- Kiran Malhotra
- Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Tanyatuth Padungkiatsagul
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
| | - Heather E. Moss
- Department of Ophthalmology, Stanford University, Palo Alto, CA, USA
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA, USA
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Liu KC, Fleischman D, Lee AG, Killer HE, Chen JJ, Bhatti MT. Current concepts of cerebrospinal fluid dynamics and the translaminar cribrosa pressure gradient: a paradigm of optic disk disease. Surv Ophthalmol 2020; 65:48-66. [DOI: 10.1016/j.survophthal.2019.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/07/2019] [Accepted: 08/16/2019] [Indexed: 12/11/2022]
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Ahmad SR, Moss HE. Update on the Diagnosis and Treatment of Idiopathic Intracranial Hypertension. Semin Neurol 2019; 39:682-691. [PMID: 31847039 DOI: 10.1055/s-0039-1698744] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Advances in ophthalmic diagnostics and results of interventional clinical trials are shifting diagnosis and management of idiopathic intracranial hypertension (IIH) to be more technology- and evidence-based. In this article, the evidence supporting current diagnostic criteria, evaluation, and medical and surgical management of IIH are reviewed.
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Affiliation(s)
- Sarah R Ahmad
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, California
| | - Heather E Moss
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, California.,Department of Ophthalmology, Stanford University, Palo Alto, California
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Boote C, Sigal IA, Grytz R, Hua Y, Nguyen TD, Girard MJA. Scleral structure and biomechanics. Prog Retin Eye Res 2019; 74:100773. [PMID: 31412277 DOI: 10.1016/j.preteyeres.2019.100773] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 12/18/2022]
Abstract
As the eye's main load-bearing connective tissue, the sclera is centrally important to vision. In addition to cooperatively maintaining refractive status with the cornea, the sclera must also provide stable mechanical support to vulnerable internal ocular structures such as the retina and optic nerve head. Moreover, it must achieve this under complex, dynamic loading conditions imposed by eye movements and fluid pressures. Recent years have seen significant advances in our knowledge of scleral biomechanics, its modulation with ageing and disease, and their relationship to the hierarchical structure of the collagen-rich scleral extracellular matrix (ECM) and its resident cells. This review focuses on notable recent structural and biomechanical studies, setting their findings in the context of the wider scleral literature. It reviews recent progress in the development of scattering and bioimaging methods to resolve scleral ECM structure at multiple scales. In vivo and ex vivo experimental methods to characterise scleral biomechanics are explored, along with computational techniques that combine structural and biomechanical data to simulate ocular behaviour and extract tissue material properties. Studies into alterations of scleral structure and biomechanics in myopia and glaucoma are presented, and their results reconciled with associated findings on changes in the ageing eye. Finally, new developments in scleral surgery and emerging minimally invasive therapies are highlighted that could offer new hope in the fight against escalating scleral-related vision disorder worldwide.
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Affiliation(s)
- Craig Boote
- Structural Biophysics Research Group, School of Optometry & Vision Sciences, Cardiff University, UK; Ophthalmic Engineering & Innovation Laboratory (OEIL), Department of Biomedical Engineering, National University of Singapore, Singapore; Newcastle Research & Innovation Institute Singapore (NewRIIS), Singapore.
| | - Ian A Sigal
- Laboratory of Ocular Biomechanics, Department of Ophthalmology, University of Pittsburgh, USA
| | - Rafael Grytz
- Department of Ophthalmology & Visual Sciences, University of Alabama at Birmingham, USA
| | - Yi Hua
- Laboratory of Ocular Biomechanics, Department of Ophthalmology, University of Pittsburgh, USA
| | - Thao D Nguyen
- Department of Mechanical Engineering, Johns Hopkins University, USA
| | - Michael J A Girard
- Ophthalmic Engineering & Innovation Laboratory (OEIL), Department of Biomedical Engineering, National University of Singapore, Singapore; Singapore Eye Research Institute (SERI), Singapore National Eye Centre, Singapore
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Tun TA, Wang X, Baskaran M, Nongpiur ME, Tham YC, Perera SA, Strouthidis NG, Aung T, Cheng CY, Girard MJA. Variation of Peripapillary Scleral Shape With Age. Invest Ophthalmol Vis Sci 2019; 60:3275-3282. [PMID: 31369672 PMCID: PMC6675518 DOI: 10.1167/iovs.19-26777] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 06/18/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To define the shape of the anterior surface of the peripapillary sclera (PPS) and evaluate its relationship with age and ocular determinants in a population-based Chinese cohort. Methods The optic nerve heads of 619 healthy Chinese subjects were imaged with spectral-domain optical coherence tomography. To assess the shape of the PPS/Bruch's membrane (BM), we measured the angle between a line parallel to the nasal anterior PPS/BM boundary and one parallel to the temporal side. A negative value indicated that the PPS/BM followed an inverted v-shaped configuration (peak pointing toward the vitreous), whereas a positive value indicated that it followed a v-shaped configuration (peak pointing toward the orbital tissues). A linear regression model was used to evaluate the relationship between the PPS angle and other ocular parameters. Results The mean PPS angle was 3.68° ± 6.73° and the BM angle was 9.69° ± 5.05°. The PPS angle increased on average by 0.233 deg/y. A v-shaped PPS was significantly associated with age (β = 0.087, P = 0.004), peripapillary choroidal thickness (β = -0.479, P < 0.001), lamina cribrosa depth (β = 0.307, P < 0.001), and BM angle (β = 0.487, P < 0.001) after adjusting for best corrected visual acuity, central corneal thickness, and axial length. Conclusions The anterior surface of PPS of an elderly adult population had a v-shaped configuration and was more pronounced with increasing age, thin peripapillary choroid, and a deep cup. Such a change in shape with age could have an impact on the biomechanical environment of the optic nerve head.
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Affiliation(s)
- Tin A. Tun
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore
- Ophthalmic Engineering & Innovation Laboratory, Department of Biomedical Engineering, National University of Singapore, Singapore
| | - Xiaofei Wang
- Ophthalmic Engineering & Innovation Laboratory, Department of Biomedical Engineering, National University of Singapore, Singapore
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Mani Baskaran
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
| | - Monisha E. Nongpiur
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
| | - Yih-Chung Tham
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore
| | - Shamira A. Perera
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
| | - Nicholas G. Strouthidis
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
- Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tin Aung
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Michaël J. A. Girard
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore
- Ophthalmic Engineering & Innovation Laboratory, Department of Biomedical Engineering, National University of Singapore, Singapore
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Patel MD, Malhotra K, Shirazi Z, Moss HE. Methods for Quantifying Optic Disc Volume and Peripapillary Deflection Volume Using Radial Optical Coherence Tomography Scans and Association With Intracranial Pressure. Front Neurol 2019; 10:798. [PMID: 31396151 PMCID: PMC6668216 DOI: 10.3389/fneur.2019.00798] [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: 03/21/2019] [Accepted: 07/10/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose: Papilledema and peripapillary deformation of Bruch's membrane (BM) are associated with elevated intracranial pressure (ICP). We have developed a novel methodology to measure these parameters using a radial optical coherence tomography (OCT) scan pattern and apply this to test the hypothesis that ICP is associated with volumetric features of ophthalmic structures. Methods: 6-radial OCT B-scans centered over the optic nerve head were acquired in 17 subjects (30 eyes) before lumbar puncture with measurement of ICP (range: 10–55 cm H2O). Internal limiting membrane (ILM) and BM were segmented. Three definitions of BM were studied to account for imaging artifact affecting peripapillary BM: connecting rater-identified BM margins(traditional), connecting rater-identified BM 1.6 mm on either side of the ONH(estimated), and excluding BM in the central 3.2 mm of the images(excluded). Optic nerve head volume (ONHV), BM displacement volume (BMDV) and cup volume (CV) were calculated by interpolating between B-scans. Ganglion cell complex volume (GCCV) was measured in the macula. Linear generalized estimating equations (GEE) modeled ONVH, BMDV, and CV as a function of ICP and GCCV. Results: Increased ONHV was associated with elevated ICP for traditional (p = 0.006), estimated (p = 0.003) and excluded (p = 0.05) BM definitions. Decreased BMDV was associated with elevated ICP for traditional (p < 0.0005), estimated (p < 0.0005) and excluded (p = 0.001) definitions. Decreased ONHV was independently associated with decreased GCCV (p = 0.001) and decreased ICP (p = 0.031) in multivariable models. CV was neither associated with ICP nor GCCV in univariate or multivariable models. Conclusions: Elevated ICP is associated with ONHV increase and BMDV decrease, calculated from OCT images accounting for image artifact. Ganglion cell atrophy affects the relationship between ICP and ONHV. OCT derived volumetric measures of the posterior eye may have application as biomarkers for elevated ICP.
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Affiliation(s)
- Megh Dipak Patel
- Department of Ophthalmology, Stanford University, Palo Alto, CA, United States
| | - Kiran Malhotra
- Department of Ophthalmology and Visual Sciences, University of Illinois College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Zainab Shirazi
- Department of Ophthalmology and Visual Sciences, University of Illinois College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Heather E Moss
- Department of Ophthalmology, Stanford University, Palo Alto, CA, United States.,Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, United States
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Wang Y, Chen D, Yang W, Cui Q, Hou W, Han W, Huang X, Lu W, Yuan Z, Yuan J, Teng Y, Qiu J. Primary Acute Angle-Closure Glaucoma: Three-Dimensional Reconstruction Imaging of Optic Nerve Heard Structure in Based on Optical Coherence Tomography (OCT). Med Sci Monit 2019; 25:3647-3654. [PMID: 31096262 PMCID: PMC6536034 DOI: 10.12659/msm.913541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background In glaucoma, the cup to plate ratio enlargement is a recognized pathological phenomenon. At present, the research on optic nerve in China and abroad mainly focuses on 2-dimensional research, and the measurement of 3-dimensional volume data is less well studied. Therefore, the recognition of 3-dimensional morphological changes is conducive to timely clinical intervention to prevent or slow down progressive vision loss. Material/Methods In this paper, optical coherence tomography (OCT) volume imaging technology was used to analyze and compare the morphological changes of primary acute angle-closure glaucoma in three-dimensional morphology, reconstruct the volume data of three-dimensional optic nerve head (ONH), and make morphological measurements. Results The rim width of the glaucoma group was significantly lower than that of the control group, and the average volume and intraocular pressure of the optic cup were significantly increased (P<0.05), while the rim width and intraocular pressure of the other group were not significantly changed (P>0.05). Conclusions We used three-dimensional reconstruction to identify OCT images between glaucoma patients and the control group with significant differences.
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Affiliation(s)
- Yi Wang
- Department of Ophthalmology, Taishan Medical University, Taian, Shandong, China (mainland).,Department of Optometry, Taishan Medical University, Taian, Shandong, China (mainland)
| | - Di Chen
- Department of Optometry, Taishan Medical University, Taian, Shandong, China (mainland)
| | - Wen Yang
- Department of Radiology, Taishan Medical University, Taian, Shandong, China (mainland)
| | - Qianqian Cui
- Beijing Youan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Weijie Hou
- Department of Radiology, Taishan Medical University, Taian, Shandong, China (mainland)
| | - Wenhui Han
- Department of Ophthalmology, Taishan Medical University, Taian, Shandong, China (mainland).,Department of Optometry, Taishan Medical University, Taian, Shandong, China (mainland)
| | - Xiaohua Huang
- Department of Radiology, Taishan Medical University, Taian, Shandong, China (mainland)
| | - Wen Lu
- Department of Ophthalmology, Taishan Medical University, Taian, Shandong, China (mainland)
| | - Zilong Yuan
- Department of Radiology, Hubei Cancer Hospital, Wuhan, Hubei, China (mainland)
| | - Jiumin Yuan
- Department of Optometry, Taishan Medical University, Taian, Shandong, China (mainland)
| | - Yufang Teng
- Department of Optometry, Taishan Medical University, Taian, Shandong, China (mainland)
| | - Jianfeng Qiu
- Department of Radiology, Taishan Medical University, Shangdong, China (mainland)
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Malhotra K, Patel MD, Shirazi Z, Moss HE. Association Between Peripapillary Bruch's Membrane Shape and Intracranial Pressure: Effect of Image Acquisition Pattern and Image Analysis Method, a Preliminary Study. Front Neurol 2018; 9:1137. [PMID: 30622510 PMCID: PMC6308322 DOI: 10.3389/fneur.2018.01137] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 12/10/2018] [Indexed: 11/28/2022] Open
Abstract
Background/Aims: High intracranial pressure (ICP) is associated with changes in peripapillary Bruch's membrane (pBM) shape on optical coherence tomography (OCT) images of the optic nerve head. It is not known if image acquisition pattern and analysis method impact this association. Materials and Methods: Cross sectional OCT scans of the optic nerve head were obtained at six angles using a radial scan pattern in 21 subjects immediately prior to ICP measurement via lumbar puncture. On each image, Bruch's membrane was manually segmented and defined by either 14 or 16 semi-landmarks and either rater identified, or distance identified boundaries. For each of these four image analysis strategies, geometric morphometric analysis identified the first principal component of Bruch's membrane shape for all images and for the set of images taken at each angle. Repeated measures ANOVA of the first principal component magnitude (PC1) for all images assessed for shape difference between image angles. Linear generalized estimating equation models assessed association between angle specific first principal component magnitudes (PC1) and ICP for each angle. Receiver operating characteristic analysis assessed angle specific PC1s' ability to differentiate elevated from normal ICP. Results: The first principal component represented deflection into the vitreous for all scan angles, but quantitatively differed across scan angles (p < 0.005, repeated measures ANOVA). Angle specific first principal components were positively correlated with ICP (p < 0.005 for all angles, generalized estimating equation models). All angle specific first principal components showed excellent ability to classify ICP (area under curve ≥ 0.8 for all). These results were independent from image analysis strategy. Discussion: Though qualitative changes in Bruch's membrane shape are similar regardless of cross-sectional angle of the 2-D OCT scan, they differ quantitatively between OCT scan angles, meaning that pBM is not axially symmetric and therefore PC1 extracted from different 2-D scan angles can't be compared between individuals. However, we do not identify an optimal scan angle for classification of ICP since there is a similarly strong linear relationship between the first principal component of shape and ICP and angle specific first principal components of Bruch's membrane shape showed similarly excellent ability to differentiate elevated from normal ICP. The results support development of Bruch's membrane shape extracted from 2-D cross sectional optic nerve head OCT scans as a biomarker of ICP and emphasize the importance of consistency of scan angle. This is relevant for developing diagnostic protocols that use OCT to detect high ICP states.
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Affiliation(s)
- Kiran Malhotra
- Department of Ophthalmology & Visual Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Megh D Patel
- Department of Ophthalmology, Stanford University, Palo Alto, CA, United States
| | - Zainab Shirazi
- Department of Ophthalmology & Visual Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Heather E Moss
- Department of Ophthalmology, Stanford University, Palo Alto, CA, United States.,Department Neurology & Neurological Sciences, Stanford University, Stanford, CA, United States
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Chen M, Gee JC, Prince JL, Aguirre GK. 2D Modeling and Correction of Fan-beam Scan Geometry in OCT. COMPUTATIONAL PATHOLOGY AND OPHTHALMIC MEDICAL IMAGE ANALYSIS : FIRST INTERNATIONAL WORKSHOP, COMPAY 2018, AND 5TH INTERNATIONAL WORKSHOP, OMIA 2018, HELD IN CONJUNCTION WITH MICCAI 2018, GRANADA, SPAIN, SEPTEMBER 16-20, 2018, PROCEEDIN... 2018; 11039:328-335. [PMID: 31131377 DOI: 10.1007/978-3-030-00949-6_39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A-scan acquisitions in OCT images are acquired in a fan-beam pattern, but saved and displayed in a rectangular space. This results in an inaccurate representation of the scan geometry of OCT images, which introduces systematic distortions that can greatly impact shape and morphology based analysis of the retina. Correction of OCT scan geometry has proven to be a challenging task due to a lack of information regarding the true angle of entry of each A-scan through the pupil and the location of the A-scan nodal points. In this work, we present a preliminary model that solves for the OCT scan geometry in a restricted 2D setting. Our approach uses two repeat scans with corresponding landmarks to estimate the necessary parameters to correctly restore the fan-beam geometry of the input B-scans. Our results show accurate estimation of the ground truth geometry from simulated B-scans, and we found qualitatively promising result when the correction was applied to longitudinal B-scans of the same subject. We establish a robust 2D framework that can potentially be expanded for full 3D estimation and correction of OCT scan geometries.
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Affiliation(s)
- Min Chen
- Department of Radiology, University of Pennsylvania, Philadelphia PA 19104, USA
| | - James C Gee
- Department of Radiology, University of Pennsylvania, Philadelphia PA 19104, USA
| | - Jerry L Prince
- Department of ECE, Johns Hopkins University, Baltimore M D 21218, USA
| | - Geoffrey K Aguirre
- Department of Neurology, University of Pennsylvania, Philadelphia PA 19104, USA
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Comparison of cross sectional optical coherence tomography images of elevated optic nerve heads across acquisition devices and scan protocols. EYE AND VISION 2018; 5:17. [PMID: 30009195 PMCID: PMC6045831 DOI: 10.1186/s40662-018-0112-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/28/2018] [Indexed: 11/29/2022]
Abstract
Background Optic nerve head measurements extracted from optical coherence tomography (OCT) show promise for monitoring clinical conditions with elevated optic nerve heads. The aim of this study is to compare reliability within and between raters and between image acquisition devices of optic nerve measurements derived from OCT scans in eyes with varying degrees of optic nerve elevation. Methods Wide angle line scans and narrow angle radial scans through optic nerve heads were obtained using three spectral domain(SD) OCT devices on 5 subjects (6 swollen optic nerves, 4 normal optic nerves). Three raters independently semi-manually segmented the internal limiting membrane(ILM) and Bruch’s membrane(BM) on each scan using customized software. One rater segmented each scan twice. Segmentations were qualitatively and quantitatively compared. Inter-rater, intra-rater and inter-device reliability was assessed for the optic nerve cross sectional area calculated from the ILM and BM segmentations using intraclass correlation coefficients and graphical comparison. Results Line scans from all devices were qualitatively similar. Radial scans for which frame rate could not be adjusted were of lower quality. Intra-rater reliability for segmentation and optic nerve cross sectional area was better than inter-rater reliability, which was better than inter-device reliability, though all ICC exceeded 0.95. Reliability was not impacted by the degree of optic nerve elevation. Conclusions SD-OCT devices acquired similar quality scans of the optic nerve head, with choice of scan protocol affecting the quality. For image derived markers, variability between devices was greater than that attributable to inter and intra-rater differences.
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Chan NCY, Chan CKM. The Role of Optical Coherence Tomography in the Acute Management of Neuro-Ophthalmic Diseases. Asia Pac J Ophthalmol (Phila) 2018; 7:265-270. [PMID: 29938406 DOI: 10.22608/apo.2018181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Optical coherence tomography (OCT) can provide high-speed and high-resolution images of the anatomical structures of the optic nerve head and macula. However, in neuro-ophthalmic conditions that present acutely, structural changes lag functional deficits, and the role of OCT in the acute setting has been challenged. This review aims to summarize the recent literature and evidence supporting the use of OCT in the acute management of some common neuro-ophthalmic scenarios, including the differential diagnosis of optic disc swelling, and in patients with suspected papilledema, optic neuritis, ischemic optic neuropathies, and Leber hereditary optic neuropathy. The limitations of OCT are also discussed.
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Affiliation(s)
- Noel C Y Chan
- Hong Kong Eye Hospital, Hong Kong
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong
| | - Carmen K M Chan
- Hong Kong Eye Hospital, Hong Kong
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong
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Sibony PA, Wei J, Sigal IA. Gaze-Evoked Deformations in Optic Nerve Head Drusen: Repetitive Shearing as a Potential Factor in the Visual and Vascular Complications. Ophthalmology 2018; 125:929-937. [PMID: 29361354 DOI: 10.1016/j.ophtha.2017.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 11/30/2017] [Accepted: 12/04/2017] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To determine if ocular ductions deform intrapapillary and peripapillary tissues in optic nerve head drusen (ONHD) and to compare these deformations with healthy eyes and eyes with other optic neuropathies. DESIGN Observational case series. PARTICIPANTS Twenty patients with ONHD. METHODS Axial rasters of the optic nerve from a spectral-domain OCT device (Cirrus 5000; Carl Zeiss Meditec, Inc, Dublin, CA) were used to analyze the shape of the peripapillary basement membrane (ppBM) layer in 20 confirmed cases of ONHD. We compared registered images obtained from 2 eye positions: 10° to 15° in adduction and 30° to 40° in abduction. Geometric morphometrics was used to analyze the shape of the ppBM layer defined by placing 10 equidistant landmarks extending 2500 μm on both sides of the basement membrane opening. We also adapted an image strain tracking technique to measure regional intrapapillary strains in 6 patients. Using manually placed nodes on the reference image (in adduction), an iterative, block-matching algorithm is used to determine local displacements between the reference and its paired image in abduction. Displacement vectors were used to calculate the mean shear and effective strain (percent change). MAIN OUTCOME MEASURES Peripapillary shape deformations, intrapapillary shear strains, and effective strains. RESULTS We found a statistically significant difference in the shape of the ppBM layer between abduction and adduction (P < 0.01). The deformation was characterized by a relative posterior displacement temporally in adduction that reversed in abduction. Strain tracking in all 6 patients showed substantial gaze-induced shearing and effective strains. Mean effective strains were 7.5% outside the drusen. Shear and effective strains were significantly larger outside versus within the drusen (P < 0.003 and P < 0.01, respectively). CONCLUSIONS This study demonstrates that horizontal ocular ductions induce significant shearing deformations of the peripapillary retina and prelaminar intrapapillary tissues. We also found that the deformations in healthy persons are similar in magnitude to ONHD. Based on these findings, we speculate that patients with intrapapillary calcifications exposed to the long-term effects of repetitive shearing (induced by ocular ductions) may contribute to the progressive axonal loss and vascular complications associated with ONHD.
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Affiliation(s)
- Patrick A Sibony
- Department of Ophthalmology, State University of New York Stony Brook, Stony Brook, New York.
| | - Junchao Wei
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ian A Sigal
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Thompson AC, Bhatti MT, El-Dairi MA. Bruch's membrane opening on optical coherence tomography in pediatric papilledema and pseudopapilledema. J AAPOS 2018; 22:38-43.e3. [PMID: 29203329 DOI: 10.1016/j.jaapos.2017.09.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 08/29/2017] [Accepted: 09/17/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine whether the diameter of Bruch's membrane opening (BMO) can distinguish mild papilledema from pseudopapilledema using optical coherence tomography (OCT). METHODS The medical records of pediatric patients with pseudopapilledma due to optic nerve head (ONH) drusen, patients with papilledema, and normal control subjects were retrospectively reviewed. All eyes underwent OCT imaging of the BMO and retinal nerve fiber layer (RNFL). Transverse horizontal diameter of the BMO and papillary height were measured. Mean BMO, papillary height, and RNFL were compared and receiver operating characteristic (ROC) curves were used to calculate the area under the curve (AUC) and determine BMO and RNFL cut-offs for papilledema and pseudopapilledema. RESULTS A total of 90 eyes of 90 subjects were included: 58 with pseudopapilledema, 19 with papilledema, and 13 controls. In eyes with papilledema, mean BMO, papillary height, and RNFL decreased as papilledema resolved (1893.8 vs 1582.2 [P = 0.0003], 193.0 vs 108.9 [P < 0.0001], 893.3 vs 695.5 [P = 0.0007], resp.). Eyes with mild papilledema had greater mean BMO and RNFL than those with pseudopapilledema and controls (1893.8 vs 1541.9 vs 1628.8 [P < 0.0001, P = 0.0265] and 193.0 vs 108.7 vs 104.1 [P < 0.0001, P < 0.0001], resp.). Papillary height in mild papilledema was similar to pseudopapilledema but greater than controls (893.3 vs 863.2 vs 593.5 [P = 0.47 and P = 0.0001], resp.). ROC showed good diagnostic discrimination for BMO (AUC = 0.81; 95% CI, 0.70-0.92) and RNFL (AUC = 0.96; 95% CI, 0.93-1.0) in distinguishing mild papilledema from pseudopapilledema. CONCLUSIONS The horizontal transverse diameter of BMO is enlarged in eyes with mild papilledema and narrows as papilledema resolves. BMO and RNFL can be used together to help distinguish mild papilledema from pseudopapilledema in children.
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Affiliation(s)
- Atalie C Thompson
- Department of Ophthalmology, Duke Eye Center and Duke University Medical Center, Durham, North Carolina
| | - M Tariq Bhatti
- Department of Ophthalmology, Duke Eye Center and Duke University Medical Center, Durham, North Carolina; Department of Neurology, Duke Eye Center and Duke University Medical Center, Durham, North Carolina; Department of Neurosurgery, Duke Eye Center and Duke University Medical Center, Durham, North Carolina
| | - Mays A El-Dairi
- Department of Ophthalmology, Duke Eye Center and Duke University Medical Center, Durham, North Carolina.
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Wang JK, Kardon RH, Ledolter J, Sibony PA, Kupersmith MJ, Garvin MK. Peripapillary Retinal Pigment Epithelium Layer Shape Changes From Acetazolamide Treatment in the Idiopathic Intracranial Hypertension Treatment Trial. Invest Ophthalmol Vis Sci 2017; 58:2554-2565. [PMID: 28492874 PMCID: PMC5425231 DOI: 10.1167/iovs.16-21089] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Recent studies indicate that the amount of deformation of the peripapillary retinal pigment epithelium and Bruch's membrane (pRPE/BM) toward or away from the vitreous may reflect acute changes in cerebrospinal fluid pressure. The study purpose is to determine if changes in optic-nerve-head (ONH) shape reflect a treatment effect (acetazolamide/placebo + weight management) using the optical coherence tomography (OCT) substudy of the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT) at baseline, 3, and 6 months. Methods The pRPE/BM shape deformation was quantified and compared with ONH volume, peripapillary retinal nerve fiber layer (pRNFL), and total retinal (pTR) thicknesses in the acetazolamide group (39 subjects) and placebo group (31 subjects) at baseline, 3, and 6 months. Results Mean changes of the pRPE/BM shape measure were significant and in the positive direction (away from the vitreous) for the acetazolamide group (P < 0.01), but not for the placebo group. The three OCT measures reflecting the reduction of optic disc swelling were significant in both treatment groups but greater in the acetazolamide group (P < 0.01). Conclusions Change in the pRPE/BM shape away from the vitreous reflects the effect of acetazolamide + weight management in reducing the pressure differential between the intraocular and retrobulbar arachnoid space. Weight management alone was also associated with a decrease in optic nerve volume/edema but without a significant change in the pRPE/BM shape, implying an alternative mechanism for improvement in papilledema and axoplasmic flow, independent of a reduction in the pressure differential. (ClinicalTrials.gov number, NCT01003639.)
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Affiliation(s)
- Jui-Kai Wang
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, Iowa, United States
| | - Randy H Kardon
- Iowa City VA Health Care System and Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States 3Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, Iowa, United States
| | - Johannes Ledolter
- Iowa City VA Health Care System and Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States 4Department of Management Sciences/Department of Statistics and Actuarial Science, The University of Iowa, Iowa City, Iowa, United States
| | - Patrick A Sibony
- Department of Ophthalmology, University Hospital and Medical Center, SUNY Stony Brook, Stony Brook, New York, United States
| | - Mark J Kupersmith
- Icahn School of Medicine at Mount Sinai and New York Eye and Ear Infirmary, New York, New York, United States
| | - Mona K Garvin
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa City, Iowa, United States 2Iowa City VA Health Care System and Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States
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Chang MY, Velez FG, Demer JL, Bonelli L, Quiros PA, Arnold AC, Sadun AA, Pineles SL. Accuracy of Diagnostic Imaging Modalities for Classifying Pediatric Eyes as Papilledema Versus Pseudopapilledema. Ophthalmology 2017; 124:1839-1848. [PMID: 28732589 DOI: 10.1016/j.ophtha.2017.06.016] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 06/13/2017] [Accepted: 06/14/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To identify the most accurate diagnostic imaging modality for classifying pediatric eyes as papilledema (PE) or pseudopapilledema (PPE). DESIGN Prospective observational study. SUBJECTS Nineteen children between the ages of 5 and 18 years were recruited. Five children (10 eyes) with PE, 11 children (19 eyes) with PPE owing to suspected buried optic disc drusen (ODD), and 3 children (6 eyes) with PPE owing to superficial ODD were included. METHODS All subjects underwent imaging with B-scan ultrasonography, fundus photography, autofluorescence, fluorescein angiography (FA), optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL), and volumetric OCT scans through the optic nerve head with standard spectral-domain (SD OCT) and enhanced depth imaging (EDI OCT) settings. Images were read by 3 masked neuro-ophthalmologists, and the final image interpretation was based on 2 of 3 reads. Image interpretations were compared with clinical diagnosis to calculate accuracy and misinterpretation rates of each imaging modality. MAIN OUTCOME MEASURES Accuracy of each imaging technique for classifying eyes as PE or PPE, and misinterpretation rates of each imaging modality for PE and PPE. RESULTS Fluorescein angiography had the highest accuracy (97%, 34 of 35 eyes, 95% confidence interval 92%-100%) for classifying an eye as PE or PPE. FA of eyes with PE showed leakage of the optic nerve, whereas eyes with suspected buried ODD demonstrated no hyperfluorescence, and eyes with superficial ODD showed nodular staining. Other modalities had substantial likelihood (30%-70%) of misinterpretation of PE as PPE. CONCLUSIONS The best imaging technique for correctly classifying pediatric eyes as PPE or PE is FA. Other imaging modalities, if used in isolation, are more likely to lead to misinterpretation of PE as PPE, which could potentially result in failure to identify a life-threatening disorder causing elevated intracranial pressure and papilledema.
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Affiliation(s)
- Melinda Y Chang
- Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California; Stein Eye Institute, University of California, Los Angeles, Los Angeles, California; Doheny Eye Institute, University of California, Los Angeles, Los Angeles, California
| | - Federico G Velez
- Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California; Stein Eye Institute, University of California, Los Angeles, Los Angeles, California; Doheny Eye Institute, University of California, Los Angeles, Los Angeles, California; Olive View-UCLA Medical Center, University of California, Los Angeles, Los Angeles, California
| | - Joseph L Demer
- Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California; Stein Eye Institute, University of California, Los Angeles, Los Angeles, California; Department of Neurology, University of California, Los Angeles, Los Angeles, California; Department of Neuroscience, University of California, Los Angeles, Los Angeles, California; Bioengineering Interdepartmental Programs, University of California, Los Angeles, Los Angeles, California
| | - Laura Bonelli
- Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California; Stein Eye Institute, University of California, Los Angeles, Los Angeles, California
| | - Peter A Quiros
- Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California; Doheny Eye Institute, University of California, Los Angeles, Los Angeles, California
| | - Anthony C Arnold
- Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California; Stein Eye Institute, University of California, Los Angeles, Los Angeles, California
| | - Alfredo A Sadun
- Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California; Doheny Eye Institute, University of California, Los Angeles, Los Angeles, California
| | - Stacy L Pineles
- Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California; Stein Eye Institute, University of California, Los Angeles, Los Angeles, California.
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Gampa A, Vangipuram G, Shirazi Z, Moss HE. Quantitative Association Between Peripapillary Bruch's Membrane Shape and Intracranial Pressure. Invest Ophthalmol Vis Sci 2017; 58:2739-2745. [PMID: 28549088 PMCID: PMC5455169 DOI: 10.1167/iovs.17-21592] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose The purpose of this study was to determine if there is a quantitative relationship between chronic intracranial pressure (ICP) and peripapillary Bruch's membrane (pp-BM) shape and to determine whether change in pp-BM shape can be detected within 1 hour after ICP lowering by lumbar puncture (LP). Methods In this study, 30° nasal-temporal optical coherence tomography B-scans were obtained within 1 hour before and after LP in 39 eyes from 20 patients (age = 23–86 years, 75% female, ICP [opening pressure] = 10–55 cm H2O). A total of 16 semi-landmarks defined pp-BM on each image. Geometric morphometric analysis identified principal components of shape in the image set. Generalized estimating equation models, accounting for within-subject correlation, were used to identify principal components that were associated with chronic ICP (comparing pre-LP images between eyes) and/or acute ICP changes (comparing pre- and post-LP images within eyes). The pp-BM width and anterior pp-BM location were calculated directly from each image and were studied in the same manner. Results Principal component 1 scalar variable on pre-LP images was associated with ICP (P < 0.0005). Principal component 4 magnitude changed within eyes after LP (P = 0.003). For both principal components 1 and 4, lower ICP corresponded with a more posterior position of pp-BM. Chronic ICP was associated with both pp-BM width (6.81 μm/cm H2O; P = 0.002) and more anterior location of temporal and nasal pp-BM margins (3.41, 3.49 μm/cm H2O; P < 0.0005, 0.002). Conclusions This study demonstrates a quantitative association between pp-BM shape and chronic ICP level. Changes in pp-BM shape are detectable within 1 hour of lowering ICP. pp-BM shape may be a useful marker for chronic ICP level and acute ICP changes. Further study is needed to determine how pp-BM shape changes relate to clinical markers of papilledema.
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Affiliation(s)
- Amulya Gampa
- Department of Ophthalmology & Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Gautam Vangipuram
- Department of Ophthalmology & Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Zainab Shirazi
- Department of Ophthalmology & Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Heather E Moss
- Department of Ophthalmology, Stanford University, Palo Alto, California, United States
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Abstract
Idiopathic intracranial hypertension (IIH) is a disorder of elevated intracranial pressure of unknown cause occurring predominantly in young women of childbearing age. The typical patient symptom profile is the presence of daily headache, pulse synchronous tinnitus, transient visual obscurations, and papilledema with its associated visual loss. Although surgical procedures are performed for those who fail medical therapy, their relative efficacy remains unclear. The main morbidity of IIH is from visual loss. This visual loss is present in most patients and can usually be reversed if recognized early in the patients' course and treated.
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Crowded optic nerve head evaluation with optical coherence tomography in anterior ischemic optic neuropathy. Eye (Lond) 2017; 31:1191-1198. [PMID: 28387764 DOI: 10.1038/eye.2017.56] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 02/12/2017] [Indexed: 02/05/2023] Open
Abstract
PurposeTo characterize the optic nerve head (ONH) structure in patients with non-arteritic anterior ischemic optic neuropathy (NAION) compared to healthy control subjects using spectral domain optical coherence tomography (SD-OCT) via the enhanced depth imaging method.MethodsIn this prospective, cross-sectional, comparative study, we assessed 66 eyes of 33 patients with unilateral NAION and 31 eyes of 31 healthy normal subjects in an academic institution. The peripapillary nerve fiber layer thickness, disc area, and quantitative parameters of the ONH structures, including the Bruch's membrane opening (BMO) area, anterior laminar depth, and prelaminar thickness and depth were compared between the three groups.ResultsLinear mixed model analysis after adjusting for age, sex, and axial length showed that the BMO area was similar in eyes with NAION (1.89±0.33 mm2), their fellow eyes (1.85±0.35 mm2), and control eyes (1.88±0.37 mm2; all P>0.99). Anterior laminar depth was also similar in the three groups. The mean prelaminar tissue thickness of the NAION eyes was 445±176 μm, which was thinner than the prelaminar tissue of their unaffected fellow eyes (mean, 539±227 μm, P=0.004), but both were thicker than the prelaminar tissue of the normal subjects (mean 243±145 μm, P=0.001 and P<0.001, respectively).ConclusionsThe thick prelaminar thickness is associated with unilateral NAION in the affected and unaffected eyes.
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Kupersmith MJ, Sibony PA, Feldon SE, Wang JK, Garvin M, Kardon R. The Effect of Treatment of Idiopathic Intracranial Hypertension on Prevalence of Retinal and Choroidal Folds. Am J Ophthalmol 2017; 176:77-86. [PMID: 28040526 PMCID: PMC5376523 DOI: 10.1016/j.ajo.2016.12.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/16/2016] [Accepted: 12/19/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE We described 3 types of folds in the retina and a crease in the outer retina associated with papilledema owing to idiopathic intracranial hypertension (IIH) at presentation. We report the change in folds relative to treatment of IIH over the 6 months. METHODS In this substudy of a randomized clinical trial, study eyes of subjects assigned to acetazolamide (ACZ, n = 44) or placebo (PLB, n = 43) had spectral-domain optical coherence tomography (SDOCT) images of the optic disc and macula regions at baseline and at 3 and 6 months. Images were evaluated for peripapillary wrinkles (PPW), retinal folds (RF), choroidal folds (CF), and creases using transaxial and en face views. The optic nerve head (ONH) shape, retinal nerve fiber layer (RNFL) thickness, ONH volume, and papilledema grade were measured. Outcome was determination of the presence or absence of PPW, RF, CF, and creases. RESULTS At presentation, except for an increase of PPW in ACZ eyes (64% vs 28%), both treatment groups were matched for all OCT features. At 6 months, ACZ-treated, but not PLB-treated, eyes had fewer folds of all types (P < .01), with a 57% reduction in frequency of RF. Creases did not resolve. Resolution of RF, but not of PPW and CF, was associated with significant reduction in RNFL thickness, ONH volume, and papilledema grade. CONCLUSIONS The various types of retinal folds associated with papilledema reflect biodynamic processes and show an ACZ treatment effect. Persistence of these folds despite marked improvement in ONH swelling suggests permanent changes in the affected retinal tissues.
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Affiliation(s)
- Mark J Kupersmith
- Mount Sinai West Hospital, New York, New York; New York Eye and Ear Infirmary and Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Patrick A Sibony
- Department of Ophthalmology, State University of New York at Stony Brook, Stony Brook, New York
| | - Steven E Feldon
- Department of Ophthalmology, University of Rochester School of Medicine & Dentistry, Rochester, New York
| | - Jui-Kai Wang
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa
| | - Mona Garvin
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa
| | - Randy Kardon
- Department of Ophthalmology and Vision Sciences, Iowa City VA Health Care System, Iowa City, Iowa
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Abstract
Ocular or eye pain is a frequent complaint encountered not only by eye care providers but neurologists. Isolated eye pain is non-specific and non-localizing; therefore, it poses significant differential diagnostic problems. A wide range of neurologic and ophthalmic disorders may cause pain in, around, or behind the eye. These include ocular and orbital diseases and primary and secondary headaches. In patients presenting with an isolated and chronic eye pain, neuroimaging is usually normal. However, at the beginning of a disease process or in low-grade disease, the eye may appear "quiet," misleading a provider lacking familiarity with underlying disorders and high index of clinical suspicion. Delayed diagnosis of some neuro-ophthalmic causes of eye pain could result in significant neurologic and ophthalmic morbidity, conceivably even mortality. This article reviews some recent advances in imaging of the eye, the orbit, and the brain, as well as research in which neuroimaging has advanced the discovery of the underlying pathophysiology and the complex differential diagnosis of eye pain.
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Chang MY, Shin A, Park J, Nagiel A, Lalane RA, Schwartz SD, Demer JL. Deformation of Optic Nerve Head and Peripapillary Tissues by Horizontal Duction. Am J Ophthalmol 2017; 174:85-94. [PMID: 27751810 DOI: 10.1016/j.ajo.2016.10.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/03/2016] [Accepted: 10/06/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE To ascertain deformation of the optic nerve head (ONH) and peripapillary tissues caused by horizontal duction. DESIGN Prospective, experimental study. METHODS Optical coherence tomography of the ONH region was performed in 23 eyes of 12 normal volunteers in central gaze and increasing (10, 20, and 30 degrees) adduction and abduction. Main outcome measures were changes from central gaze in the configuration of the ONH and peripapillary tissues in eccentric gazes. RESULTS Adduction but not abduction was associated with significant, progressive relative posterior displacement of the temporal peripapillary retinal pigment epithelium (tRPE) from its position in central gaze reaching 49 ± 10 μm in 30-degree adduction (standard error of mean, P < .0001). Absolute (anterior or posterior) optic cup displacement (OCD) averaged 41 ± 7 μm in 30-degree adduction. Linear regression showed significant effect of adduction on absolute OCD (slope 1.09 ± 0.36 μm/degree, P = .0037). In 20-degree and 30-degree adduction, all eyes exhibited significant progressive temporal ONH tilting reaching 3.1 ± 0.4 degrees in 30-degree adduction (P < .0001). Abduction was not associated with significant peripapillary RPE displacement, OCD, or ONH tilt. Both nasal and temporal peripapillary choroid averaged 9-19 μm thinner in adduction and abduction than in central gaze (P < .02). CONCLUSIONS Adduction temporally tilts and displaces the prelaminar ONH and peripapillary tissues. Both adduction and abduction compress the peripapillary choroid. These effects support magnetic resonance imaging and biomechanical evidence that adduction imposes strain on the ONH and peripapillary tissues. Repetitive strain from eye movements over decades might in susceptible individuals lead to optic neuropathies such as normal tension glaucoma.
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Abstract
A 64-year-old woman, with a history of diabetes and melanoma, developed a central retinal vein occlusion (CRVO) in her left eye. On exam, she had severe disc edema with retinal nerve fiber layer thickening, and anterior deformation of the peripapillary retinal pigment epithelium (RPE)/Bruch membrane layer (ppRPE/BM) toward the vitreous on spectral domain optical coherence tomography (SD-OCT) suggesting an optic nerve sheath (ONS) meningioma. Magnetic resonance imaging findings and ONS biopsy later confirmed a metastatic melanoma. This case demonstrates that the shape of the RPE/BM on SD-OCT may aid in the decision to consider imaging in patients with isolated CRVO.
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Wall M, Johnson CA, Cello KE, Zamba KD, McDermott MP, Keltner JL. Visual Field Outcomes for the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT). Invest Ophthalmol Vis Sci 2016; 57:805-12. [PMID: 26934136 PMCID: PMC4777274 DOI: 10.1167/iovs.15-18626] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose The Idiopathic Intracranial Hypertension Treatment Trial (IIHTT) showed that acetazolamide provided a modest, significant improvement in mean deviation (MD). Here, we further analyze visual field changes over the 6-month study period. Methods Of 165 subjects with mild visual loss in the IIHTT, 125 had perimetry at baseline and 6 months. We evaluated pointwise linear regression of visual sensitivity versus time to classify test locations in the worst MD (study) eye as improving or not; pointwise changes from baseline to month 6 in decibels; and clinical consensus of change from baseline to 6 months. Results The average study eye had 36 of 52 test locations with improving sensitivity over 6 months using pointwise linear regression, but differences between the acetazolamide and placebo groups were not significant. Pointwise results mostly improved in both treatment groups with the magnitude of the mean change within groups greatest and statistically significant around the blind spot and the nasal area, especially in the acetazolamide group. The consensus classification of visual field change from baseline to 6 months in the study eye yielded percentages (acetazolamide, placebo) of 7.2% and 17.5% worse, 35.1% and 31.7% with no change, and 56.1% and 50.8% improved; group differences were not statistically significant. Conclusions In the IIHTT, compared to the placebo group, the acetazolamide group had a significant pointwise improvement in visual field function, particularly in the nasal and pericecal areas; the latter is likely due to reduction in blind spot size related to improvement in papilledema. (ClinicalTrials.gov number, NCT01003639.)
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Affiliation(s)
- Michael Wall
- Department of Neurology, University of Iowa, Iowa City, Iowa, United States 2Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
| | - Chris A Johnson
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
| | - Kimberly E Cello
- Department of Ophthalmology and Vision Science, University of California Davis, Davis, California, United States
| | - K D Zamba
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, United States
| | - Michael P McDermott
- Departments of Biostatistics and Computational Biology and Neurology, University of Rochester Medical Center, Rochester, New York, United States
| | - John L Keltner
- Department of Ophthalmology and Vision Science, University of California Davis, Davis, California, United States 6Department of Neurology and Neurological Surgery, University of California Davis, Davis, California, United States
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Christopher M, Abràmoff MD, Tang L, Gordon MO, Kass MA, Budenz DL, Fingert JH, Scheetz TE. Stereo Photo Measured ONH Shape Predicts Development of POAG in Subjects With Ocular Hypertension. Invest Ophthalmol Vis Sci 2015; 56:4470-9. [PMID: 26193923 DOI: 10.1167/iovs.14-16142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To identify objective, quantitative optic nerve head (ONH) structural features and model the contributions of glaucoma. METHODS Baseline stereoscopic optic disc images of 1635 glaucoma-free participants at risk for developing primary open-angle glaucoma (POAG) were collected as part of the Ocular Hypertension Treatment Study. A stereo correspondence algorithm designed for fundus images was applied to extract the three-dimensional (3D) information about the ONH. Principal component analysis was used to identify ONH 3D structural features and the contributions of demographic features, clinical variables, and disease were modeled using linear regression and linear component analysis. The computationally identified features were evaluated based on associations with glaucoma and ability to predict which participants would develop POAG. RESULTS The computationally identified features were significantly associated with future POAG, POAG-related demographics (age, ethnicity), and clinical measurements (horizontal and vertical cup-to-disc ratio, central corneal thickness, and refraction). Models predicting future POAG development using the OHTS baseline data and STEP features achieved an AUC of 0.722 in cross-validation testing. This was a significant improvement over using only demographics (age, sex, and ethnicity), which had an AUC of 0.599. CONCLUSIONS Methods for identifying objective, quantitative measurements of 3D ONH structure were developed using a large dataset. The identified features were significantly associated with POAG and POAG-related variables. Further, these features increased predictive model accuracy in predicting future POAG. The results indicate that the computationally identified features might be useful in POAG early screening programs or as endophenotypes to investigate POAG genetics.
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Affiliation(s)
- Mark Christopher
- Stephen A. Wynn Institute for Vision Research, University of Iowa, Iowa City, Iowa, United States 2Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, United States
| | - Michael D Abràmoff
- Stephen A. Wynn Institute for Vision Research, University of Iowa, Iowa City, Iowa, United States 2Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, United States 3Department of Electrical and Computer Engineering, University of I
| | - Li Tang
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
| | - Mae O Gordon
- Division of Biostatistics, Washington University, St. Louis, Missouri, United States 7Department of Ophthalmology and Visual Sciences, Washington University, St. Louis, Missouri, United States
| | - Michael A Kass
- Department of Ophthalmology and Visual Sciences, Washington University, St. Louis, Missouri, United States
| | - Donald L Budenz
- Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina, United States
| | - John H Fingert
- Stephen A. Wynn Institute for Vision Research, University of Iowa, Iowa City, Iowa, United States 4Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
| | - Todd E Scheetz
- Stephen A. Wynn Institute for Vision Research, University of Iowa, Iowa City, Iowa, United States 2Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, United States 4Department of Ophthalmology and Visual Sciences, University of Iow
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Sibony PA, Kupersmith MJ, Feldon SE, Wang JK, Garvin M. Retinal and Choroidal Folds in Papilledema. Invest Ophthalmol Vis Sci 2015; 56:5670-80. [PMID: 26335066 PMCID: PMC4562343 DOI: 10.1167/iovs.15-17459] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 12/12/2015] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To determine the frequency, patterns, associations, and biomechanical implications of retinal and choroidal folds in papilledema due to idiopathic intracranial hypertension (IIH). METHODS Retinal and choroidal folds were studied in patients enrolled in the IIH Treatment Trial using fundus photography (n = 165 study eyes) and spectral-domain optical coherence tomography (SD-OCT; n = 125). We examined the association between folds and peripapillary shape, retinal nerve fiber layer (RNFL) thickness, disc volume, Frisén grade, acuity, perimetric mean deviation, intraocular pressure, intracranial pressure, and refractive error. RESULTS We identified three types of folds in IIH patients with papilledema: peripapillary wrinkles (PPW), retinal folds (RF), and choroidal folds (CF). Frequency, with photos, was 26%, 19%, and 1%, respectively; SD-OCT frequency was 46%, 47%, and 10%. At least one type of fold was present in 41% of patients with photos and 73% with SD-OCT. Spectral-domain OCT was more sensitive. Structural parameters related to the severity of papilledema were associated with PPW and RF, whereas anterior deformation of the peripapillary RPE/basement membrane layer was associated with CF and RF. Folds were not associated with vision loss at baseline. CONCLUSIONS Folds in papilledema are biomechanical signs of stress/strain on the optic nerve head and load-bearing structures induced by intracranial hypertension. Folds are best imaged with SD-OCT. The patterns of retinal and choroidal folds are the products of a complex interplay between the degree of papilledema and anterior deformation of the load-bearing structures (sclera and possibly the lamina cribrosa), both modulated by structural geometry and material properties of the optic nerve head. (ClinicalTrials.gov number, NCT01003639.).
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Affiliation(s)
- Patrick A. Sibony
- Department of Ophthalmology State University of New York at Stony Brook, Stony Brook, New York, United States
| | - Mark J. Kupersmith
- Hyman-Newman Institute for Neurosurgery, Roosevelt Hospital, New York, New York, United States; and the New York Eye and Ear Infirmary, New York, New York, United States
| | - Steven E. Feldon
- Department of Ophthalmology, Flaum Eye Institute, University of Rochester School of Medicine & Dentistry, Rochester, New York, United States
| | - Jui-Kai Wang
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, United States; and Iowa City VA Health Care System, Iowa City, Iowa, United States
| | - Mona Garvin
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, United States; and Iowa City VA Health Care System, Iowa City, Iowa, United States
| | - OCT Substudy Group for the NORDIC Idiopathic Intracranial Hypertension Treatment Trial
- Department of Ophthalmology State University of New York at Stony Brook, Stony Brook, New York, United States
- Hyman-Newman Institute for Neurosurgery, Roosevelt Hospital, New York, New York, United States; and the New York Eye and Ear Infirmary, New York, New York, United States
- Department of Ophthalmology, Flaum Eye Institute, University of Rochester School of Medicine & Dentistry, Rochester, New York, United States
- Department of Electrical and Computer Engineering, University of Iowa, Iowa City, Iowa, United States; and Iowa City VA Health Care System, Iowa City, Iowa, United States
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Kupersmith MJ. Optical imaging of the optic nerve: beyond demonstration of retinal nerve fiber layer loss. J Neuroophthalmol 2015; 35:210-9. [PMID: 25893873 DOI: 10.1097/wno.0000000000000248] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although we are still early in the evolution of optical imaging of the optic nerve, the available techniques already play an important role in clinical decision making. I would summarize our findings to date as follows: For acute ON: Presentation: OCT shows RNFL swelling, normal GCL + IPL by OCT; 1 month: OCT and SLP show RNFL thinning and swelling, GCL + IPL thinning by OCT; 3 months or later: OCT and SLP show RNFL thinning, further mild GCL thinning by OCT; 6 months: RNFL and GCL + IPL thinning finished. For acute NAION: Presentation: OCT shows RNFL swelling and SLP shows loss of birefringence, normal GCL + IPL by OCT; 1 month: RNFL swelling and thinning by OCT and thinning by SLP, GCL + IPL thinning by OCT; 3 months or later: RNFL and further mild GCL + IPL thinning; 6 months: RNFL and GCL + IPL thinning finished. For IIH Papilledema with mild vision loss: Presentation: OCT shows swelling of RNFL, TRT, and ONH volume; Presentation: OCT shows normal GCL + IPL; Presentation: OCT shows neural canal border inward deflection; 6 months: OCT shows structural shape changes reflecting the effectiveness of treatment.
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Affiliation(s)
- Mark J Kupersmith
- New York Eye and Ear Infirmary, Mount Sinai Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, New York, New York
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Abstract
BACKGROUND Grading of papilledema severity is subjective and based on monocular fundus features of the optic nerve. Interobserver agreement on grading the severity of papilledema is poor among expert observers, even using well-defined criteria such as the Frisen scale, which is a non-continuous ordinal scale of grading. Furthermore, non-expert clinicians often find it difficult to properly view and interpret features of the optic nerve using ophthalmoscopy, which can lead to failure to diagnose papilledema in non-ophthalmologic care settings. This may delay treatment, which can result in vision loss. Distinguishing papilledema from pseudopapilledema can also be difficult when surface drusen are not easily identified. Once papilledema is diagnosed, it is often difficult to determine whether a reduction in optic nerve edema is due solely to improvement in the status of the nerve or whether this represents concomitant loss of axons and viable retinal ganglion cells, leading to a poor visual outcome. Timely advancement of treatment would occur if loss of neurons could be diagnosed at an earlier stage of evaluation while optic disc edema is still present. This review will critically assess the role of optical coherence tomography (OCT) in solving these problems by providing an advanced imaging approach for diagnosis of papilledema and evaluating its severity on a continuous scale and evaluating the causes of visual loss in the setting of a swollen nerve. METHODS ACQUISITION The published literature (PubMed) was reviewed from 2000 to 2014 on the use of OCT for diagnosing papilledema, differentiating it from pseudopapilledema, providing a continuous scale of its severity and in evaluating causes of visual loss. RESULTS Recent evidence shows that OCT analysis of the retinal nerve fiber layer and retinal ganglion cell layer in papilledema can be associated with misleading artifacts due to layer segmentation failures. Newer 3D algorithms using neighboring locations help to overcome these problems. Disc volume appears to be a promising continuous measure of papilledema that is robust and has less associated artifacts. Buried optic disc drusen can be identified using enhanced depth OCT imaging, but recent studies have shown poor ability to differentiate papilledema from pseudopapilledema using OCT when the degree of disc evaluation is similar. Analysis of the retinal ganglion cell layer shows promise of early detection of vision loss due to neuronal injury. Subretinal fluid is easily identified with OCT and can help to identify a potentially reversible component of vision loss. Newer OCT imaging methods will allow the definition of capillaries and flow within them in and around the optic nerve head. CONCLUSIONS Currently, the most useful OCT derived features relevant to papilledema are disc volume, subretinal fluid, buried disc drusen, and thickness of the retinal ganglion cell layer.
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Avery RA, Rajjoub RD, Trimboli-Heidler C, Waldman AT. Applications of optical coherence tomography in pediatric clinical neuroscience. Neuropediatrics 2015; 46:88-97. [PMID: 25803824 PMCID: PMC4436151 DOI: 10.1055/s-0035-1549098] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
For nearly two centuries, the ophthalmoscope has permitted examination of the retina and optic nerve-the only axons directly visualized by the physician. The retinal ganglion cells project their axons, which travel along the innermost retina to form the optic nerve, marking the beginning of the anterior visual pathway. Both the structure and function of the visual pathway are essential components of the neurologic examination as it can be involved in numerous acquired, congenital and genetic central nervous system conditions. The development of optical coherence tomography now permits the pediatric neuroscientist to visualize and quantify the optic nerve and retinal layers with unprecedented resolution. As optical coherence tomography becomes more accessible and integrated into research and clinical care, the pediatric neuroscientist may have the opportunity to utilize and/or interpret results from this device. This review describes the basic technical features of optical coherence tomography and highlights its potential clinical and research applications in pediatric clinical neuroscience including optic nerve swelling, optic neuritis, tumors of the visual pathway, vigabatrin toxicity, nystagmus, and neurodegenerative conditions.
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Affiliation(s)
- Robert A. Avery
- The Gilbert Family Neurofibromatosis Institute, Children’s National Health System, Washington, District of Columbia, United States,Department of Neurology, Children’s National Health System, Washington, District of Columbia, United States,Department of Ophthalmology, Children’s National Health System, Washington, District of Columbia, United States,Department of Pediatrics, Children’ s National Health System, Washington, District of Columbia, United States,Center for Neuroscience and Behavior, Children’s National Health System, Washington, District of Columbia, United States
| | - Raneem D. Rajjoub
- George Washington University School of Medicine, Washington, District of Columbia, United States
| | - Carmelina Trimboli-Heidler
- The Gilbert Family Neurofibromatosis Institute, Children’s National Health System, Washington, District of Columbia, United States
| | - Amy T. Waldman
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
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Optical coherence tomography shape analysis of the peripapillary retinal pigment epithelium layer in presumed optic nerve sheath meningiomas. J Neuroophthalmol 2014; 34:130-6. [PMID: 24625774 DOI: 10.1097/wno.0000000000000107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Geometric morphometrics (GM) was used to compare the shape of the peripapillary retinal pigment epithelium-Bruch's membrane (ppRPE) layer imaged on spectral domain optical coherence tomography (SD-OCT) of patients with presumed optic nerve sheath meningiomas (pONSM) and normal subjects. METHODS We compared 2 groups: 30 normals to 10 patients (11 eyes) with pONSM. We digitized 20 equidistant semi-landmarks on OCT images of the ppRPE-layer, spanning 2500 μm on each side of the neural canal opening (NCO). Data were analyzed using standard GM techniques including a generalized least squares Procrustes superimposition, principal component analysis (PCA), thin-plate spline, and permutation statistical analysis to evaluate differences in shape. We also analyzed other variables with respect to shape including tumor size-proximity to the globe, age, retinal nerve fiber layer, and optic disc height. RESULTS All pONSM patients were female (age 37-66 years); 10 had unilateral and 1 had bilateral optic nerve involvement. Ten of the eyes had optic disc edema at presentation, 4 went on to develop shunt vessels, and 4 had optic atrophy. The ppRPE-layer bordering the NCO in normals is V-shaped pointing away from the vitreous; the ppRPE-layer in pONSM is indented causing an inverted-U shaped deformation skewed nasally toward the vitreous. PCA showed a significant difference between normals and pONSM (permutation, n = 10,000, P = 0.001). The size and proximity of the tumor to the globe correlates with the shape of the ppRPE-layer (r = 0.75, P = 0.04). Correlation between shape variables and RNFL thickening (r = 0.51), optic disc height (r = 0.67), and age (r = 0.67) were not statistically significant. CONCLUSION The shape of the RPE layer in pONSM is characterized by an inverted-U shape or indentation that differs significantly from normals. It is indistinguishable from the shape we previously reported in papilledema and is not caused by disc edema. The mechanism in pONSM is unknown but may involve a change in the compliance of the nerve and/or localized sequestration of cerebrospinal fluid in the distal optic nerve sheath.
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