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Balas M, Issa M, Popovic MM, Moayad L, Zajner C, Aponte PO, Hamli H, Yan P, Wright T, Melo IM, Muni RH. ADAPTIVE OPTICS IMAGING IN DIABETIC RETINOPATHY: A Prospective Cohort Study. Retina 2024; 44:1115-1123. [PMID: 38478760 DOI: 10.1097/iae.0000000000004088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
PURPOSE To investigate the correlation between diabetic retinopathy (DR) severity and microscopic retinal and vascular alterations using adaptive optics imaging. METHODS In this single-center, prospective cohort study, adult participants with healthy eyes or DR underwent adaptive optics imaging. Participants were classified into control/mild nonproliferative DR, moderate/severe nonproliferative DR, and proliferative DR. Adaptive optics imaging using the RTX1 camera was obtained from 48 participants (87 eyes) for photoreceptor data and from 36 participants (62 eyes) for vascular data. RESULTS Photoreceptor parameters significantly differed between DR groups at 2° and 4° of retinal eccentricity. Wall-to-lumen ratio varied significantly at 2° eccentricity, while other vascular parameters remained nonsignificant. Cone density and dispersion were the strongest predictors for DR severity ( P < 0.001) in multivariable generalized estimating equation modeling, while other vascular parameters remained nonsignificant between DR severity groups. All photoreceptor parameters showed significant correlations with visual acuity overall and across most DR severity groups. CONCLUSION To date, this is one of the largest studies evaluating the use of adaptive optics imaging in DR. Adaptive optics imaging was demonstrated to differentiate between various levels of disease severity in DR. These results support the potential role in diagnostic and therapeutic microstructural evaluation in research and clinical practice.
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Affiliation(s)
- Michael Balas
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mariam Issa
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Lana Moayad
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Chris Zajner
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Paola Oquendo Aponte
- Department of Ophthalmology, McMaster University, Hamilton, Ontario, Canada
- Department of Ophthalmology, Unity Health Toronto, Toronto, Ontario, Canada; and
| | - Hesham Hamli
- Department of Ophthalmology, Unity Health Toronto, Toronto, Ontario, Canada; and
| | - Peng Yan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Kensington Eye Institute, Toronto, Ontario, Canada
| | - Tom Wright
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Kensington Eye Institute, Toronto, Ontario, Canada
| | - Isabela M Melo
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, Unity Health Toronto, Toronto, Ontario, Canada; and
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, Unity Health Toronto, Toronto, Ontario, Canada; and
- Kensington Eye Institute, Toronto, Ontario, Canada
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Johnson DA, Doble N, Choi SS. Quantitative Analysis of the Vasculature and Cone Photoreceptors in Subjects With Diabetes Without Diabetic Retinopathy. Curr Eye Res 2024; 49:650-662. [PMID: 38407181 DOI: 10.1080/02713683.2024.2320787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/13/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE To characterize any differences in the vasculature and cone photoreceptor packing geometry (CPG) between subjects with diabetes without/no diabetic retinopathy (NDR) and healthy controls. METHODS Eight NDR and five controls were enrolled. Optical coherence tomography angiography (OCTA) taken at the macula was used to measure vessel density, vessel length density, and vessel density index (VDI) in three vascular plexuses, namely, the superficial vascular plexus, intermediate capillary plexus, and deep capillary plexus (DCP). The choriocapillaris (CC) flow deficit (FD) was also measured. OCTA images were binarized and processed to extrapolate the parafovea and parafoveal quadrants and the OCTA indices mentioned above. The CC was processed with six different radii to quantify FD. Adaptive optics - scanning laser ophthalmoscopy images were acquired and processed to extract CPG indices, i.e., cone density (CD), cone-to-cone spacing (CS), linear dispersion index, heterogeneity packing index and percent of cells with six neighbors at 3.6° in the temporal retina. RESULTS In all eyes, statistically significant differences were found (i) in parafoveal FD across the six radii (p < 0.001) and (ii) in the correlation between the parafoveal temporal quadrant (PTQ) DCP VDI and CS (r = 0.606, p = 0.048). No other significant correlations were found. For OCTA or CPG indices, no significant differences were found between the cohorts in the parafovea or parafoveal quadrants. CONCLUSIONS CS is the most sensitive CPG index for detecting alterations in the cone mosaic. The DCP and the cone photoreceptors are significantly correlated, indicating that alterations in the DCP can affect the cones. Future work elucidating the vascular alterations and neurodegeneration present in diabetic eyes should focus on the DCP and multiple CPG indices, not solely CD. Moreover, such alterations are highly localized, hence using larger regions e.g. parafovea versus smaller areas, such as the PTQ, will potentially mask significant correlations.
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Affiliation(s)
- Danae A Johnson
- College of Optometry, The Ohio State University, Columbus, OH, USA
| | - Nathan Doble
- College of Optometry, The Ohio State University, Columbus, OH, USA
- Department of Ophthalmology and Vision Science, Havener Eye Institute, The Ohio State University, Columbus, OH, USA
| | - Stacey S Choi
- College of Optometry, The Ohio State University, Columbus, OH, USA
- Department of Ophthalmology and Vision Science, Havener Eye Institute, The Ohio State University, Columbus, OH, USA
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Matuszewski W, Szklarz M, Wołos-Kłosowicz K, Harazny JM, Bandurska-Stankiewicz E. High-Resolution Imaging of Cones and Retinal Arteries in Patients with Diabetes Mellitus Type 1 Using Adaptive Optics (rtx1). Biomedicines 2024; 12:863. [PMID: 38672217 PMCID: PMC11048079 DOI: 10.3390/biomedicines12040863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/27/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background. Diabetes mellitus (DM), called the first non-infectious epidemic of the modern era, has long-term health consequences leading to a reduced quality of life, long-term disabilities, and high mortality. Diabetic retinopathy (DR) is a neurovascular complication of diabetes and accounts for about 80% cases of vision loss in the diabetic population. The adaptive optics (AO) technique allows for a non-invasive in vivo assessment of retinal cones. Changes in number or morphology of retinal cones may be one of the first indicators of DR. (2) Methods. This study included 68 DM1 patients (17 women) aged 42.11 ± 9.69 years with a mean duration of diabetes of 22.07 ± 10.28 years, and 41 healthy volunteers (20 women) aged 41.02 ± 9.84 years. Blood pressure, BMI, waist circumference, and metabolic control measures were analysed. Cones' morphological parameters were examined with a retinal camera with Imagine Eyes adaptive optics (rtx1). Statistical analysis was carried out with IMB SPSS version 23 software. (3) Results. Neither study group differed significantly in age, BMI, blood pressure, or eyeball length. Intraocular pressure (IOP) was statistically significantly higher in DM1 patients but remained within physiological range in both groups. Analysis of cone parameters showed a statistically significant lower mean regularity of cones (Rmean) in the DM1 group compared to control group (p = 0.01), with the lowest value in the group with DM1 and hypertension (p = 0.014). In addition, DM1 patients tended to have fewer cones. (4) Conclusions. Our study revealed abnormalities in cone and vessel parameters and these abnormalities should be considered as risk factors for the development of DR. Complementing an eye examination with AO facilitates non-invasive in vivo cellular imaging of the retina. Lesions like those detected in the eye may occur in the brain and certainly require further investigation.
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Affiliation(s)
- Wojciech Matuszewski
- Clinic of Endocrinology, Diabetology and Internal Medicine, Department of Internal Medicine, University of Warmia and Mazury, 10−082 Olsztyn, Poland
| | - Michał Szklarz
- Clinic of Endocrinology, Diabetology and Internal Medicine, Department of Internal Medicine, University of Warmia and Mazury, 10−082 Olsztyn, Poland
| | - Katarzyna Wołos-Kłosowicz
- Clinic of Endocrinology, Diabetology and Internal Medicine, Department of Internal Medicine, University of Warmia and Mazury, 10−082 Olsztyn, Poland
| | - Joanna Maria Harazny
- . Department of Human Physiology and Pathophysiology, University of Warmia and Mazury, 10−082 Olsztyn, Poland;
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University Erlangen Nuremberg (FAU), 91054 Erlangen, Germany
| | - Elżbieta Bandurska-Stankiewicz
- Clinic of Endocrinology, Diabetology and Internal Medicine, Department of Internal Medicine, University of Warmia and Mazury, 10−082 Olsztyn, Poland
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Huang RS, Mihalache A, Popovic MM, Munn C, Balas M, Issa M, Melo IM, Friedman A, Wright T, Yan P, Muni RH. ASSOCIATION OF INTRAVENOUS FLUORESCEIN ANGIOGRAPHY AND ADAPTIVE OPTICS IMAGING IN DIABETIC RETINOPATHY: A Prospective Case Series. Retina 2024; 44:689-699. [PMID: 38011843 DOI: 10.1097/iae.0000000000004012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
PURPOSE To our knowledge, we present the first case series investigating the relationship between adaptive optics (AO) imaging and intravenous fluorescein angiography (IVFA) parameters in patients with diabetic retinopathy. METHODS Consecutive patients with diabetic retinopathy older than age 18 years presenting to a single center in Toronto, Canada, from 2020 to 2021 were recruited. Adaptive optics was performed with the RTX1 camera (Imagine Eyes, Orsay, France) at retinal eccentricities of 2° and 4°. Intravenous fluorescein angiography was assessed with the artificial intelligence-based RETICAD system to extract blood flow, perfusion, and blood-retinal-barrier (BRB) permeability at the same retinal locations. Correlations between AO and IVFA parameters were calculated using Pearson's correlation coefficient. RESULTS Across nine cases, a significant positive correlation existed between photoreceptor spacing on AO and BRB permeability (r = 0.303, P = 0.027), as well as perfusion (r = 0.272, P = 0.049) on IVFA. When stratified by location, a significant positive correlation between photoreceptor dispersion and both BRB permeability and perfusion (r = 0.770, P = 0.043; r = 0.846, P = 0.034, respectively) was observed. Cone density was also negatively correlated with BRB permeability (r = -0.819, P = 0.046). CONCLUSION Photoreceptor spacing on AO was significantly correlated with BRB permeability and perfusion on IVFA in patients with diabetic retinopathy. Future studies with larger sample sizes are needed to understand the relationship between AO and IVFA parameters in diverse patient populations.
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Affiliation(s)
- Ryan S Huang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Mihalache
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Colyn Munn
- Emagix Inc, Halifax, Nova Scotia, Canada
- Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Balas
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mariam Issa
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Isabela Martins Melo
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Alon Friedman
- Emagix Inc, Halifax, Nova Scotia, Canada
- Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Tom Wright
- Kensington Vision and Research Centre, Kensington Eye Institute, Toronto, Ontario, Canada; and
| | - Peng Yan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Kensington Vision and Research Centre, Kensington Eye Institute, Toronto, Ontario, Canada; and
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
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Kitahata S, Gocho K, Motozawa N, Yokota S, Yamamoto M, Maeda A, Hirami Y, Kurimoto Y, Kadonosono K, Takahashi M. Evaluation of photoreceptor features in retinitis pigmentosa with cystoid macular edema by using an adaptive optics fundus camera. PLoS One 2024; 19:e0296493. [PMID: 38166083 PMCID: PMC10760661 DOI: 10.1371/journal.pone.0296493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/14/2023] [Indexed: 01/04/2024] Open
Abstract
OBJECTIVE Cystoid macular edema (CME) in retinitis pigmentosa (RP) is an important complication causing visual dysfunction. We investigated the effect of CME on photoreceptors in RP patients with previous or current CME, using an adaptive optics (AO) fundus camera. METHODS We retrospectively observed the CME and ellipsoid zone (EZ) length (average of horizontal and vertical sections) by optical coherence tomography. The density and regularity of the arrangement of photoreceptor cells (Voronoi analysis) were examined at four points around 1.5° from superior to inferior and temporal to nasal. We also performed a multivariate analysis using CME duration, central macular thickness and transversal length of CME. RESULTS We evaluated 18 patients with previous or current CME (18 eyes; age, 48.7 ± 15.6 years) and 24 patients without previous or current CME (24 eyes; age, 46.0 ± 14.5 years). There were no significant differences in age, logMAR visual acuity, or EZ length. In groups with and without CME, cell density was 11967 ± 3148 and 16239 ± 2935 cells/mm2, and sequence regularity was 85.5 ± 3.4% and 88.5 ± 2.8%, respectively; both parameters were significantly different. The correlation between photoreceptor density and age was more negative in group with CME. The CME group tended toward greater reductions in duration of CME. CONCLUSION Complications of CME in RP patients may lead to a decrease in photoreceptor density and regularity. Additionally, a longer duration of CME may result in a greater reduction in photoreceptor density.
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Affiliation(s)
- Shohei Kitahata
- Kobe City Eye Hospital, Chuo-ku, Kobe, Japan
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Minami-ku, Yokohama, Japan
- Department of Ophthalmology, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Japan
| | - Kiyoko Gocho
- Kobe City Eye Hospital, Chuo-ku, Kobe, Japan
- Inserm and Quinze-Vingts National Ophthalmology Hospital, Paris, France
| | - Naohiro Motozawa
- RIKEN Center for Biosystems Dynamics Research, Chuo-ku, Kobe, Japan
| | - Satoshi Yokota
- Kobe City Eye Hospital, Chuo-ku, Kobe, Japan
- Department of Ophthalmology, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Japan
| | | | - Akiko Maeda
- Kobe City Eye Hospital, Chuo-ku, Kobe, Japan
| | - Yasuhiko Hirami
- Kobe City Eye Hospital, Chuo-ku, Kobe, Japan
- Department of Ophthalmology, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Japan
| | - Yasuo Kurimoto
- Kobe City Eye Hospital, Chuo-ku, Kobe, Japan
- Department of Ophthalmology, Kobe City Medical Center General Hospital, Chuo-ku, Kobe, Japan
| | - Kazuaki Kadonosono
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Minami-ku, Yokohama, Japan
| | - Masayo Takahashi
- Kobe City Eye Hospital, Chuo-ku, Kobe, Japan
- RIKEN Center for Biosystems Dynamics Research, Chuo-ku, Kobe, Japan
- Vision Care Inc., Chuo-ku, Kobe, Japan
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Kupis M, Wawrzyniak ZM, Szaflik JP, Zaleska-Żmijewska A. Retinal Photoreceptors and Microvascular Changes in the Assessment of Diabetic Retinopathy Progression: A Two-Year Follow-Up Study. Diagnostics (Basel) 2023; 13:2513. [PMID: 37568876 PMCID: PMC10417253 DOI: 10.3390/diagnostics13152513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND With the increasing global incidence of diabetes mellitus (DM), diabetic retinopathy (DR) has become one of the leading causes of blindness in developed countries. DR leads to changes in retinal neurons and microcirculation. Rtx1TM (Imagine Eyes, Orsay, France) is a retinal camera that allows histological visualisations of cones and retinal microcirculation throughout the DM duration. OBJECTIVE This study aimed to analyse the cones and retinal microvascular changes in 50 diabetic individuals and 18 healthy volunteers. The patients participated in the initial visit and two follow-up appointments, one and two years after the study, beginning with Rtx1TM image acquisition, visual acuity assessment, macular OCT scans and blood measurements. RESULTS The study revealed significant differences in the cone density, mosaic arrangement and vascular morphology between healthy and diabetic patients. The final measurements showed decreased photoreceptor and microvascular parameters in the DR group compared with the control group. Furthermore, in the 2-year follow-up, both groups' Rtx1TM-acquired morphological changes were statistically significant. CONCLUSIONS Rtx1TM technology was successfully used as a non-invasive method of photoreceptors and retinal vasculature assessment over time in patients with diabetic retinopathy. The study revealed a trend toward more vascular morphological changes occurring over time in diabetic patients.
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Affiliation(s)
- Magdalena Kupis
- Department of Ophthalmology, SPKSO Ophthalmic Hospital, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Zbigniew M. Wawrzyniak
- Faculty of Electronics and Information Technology, Warsaw University of Technology, 00-665 Warsaw, Poland
| | - Jacek P. Szaflik
- Department of Ophthalmology, SPKSO Ophthalmic Hospital, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Anna Zaleska-Żmijewska
- Department of Ophthalmology, SPKSO Ophthalmic Hospital, Medical University of Warsaw, 02-097 Warsaw, Poland
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7
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Fickweiler W, Mitzner M, Jacoba CMP, Sun JK. Circulatory Biomarkers and Diabetic Retinopathy in Racial and Ethnic Populations. Semin Ophthalmol 2023:1-11. [PMID: 36710371 DOI: 10.1080/08820538.2023.2168488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Clinical staging systems for diagnosis and treatment of diabetic retinopathy (DR) must closely relate to endpoints that are both relevant for patients and feasible for physicians to implement. Current DR staging systems for clinical eye care and research provide detailed phenotypic characterization to predict patient outcomes in diabetes but have limitations. Biochemical biomarkers provide a rich pool of potential candidates for new DR staging systems that can be readily measured in accessible fluids. Circulating biomarkers that are specific to the retina and relate to angiogenesis and inflammation have been suggested as relevant for DR. Although there is a lack of multi-ethnic studies evaluating circulatory biomarkers in DR, variability in circulatory biomarkers have been reported in people from different ethnic and racial backgrounds. Therefore, there is a need for future studies to evaluate individual or combinations of biomarkers in diverse populations with DR from different ethnic and racial backgrounds.
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Affiliation(s)
- Ward Fickweiler
- Research Division, Joslin Diabetes Center, Boston, MA, USA.,Beetham Eye Institute, Joslin Diabetes Center, Boston, MA, USA.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Margalit Mitzner
- Research Division, Joslin Diabetes Center, Boston, MA, USA.,Beetham Eye Institute, Joslin Diabetes Center, Boston, MA, USA
| | - Cris Martin P Jacoba
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA, USA.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Jennifer K Sun
- Research Division, Joslin Diabetes Center, Boston, MA, USA.,Beetham Eye Institute, Joslin Diabetes Center, Boston, MA, USA.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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8
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Morgan JIW, Chui TYP, Grieve K. Twenty-five years of clinical applications using adaptive optics ophthalmoscopy [Invited]. BIOMEDICAL OPTICS EXPRESS 2023; 14:387-428. [PMID: 36698659 PMCID: PMC9841996 DOI: 10.1364/boe.472274] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/22/2022] [Accepted: 11/27/2022] [Indexed: 05/02/2023]
Abstract
Twenty-five years ago, adaptive optics (AO) was combined with fundus photography, thereby initiating a new era in the field of ophthalmic imaging. Since that time, clinical applications of AO ophthalmoscopy to investigate visual system structure and function in both health and disease abound. To date, AO ophthalmoscopy has enabled visualization of most cell types in the retina, offered insight into retinal and systemic disease pathogenesis, and been integrated into clinical trials. This article reviews clinical applications of AO ophthalmoscopy and addresses remaining challenges for AO ophthalmoscopy to become fully integrated into standard ophthalmic care.
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Affiliation(s)
- Jessica I. W. Morgan
- Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA 19104, USA
- Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Contributed equally
| | - Toco Y. P. Chui
- Department of Ophthalmology, The New York Eye and Ear Infirmary of Mount Sinai, New York, NY 10003, USA
- Contributed equally
| | - Kate Grieve
- Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17 rue Moreau, and CHNO des Quinze-Vingts, INSERM-DGOS CIC 1423, 28 rue de Charenton, F-75012 Paris, France
- Contributed equally
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9
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Fickweiler W, Park H, Park K, Mitzner MG, Chokshi T, Boumenna T, Gautier J, Zaitsu Y, Wu IH, Cavallerano J, Aiello LP, Sun JK, King GL. Elevated Retinol Binding Protein 3 Concentrations Are Associated With Decreased Vitreous Inflammatory Cytokines, VEGF, and Progression of Diabetic Retinopathy. Diabetes Care 2022; 45:2159-2162. [PMID: 35852358 PMCID: PMC9472483 DOI: 10.2337/dc22-0165] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/10/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To correlate inflammatory cytokines and vascular endothelial growth factor (VEGF) in vitreous and plasma with vitreous retinol binding protein 3 (RBP3), diabetic retinopathy (DR) severity, and DR worsening in a population with type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS RBP3, VEGF, and inflammatory cytokines were measured in plasma and vitreous samples (n = 205) from subjects of the Joslin Medalist Study and Beetham Eye Institute. RESULTS Higher vitreous RBP3 concentrations were associated with less severe DR (P < 0.0001) and a reduced risk of developing proliferative DR (PDR) (P < 0.0001). Higher RBP3 correlated with increased photoreceptor segment thickness and lower vitreous interleukin-12 (IL-12), tumor necrosis factor-α (TNF-α), and TNF-β (P < 0.05). PDR was associated with lower vitreous interferon-γ and IL-10 and higher VEGF, IL-6, and IL-15 (P < 0.05), but was not associated with their plasma concentrations. CONCLUSIONS Higher vitreous RBP3 concentrations are associated with less severe DR and slower rates of progression to PDR, supporting its potential as a biomarker and therapeutic agent for preventing DR worsening, possibly by lowering retinal VEGF and inflammatory cytokines.
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Affiliation(s)
- Ward Fickweiler
- Research Division, Joslin Diabetes Center, Boston, MA
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
- Department of Ophthalmology, Harvard Medical School, Boston, MA
| | - Hyunseok Park
- Research Division, Joslin Diabetes Center, Boston, MA
| | | | - Margalit G. Mitzner
- Research Division, Joslin Diabetes Center, Boston, MA
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
| | - Tanvi Chokshi
- Research Division, Joslin Diabetes Center, Boston, MA
| | | | - John Gautier
- Research Division, Joslin Diabetes Center, Boston, MA
| | - Yumi Zaitsu
- Research Division, Joslin Diabetes Center, Boston, MA
| | - I-Hsien Wu
- Research Division, Joslin Diabetes Center, Boston, MA
| | - Jerry Cavallerano
- Research Division, Joslin Diabetes Center, Boston, MA
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
- Department of Ophthalmology, Harvard Medical School, Boston, MA
| | - Lloyd P. Aiello
- Research Division, Joslin Diabetes Center, Boston, MA
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
- Department of Ophthalmology, Harvard Medical School, Boston, MA
| | - Jennifer K. Sun
- Research Division, Joslin Diabetes Center, Boston, MA
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
- Department of Ophthalmology, Harvard Medical School, Boston, MA
| | - George L. King
- Research Division, Joslin Diabetes Center, Boston, MA
- Department of Ophthalmology, Harvard Medical School, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
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10
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The Role of Medical Image Modalities and AI in the Early Detection, Diagnosis and Grading of Retinal Diseases: A Survey. Bioengineering (Basel) 2022; 9:bioengineering9080366. [PMID: 36004891 PMCID: PMC9405367 DOI: 10.3390/bioengineering9080366] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022] Open
Abstract
Traditional dilated ophthalmoscopy can reveal diseases, such as age-related macular degeneration (AMD), diabetic retinopathy (DR), diabetic macular edema (DME), retinal tear, epiretinal membrane, macular hole, retinal detachment, retinitis pigmentosa, retinal vein occlusion (RVO), and retinal artery occlusion (RAO). Among these diseases, AMD and DR are the major causes of progressive vision loss, while the latter is recognized as a world-wide epidemic. Advances in retinal imaging have improved the diagnosis and management of DR and AMD. In this review article, we focus on the variable imaging modalities for accurate diagnosis, early detection, and staging of both AMD and DR. In addition, the role of artificial intelligence (AI) in providing automated detection, diagnosis, and staging of these diseases will be surveyed. Furthermore, current works are summarized and discussed. Finally, projected future trends are outlined. The work done on this survey indicates the effective role of AI in the early detection, diagnosis, and staging of DR and/or AMD. In the future, more AI solutions will be presented that hold promise for clinical applications.
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11
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Sener H, Gulmez Sevim D, Erkilic K, Oner A, Gunay Sener AB. Evaluation of Ring Amplitude and Factors Affecting Ring Amplitude in Multifocal Electroretinography in Diabetic Eyes. Semin Ophthalmol 2022; 37:895-901. [PMID: 35834721 DOI: 10.1080/08820538.2022.2100714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE The aim of this paper was to evaluate the ring amplitudes in diabetic patients and to evaluate the effect of the risk factors for diabetic retinopathy on the ring amplitudes. We also aimed to investigate the success of ring amplitudes in classifying diabetic retinopathy. METHODS The study included 32 eyes of 32 diabetic patients without retinopathy (DM), 34 eyes of 34 patients with mild non-proliferative diabetic retinopathy (NPDR) without macular edema, and 62 eyes of 62 age- and sex-matched controls (CG). All subjects were evaluated using mfERG. The relationship between age, diabetes duration, HbA1c and ring amplitudes and the effect of diabetes and hypertension on ring amplitudes were evaluated. Three-way ROC analysis was performed to evaluate the discrimination power of the ring amplitudes. RESULTS In the comparison of the ring amplitudes, the amplitudes of the DM and NPDR groups were statistically significantly decreased compared to the CG (p < .05). A moderate to strong correlation was found between the duration of diabetes, HbA1c and ring amplitudes (p < .05). The effect of diabetes decreased towards the peripheral rings and hypertension did not affect ring amplitudes. Volume under the ROC surface of R1 = 0.65 had p < .05 and 95% CI [0.50-0.72], and the best cut-off point pair to differentiate the three classes was found to be c1 = 217.3, c2 = 151.2 in three-way ROC analysis. CONCLUSION In conclusion, the effects of diabetes are unevenly distributed on the retina topographically. Diabetes affects the central rings more than peripheral rings in multifocal ERG. Both ring densities and ring ratios are effective ways to identify early changes in retinal function.
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Affiliation(s)
- Hidayet Sener
- Department of Ophthalmology, Cukurca State Hospital, Hakkari, Turkey
| | - Duygu Gulmez Sevim
- Department of Ophthalmology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Kuddusi Erkilic
- Department of Ophthalmology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Ayse Oner
- Department of Ophthalmology, Acibadem Hospital, Kayseri, Turkey
| | - Ayse Busra Gunay Sener
- Department of Medical Informatics and Biostatistics, Erciyes University School of Medicine, Kayseri, Turkey
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12
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Elsner AE, Walker BR, Gilbert RN, Parimi V, Papay JA, Gast TJ, Burns SA. Cone Photoreceptors in Diabetic Patients. Front Med (Lausanne) 2022; 9:826643. [PMID: 35372411 PMCID: PMC8968172 DOI: 10.3389/fmed.2022.826643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Cones in diabetic patients are at risk due to metabolic and vascular changes. By imaging retinal vessel modeling at high magnification, we reduced its impact on cone distribution measurements. The retinal vessel images and retinal thickness measurements provided information about cone microenvironment. Methods We compared cone data in 10 diabetic subjects (28–78 yr) to our published norms from 36 younger and 10 older controls. All subjects were consented and tested in a manner approved by the Indiana University Institutional Review Board, which adhered to the Declaration of Helsinki. Custom adaptive optics scanning laser ophthalmoscopy (AOSLO) was used to image cones and retinal microcirculation. We counted cones in a montage of foveal and temporal retina, using four non-contiguous samples within 0.9–7 deg that were selected for best visibility of cones and least pathology. The data were fit with a two parameter exponential model: ln(cone density) = a * microns eccentricity + b. These results were compared to retinal thickness measurements from SDOCT. Results Diabetic cone maps were more variable than in controls and included patches, or unusually bright and dark cones, centrally and more peripherally. Model parameters and total cones within the central 14 deg of the macula differed across diabetic patients. Total cones fell into two groups: similar to normal for 5 vs. less than normal for 2 of 2 younger diabetic subjects and 3 older subjects, low but not outside the confidence limits. Diabetic subjects had all retinal vascular remodeling to varying degrees: microaneurysms; capillary thickening, thinning, or bends; and vessel elongation including capillary loops, tangles, and collaterals. Yet SD-OCT showed that no diabetic subject had a Total Retinal Thickness in any quadrant that fell outside the confidence limits for controls. Conclusions AOSLO images pinpointed widespread retinal vascular remodeling in all diabetic eyes, but the SDOCT showed no increased retinal thickness. Cone reflectivity changes were found in all diabetic patients, but significantly low cone density in only some. These results are consistent with early changes to neural, glial, or vascular components of the retinal without significant retinal thickening due to exudation.
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13
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Datlinger F, Wassermann L, Reumueller A, Hajdu D, Steiner I, Salas M, Drexler W, Pircher M, Schmidt-Erfurth U, Pollreisz A. Assessment of Detailed Photoreceptor Structure and Retinal Sensitivity in Diabetic Macular Ischemia Using Adaptive Optics-OCT and Microperimetry. Invest Ophthalmol Vis Sci 2021; 62:1. [PMID: 34605880 PMCID: PMC8496411 DOI: 10.1167/iovs.62.13.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to assess density and morphology of cone photoreceptors (PRs) and corresponding retinal sensitivity in ischemic compared to nonischemic retinal capillary areas of diabetic eyes using adaptive optics optical coherence tomography (AO-OCT) and microperimetry (MP). Methods In this cross-sectional, observational study five eyes of four patients (2 eyes with proliferative diabetic retinopathy (DR) and 3 eyes moderate nonproliferative DR) were included. PR morphology and density was manually assessed in AO-OCT en face images both at the axial position of the inner-segment outer segment (IS/OS) and cone outer segment tips (COSTs). Retinal sensitivity was determined by fundus-controlled microperimetry in corresponding areas (MP-3, Nidek). Results In AO-OCT, areas affected by capillary nonperfusion showed severe alterations of cone PR morphology at IS/OS and COST compared to areas with intact capillary perfusion (84% and 87% vs. 9% and 8% of area affected for IS/OS and COST, respectively). Mean reduction of PR signal density in affected areas compared to those with intact superficial capillary plexus (SCP) and deep capillary plexus (DCP) perfusion of similar eccentricity was -38% at the level of IS/OS (P = 0.01) and -39% at the level of COST (P = 0.01). Mean retinal sensitivity was 10.8 ± 5.4 in areas affected by DCP nonperfusion and 28.2 ± 1.5 outside these areas (P < 0.001). Conclusions Cone PR morphology and signal density are severely altered in areas of capillary nonperfusion. These structural changes are accompanied by a severe reduction of retinal sensitivity, indicating the importance of preventing impaired capillary circulation in patients with DR.
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Affiliation(s)
- Felix Datlinger
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Lorenz Wassermann
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Adrian Reumueller
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Dorottya Hajdu
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Irene Steiner
- Center of Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Matthias Salas
- Center of Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Drexler
- Center of Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Michael Pircher
- Center of Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Andreas Pollreisz
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
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Mateos-Olivares M, García-Onrubia L, Valentín-Bravo FJ, González-Sarmiento R, Lopez-Galvez M, Pastor JC, Usategui-Martín R, Pastor-Idoate S. Rho-Kinase Inhibitors for the Treatment of Refractory Diabetic Macular Oedema. Cells 2021; 10:cells10071683. [PMID: 34359853 PMCID: PMC8307715 DOI: 10.3390/cells10071683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/26/2021] [Accepted: 06/29/2021] [Indexed: 12/13/2022] Open
Abstract
Diabetic macular oedema (DMO) is one of the leading causes of vision loss associated with diabetic retinopathy (DR). New insights in managing this condition have changed the paradigm in its treatment, with intravitreal injections of antivascular endothelial growth factor (anti-VEGF) having become the standard therapy for DMO worldwide. However, there is no single standard therapy for all patients DMO refractory to anti-VEGF treatment; thus, further investigation is still needed. The key obstacles in developing suitable therapeutics for refractory DMO lie in its complex pathophysiology; therefore, there is an opportunity for further improvements in the progress and applications of new drugs. Previous studies have indicated that Rho-associated kinase (Rho-kinase/ROCK) is an essential molecule in the pathogenesis of DMO. This is why the Rho/ROCK signalling pathway has been proposed as a possible target for new treatments. The present review focuses on the recent progress on the possible role of ROCK and its therapeutic potential in DMO. A systematic literature search was performed, covering the years 1991 to 2021, using the following keywords: "rho-Associated Kinas-es", "Diabetic Retinopathy", "Macular Edema", "Ripasudil", "Fasudil" and "Netarsudil". Better insight into the pathological role of Rho-kinase/ROCK may lead to the development of new strategies for refractory DMO treatment and prevention.
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Affiliation(s)
- Milagros Mateos-Olivares
- Department of Ophthalmology, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (M.M.-O.); (L.G.-O.); (F.J.V.-B.); (M.L.-G.); (J.C.P.)
| | - Luis García-Onrubia
- Department of Ophthalmology, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (M.M.-O.); (L.G.-O.); (F.J.V.-B.); (M.L.-G.); (J.C.P.)
- Department of Ophthalmology, St Thomas’ Hospital, London SE1 7EH, UK
| | - Fco. Javier Valentín-Bravo
- Department of Ophthalmology, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (M.M.-O.); (L.G.-O.); (F.J.V.-B.); (M.L.-G.); (J.C.P.)
| | - Rogelio González-Sarmiento
- Area of Infectious, Inflammatory and Metabolic Disease, Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain;
- Institute of Molecular and Cellular Biology of Cancer (IBMCC), University of Salamanca-CSIC, 37007 Salamanca, Spain
| | - Maribel Lopez-Galvez
- Department of Ophthalmology, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (M.M.-O.); (L.G.-O.); (F.J.V.-B.); (M.L.-G.); (J.C.P.)
- Retina Group, IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, 47002 Valladolid, Spain
- Cooperative Network for Research in Ophthalmology Oftared, National Institute of Health Carlos III, 28220 Madrid, Spain
| | - J. Carlos Pastor
- Department of Ophthalmology, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (M.M.-O.); (L.G.-O.); (F.J.V.-B.); (M.L.-G.); (J.C.P.)
- Retina Group, IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, 47002 Valladolid, Spain
- Cooperative Network for Research in Ophthalmology Oftared, National Institute of Health Carlos III, 28220 Madrid, Spain
| | - Ricardo Usategui-Martín
- Institute of Molecular and Cellular Biology of Cancer (IBMCC), University of Salamanca-CSIC, 37007 Salamanca, Spain
- Retina Group, IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, 47002 Valladolid, Spain
- Correspondence: (R.U.-M.); (S.P.-I.); Tel.: +34-983-423-559
| | - Salvador Pastor-Idoate
- Department of Ophthalmology, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain; (M.M.-O.); (L.G.-O.); (F.J.V.-B.); (M.L.-G.); (J.C.P.)
- Retina Group, IOBA (Institute of Applied Ophthalmobiology), University of Valladolid, 47002 Valladolid, Spain
- Cooperative Network for Research in Ophthalmology Oftared, National Institute of Health Carlos III, 28220 Madrid, Spain
- Correspondence: (R.U.-M.); (S.P.-I.); Tel.: +34-983-423-559
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Tonade D, Kern TS. Photoreceptor cells and RPE contribute to the development of diabetic retinopathy. Prog Retin Eye Res 2021; 83:100919. [PMID: 33188897 PMCID: PMC8113320 DOI: 10.1016/j.preteyeres.2020.100919] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/27/2020] [Accepted: 10/31/2020] [Indexed: 12/26/2022]
Abstract
Diabetic retinopathy (DR) is a leading cause of blindness. It has long been regarded as vascular disease, but work in the past years has shown abnormalities also in the neural retina. Unfortunately, research on the vascular and neural abnormalities have remained largely separate, instead of being integrated into a comprehensive view of DR that includes both the neural and vascular components. Recent evidence suggests that the most predominant neural cell in the retina (photoreceptors) and the adjacent retinal pigment epithelium (RPE) play an important role in the development of vascular lesions characteristic of DR. This review summarizes evidence that the outer retina is altered in diabetes, and that photoreceptors and RPE contribute to retinal vascular alterations in the early stages of the retinopathy. The possible molecular mechanisms by which cells of the outer retina might contribute to retinal vascular damage in diabetes also are discussed. Diabetes-induced alterations in the outer retina represent a novel therapeutic target to inhibit DR.
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Affiliation(s)
- Deoye Tonade
- Department of Pharmacology, Case Western Reserve University, Cleveland, OH, USA
| | - Timothy S Kern
- Department of Pharmacology, Case Western Reserve University, Cleveland, OH, USA; Veterans Administration Medical Center Research Service, Cleveland, OH, USA; Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA, USA; Veterans Administration Medical Center Research Service, Long Beach, CA, USA.
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16
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Akyol E, Hagag AM, Sivaprasad S, Lotery AJ. Adaptive optics: principles and applications in ophthalmology. Eye (Lond) 2021; 35:244-264. [PMID: 33257798 PMCID: PMC7852593 DOI: 10.1038/s41433-020-01286-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/19/2020] [Accepted: 11/04/2020] [Indexed: 12/26/2022] Open
Abstract
This is a comprehensive review of the principles and applications of adaptive optics (AO) in ophthalmology. It has been combined with flood illumination ophthalmoscopy, scanning laser ophthalmoscopy, as well as optical coherence tomography to image photoreceptors, retinal pigment epithelium (RPE), retinal ganglion cells, lamina cribrosa and the retinal vasculature. In this review, we highlight the clinical studies that have utilised AO to understand disease mechanisms. However, there are some limitations to using AO in a clinical setting including the cost of running an AO imaging service, the time needed to scan patients, the lack of normative databases and the very small size of area imaged. However, it is undoubtedly an exceptional research tool that enables visualisation of the retina at a cellular level.
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Affiliation(s)
- Engin Akyol
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
| | - Ahmed M Hagag
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK
- UCL Institute of Ophthalmology, London, EC1V 9EL, UK
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK
- UCL Institute of Ophthalmology, London, EC1V 9EL, UK
| | - Andrew J Lotery
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK.
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Ro-Mase T, Ishiko S, Omae T, Ishibazawa A, Shimouchi A, Yoshida A. Association Between Alterations of the Choriocapillaris Microcirculation and Visual Function and Cone Photoreceptors in Patients With Diabetes. Invest Ophthalmol Vis Sci 2021; 61:1. [PMID: 32492109 PMCID: PMC7415292 DOI: 10.1167/iovs.61.6.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose The purpose of this study was to investigate the association between the choriocapillaris microcirculation and the visual function and cone photoreceptor structure in patients with diabetes. Methods Thirteen control subjects and 26 patients with type 2 diabetes were recruited. The patients with diabetes were divided into three groups based on the grade of diabetic retinopathy (DR). The retinal sensitivity (RS) was evaluated using microperimetry. Cone photoreceptor mosaics were imaged using an adaptive optics retinal camera, and the cone heterogeneity packing index (HPi) was calculated. Optical coherence tomography angiography (OCTA) images of the choriocapillaris were obtained using spectral-domain OCTA, and the area of flow deficit (FD) was evaluated. All parameters were evaluated in the foveal and parafoveal areas. Results The study included four patients with diabetes without retinopathy, 12 patients with nonproliferative diabetic retinopathy (NPDR), and 10 patients with proliferative diabetic retinopathy (PDR). The foveal and parafoveal FDs were correlated significantly (fovea, r = −0.58; P = 0.046 and r = −0.82; P = 0.003; parafovea, r = −0.59; P = 0.044 and r = −0.72; and P = 0.019, respectively) with the RS in patients with NPDR and PDR, but not in control and no diabetic retinopathy (NDR) groups. There were no differences in the foveal HPi among the groups. Conclusions Impaired choriocapillaris microcirculation is associated with impaired visual function but not cone photoreceptor integrity in eyes with DR.
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18
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Reumueller A, Wassermann L, Salas M, Schranz M, Told R, Kostolna K, Drexler W, Pircher M, Schmidt-Erfurth U, Pollreisz A. Three-dimensional assessment of para- and perifoveal photoreceptor densities and the impact of meridians and age in healthy eyes with adaptive-optics optical coherence tomography (AO-OCT). OPTICS EXPRESS 2020; 28:36723-36739. [PMID: 33379760 DOI: 10.1364/oe.409076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/08/2020] [Indexed: 06/12/2023]
Abstract
An adaptive optics optical coherence tomography (AO-OCT) system is used to assess sixty healthy eyes of thirty subjects (age 22 to 75) to evaluate how the outer retinal layers, foveal eccentricity and age effect the mean cone density. The cone mosaics of different retinal planes (the cone inner segment outer segment junction (IS/OS), the cone outer segment combined with the IS/OS (ISOS+), the cone outer segment tips (COST), and the full en-face plane (FEF)) at four main meridians (superior, nasal, inferior, temporal) and para- and perifoveal eccentricities (ecc 2.5° and 6.5°) were analyzed quantitatively. The mean overall cone density was 19,892/mm2 at ecc 2.5° and 13,323/mm2 at ecc 6.5°. A significant impact on cone density was found for eccentricity (up to 6,700/mm2 between ecc 2.5° and 6.5°), meridian (up to 3,700/mm2 between nasal and superior meridian) and layer (up to 1,400/mm2 between FEF and IS/OS). Age showed only a weak negative effect. These factors as well as inter-individual variability have to be taken into account when comparing cone density measurements between healthy and pathologically changed eyes, as their combined effect on density can easily exceed several thousand cones per mm2 even in parafoveal regions.
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Bueno JM, Cruz-Castillo R, Avilés-Trigueros M, Bautista-Elivar N. Arrangement of the photoreceptor mosaic in a diabetic rat model imaged with multiphoton microscopy. BIOMEDICAL OPTICS EXPRESS 2020; 11:4901-4914. [PMID: 33014589 PMCID: PMC7510868 DOI: 10.1364/boe.399835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 06/11/2023]
Abstract
Diabetic retinopathy (DR) is defined as a microvascular pathology. However, some data have suggested that the retinal photoreceptors (PRs) might be important in the pathogenesis of this ocular disease. In this study the organization of the PRs in control and diabetic-induced rats was compared using multiphoton microscopy. The PR mosaic was imaged at different locations in non-stained retinas. The density of PRs was directly quantified from cell counting. The spatially resolved density presents a double-slope pattern (from the central retina towards the periphery) in both healthy and pathological samples, although the values for the latter were significantly lower all across the retina. Moreover, Voronoi analysis was performed to explore changes in PR topography. In control specimens a hexagonally packed structure was dominant. However, despite the non-controlled effects of the disease in retinal structures, this PR regularity was fairly maintained in diabetic retinas.
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Affiliation(s)
- Juan M. Bueno
- Laboratorio de Óptica, Instituto Universitario de Investigación en Óptica y Nanofísica, Universidad de Murcia, Murcia, Spain
| | - Ricardo Cruz-Castillo
- Área Académica de Matemáticas y Física, Instituto de Ciencias Básicas e Ingeniería, Universidad Autónoma del Estado de Hidalgo, Hidalgo, Mexico
| | - Marcelino Avilés-Trigueros
- Departamento de Oftalmología, Facultad de Medicina, Universidad de Murcia e Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca, “Campus Mare Nostrum” de Excelencia International, Murcia, Spain
| | - Nazario Bautista-Elivar
- Departamento de Ingeniería Eléctrica, Tecnológico Nacional de México, Instituto Tecnológico de Pachuca, Hidalgo, Mexico
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Abstract
Diabetic retinopathy (DR) is a frequent complication of diabetes mellitus and an increasingly common cause of visual impairment. Blood vessel damage occurs as the disease progresses, leading to ischemia, neovascularization, blood-retina barrier (BRB) failure and eventual blindness. Although detection and treatment strategies have improved considerably over the past years, there is room for a better understanding of the pathophysiology of the diabetic retina. Indeed, it has been increasingly realized that DR is in fact a disease of the retina's neurovascular unit (NVU), the multi-cellular framework underlying functional hyperemia, coupling neuronal computations to blood flow. The accumulating evidence reveals that both neurochemical (synapses) and electrical (gap junctions) means of communications between retinal cells are affected at the onset of hyperglycemia, warranting a global assessment of cellular interactions and their role in DR. This is further supported by the recent data showing down-regulation of connexin 43 gap junctions along the vascular relay from capillary to feeding arteriole as one of the earliest indicators of experimental DR, with rippling consequences to the anatomical and physiological integrity of the retina. Here, recent advancements in our knowledge of mechanisms controlling the retinal neurovascular unit will be assessed, along with their implications for future treatment and diagnosis of DR.
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AbdelAl O, Ashraf M, Sampani K, Sun JK. "For Mass Eye and Ear Special Issue" Adaptive Optics in the Evaluation of Diabetic Retinopathy. Semin Ophthalmol 2019; 34:189-197. [PMID: 31188056 DOI: 10.1080/08820538.2019.1620794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Retinal imaging is a fundamental tool for clinical and research efforts in the evaluation and management of diabetic retinopathy. Adaptive optics (AO) is an imaging technique that enables correction of over 90% of the optical aberrations of an individual eye induced primarily by the tear film, cornea and lens. The two major tasks of any AO system are to measure the optical imperfections of the eye and to then compensate for these aberrations to generate a corrected wavefront of reflected light from the eye. AO scanning laser ophthalmoscopy (AOSLO) provides a theoretical lateral resolution limit of 1.4 μm, allowing the study of microscopic features of the retinal vascular and neural tissue. AOSLO studies have revealed irregularities of the photoreceptor mosaic, vascular loss, and details of vascular lesions in diabetic eyes that may provide new insight into development, regression, and response to therapy of diabetic eye disease.
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Affiliation(s)
- Omar AbdelAl
- a Beetham Eye Institute , Joslin Diabetes Center , Boston , MA , USA.,b Department of Ophthalmology , Harvard Medical School , Boston , MA , USA
| | - Mohammed Ashraf
- a Beetham Eye Institute , Joslin Diabetes Center , Boston , MA , USA.,b Department of Ophthalmology , Harvard Medical School , Boston , MA , USA
| | - Konstantina Sampani
- a Beetham Eye Institute , Joslin Diabetes Center , Boston , MA , USA.,c Department of Medicine , Harvard Medical School , Boston , MA , USA
| | - Jennifer K Sun
- a Beetham Eye Institute , Joslin Diabetes Center , Boston , MA , USA.,b Department of Ophthalmology , Harvard Medical School , Boston , MA , USA
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Zaleska-Żmijewska A, Wawrzyniak ZM, Dąbrowska A, Szaflik JP. Adaptive Optics (rtx1) High-Resolution Imaging of Photoreceptors and Retinal Arteries in Patients with Diabetic Retinopathy. J Diabetes Res 2019; 2019:9548324. [PMID: 31008115 PMCID: PMC6441527 DOI: 10.1155/2019/9548324] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/05/2019] [Accepted: 01/30/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is the leading cause of impaired vision in patients with diabetes mellitus. An adaptive optics retinal camera (rtx1™; Imagine Eyes, France) was used to capture images of cones and retinal arteries from patients with DR. OBJECTIVE Cone parameters (density, interphotoreceptor distance, and regularity) and retinal artery parameters (wall thickness, lumen diameter, WLR, and WCSA) were analyzed in 36 patients with nonproliferative DR (NPDR; 22 with mild NPDR and 14 with moderate NPDR) and in 20 healthy volunteers (the control group). RESULTS Cone density at 2° eccentricities was significantly lower in the DR compared to the control group (19822 ± 4342 cells/mm2 vs. 24722 ± 3507 cells/mm2, respectively). Cone density and regularity decreased with increasing severity of DR. The artery walls were significantly thicker in the DR group. The WLR and WCSA differed significantly between the DR and the control groups (WLR 0.339 ± 0.06 vs. 0.254 ± 0.04; WCSA 5567 ± 1140 vs. 4178 ± 944, respectively). CONCLUSIONS Decreased cone regularity and density are seen in patients with mild and moderate NPDR. Abnormalities of retinal arterioles show signs of arteriolar dysfunction in DR. Retinal image analysis with the rtx1 offers a novel noninvasive measurement of early changes in the neural cells and retina vasculature in diabetic eyes.
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Affiliation(s)
- Anna Zaleska-Żmijewska
- Medical University of Warsaw, Department of Ophthalmology, Warsaw, Poland
- SPKSO Ophthalmic Teaching Hospital, Warsaw, Poland
| | - Zbigniew M. Wawrzyniak
- Warsaw University of Technology, Faculty of Electronics and Information Technology, Warsaw, Poland
| | | | - Jacek P. Szaflik
- Medical University of Warsaw, Department of Ophthalmology, Warsaw, Poland
- SPKSO Ophthalmic Teaching Hospital, Warsaw, Poland
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Burns SA, Elsner AE, Sapoznik KA, Warner RL, Gast TJ. Adaptive optics imaging of the human retina. Prog Retin Eye Res 2019; 68:1-30. [PMID: 30165239 PMCID: PMC6347528 DOI: 10.1016/j.preteyeres.2018.08.002] [Citation(s) in RCA: 126] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 12/18/2022]
Abstract
Adaptive Optics (AO) retinal imaging has provided revolutionary tools to scientists and clinicians for studying retinal structure and function in the living eye. From animal models to clinical patients, AO imaging is changing the way scientists are approaching the study of the retina. By providing cellular and subcellular details without the need for histology, it is now possible to perform large scale studies as well as to understand how an individual retina changes over time. Because AO retinal imaging is non-invasive and when performed with near-IR wavelengths both safe and easily tolerated by patients, it holds promise for being incorporated into clinical trials providing cell specific approaches to monitoring diseases and therapeutic interventions. AO is being used to enhance the ability of OCT, fluorescence imaging, and reflectance imaging. By incorporating imaging that is sensitive to differences in the scattering properties of retinal tissue, it is especially sensitive to disease, which can drastically impact retinal tissue properties. This review examines human AO retinal imaging with a concentration on the use of the Adaptive Optics Scanning Laser Ophthalmoscope (AOSLO). It first covers the background and the overall approaches to human AO retinal imaging, and the technology involved, and then concentrates on using AO retinal imaging to study the structure and function of the retina.
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Affiliation(s)
- Stephen A Burns
- 800E. Atwater S, School of Optometry, Indiana University, Bloomington, IN, United States.
| | - Ann E Elsner
- 800E. Atwater S, School of Optometry, Indiana University, Bloomington, IN, United States
| | - Kaitlyn A Sapoznik
- 800E. Atwater S, School of Optometry, Indiana University, Bloomington, IN, United States
| | - Raymond L Warner
- 800E. Atwater S, School of Optometry, Indiana University, Bloomington, IN, United States
| | - Thomas J Gast
- 800E. Atwater S, School of Optometry, Indiana University, Bloomington, IN, United States
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Abstract
PURPOSE OF REVIEW Diabetic retinopathy is the most common microvascular complication of diabetes mellitus and a leading cause of blindness throughout the world. Ocular imaging continues to play a vital role in the diagnosis, management and monitoring of diabetic retinopathy. Major technological advancements in imaging over the past decade have improved our understanding and knowledge of diabetic retinopathy and therefore a multimodal approach to imaging has become the standard of care. RECENT FINDINGS Updates to traditional technologies such as digital fundus photography along with recent advancements in optical coherence tomography (OCT) and OCT angiography (OCTA) have provided clinicians with new information and improved efficiency. SUMMARY In this review, we describe the benefits and clinical applications of several imaging techniques in diabetic retinopathy including color photography, fluorescein angiography, OCT, OCTA and adaptive optics. Understanding the indications and limitations of each technology allows clinicians to gain the most information from each modality and thereby optimize patient care.
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Affiliation(s)
- Khoi Tran
- Department of Ophthalmology, University of British Columbia, Vancouver, British Columbia, Canada
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Lammer J, Karst SG, Lin MM, Cheney M, Silva PS, Burns SA, Aiello LP, Sun JK. Association of Microaneurysms on Adaptive Optics Scanning Laser Ophthalmoscopy With Surrounding Neuroretinal Pathology and Visual Function in Diabetes. Invest Ophthalmol Vis Sci 2018; 59:5633-5640. [PMID: 30481280 PMCID: PMC6262647 DOI: 10.1167/iovs.18-24386] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 09/13/2018] [Indexed: 12/16/2022] Open
Abstract
Purpose We evaluate diabetic microaneurysm (MA) features on high-resolution adaptive optics scanning laser ophthalmoscopy (AOSLO) and their correlations with visual acuity (VA) and local retinal pathology on spectral domain optical coherence tomography (SDOCT). Methods Diabetic participants underwent VA testing and AOSLO and SDOCT imaging of MAs. AOSLO images were graded for MA dimension, wall hyperreflectivity (WH), intraluminal hyperreflectivity (IH), and perfusion pattern. SDOCTs centered on each MA were graded for disorganization of the retinal inner layers (DRIL) and other neuroretinal pathology. Results We imaged 109 MAs (30 eyes). Multivariate modeling, including statistically significant covariates from bivariate analyses, associated WH with greater MA size (P = 0.001) and DRIL (P = 0.04). IH was associated with perfusion (P = 0.003) and MA visibility on photographs (P = 0.0001), and larger MA size with partial perfusion (P = 0.03), MA ring signs (P = 0.0002), and photographic visibility (P = 0.01). Multivariate modeling revealed an association of WH and VA with DRIL. Conclusions AOSLO imaging demonstrates associations of hyperreflective MA walls with MA size and adjacent DRIL, as well as the presence of DRIL with lower VA. This study identifies a correlation between vascular and neural pathology associated with VA decline. Further studies of MA structure and neuroretinal disorganization may enable novel approaches to assess anatomic and functional outcomes in the diabetic eye.
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Affiliation(s)
- Jan Lammer
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
- Department of Ophthalmology and Optometry, Medical University Vienna, Vienna, Austria
| | - Sonja G. Karst
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
- Department of Ophthalmology and Optometry, Medical University Vienna, Vienna, Austria
| | - Michael M. Lin
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Michael Cheney
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
| | - Paolo S. Silva
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Stephen A. Burns
- School of Optometry, Indiana University, Bloomington, Indiana, United States
| | - Lloyd Paul Aiello
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Jennifer K. Sun
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
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Kusuhara S, Fukushima Y, Ogura S, Inoue N, Uemura A. Pathophysiology of Diabetic Retinopathy: The Old and the New. Diabetes Metab J 2018; 42:364-376. [PMID: 30362302 PMCID: PMC6202564 DOI: 10.4093/dmj.2018.0182] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 10/05/2018] [Indexed: 12/29/2022] Open
Abstract
Vision loss in diabetic retinopathy (DR) is ascribed primarily to retinal vascular abnormalities-including hyperpermeability, hypoperfusion, and neoangiogenesis-that eventually lead to anatomical and functional alterations in retinal neurons and glial cells. Recent advances in retinal imaging systems using optical coherence tomography technologies and pharmacological treatments using anti-vascular endothelial growth factor drugs and corticosteroids have revolutionized the clinical management of DR. However, the cellular and molecular mechanisms underlying the pathophysiology of DR are not fully determined, largely because hyperglycemic animal models only reproduce limited aspects of subclinical and early DR. Conversely, non-diabetic mouse models that represent the hallmark vascular disorders in DR, such as pericyte deficiency and retinal ischemia, have provided clues toward an understanding of the sequential events that are responsible for vision-impairing conditions. In this review, we summarize the clinical manifestations and treatment modalities of DR, discuss current and emerging concepts with regard to the pathophysiology of DR, and introduce perspectives on the development of new drugs, emphasizing the breakdown of the blood-retina barrier and retinal neovascularization.
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Affiliation(s)
- Sentaro Kusuhara
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoko Fukushima
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shuntaro Ogura
- Department of Retinal Vascular Biology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Department of Ophthalmology, Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Naomi Inoue
- Department of Retinal Vascular Biology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akiyoshi Uemura
- Department of Retinal Vascular Biology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
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Cunefare D, Langlo CS, Patterson EJ, Blau S, Dubra A, Carroll J, Farsiu S. Deep learning based detection of cone photoreceptors with multimodal adaptive optics scanning light ophthalmoscope images of achromatopsia. BIOMEDICAL OPTICS EXPRESS 2018; 9:3740-3756. [PMID: 30338152 PMCID: PMC6191607 DOI: 10.1364/boe.9.003740] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/15/2018] [Accepted: 07/15/2018] [Indexed: 05/18/2023]
Abstract
Fast and reliable quantification of cone photoreceptors is a bottleneck in the clinical utilization of adaptive optics scanning light ophthalmoscope (AOSLO) systems for the study, diagnosis, and prognosis of retinal diseases. To-date, manual grading has been the sole reliable source of AOSLO quantification, as no automatic method has been reliably utilized for cone detection in real-world low-quality images of diseased retina. We present a novel deep learning based approach that combines information from both the confocal and non-confocal split detector AOSLO modalities to detect cones in subjects with achromatopsia. Our dual-mode deep learning based approach outperforms the state-of-the-art automated techniques and is on a par with human grading.
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Affiliation(s)
- David Cunefare
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Christopher S. Langlo
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Emily J. Patterson
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Sarah Blau
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Alfredo Dubra
- Department of Ophthalmology, Stanford University, Palo Alto, CA 94303, USA
| | - Joseph Carroll
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI 53226, USA
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Sina Farsiu
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
- Department of Ophthalmology, Duke University Medical Center, Durham, NC 27710, USA
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Lu J, Gu B, Wang X, Zhang Y. High speed adaptive optics ophthalmoscopy with an anamorphic point spread function. OPTICS EXPRESS 2018; 26:14356-14374. [PMID: 29877476 PMCID: PMC6005671 DOI: 10.1364/oe.26.014356] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/11/2018] [Indexed: 05/04/2023]
Abstract
Retinal imaging working with a line scan mechanism and a line camera has the potential to image the eye with a near-confocal performance at the high frame rate, but this regime has difficulty to collect sufficient imaging light while adequately digitize the optical resolution in adaptive optics imaging. To meet this challenge, we have developed an adaptive optics line scan ophthalmoscope with an anamorphic point spread function. The instrument uses a high-speed line camera to acquire the retinal image and act as a confocal gate. Meanwhile, it employs a digital micro-mirror device to modulate the imaging light into a line of point sources illuminating the retina. The anamorphic mechanism ensures adequate digitization of the optical resolution and increases light collecting efficiency. We demonstrate imaging of the living human retina with cellular level resolution at a frame rate of 200 frames/second (FPS) with a digitization of 512 × 512 pixels over a field of view of 1.2° × 1.2°. We have assessed cone photoreceptor structure in images acquired at 100, 200, and 800 FPS in 2 normal human subjects, and confirmed that retinal images acquired at high speed rendered macular cone mosaic with improved measurement repeatability.
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Abstract
Throughout ophthalmic history it has been shown that progress has gone hand in hand with technological breakthroughs. In the past, fluorescein angiography and fundus photographs were the most commonly used imaging modalities in the management of diabetic macular edema (DME). Today, despite the moderate correlation between macular thickness and functional outcomes, spectral domain optical coherence tomography (SD-OCT) has become the DME workhorse in clinical practice. Several SD-OCT biomarkers have been looked at including presence of epiretinal membrane, vitreomacular adhesion, disorganization of the inner retinal layers, central macular thickness, integrity of the ellipsoid layer, and subretinal fluid, among others. Emerging imaging modalities include fundus autofluorescence, macular pigment optical density, fluorescence lifetime imaging ophthalmoscopy, OCT angiography, and adaptive optics. Technological advances in imaging of the posterior segment of the eye have enabled ophthalmologists to develop hypotheses about pathological mechanisms of disease, monitor disease progression, and assess response to treatment. Spectral domain OCT is the most commonly performed imaging modality in the management of DME. However, reliable biomarkers have yet to be identified. Machine learning may provide treatment algorithms based on multimodal imaging.
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Affiliation(s)
- Dhariana Acón
- Asociación para Evitar la Ceguera, Hospital Luis Sanchez Bulnes. Mexico City, Mexico
| | - Lihteh Wu
- Asociados de Mácula, Vítreo y Retina de Costa Rica, San José, Costa Rica
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Zhang B, Li N, Kang J, He Y, Chen XM. Adaptive optics scanning laser ophthalmoscopy in fundus imaging, a review and update. Int J Ophthalmol 2017; 10:1751-1758. [PMID: 29181321 DOI: 10.18240/ijo.2017.11.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 09/04/2017] [Indexed: 02/05/2023] Open
Abstract
Adaptive optics scanning laser ophthalmoscopy (AO-SLO) has been a promising technique in funds imaging with growing popularity. This review firstly gives a brief history of adaptive optics (AO) and AO-SLO. Then it compares AO-SLO with conventional imaging methods (fundus fluorescein angiography, fundus autofluorescence, indocyanine green angiography and optical coherence tomography) and other AO techniques (adaptive optics flood-illumination ophthalmoscopy and adaptive optics optical coherence tomography). Furthermore, an update of current research situation in AO-SLO is made based on different fundus structures as photoreceptors (cones and rods), fundus vessels, retinal pigment epithelium layer, retinal nerve fiber layer, ganglion cell layer and lamina cribrosa. Finally, this review indicates possible research directions of AO-SLO in future.
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Affiliation(s)
- Bing Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ni Li
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jie Kang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yi He
- Institute of Optics and Electronics, Chinese Academy of Sciences, Chengdu 610209, Sichuan Province, China
| | - Xiao-Ming Chen
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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31
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Zaleska-Żmijewska A, Piątkiewicz P, Śmigielska B, Sokołowska-Oracz A, Wawrzyniak ZM, Romaniuk D, Szaflik J, Szaflik JP. Retinal Photoreceptors and Microvascular Changes in Prediabetes Measured with Adaptive Optics (rtx1™): A Case-Control Study. J Diabetes Res 2017; 2017:4174292. [PMID: 29238728 PMCID: PMC5697118 DOI: 10.1155/2017/4174292] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/15/2017] [Accepted: 09/28/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Patients with prediabetes are at risk for diabetes, cardiovascular events, and microvascular complications. The rtx1 (Imagine Eyes, France) permits early detection of changes in the retinal photoreceptors and vessels. OBJECTIVE Cone parameters and retinal microvasculature were analyzed with the rtx1 in 12 prediabetic patients and 22 healthy subjects. The analysis was based on cone density (DM), interphotoreceptor distance (SM), cone packing regularity, and retinal vessel parameters: wall thickness, lumen diameter (LD), wall-to-lumen ratio (WLR), and cross-sectional area of the vascular wall. RESULTS DM in the prediabetic group was not significantly lower than that in the control group (18,935 ± 1713 cells/mm2 and 19,900 ± 2375 cells/mm2, respectively; p = 0.0928). The LD and WLR means differed significantly between the prediabetic and the control groups (LD 94.3 ± 10.9 versus 101.2 ± 15, p = 0.022; WLR 0.29 ± 0.05 versus 0.22 ± 0.03, p < 0.05). A multivariate regression analysis showed that the WLR was significantly correlated with BMI and total cholesterol. CONCLUSIONS Abnormalities found in rtx1 examinations indicated early signs of arteriolar dysfunction, prior to impaired glucose tolerance progressing to diabetes. The rtx1 retinal image analysis offers noninvasive measurement of early changes in the vasculature that routine clinical examination cannot detect.
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Affiliation(s)
- Anna Zaleska-Żmijewska
- Department of Ophthalmology, SPKSO Ophthalmic Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Paweł Piątkiewicz
- Department of Internal Diseases, Diabetology and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Barbara Śmigielska
- Department of Ophthalmology, SPKSO Ophthalmic Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Anna Sokołowska-Oracz
- Department of Internal Diseases, Diabetology and Endocrinology, Medical University of Warsaw, Warsaw, Poland
- Retinopathy Outpatient Clinic, Masovian Hospital Bródno, Warsaw, Poland
| | - Zbigniew M. Wawrzyniak
- Faculty of Electronics and Information Technology, Warsaw University of Technology, Warsaw, Poland
| | - Dorota Romaniuk
- Department of Ophthalmology, SPKSO Ophthalmic Hospital, Warsaw, Poland
| | - Jerzy Szaflik
- Department of Ophthalmology, SPKSO Ophthalmic Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Jacek P. Szaflik
- Department of Ophthalmology, SPKSO Ophthalmic Hospital, Medical University of Warsaw, Warsaw, Poland
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Mechanisms of macular edema: Beyond the surface. Prog Retin Eye Res 2017; 63:20-68. [PMID: 29126927 DOI: 10.1016/j.preteyeres.2017.10.006] [Citation(s) in RCA: 362] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 10/24/2017] [Accepted: 10/31/2017] [Indexed: 02/07/2023]
Abstract
Macular edema consists of intra- or subretinal fluid accumulation in the macular region. It occurs during the course of numerous retinal disorders and can cause severe impairment of central vision. Major causes of macular edema include diabetes, branch and central retinal vein occlusion, choroidal neovascularization, posterior uveitis, postoperative inflammation and central serous chorioretinopathy. The healthy retina is maintained in a relatively dehydrated, transparent state compatible with optimal light transmission by multiple active and passive systems. Fluid accumulation results from an imbalance between processes governing fluid entry and exit, and is driven by Starling equation when inner or outer blood-retinal barriers are disrupted. The multiple and intricate mechanisms involved in retinal hydro-ionic homeostasis, their molecular and cellular basis, and how their deregulation lead to retinal edema, are addressed in this review. Analyzing the distribution of junction proteins and water channels in the human macula, several hypotheses are raised to explain why edema forms specifically in the macular region. "Pure" clinical phenotypes of macular edema, that result presumably from a single causative mechanism, are detailed. Finally, diabetic macular edema is investigated, as a complex multifactorial pathogenic example. This comprehensive review on the current understanding of macular edema and its mechanisms opens perspectives to identify new preventive and therapeutic strategies for this sight-threatening condition.
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Cunefare D, Fang L, Cooper RF, Dubra A, Carroll J, Farsiu S. Open source software for automatic detection of cone photoreceptors in adaptive optics ophthalmoscopy using convolutional neural networks. Sci Rep 2017; 7:6620. [PMID: 28747737 PMCID: PMC5529414 DOI: 10.1038/s41598-017-07103-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 06/21/2017] [Indexed: 01/07/2023] Open
Abstract
Imaging with an adaptive optics scanning light ophthalmoscope (AOSLO) enables direct visualization of the cone photoreceptor mosaic in the living human retina. Quantitative analysis of AOSLO images typically requires manual grading, which is time consuming, and subjective; thus, automated algorithms are highly desirable. Previously developed automated methods are often reliant on ad hoc rules that may not be transferable between different imaging modalities or retinal locations. In this work, we present a convolutional neural network (CNN) based method for cone detection that learns features of interest directly from training data. This cone-identifying algorithm was trained and validated on separate data sets of confocal and split detector AOSLO images with results showing performance that closely mimics the gold standard manual process. Further, without any need for algorithmic modifications for a specific AOSLO imaging system, our fully-automated multi-modality CNN-based cone detection method resulted in comparable results to previous automatic cone segmentation methods which utilized ad hoc rules for different applications. We have made free open-source software for the proposed method and the corresponding training and testing datasets available online.
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Affiliation(s)
- David Cunefare
- Department of Biomedical Engineering, Duke University, Durham, NC, 27708, USA.
| | - Leyuan Fang
- Department of Biomedical Engineering, Duke University, Durham, NC, 27708, USA
| | - Robert F Cooper
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, 19104, USA.,Department of Psychology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Alfredo Dubra
- Department of Ophthalmology, Stanford University, Palo Alto, CA, 94303, USA
| | - Joseph Carroll
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI, 53233, USA.,Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
| | - Sina Farsiu
- Department of Biomedical Engineering, Duke University, Durham, NC, 27708, USA.,Department of Ophthalmology, Duke University Medical Center, Durham, NC, 27710, USA
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Duh EJ, Sun JK, Stitt AW. Diabetic retinopathy: current understanding, mechanisms, and treatment strategies. JCI Insight 2017; 2:93751. [PMID: 28724805 DOI: 10.1172/jci.insight.93751] [Citation(s) in RCA: 556] [Impact Index Per Article: 79.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Diabetic retinopathy (DR) causes significant visual loss on a global scale. Treatments for the vision-threatening complications of diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) have greatly improved over the past decade. However, additional therapeutic options are needed that take into account pathology associated with vascular, glial, and neuronal components of the diabetic retina. Recent work indicates that diabetes markedly impacts the retinal neurovascular unit and its interdependent vascular, neuronal, glial, and immune cells. This knowledge is leading to identification of new targets and therapeutic strategies for preventing or reversing retinal neuronal dysfunction, vascular leakage, ischemia, and pathologic angiogenesis. These advances, together with approaches embracing the potential of preventative or regenerative medicine, could provide the means to better manage DR, including treatment at earlier stages and more precise tailoring of treatments based on individual patient variations.
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Affiliation(s)
- Elia J Duh
- Wilmer Ophthalmologic Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer K Sun
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Alan W Stitt
- Centre for Experimental Medicine, Queen's University Belfast, Northern Ireland, United Kingdom
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Sawides L, Sapoznik KA, de Castro A, Walker BR, Gast TJ, Elsner AE, Burns SA. Alterations to the Foveal Cone Mosaic of Diabetic Patients. Invest Ophthalmol Vis Sci 2017; 58:3395-3403. [PMID: 28687853 PMCID: PMC5501497 DOI: 10.1167/iovs.17-21793] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose We measured localized changes occurring in the foveal cone photoreceptors and related defects in the cone mosaic to alterations in the nearby retinal vasculature. Methods The central 4° of the retina of 54 diabetic (53.7 ± 12.5 years) and 85 control (35.8 ± 15.2 years) participants were imaged with the Indiana adaptive optics scanning laser ophthalmoscope. Foveal cones and overlying retinal capillaries were imaged and infrared scanning laser ophthalmoscopy (IR SLO) images and optical coherence tomography (OCT) B-scans were obtained. Follow-up imaging sessions were performed with intervals from 4 to 50 months for 22 of the 54 diabetic participants. Results The foveal cone mosaics of 49 of 54 diabetic participants were of sufficient quality to assess the absence or presence of small localized defects in the cone mosaic. In 13 of these 49 diabetic participants we found localized defects, visualized as sharp-edged areas of cones with diminished reflectivity. These small, localized areas ranged in size from 10 × 10 μm to 75 × 30 μm. Of these 13 participants with cone defects, 11 were imaged over periods from 4 to 50 months and the defects remained relatively stable. These dark regions were not shadows of overlying retinal vessels, but all participants with these localized defects had alterations in the juxtafoveal capillary network. Conclusions The foveal cone mosaic can show localized areas of dark cones that persist over time, that apparently correspond to either missing or nonreflecting cones, and may be related to local retinal ischemia.
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Affiliation(s)
- Lucie Sawides
- School of Optometry, Indiana University, Bloomington, Indiana, United States
| | - Kaitlyn A Sapoznik
- School of Optometry, Indiana University, Bloomington, Indiana, United States
| | - Alberto de Castro
- School of Optometry, Indiana University, Bloomington, Indiana, United States
| | - Brittany R Walker
- School of Optometry, Indiana University, Bloomington, Indiana, United States
| | - Thomas J Gast
- School of Optometry, Indiana University, Bloomington, Indiana, United States
| | - Ann E Elsner
- School of Optometry, Indiana University, Bloomington, Indiana, United States
| | - Stephen A Burns
- School of Optometry, Indiana University, Bloomington, Indiana, United States
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Marcos S, Werner JS, Burns SA, Merigan WH, Artal P, Atchison DA, Hampson KM, Legras R, Lundstrom L, Yoon G, Carroll J, Choi SS, Doble N, Dubis AM, Dubra A, Elsner A, Jonnal R, Miller DT, Paques M, Smithson HE, Young LK, Zhang Y, Campbell M, Hunter J, Metha A, Palczewska G, Schallek J, Sincich LC. Vision science and adaptive optics, the state of the field. Vision Res 2017; 132:3-33. [PMID: 28212982 PMCID: PMC5437977 DOI: 10.1016/j.visres.2017.01.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/24/2017] [Accepted: 01/25/2017] [Indexed: 12/27/2022]
Abstract
Adaptive optics is a relatively new field, yet it is spreading rapidly and allows new questions to be asked about how the visual system is organized. The editors of this feature issue have posed a series of question to scientists involved in using adaptive optics in vision science. The questions are focused on three main areas. In the first we investigate the use of adaptive optics for psychophysical measurements of visual system function and for improving the optics of the eye. In the second, we look at the applications and impact of adaptive optics on retinal imaging and its promise for basic and applied research. In the third, we explore how adaptive optics is being used to improve our understanding of the neurophysiology of the visual system.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Yuhua Zhang
- University of Alabama at Birmingham, Birmingham, USA
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Adaptive Optics Reveals Photoreceptor Abnormalities in Diabetic Macular Ischemia. PLoS One 2017; 12:e0169926. [PMID: 28068435 PMCID: PMC5222506 DOI: 10.1371/journal.pone.0169926] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/22/2016] [Indexed: 11/19/2022] Open
Abstract
Diabetic macular ischemia (DMI) is a phenotype of diabetic retinopathy (DR) associated with chronic hypoxia of retinal tissue. The goal of this prospective observational study was to report evidence of photoreceptor abnormalities using adaptive optics scanning laser ophthalmoscopy (AOSLO) in eyes with DR in the setting of deep capillary plexus (DCP) non-perfusion. Eleven eyes from 11 patients (6 women, age 31-68), diagnosed with DR without macular edema, underwent optical coherence tomography angiography (OCTA) and AOSLO imaging. One patient without OCTA imaging underwent fluorescein angiography to characterize the enlargement of the foveal avascular zone. The parameters studied included photoreceptor heterogeneity packing index (HPi) on AOSLO, as well as DCP non-perfusion and vessel density on OCTA. Using AOSLO, OCTA and spectral domain (SD)-OCT, we observed that photoreceptor abnormalities on AOSLO and SD-OCT were found in eyes with non-perfusion of the DCP on OCTA. All eight eyes with DCP non-flow on OCTA showed photoreceptor abnormalities on AOSLO. Six of the eight eyes also had outer retinal abnormalities on SD-OCT. Three eyes with DR and robust capillary perfusion of the DCP had normal photoreceptors on SD-OCT and AOSLO. Compared to eyes with DR without DCP non-flow, the eight eyes with DCP non-flow had significantly lower HPi (P = 0.013) and parafoveal DCP vessel density (P = 0.016). We found a significant correlation between cone HPi and parafoveal DCP vessel density (r = 0.681, P = 0.030). Using a novel approach with AOSLO and OCTA, this study shows an association between capillary non-perfusion of the DCP and abnormalities in the photoreceptor layer in eyes with DR. This observation is important in confirming the significant contribution of the DCP to oxygen requirements of photoreceptors in DMI, while highlighting the ability of AOSLO to detect subtle photoreceptor changes not always visible on SD-OCT.
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