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Servillo A, Sacconi R, Oldoni G, Barlocci E, Tombolini B, Battista M, Fantaguzzi F, Rissotto F, Mularoni C, Parravano M, Zucchiatti I, Querques L, Bandello F, Querques G. Advancements in Imaging and Therapeutic Options for Dry Age-Related Macular Degeneration and Geographic Atrophy. Ophthalmol Ther 2024; 13:2067-2082. [PMID: 38833127 PMCID: PMC11246354 DOI: 10.1007/s40123-024-00970-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/13/2024] [Indexed: 06/06/2024] Open
Abstract
Age-related macular degeneration (AMD) is a leading cause of vision loss in the elderly, with dry AMD (d-AMD) leading to geographic atrophy (GA) and significant visual impairment. Multimodal imaging plays a crucial role in d-AMD diagnosis and management, allowing for detailed classification of patient phenotypes and aiding in treatment planning and prognosis determination. Treatment approaches for d-AMD have recently witnessed profound change with the development of specific drugs targeting the complement cascade, with the first anticomplement agents recently approved for GA treatment. Additionally, emerging strategies such as gene therapy and laser treatments may offer potential benefits, though further research is needed to fully establish their efficacy. However, the lack of effective therapies capable of restoring damaged retinal cells remains a major challenge. In the future, genetic treatments aimed at preventing the progression of d-AMD may emerge as a powerful approach. Currently, however, their development is still in the early stages.
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Affiliation(s)
- Andrea Servillo
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Riccardo Sacconi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Gloria Oldoni
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Eugenio Barlocci
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Beatrice Tombolini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Marco Battista
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Federico Fantaguzzi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Federico Rissotto
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Cecilia Mularoni
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | | | - Ilaria Zucchiatti
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Lea Querques
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Giuseppe Querques
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
- Division of Head and Neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
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Goh KL, Abbott CJ, Campbell TG, Cohn AC, Ong DN, Wickremasinghe SS, Hodgson LAB, Guymer RH, Wu Z. Clinical performance of predicting late age-related macular degeneration development using multimodal imaging. Clin Exp Ophthalmol 2024. [PMID: 38812454 DOI: 10.1111/ceo.14405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 04/17/2024] [Accepted: 05/17/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND To examine whether the clinical performance of predicting late age-related macular degeneration (AMD) development is improved through using multimodal imaging (MMI) compared to using colour fundus photography (CFP) alone, and how this compares with a basic prediction model using well-established AMD risk factors. METHODS Individuals with AMD in this study underwent MMI, including optical coherence tomography (OCT), fundus autofluorescence, near-infrared reflectance and CFP at baseline, and then at 6-monthly intervals for 3-years to determine MMI-defined late AMD development. Four retinal specialists independently assessed the likelihood that each eye at baseline would progress to MMI-defined late AMD over 3-years with CFP, and then with MMI. Predictive performance with CFP and MMI were compared to each other, and to a basic prediction model using age, presence of pigmentary abnormalities, and OCT-based drusen volume. RESULTS The predictive performance of the clinicians using CFP [AUC = 0.75; 95% confidence interval (CI) = 0.68-0.82] improved when using MMI (AUC = 0.79; 95% CI = 0.72-0.85; p = 0.034). However, a basic prediction model outperformed clinicians using either CFP or MMI (AUC = 0.85; 95% CI = 0.78-91; p ≤ 0.002). CONCLUSIONS Clinical performance for predicting late AMD development was improved by using MMI compared to CFP. However, a basic prediction model using well-established AMD risk factors outperformed retinal specialists, suggesting that such a model could further improve personalised counselling and monitoring of individuals with the early stages of AMD in clinical practice.
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Affiliation(s)
- Kai Lyn Goh
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia
| | - Carla J Abbott
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia
| | - Thomas G Campbell
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Amy C Cohn
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Dai Ni Ong
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Sanjeewa S Wickremasinghe
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia
| | - Lauren A B Hodgson
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia
| | - Zhichao Wu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia
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Tan TF, Yap CL, Peterson CL, Wong D, Wong TY, Cheung CMG, Schmetterer L, Tan ACS. Defining the structure-function relationship of specific lesions in early and advanced age-related macular degeneration. Sci Rep 2024; 14:8724. [PMID: 38622152 PMCID: PMC11018739 DOI: 10.1038/s41598-024-54619-3] [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: 09/30/2023] [Accepted: 02/14/2024] [Indexed: 04/17/2024] Open
Abstract
The objective of this study is to define structure-function relationships of pathological lesions related to age-related macular degeneration (AMD) using microperimetry and multimodal retinal imaging. We conducted a cross-sectional study of 87 patients with AMD (30 eyes with early and intermediate AMD and 110 eyes with advanced AMD), compared to 33 normal controls (66 eyes) recruited from a single tertiary center. All participants had enface and cross-sectional optical coherence tomography (Heidelberg HRA-2), OCT angiography, color and infra-red (IR) fundus and microperimetry (MP) (Nidek MP-3) performed. Multimodal images were graded for specific AMD pathological lesions. A custom marking tool was used to demarcate lesion boundaries on corresponding enface IR images, and subsequently superimposed onto MP color fundus photographs with retinal sensitivity points (RSP). The resulting overlay was used to correlate pathological structural changes to zonal functional changes. Mean age of patients with early/intermediate AMD, advanced AMD and controls were 73(SD = 8.2), 70.8(SD = 8), and 65.4(SD = 7.7) years respectively. Mean retinal sensitivity (MRS) of both early/intermediate (23.1 dB; SD = 5.5) and advanced AMD (18.1 dB; SD = 7.8) eyes were significantly worse than controls (27.8 dB, SD = 4.3) (p < 0.01). Advanced AMD eyes had significantly more unstable fixation (70%; SD = 63.6), larger mean fixation area (3.9 mm2; SD = 3.0), and focal fixation point further away from the fovea (0.7 mm; SD = 0.8), than controls (29%; SD = 43.9; 2.6 mm2; SD = 1.9; 0.4 mm; SD = 0.3) (p ≤ 0.01). Notably, 22 fellow eyes of AMD eyes (25.7 dB; SD = 3.0), with no AMD lesions, still had lower MRS than controls (p = 0.04). For specific AMD-related lesions, end-stage changes such as fibrosis (5.5 dB, SD = 5.4 dB) and atrophy (6.2 dB, SD = 7.0 dB) had the lowest MRS; while drusen and pigment epithelial detachment (17.7 dB, SD = 8.0 dB) had the highest MRS. Peri-lesional areas (20.2 dB, SD = 7.6 dB) and surrounding structurally normal areas (22.2 dB, SD = 6.9 dB) of the retina with no AMD lesions still had lower MRS compared to controls (27.8 dB, SD = 4.3 dB) (p < 0.01). Our detailed topographic structure-function correlation identified specific AMD pathological changes associated with a poorer visual function. This can provide an added value to the assessment of visual function to optimize treatment outcomes to existing and potentially future novel therapies.
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Affiliation(s)
- Ting Fang Tan
- Singapore National Eye Centre, Singapore General Hospital, 11 Third Hospital Avenue, Singapore, 119228, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
| | - Chun Lin Yap
- Singapore Eye Research Institute, Singapore, Singapore
| | - Claire L Peterson
- Singapore National Eye Centre, Singapore General Hospital, 11 Third Hospital Avenue, Singapore, 119228, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
| | - Damon Wong
- Singapore Eye Research Institute, Singapore, Singapore
| | - Tien Yin Wong
- Singapore National Eye Centre, Singapore General Hospital, 11 Third Hospital Avenue, Singapore, 119228, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Chui Ming Gemmy Cheung
- Singapore National Eye Centre, Singapore General Hospital, 11 Third Hospital Avenue, Singapore, 119228, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Leopold Schmetterer
- Singapore National Eye Centre, Singapore General Hospital, 11 Third Hospital Avenue, Singapore, 119228, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore, Singapore
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Anna Cheng Sim Tan
- Singapore National Eye Centre, Singapore General Hospital, 11 Third Hospital Avenue, Singapore, 119228, Singapore.
- Singapore Eye Research Institute, Singapore, Singapore.
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore, Singapore.
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Angelia M, Amelia YS, Pratama KG. Mediterranean diet as a modifiable risk factor for age-related macular degeneration: A systematic review and meta-analysis. Tzu Chi Med J 2024; 36:223-230. [PMID: 38645781 PMCID: PMC11025595 DOI: 10.4103/tcmj.tcmj_153_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/23/2023] [Accepted: 08/31/2023] [Indexed: 04/23/2024] Open
Abstract
Objectives Age-related macular degeneration (AMD) is a chronic and degenerative disease of the retina that leads to irreversible blindness. There is no proven effective treatment for early AMD and advanced AMD. Mediterranean diet (MD) has been linked to reducing the risk or delaying the progression of AMD. Therefore, in this study, we aim to investigate the potential of MD as a modifiable risk factor for AMD. Materials and Methods A systematic search was performed in three databases: PubMed, EBSCO host, and Proquest. We search for studies that determine the association of MD in AMD. Then, we pooled the data for meta-analysis. Results Eight studies were included in our systematic review. Seven studies were included for meta-analysis. Subjects with medium-high (hazard ratio [HR] 0.82; 95% confidence interval [CI]: 0.75-0.90) adherence to the MD showed a reduced risk of developing AMD. Moreover, medium adherence AMD shows a significant and inverse relationship with the progression to advanced AMD (HR: 0.87; 95% CI: 0.81-0.93). Although it is still inconsistent, the reduction appears stronger for geographic atrophy than for neovascular AMD. Conclusion Adhering to the MD, particularly at a medium to high level, appears to confer a protective effect against AMD. The sub-analysis demonstrates even that there is a protective effect associated with moderate adherence against advanced AMD. The presence of considerable heterogeneity within the results warrants cautious interpretation. Further research is needed to enhance our understanding.
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Affiliation(s)
- Maria Angelia
- School of Medicine and Health Sciences, Atma Jaya University Catholic of Indonesia, Jakarta, Indonesia
| | - Yufilia Suci Amelia
- School of Medicine and Health Sciences, Atma Jaya University Catholic of Indonesia, Jakarta, Indonesia
| | - Kevin Gracia Pratama
- School of Medicine and Health Sciences, Atma Jaya University Catholic of Indonesia, Jakarta, Indonesia
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Rajeswaren V, Wagner BD, Patnaik JL, Mandava N, Mathias MT, Manoharan N, de Carlo Forest TE, Gnanaraj R, Lynch AM, Palestine AG. Elevated tumor necrosis factor alpha and vascular endothelial growth factor in intermediate age-related macular degeneration and geographic atrophy. FRONTIERS IN OPHTHALMOLOGY 2024; 4:1356957. [PMID: 38984140 PMCID: PMC11182128 DOI: 10.3389/fopht.2024.1356957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/06/2024] [Indexed: 07/11/2024]
Abstract
Introduction Tumor necrosis factor alpha (TNF-α) is an inflammatory cytokine implicated in pathological changes to the retinal pigment epithelium that are similar to changes in geographic atrophy (GA), an advanced form of age related macular degeneration (AMD). TNF-α also modulates expression of other cytokines including vascular endothelial growth factor (VEGF), leading to choroidal atrophy in models of AMD. The purpose of this study was to investigate systemic TNF-α and VEGF in patients with GA and intermediate AMD (iAMD) compared to controls without AMD. Methods We examined plasma levels of TNF-α and VEGF in patients with GA, iAMD, and controls without AMD from the University of Colorado AMD registry (2014 to 2021). Cases and controls were characterized by multimodal imaging. TNF-α and VEGF were measured via multiplex immunoassay and data were analyzed using a non-parametric rank based linear regression model fit to plasma biomarkers. Results There were 97 GA, 199 iAMD patients and 139 controls. TNF-α was significantly increased in GA (Median:9.9pg/ml, IQR:7.3-11.8) compared to iAMD (Median:7.4, IQR:5.3-9.1) and in both GA and iAMD compared to controls (Median:6.4, IQR:5.3-7.8), p<0.01 for all comparisons. VEGF was significantly increased in iAMD (Median:8.9, IQR:4.8-14.3) compared to controls (Median:7.7, IQR:4.6-11.1), p<0.01. There was a significant positive correlation between TNF-α and VEGF in GA (0.46, p<0.01), and iAMD (0.20, p=0.01) with no significant interaction between TNF-α and VEGF in any group. Discussion These findings suggest TNF-α and VEGF may contribute to systemic inflammatory processes associated with iAMD and GA. TNF-α and VEGF may function as systemic biomarkers for disease development.
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Affiliation(s)
- Vivian Rajeswaren
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Brandie D. Wagner
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, United States
- Colorado School of Public Health, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jennifer L. Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Naresh Mandava
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Marc T. Mathias
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Niranjan Manoharan
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, United States
| | | | - Ramya Gnanaraj
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Anne M. Lynch
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Alan G. Palestine
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, United States
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Song MY, Kim Y, Han K, Kim JH. Prevalence and Risk Factors of Age-Related Macular Degeneration in South Korea: Korea National Health and Nutrition Examination Survey. Ophthalmic Epidemiol 2024:1-10. [PMID: 38507599 DOI: 10.1080/09286586.2024.2321892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 02/18/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE To evaluate the prevalence and risk factors of age-related macular degeneration (AMD) in the Korean population. METHODS In this cross-sectional study based on the Korea National Health and Nutrition Examination Survey (2017-2020) data 13,737 participants aged ≥ 40 years with assessable fundus images were included. The prevalence and risk factors of AMD were evaluated. The prevalence of early AMD, geographic atrophy (GA), and neovascular AMD were also assessed. Logistic regression analyses were used to identify risk factors. RESULTS The prevalence (95% confidence interval [CI]) of AMD was 13.94% (13.15-14.72). The prevalence (95% CI) of early AMD, GA, and neovascular AMD was 13.07% (12.29-13.85), 0.26% (0.17-0.35), and 0.61% (0.47-0.75), respectively. The prevalence increased with age; it was 3.61%, 11.33%, 20.31%, 31.37%, and 33.98% in participants in their 40s, 50s, 60s, 70s, and ≥ 80 years, respectively. In multivariate analysis, AMD was positively associated with older age (p < 0.001; odds ratio [OR], 1.08; 95% CI, 1.07-1.09), male sex (p = 0.014; OR, 1.27; 95% CI, 1.05-1.53), and lower degree of education (p < 0.001; OR, 1.36 (for junior high school graduates); 95% CI, 1.12-1.65). CONCLUSIONS AMD was detected in approximately one-third of individuals aged ≥ 70 years, thus indicating that AMD is a common disease among older Koreans. Regular fundus examinations in populations with risk factors for AMD as well as education on methods to prevent or delay AMD progression, such as the Mediterranean diet, are necessary.
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Affiliation(s)
- Mi Yeon Song
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, South Korea
- Department of Ophthalmology, Samsung Medical Center, Seoul, South Korea
| | - Yeji Kim
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, South Korea
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7
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Großpötzl M, Riedl R, Schließleder G, Hu ZJ, Michaelides M, Sadda S, Birch D, Charbel Issa P, Wedrich A, Seidel G, Scholl HPN, Strauss RW. Progression of PROM1-Associated Retinal Degeneration as Determined by Spectral-Domain Optical Coherence Tomography Over a 24-Month Period. Am J Ophthalmol 2024; 259:109-116. [PMID: 37979600 DOI: 10.1016/j.ajo.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 11/20/2023]
Abstract
PURPOSE To evaluate the progression of atrophy as determined by spectral-domain optical coherence tomography (SD-OCT) in patients with molecularly confirmed PROM1-associated retinal degeneration (RD) over a 24-month period. DESIGN International, multicenter, prospective case series. METHODS A total of 13 eyes (13 patients) affected with PROM1-associated RD were enrolled at 5 sites and SD-OCT images were obtained at baseline and after 24 months. Loss of mean thickness (MT) and intact area were estimated after semi-automated segmentation for the following individual retinal layers in the central subfield (CS), inner ring, and outer ring of the ETDRS grid: retinal pigment epithelium (RPE), outer segments (OS), inner segments (IS), outer nuclear layer (ONL), inner retina (IR), and total retina (TR). RESULTS Statistically significant losses of thickness of RPE and TR were detected in the CS and inner ring and of ONL and IS in the outer ring (all P < .05); a statistically significant decrease in the intact area of RPE and IS was observed in the inner ring, and of ONL in the outer ring (all P < .05); the change in MT and the intact area of the other layers showed a trend of decline over an observational period of 24 months. CONCLUSIONS Significant thickness losses could be detected in outer retinal layers by SD-OCT over a 24-month period in patients with PROM1-associated retinal degeneration. Loss of thickness and/or intact area of such layers may serve as potential endpoints for clinical trials that aim to slow down the disease progression of PROM1-associated retinal degeneration.
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Affiliation(s)
- Manuel Großpötzl
- Department of Ophthalmology (M.G., G.S., A.W., G.S., R.W.S), Medical University Graz, Graz, Austria
| | - Regina Riedl
- Institute for Medical Informatics, Statistics and Documentation (R.R.), Medical University Graz, Graz, Austria
| | - Gernot Schließleder
- Department of Ophthalmology (M.G., G.S., A.W., G.S., R.W.S), Medical University Graz, Graz, Austria
| | - Zhihong Jewel Hu
- Doheny Eye Institute (Z.J.H., S.V.S.), David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Michel Michaelides
- Moorfields Eye Hospital (M.M., R.W.S.), NHS Foundation Trust, London, United Kingdom; UCL Institute of Ophthalmology (M.M., R.W.S.), University College London, London, United Kingdom
| | - SriniVas Sadda
- Doheny Eye Institute (Z.J.H., S.V.S.), David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - David Birch
- Retina Foundation of the Southwest (D.B.), Dallas, Texas, USA
| | - Peter Charbel Issa
- Department of Ophthalmology (P.C.I.), University of Bonn, Bonn, Germany; Oxford Eye Hospital (P.C.I.), Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Nuffield Laboratory of Ophthalmology (P.C.I.), Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Andreas Wedrich
- Department of Ophthalmology (M.G., G.S., A.W., G.S., R.W.S), Medical University Graz, Graz, Austria
| | - Gerald Seidel
- Department of Ophthalmology (M.G., G.S., A.W., G.S., R.W.S), Medical University Graz, Graz, Austria
| | - Hendrik P N Scholl
- Institute of Molecular and Clinical Ophthalmology Basel (H.P.N.S.), Basel, Switzerland; Department of Ophthalmology (R.W.S.), University of Basel, Basel, Switzerland
| | - Rupert W Strauss
- Department of Ophthalmology (M.G., G.S., A.W., G.S., R.W.S), Medical University Graz, Graz, Austria; Moorfields Eye Hospital (M.M., R.W.S.), NHS Foundation Trust, London, United Kingdom; UCL Institute of Ophthalmology (M.M., R.W.S.), University College London, London, United Kingdom; Institute of Molecular and Clinical Ophthalmology Basel (H.P.N.S.), Basel, Switzerland; Wilmer Eye Institute (R.W.S.), Johns Hopkins University, Baltimore, Maryland, USA.
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8
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Kim Y, Song MY, Han K, Kim JH. Bilateral Involvement of Age-Related Macular Degeneration in South Korea: Findings from the Korea National Health and Nutrition Examination Survey 2017-2020. Ophthalmic Epidemiol 2024:1-8. [PMID: 38265052 DOI: 10.1080/09286586.2023.2301583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 12/26/2023] [Indexed: 01/25/2024]
Abstract
PURPOSE To evaluate the bilateral involvement of age-related macular degeneration (AMD) in South Koreans. METHODS This was a cross-sectional study of the Korean National Health and Nutrition Examination Survey (2017-2020). This study included 13,737 participants aged 40 years or older. Participants were evaluated to determine the prevalence of bilateral early and late AMD. In cases in which exudative AMD or geographic atrophy (GA) was diagnosed in a single eye, the fellow eye was evaluated to determine the presence and type of late AMD. RESULTS The overall prevalence of bilateral AMD was 6.12% (95% confidence interval [CI], 5.63-6.61). The prevalence of bilateral early AMD was 5.71% (95% CI, 5.24-6.18), while that of late AMD was 0.14% (95% CI, 0.08-0.20). The prevalence of the bilateral involvement of late AMD increased with age. A 0.02% prevalence (95% CI, 0.00-0.06) of late AMD was observed in participants aged 50-59. The prevalence increased to 0.08% (95% CI, 0.00-0.18) in participants aged 60-69, while the prevalence in participants aged 70-79 and over 80 was 0.45% (95% CI, 0.12-0.78) and 1.97% (95% CI, 0.75-3.19), respectively. The prevalence of early AMD in one eye and late AMD in the fellow eye was 0.26% (95% CI, 0.16-0.36). CONCLUSIONS An assessment of the incidence of AMD revealed that a significant number of persons had bilateral involvement. The treatment burden may significantly increase for participants with bilateral late AMD compared to those with unilateral involvement. Therefore, the study may be helpful with the establishment of private and national insurance policies.
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Affiliation(s)
- Yeji Kim
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, South Korea
| | - Mi Yeon Song
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, South Korea
- Department of Ophthalmology, Samsung Medical Center, Seoul, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Jae Hui Kim
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, South Korea
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Emamverdi M, Habibi A, Ashrafkhorasani M, Nittala MG, Kadomoto S, Sadda SR. Optical Coherence Tomography Features of Macular Hyperpigmented Lesions without Intraretinal Hyperreflective Foci in Age-Related Macular Degeneration. Curr Eye Res 2024; 49:73-79. [PMID: 37937806 DOI: 10.1080/02713683.2023.2267801] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/02/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE To evaluate the optical coherence tomography (OCT) features of hyperpigmented lesions in the absence of intraretinal hyperreflective foci (IHRF) on OCT in eyes with age-related macular degeneration (AMD). METHODS We retrospectively analyzed OCT images of eyes with intermediate AMD (iAMD) and macular hyperpigmentation (HP) on color fundus photograph (CFP) but without IHRF on OCT in the corresponding location. The most prominent or definite HP was selected for analysis. The infrared reflectance (IR) image registered with the CFP, and the location corresponding to the HP lesion were defined on the IR image. The location of the HP on the corresponding OCT B-scan was assessed for retinal pigment epithelium (RPE) elevation, acquired vitelliform lesion (AVL), abnormal retinal pigment epithelium + basal lamina (RPE + BL) band reflectivity, RPE + BL band thickening, as well as interdigitation zone (IZ), ellipsoid zone (EZ) and external limiting membrane (ELM) disruption. RESULTS 49 eyes (39 patients) were included in this study. Forty-six (94%) of the hyperpigmented lesions showed a thickened RPE + BL band. RPE + BL band reflectivity was increased in 37 (76%) of the lesions. RPE + BL band thickening, however, was not correlated with RPE + BL band reflectivity (p-value = 0.31). Either thickening or hyperreflectivity of the RPE + BL band was present in all cases. Twenty (41%) lesions had evidence of ELM disruption, 42 (86%) demonstrated EZ disruption and 48 (98%) had IZ disruption. Five (10%) HPs demonstrated AVL. Among cases with RPE elevation (15 cases, 31%), 10 were classified as drusen, 2 as drusenoid PEDs, and 3 as fibrovascular PEDs. CONCLUSIONS Thickening and/or hyperreflectivity of the RPE + BL band commonly correspond to regions of macular hyperpigmentation without IHRF in eyes with iAMD.
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Affiliation(s)
- Mehdi Emamverdi
- Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Doheny Image Reading and Research Laboratory, Doheny Eye Institute, Pasadena, CA, USA
| | - Abbas Habibi
- Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Doheny Image Reading and Research Laboratory, Doheny Eye Institute, Pasadena, CA, USA
| | - Maryam Ashrafkhorasani
- Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Doheny Image Reading and Research Laboratory, Doheny Eye Institute, Pasadena, CA, USA
| | - Muneeswar G Nittala
- Doheny Image Reading and Research Laboratory, Doheny Eye Institute, Pasadena, CA, USA
| | - Shin Kadomoto
- Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Doheny Image Reading and Research Laboratory, Doheny Eye Institute, Pasadena, CA, USA
| | - SriniVas R Sadda
- Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Doheny Image Reading and Research Laboratory, Doheny Eye Institute, Pasadena, CA, USA
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Lee JH, Ahn J, Shin JY. Sequential structural and functional change in geographic atrophy on multimodal imaging in non-exudative age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2023; 261:2199-2207. [PMID: 36877299 DOI: 10.1007/s00417-023-06022-3] [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: 10/20/2022] [Revised: 02/06/2023] [Accepted: 02/18/2023] [Indexed: 03/07/2023] Open
Abstract
PURPOSE To investigate the temporal order of photoreceptor atrophy, retinal pigment epithelium (RPE) atrophy and visual acuity loss in patients with center-involving geographic atrophy (GA) in non-exudative age-related macular degeneration (neAMD). METHODS Forty eyes of 25 consecutive patients who eventually developed center-involving GA were investigated. Fundus autofluorescence (FAF) and infrared image coupled optical coherence tomography (OCT) were acquired at each visit. Development of RPE atrophy and photoreceptor atrophy was defined as abnormal hyper/hypo-fluorescence on FAF and photoreceptor loss on OCT over 50% of the vertical or horizontal diameters of the center 1 mm circle, respectively. Visual acuity loss was defined as worsening of more than 0.2 logMAR compared to baseline. Kaplan-Meier analyses was performed to compare the sequential order of these three events. RESULTS Mean age was 72.72 ± 8.63 years, and follow-up duration was 27.36 ± 17.22 months, with an average number of visits of 3.04 ± 1.54 during follow-up. GA progressed from photoreceptor atrophy on OCT, RPE atrophy on FAF, and then to vision loss (p < 0.001). The median survival time of photoreceptors preceded that of visual acuity by 16.3 months, and the median survival time of RPE preceded that of visual acuity by 7.0 months. At baseline, majority of eyes showed drusen only (57.5%), while the most common feature was incomplete RPE and outer retinal atrophy at 3-year follow-up (40.4%). CONCLUSION In the progression of center-involving GA, photoreceptor atrophy on OCT and RPE atrophy on FAF precedes visual decline, and can act as biomarkers predicting future visual decline within the following years.
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Affiliation(s)
- Jeong Hyun Lee
- Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, 07061, Korea
| | - Jeeyun Ahn
- Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, 07061, Korea
| | - Joo Young Shin
- Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, 07061, Korea.
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11
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Ranetti AE, Stanca HT, Tăbăcaru B, Teodoru A, Munteanu M, Stanca S. Retromode Imaging in Age-Related Macular Degeneration. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040647. [PMID: 37109604 PMCID: PMC10144202 DOI: 10.3390/medicina59040647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/14/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Retromode is a relatively new retinal-imaging technique that is based on the transillumination principle and is obtained with a scanning laser ophthalmoscope that uses light in the infrared spectrum. The laser light penetrates into the deep retinal layers and the choroid. Retromode images are captured with a laterally displaced aperture, and the detector captures only the scattered light. The result is a high-contrast pseudo-three-dimensional image. Age-related macular degeneration (AMD) is a disabling retinal disease. AMD is characterized in its early stage by small and intermediate drusen formation, while the signs of intermediate AMD are large drusen and/or pigmentary abnormalities. Late AMD has two forms, geographic atrophy, which is the advanced form of dry AMD, and wet AMD. Most of the lesions of AMD are located in the outer layers of the retina. This new imaging method can provide a glimpse of the deep retinal layers' topographic changes in a non-invasive, fast, and effective way that can match the other imaging tools available. Materials and Methods: The literature review was performed by searching the PubMed database using the following combination of keywords: retromode imaging and age-related macular degeneration. Relevant images similar to the ones in the literature were identified and used as models. Results: The purpose of this article is to highlight the utility of incorporating retromode imaging into the multimodal evaluation of the retina in patients with AMD and to gather and integrate these findings into a brief but comprehensive paper. Conclusions: Retromode imaging is a good screening, diagnosis, and monitoring tool for patients with AMD.
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Affiliation(s)
- Antonia-Elena Ranetti
- Doctoral School, University of Medicine and Pharmacy "Carol Davila", 020021 București, Romania
| | - Horia Tudor Stanca
- Doctoral School, University of Medicine and Pharmacy "Carol Davila", 020021 București, Romania
- Clinical Department of Ophthalmology, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Bogdana Tăbăcaru
- Clinical Department of Ophthalmology, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adrian Teodoru
- Clinical Surgical Department, Faculty of Medicine, "Lucian Blaga" University Sibiu, 550169 Sibiu, Romania
| | - Mihnea Munteanu
- Department of Ophthalmology, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Simona Stanca
- Clinical Department of Pediatrics, University of Medicine and Pharmacy "Carol Davila", 020021 București, Romania
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12
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Freeman WR, Bandello F, Souied E, Guymer RH, Garg SJ, Chen FK, Rich R, Holz FG, Patel SS, Kim K, López FJ, Guymer R, Korobelnik JF, Souied E, Holz F, Ziemssen F, Bandello F, Campos E, Grignolo/Eandi C, Midena E, Peiretti E, Staurenghi G, Viola F, Bailey C, Esposti SD, Jackson T, Menon G, Pagliarini S, Quhill F, Antoszyk A, Brooks L, Callanan D, Csaky K, Edwards A, Eichenbaum D, Freeman W, Garg S, Ghuman AT, Gonzalez V, Gupta S, Hamilton R, Khurana R, Kunimoto D, Kuppermann B, Lauer A, Lee SY, Maturi R, Patel S, Reddy R, Rich R, Rivellese M, Rose S, Segal Z, Wong R. Randomized Phase 2b Study of Brimonidine Drug Delivery System Generation 2 for Geographic Atrophy in Age-related Macular Degeneration. Ophthalmol Retina 2023:S2468-6530(23)00097-0. [PMID: 36906177 DOI: 10.1016/j.oret.2023.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of repeat injections of Brimonidine Drug Delivery System (Brimo DDS) Generation 2 (Gen 2) containing 400 μg brimonidine in patients with geographic atrophy (GA) secondary to age-related macular degeneration (AMD). DESIGN Phase 2b, randomized, multicenter, double-masked, sham-controlled, 30-month study (BEACON). PARTICIPANTS Patients diagnosed with GA secondary to AMD and multifocal lesions with total area >1.25 mm2 and ≤18 mm2 in the study eye. METHODS Enrolled patients were randomized to treatment with intravitreal injections of 400-μg Brimo DDS (n=154) or sham procedure (n=156) in the study eye every 3 months from day 1 through month 21. MAIN OUTCOME MEASURES The primary efficacy endpoint was change from baseline in the GA lesion area in the study eye, assessed with fundus autofluorescence imaging, at month 24. Safety measures included treatment-emergent adverse events (AEs). RESULTS The study was terminated early, at the time of the planned interim analysis, because of a slow GA progression rate (∼1.6 mm2/year) in the enrolled population. Least-squares mean (standard error) GA area change from baseline at month 24 (primary endpoint) was 3.24 (0.13) mm2 with Brimo DDS (n=84) versus 3.48 (0.13) mm2 with sham (n=91); the reduction in GA area change from baseline in the Brimo DDS group compared with the sham group was 0.25 mm2 (7%) (P = 0.150). At month 30, the GA area change from baseline was 4.09 (0.15) mm2 with Brimo DDS (n=49) versus 4.52 (0.15) mm2 with sham (n=46), a reduction of 0.43 mm2 (10%) with Brimo DDS compared with sham (P=0.033). Exploratory analysis showed numerically smaller loss over time in retinal sensitivity assessed with scotopic microperimetry with Brimo DDS compared with sham (P=0.053 at month 24). Treatment-related AEs were usually related to the injection procedure. No implant accumulation was observed. CONCLUSIONS Multiple intravitreal administrations of Brimo DDS (Gen 2) were well tolerated. The primary efficacy endpoint at 24 months was not met, but there was a numerical trend for reduction in GA progression at 24 months compared with sham treatment. The study was terminated early because of the lower-than-expected GA progression rate in the sham/control group.
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Affiliation(s)
- William R Freeman
- Jacobs Retina Center, University of California San Diego, La Jolla, California, USA.
| | - Francesco Bandello
- University Vita-Salute Scientific Institute, Hospital San Raffaele, Milan, Italy
| | - Eric Souied
- Centre Hospitalier Creteil, Service Universitaire d'Ophthalmologie, Creteil, France
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, and Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Australia
| | - Sunir J Garg
- Mid Atlantic Retina, the Retina Service of Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Fred K Chen
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, and Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Australia; Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, Western Australia, Australia
| | - Ryan Rich
- Retina Consultants of Southern Colorado PC, Colorado Springs, Colorado, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Kimmie Kim
- Allergan, an AbbVie company, Irvine, California, USA
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Domalpally A, Whittier SA, Pan Q, Dabelea DM, Darwin CH, Knowler WC, Lee CG, Luchsinger JA, White NH, Chew EY, Gadde KM, Culbert IW, Arceneaux J, Chatellier A, Dragg A, Champagne CM, Duncan C, Eberhardt B, Greenway F, Guillory FG, Herbert AA, Jeffirs ML, Kennedy BM, Levy E, Lockett M, Lovejoy JC, Morris LH, Melancon LE, Ryan DH, Sanford DA, Smith KG, Smith LL, St.Amant JA, Tulley RT, Vicknair PC, Williamson D, Zachwieja JJ, Polonsky KS, Tobian J, Ehrmann DA, Matulik MJ, Temple KA, Clark B, Czech K, DeSandre C, Dotson B, Hilbrich R, McNabb W, Semenske AR, Caro JF, Furlong K, Goldstein BJ, Watson PG, Smith KA, Mendoza J, Simmons M, Wildman W, Liberoni R, Spandorfer J, Pepe C, Donahue RP, Goldberg RB, Prineas R, Calles J, Giannella A, Rowe P, Sanguily J, Cassanova-Romero P, Castillo-Florez S, Florez HJ, Garg R, Kirby L, Lara O, Larreal C, McLymont V, Mendez J, Perry A, Saab P, Veciana B, Haffner SM, Hazuda HP, Montez MG, Hattaway K, Isaac J, Lorenzo C, Martinez A, Salazar M, Walker T, Hamman RF, Nash PV, Steinke SC, Testaverde L, Truong J, Anderson DR, Ballonoff LB, Bouffard A, Bucca B, Calonge BN, Delve L, Farago M, Hill JO, Hoyer SR, Jenkins T, Jortberg BT, Lenz D, Miller M, Nilan T, Perreault L, Price DW, Regensteiner JG, Schroeder EB, Seagle H, Smith CM, VanDorsten B, Horton ES, Munshi M, Lawton KE, Jackson SD, Poirier CS, Swift K, Arky RA, Bryant M, Burke JP, Caballero E, Callaphan KM, Fargnoli B, Franklin T, Ganda OP, Guidi A, Guido M, Jacobsen AM, Kula LM, Kocal M, Lambert L, Ledbury S, Malloy MA, Middelbeek RJ, Nicosia M, Oldmixon CF, Pan J, Quitingon M, Rainville R, Rubtchinsky S, Seely EW, Sansoucy J, Schweizer D, Simonson D, Smith F, Solomon CG, Spellman J, Warram J, Kahn SE, Fattaleh B, Montgomery BK, Colegrove C, Fujimoto W, Knopp RH, Lipkin EW, Marr M, Morgan-Taggart I, Murillo A, O’Neal K, Trence D, Taylor L, Thomas A, Tsai EC, Dagogo-Jack S, Kitabchi AE, Murphy ME, Taylor L, Dolgoff J, Applegate WB, Bryer-Ash M, Clark D, Frieson SL, Ibebuogu U, Imseis R, Lambeth H, Lichtermann LC, Oktaei H, Ricks H, Rutledge LM, Sherman AR, Smith CM, Soberman JE, Williams-Cleaves B, Patel A, Nyenwe EA, Hampton EF, Metzger BE, Molitch ME, Johnson MK, Adelman DT, Behrends C, Cook M, Fitzgibbon M, Giles MM, Heard D, Johnson CK, Larsen D, Lowe A, Lyman M, McPherson D, Penn SC, Pitts T, Reinhart R, Roston S, Schinleber PA, Wallia A, Nathan DM, McKitrick C, Turgeon H, Larkin M, Mugford M, Abbott K, Anderson E, Bissett L, Bondi K, Cagliero E, Florez JC, Delahanty L, Goldman V, Grassa E, Gurry L, D’Anna K, Leandre F, Lou P, Poulos A, Raymond E, Ripley V, Stevens C, Tseng B, Olefsky JM, Barrett-Connor E, Mudaliar S, Araneta MR, Carrion-Petersen ML, Vejvoda K, Bassiouni S, Beltran M, Claravall LN, Dowden JM, Edelman SV, Garimella P, Henry RR, Horne J, Lamkin M, Janesch SS, Leos D, Polonsky W, Ruiz R, Smith J, Torio-Hurley J, Pi-Sunyer FX, Lee JE, Hagamen S, Allison DB, Agharanya N, Aronoff NJ, Baldo M, Crandall JP, Foo ST, Luchsinger JA, Pal C, Parkes K, Pena MB, Rooney ES, Van Wye GE, Viscovich KA, de Groot M, Marrero DG, Mather KJ, Prince MJ, Kelly SM, Jackson MA, McAtee G, Putenney P, Ackermann RT, Cantrell CM, Dotson YF, Fineberg ES, Fultz M, Guare JC, Hadden A, Ignaut JM, Kirkman MS, Phillips EO, Pinner KL, Porter BD, Roach PJ, Rowland ND, Wheeler ML, Aroda V, Magee M, Ratner RE, Youssef G, Shapiro S, Andon N, Bavido-Arrage C, Boggs G, Bronsord M, Brown E, Love Burkott H, Cheatham WW, Cola S, Evans C, Gibbs P, Kellum T, Leon L, Lagarda M, Levatan C, Lindsay M, Nair AK, Park J, Passaro M, Silverman A, Uwaifo G, Wells-Thayer D, Wiggins R, Saad MF, Watson K, Budget M, Jinagouda S, Botrous M, Sosa A, Tadros S, Akbar K, Conzues C, Magpuri P, Ngo K, Rassam A, Waters D, Xapthalamous K, Santiago JV, Brown AL, Das S, Khare-Ranade P, Stich T, Santiago A, Fisher E, Hurt E, Jones T, Kerr M, Ryder L, Wernimont C, Golden SH, Saudek CD, Bradley V, Sullivan E, Whittington T, Abbas C, Allen A, Brancati FL, Cappelli S, Clark JM, Charleston JB, Freel J, Horak K, Greene A, Jiggetts D, Johnson D, Joseph H, Loman K, Mathioudakis N, Mosley H, Reusing J, Rubin RR, Samuels A, Shields T, Stephens S, Stewart KJ, Thomas L, Utsey E, Williamson P, Schade DS, Adams KS, Canady JL, Johannes C, Hemphill C, Hyde P, Atler LF, Boyle PJ, Burge MR, Chai L, Colleran K, Fondino A, Gonzales Y, Hernandez-McGinnis DA, Katz P, King C, Middendorf J, Rubinchik S, Senter W, Crandall J, Shamoon H, Brown JO, Trandafirescu G, Powell D, Adorno E, Cox L, Duffy H, Engel S, Friedler A, Goldstein A, Howard-Century CJ, Lukin J, Kloiber S, Longchamp N, Martinez H, Pompi D, Scheindlin J, Violino E, Walker EA, Wylie-Rosett J, Zimmerman E, Zonszein J, Orchard T, Venditti E, Wing RR, Jeffries S, Koenning G, Kramer MK, Smith M, Barr S, Benchoff C, Boraz M, Clifford L, Culyba R, Frazier M, Gilligan R, Guimond S, Harrier S, Harris L, Kriska A, Manjoo Q, Mullen M, Noel A, Otto A, Pettigrew J, Rockette-Wagner B, Rubinstein D, Semler L, Smith CF, Weinzierl V, Williams KV, Wilson T, Mau MK, Baker-Ladao NK, Melish JS, Arakaki RF, Latimer RW, Isonaga MK, Beddow R, Bermudez NE, Dias L, Inouye J, Mikami K, Mohideen P, Odom SK, Perry RU, Yamamoto RE, Anderson H, Cooeyate N, Dodge C, Hoskin MA, Percy CA, Enote A, Natewa C, Acton KJ, Andre VL, Barber R, Begay S, Bennett PH, Benson MB, Bird EC, Broussard BA, Bucca BC, Chavez M, Cook S, Curtis J, Dacawyma T, Doughty MS, Duncan R, Edgerton C, Ghahate JM, Glass J, Glass M, Gohdes D, Grant W, Hanson RL, Horse E, Ingraham LE, Jackson M, Jay P, Kaskalla RS, Kavena K, Kessler D, Kobus KM, Krakoff J, Kurland J, Manus C, McCabe C, Michaels S, Morgan T, Nashboo Y, Nelson JA, Poirier S, Polczynski E, Piromalli C, Reidy M, Roumain J, Rowse D, Roy RJ, Sangster S, Sewenemewa J, Smart M, Spencer C, Tonemah D, Williams R, Wilson C, Yazzie M, Bain R, Fowler S, Temprosa M, Larsen MD, Brenneman T, Edelstein SL, Abebe S, Bamdad J, Barkalow M, Bethepu J, Bezabeh T, Bowers A, Butler N, Callaghan J, Carter CE, Christophi C, Dwyer GM, Foulkes M, Gao Y, Gooding R, Gottlieb A, Grimes KL, Grover-Fairchild N, Haffner L, Hoffman H, Jablonski K, Jones S, Jones TL, Katz R, Kolinjivadi P, Lachin JM, Ma Y, Mucik P, Orlosky R, Reamer S, Rochon J, Sapozhnikova A, Sherif H, Stimpson C, Hogan Tjaden A, Walker-Murray F, Venditti EM, Kriska AM, Weinzierl V, Marcovina S, Aldrich FA, Harting J, Albers J, Strylewicz G, Eastman R, Fradkin J, Garfield S, Lee C, Gregg E, Zhang P, O’Leary D, Evans G, Budoff M, Dailing C, Stamm E, Schwartz A, Navy C, Palermo L, Rautaharju P, Prineas RJ, Alexander T, Campbell C, Hall S, Li Y, Mills M, Pemberton N, Rautaharju F, Zhang Z, Soliman EZ, Hu J, Hensley S, Keasler L, Taylor T, Blodi B, Danis R, Davis M, Hubbard* L, Endres** R, Elsas** D, Johnson** S, Myers** D, Barrett N, Baumhauer H, Benz W, Cohn H, Corkery E, Dohm K, Gama V, Goulding A, Ewen A, Hurtenbach C, Lawrence D, McDaniel K, Pak J, Reimers J, Shaw R, Swift M, Vargo P, Watson S, Manly J, Mayer-Davis E, Moran RR, Ganiats T, David K, Sarkin AJ, Groessl E, Katzir N, Chong H, Herman WH, Brändle M, Brown MB, Altshuler D, Billings LK, Chen L, Harden M, Knowler WC, Pollin TI, Shuldiner AR, Franks PW, Hivert MF. Association of Metformin With the Development of Age-Related Macular Degeneration. JAMA Ophthalmol 2023; 141:140-147. [PMID: 36547967 PMCID: PMC9936345 DOI: 10.1001/jamaophthalmol.2022.5567] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/29/2022] [Indexed: 12/24/2022]
Abstract
Importance Age-related macular degeneration (AMD) is a leading cause of blindness with no treatment available for early stages. Retrospective studies have shown an association between metformin and reduced risk of AMD. Objective To investigate the association between metformin use and age-related macular degeneration (AMD). Design, Setting, and Participants The Diabetes Prevention Program Outcomes Study is a cross-sectional follow-up phase of a large multicenter randomized clinical trial, Diabetes Prevention Program (1996-2001), to investigate the association of treatment with metformin or an intensive lifestyle modification vs placebo with preventing the onset of type 2 diabetes in a population at high risk for developing diabetes. Participants with retinal imaging at a follow-up visit 16 years posttrial (2017-2019) were included. Analysis took place between October 2019 and May 2022. Interventions Participants were randomly distributed between 3 interventional arms: lifestyle, metformin, and placebo. Main Outcomes and Measures Prevalence of AMD in the treatment arms. Results Of 1592 participants, 514 (32.3%) were in the lifestyle arm, 549 (34.5%) were in the metformin arm, and 529 (33.2%) were in the placebo arm. All 3 arms were balanced for baseline characteristics including age (mean [SD] age at randomization, 49 [9] years), sex (1128 [71%] male), race and ethnicity (784 [49%] White), smoking habits, body mass index, and education level. AMD was identified in 479 participants (30.1%); 229 (14.4%) had early AMD, 218 (13.7%) had intermediate AMD, and 32 (2.0%) had advanced AMD. There was no significant difference in the presence of AMD between the 3 groups: 152 (29.6%) in the lifestyle arm, 165 (30.2%) in the metformin arm, and 162 (30.7%) in the placebo arm. There was also no difference in the distribution of early, intermediate, and advanced AMD between the intervention groups. Mean duration of metformin use was similar for those with and without AMD (mean [SD], 8.0 [9.3] vs 8.5 [9.3] years; P = .69). In the multivariate models, history of smoking was associated with increased risks of AMD (odds ratio, 1.30; 95% CI, 1.05-1.61; P = .02). Conclusions and Relevance These data suggest neither metformin nor lifestyle changes initiated for diabetes prevention were associated with the risk of any AMD, with similar results for AMD severity. Duration of metformin use was also not associated with AMD. This analysis does not address the association of metformin with incidence or progression of AMD.
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Affiliation(s)
- Amitha Domalpally
- Wisconsin Reading Center, Department of Ophthalmology, University of Wisconsin School of Medicine and Public and Health, Madison
| | - Samuel A. Whittier
- Wisconsin Reading Center, Department of Ophthalmology, University of Wisconsin School of Medicine and Public and Health, Madison
| | - Qing Pan
- Department of Statistics, George Washington University, Washington, DC
| | - Dana M. Dabelea
- Department of Epidemiology, University of Colorado School of Public Health, Denver
| | - Christine H. Darwin
- Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - William C. Knowler
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona
| | - Christine G. Lee
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institutes of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Jose A. Luchsinger
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Neil H. White
- Division of Endocrinology & Diabetes, Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Emily Y. Chew
- Division of Epidemiology and Clinical Applications–Clinical Trials Branch, National Eye Institute - National Institutes of Health, Bethesda, Maryland
| | | | | | | | | | | | - Amber Dragg
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Crystal Duncan
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Frank Greenway
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | - Erma Levy
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Monica Lockett
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Donna H. Ryan
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Lisa L. Smith
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | | | - Janet Tobian
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Bart Clark
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kirsten Czech
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Wylie McNabb
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Jose F. Caro
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kevin Furlong
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Jewel Mendoza
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Marsha Simmons
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Wendi Wildman
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Renee Liberoni
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Constance Pepe
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Ronald Prineas
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Anna Giannella
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Patricia Rowe
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | - Rajesh Garg
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Olga Lara
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Carmen Larreal
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Jadell Mendez
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Arlette Perry
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Patrice Saab
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Bertha Veciana
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Kathy Hattaway
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Juan Isaac
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Carlos Lorenzo
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Monica Salazar
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Tatiana Walker
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | | | | | | | - Brian Bucca
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - B. Ned Calonge
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lynne Delve
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Martha Farago
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - James O. Hill
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Tonya Jenkins
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Dione Lenz
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Marsha Miller
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Thomas Nilan
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - David W. Price
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Helen Seagle
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Medha Munshi
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Kati Swift
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ronald A. Arky
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | | | - Om P. Ganda
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ashley Guidi
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Mathew Guido
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Lyn M. Kula
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Margaret Kocal
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lori Lambert
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Sarah Ledbury
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | - Jocelyn Pan
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Ellen W. Seely
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Dana Schweizer
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Fannie Smith
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - James Warram
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Steven E. Kahn
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Basma Fattaleh
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | - Michelle Marr
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Anne Murillo
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kayla O’Neal
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Dace Trence
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lonnese Taylor
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - April Thomas
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Elaine C. Tsai
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Mary E. Murphy
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Laura Taylor
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Debra Clark
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Uzoma Ibebuogu
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Raed Imseis
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Helen Lambeth
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Hooman Oktaei
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Harriet Ricks
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Amy R. Sherman
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Clara M. Smith
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Avnisha Patel
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | | | | | - Michelle Cook
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Mimi M. Giles
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Deloris Heard
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Diane Larsen
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Anne Lowe
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Megan Lyman
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Samsam C. Penn
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Thomas Pitts
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Renee Reinhart
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Susan Roston
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Amisha Wallia
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Mary Larkin
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Kathy Abbott
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ellen Anderson
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Laurie Bissett
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kristy Bondi
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Jose C. Florez
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Elaine Grassa
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lindsery Gurry
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kali D’Anna
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Peter Lou
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Elyse Raymond
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Valerie Ripley
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Beverly Tseng
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | - Karen Vejvoda
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | | | | | - Javiva Horne
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Marycie Lamkin
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Diana Leos
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Rosa Ruiz
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Jean Smith
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Jane E. Lee
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Susan Hagamen
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Maria Baldo
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Sandra T. Foo
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Carmen Pal
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kathy Parkes
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Mary Beth Pena
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Mary de Groot
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Susie M. Kelly
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Gina McAtee
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Paula Putenney
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | - Megan Fultz
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - John C. Guare
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Angela Hadden
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Kisha L Pinner
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Paris J. Roach
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Vanita Aroda
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Michelle Magee
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Sue Shapiro
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Natalie Andon
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | | | - Susan Cola
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Cindy Evans
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Peggy Gibbs
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Tracy Kellum
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lilia Leon
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Milvia Lagarda
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Asha K. Nair
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Jean Park
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Gabriel Uwaifo
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Renee Wiggins
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Karol Watson
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Maria Budget
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Medhat Botrous
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Anthony Sosa
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Sameh Tadros
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Khan Akbar
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Kathy Ngo
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Amer Rassam
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Debra Waters
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Samia Das
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Tamara Stich
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ana Santiago
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Edwin Fisher
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Emma Hurt
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Tracy Jones
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Michelle Kerr
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lucy Ryder
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | - Emily Sullivan
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Caroline Abbas
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Adrienne Allen
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | - Janice Freel
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Alicia Greene
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Dawn Jiggetts
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Hope Joseph
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kimberly Loman
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Henry Mosley
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - John Reusing
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Alafia Samuels
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Thomas Shields
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - LeeLana Thomas
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Evonne Utsey
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | | | - Penny Hyde
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Mark R. Burge
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lisa Chai
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Ateka Fondino
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ysela Gonzales
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Patricia Katz
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Carolyn King
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Jill Crandall
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Harry Shamoon
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Janet O. Brown
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Elsie Adorno
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Liane Cox
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Helena Duffy
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Samuel Engel
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Jennifer Lukin
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Stacey Kloiber
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Helen Martinez
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Dorothy Pompi
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Elissa Violino
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Joel Zonszein
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Trevor Orchard
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Rena R. Wing
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Susan Jeffries
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Gaye Koenning
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - M. Kaye Kramer
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Marie Smith
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Susan Barr
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Miriam Boraz
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lisa Clifford
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Rebecca Culyba
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Ryan Gilligan
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Susan Harrier
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Louann Harris
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Andrea Kriska
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Monica Mullen
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Alicia Noel
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Amy Otto
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Linda Semler
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Tara Wilson
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - John S. Melish
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Mae K. Isonaga
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ralph Beddow
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Lorna Dias
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Jillian Inouye
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kathy Mikami
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Sharon K. Odom
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | - Mary A. Hoskin
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Carol A. Percy
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Alvera Enote
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Camille Natewa
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kelly J. Acton
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Rosalyn Barber
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Shandiin Begay
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Evelyn C. Bird
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Brian C. Bucca
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Sherron Cook
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Jeff Curtis
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Tara Dacawyma
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Roberta Duncan
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Cyndy Edgerton
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Justin Glass
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Martia Glass
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Dorothy Gohdes
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Wendy Grant
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Ellie Horse
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Merry Jackson
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Priscilla Jay
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Karen Kavena
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - David Kessler
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Jason Kurland
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Cherie McCabe
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Sara Michaels
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Tina Morgan
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Steven Poirier
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Mike Reidy
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Debra Rowse
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Robert J. Roy
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Miranda Smart
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Darryl Tonemah
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Raymond Bain
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Sarah Fowler
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Tina Brenneman
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Solome Abebe
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Julie Bamdad
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Joel Bethepu
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Anna Bowers
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Nicole Butler
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | - Mary Foulkes
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Yuping Gao
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Robert Gooding
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | - Lori Haffner
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Steve Jones
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Tara L. Jones
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Richard Katz
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - John M. Lachin
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Yong Ma
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Pamela Mucik
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Robert Orlosky
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Susan Reamer
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - James Rochon
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Hanna Sherif
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | | | | | | | | | - John Albers
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - R. Eastman
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Judith Fradkin
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Christine Lee
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Edward Gregg
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ping Zhang
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Dan O’Leary
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Gregory Evans
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Matthew Budoff
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Chris Dailing
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Ann Schwartz
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Caroline Navy
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lisa Palermo
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | - Sharon Hall
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Yabing Li
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Margaret Mills
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Zhuming Zhang
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Julie Hu
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Susan Hensley
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Lisa Keasler
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Tonya Taylor
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Barbara Blodi
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ronald Danis
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Matthew Davis
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Larry Hubbard*
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ryan Endres**
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Dawn Myers**
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Nancy Barrett
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Wendy Benz
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Holly Cohn
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ellie Corkery
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kristi Dohm
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Vonnie Gama
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Anne Goulding
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Andy Ewen
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Kyle McDaniel
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Jeong Pak
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - James Reimers
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Ruth Shaw
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Maria Swift
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Pamela Vargo
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Sheila Watson
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Jennifer Manly
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | - Ted Ganiats
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Kristin David
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Erik Groessl
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Naomi Katzir
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Helen Chong
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | | | | | | | | - Ling Chen
- for the Diabetes Prevention Program Research (DPPOS) Group
| | - Maegan Harden
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Toni I. Pollin
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | - Paul W. Franks
- for the Diabetes Prevention Program Research (DPPOS) Group
| | | | | |
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Du Z, Wang T. Knowledge domain and dynamic patterns in multimodal molecular imaging from 2012 to 2021: A visual bibliometric analysis. Medicine (Baltimore) 2023; 102:e32780. [PMID: 36705366 PMCID: PMC9875962 DOI: 10.1097/md.0000000000032780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Multimodal molecular imaging technologies have been widely used to optimize medical research and clinical practice. Bibliometric analysis was performed to identify global research trends, hot spots, and scientific frontiers of multimodal molecular imaging technology from 2012 to 2021. The articles and reviews related to multimodal molecular imaging were retrieved from the Web of Science Core Collection. A bibliometric study was performed using CiteSpace and VOSviewer. A total of 4169 articles and reviews from 2012 to 2021 were analyzed. An increasing trend in the number of articles on multimodal molecular imaging technology was observed. These publications mainly come from 417 institutions in 92 countries, led by the USA and China. K. Bailey Freund published the most papers amongst the publications, while R.F. Spaide had the most co-citations. A dual map overlay of the literature shows that most publications were specialized in physics/materials/chemistry, and molecular/biology/immunology. Synergistic therapy in cancer, advanced nanotechnology, and multimodal imaging in ophthalmology are new trends and developing areas of interest. A global bibliometric and visualization analysis was used to comprehensively review the published research related to multimodal molecular imaging. This study may help in understanding the dynamic patterns of multimodal molecular imaging technology research and point out the developing areas of this field.
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Affiliation(s)
- Zhe Du
- Trauma Center, Peking University People’s Hospital, National Center for Trauma Medicine, Key Laboratory of Trauma and Neural Regeneration (Ministry of Education), Beijing, China
| | - Tianbing Wang
- Trauma Center, Peking University People’s Hospital, National Center for Trauma Medicine, Key Laboratory of Trauma and Neural Regeneration (Ministry of Education), Beijing, China
- *Correspondence: Tianbing Wang, Trauma Center, Peking University People’s Hospital, No.11 South Xizhimen Street, Beijing 100044, China (e-mail: )
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15
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Salehi MA, Mohammadi S, Gouravani M, Rezagholi F, Arevalo JF. Retinal and choroidal changes in AMD: A systematic review and meta-analysis of spectral-domain optical coherence tomography studies. Surv Ophthalmol 2023; 68:54-66. [PMID: 35908660 DOI: 10.1016/j.survophthal.2022.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 02/01/2023]
Abstract
Optical coherence tomography is a noninvasive imaging technology using the optical reflectivity of tissues that is capable of detecting quantitative and qualitative biomarkers of age-related macular degeneration (AMD) that cannot be similarly recognized in conventional imaging. We systematically searched PubMed and Embase databases to identify relevant articles to this subject. A fixed-effect or random-effect model was applied for the meta-analysis based on the heterogeneity level. In addition, subgroup analyses, meta-regression, publication bias, and quality assessment were also performed. Twenty-five studies with 1,632 cases and 1,445 healthy controls in total were included. Our results revealed that, when compared to controls, AMD subjects showed a significantly lower thickness in the choroid at 500 µm temporal, 1,500 µm nasal, and temporal to the fovea, subfoveal choroid, average peripapillary retinal nerve fiber layer, and average macular ganglion cell complex (GCC); however, average and central choroidal thickness 500 µm nasal, 1,000 µm nasal and temporal to the fovea, central and parafoveal macular GCC, retinal nerve fiber layer, and inner plexiform layer, and central macular thickness did not change significantly. Various regional analyses showed several other significant differences. The findings of the current study confirm that some retinal layers are altered in AMD patients compared to healthy controls. Thus, future studies are required to derive more definitive conclusions.
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Affiliation(s)
| | - Soheil Mohammadi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Gouravani
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fateme Rezagholi
- School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - J Fernando Arevalo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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16
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Kim JT, Jun JH, Lee SC, Lee MW. Retinal microvasculature and choriocapillaris impairments according to the stage of dry age-related macular degeneration. Clin Exp Ophthalmol 2023; 51:36-43. [PMID: 36067116 DOI: 10.1111/ceo.14165] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND We aimed to analyse the retinal microvasculature and choriocapillaris according to the dry age-related macular degeneration (AMD) stage and to identify factors associated with their microvasculatures. METHODS Patients were divided into four groups: normal controls, early, intermediate and advanced AMD groups. The vessel density (VD) of superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris was compared using optical coherence tomography angiography among the groups. Linear regression analysis was performed to identify factors associated with the VD. RESULTS The VDs of the SCP were 22.1 ± 5.7, 19.1 ± 5.4, 18.0 ± 6.4 and 12.2 ± 6.4% (p < 0.001); the VDs of the DCP were 22.4 ± 4.5, 20.7 ± 4.3, 18.1 ± 5.3 and 14.6 ± 5.8% (p < 0.001); the VDs of the choriocapillaris were 29.4 ± 3.7, 26.4 ± 4.8, 24.5 ± 4.9 and 24.2 ± 3.7% (p < 0.001) in the control, early, intermediate, and advanced groups, respectively. AMD stage and age were significantly associated with the VDs of all layers, and the VDs of the SCP and DCP were associated with visual acuity (both p < 0.001). Additionally, hypertension was associated with the VDs of the DCP (p = 0.027) and choriocapillaris (p = 0.024). CONCLUSIONS The retinal microvasculature and choriocapillaris tended to become more impaired as the AMD stage progressed. Age was significantly associated with the microvasculature impairments of all layers, and hypertension was significantly associated with impairments of the DCP microvasculature and choriocapillaris.
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Affiliation(s)
- Jung-Tae Kim
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Ji-Ho Jun
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Sung-Chul Lee
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Min-Woo Lee
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
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The role of near-infrared reflectance imaging in retinal disease: A systematic review. Surv Ophthalmol 2022; 68:313-331. [PMID: 36535488 DOI: 10.1016/j.survophthal.2022.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
Near-infrared reflectance (NIR) retinal imaging aids in a better visualization of structures at the level of outer retina, retinal pigment epithelium, and choroid. It has multiple advantages, including easy acquisition in association with structural spectral domain optical coherence tomography, more comfort for patients, and enhanced contrast and spatial resolution. It helps in the diagnosis of chorioretinal diseases that present with minimal funduscopic findings and can be used to follow up many chorioretinal conditions. We describe the chorioretinal NIR imaging appearance and the clinical role of NIR imaging in ocular inflammatory disease, vascular and acquired disease, degenerative disease, tumors, associated systemic condition, toxic and traumatic disease, optic nerve head conditions, and physiological findings.
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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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A Systematic Review of Deep Learning Applications for Optical Coherence Tomography in Age-Related Macular Degeneration. Retina 2022; 42:1417-1424. [DOI: 10.1097/iae.0000000000003535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nam J, Ly A, Kalloniatis M, Nivison-Smith L. Multispectral pattern recognition measures change in drusen area in age-related macular degeneration with high congruency to expert graders. Sci Rep 2022; 12:7442. [PMID: 35524159 PMCID: PMC9076877 DOI: 10.1038/s41598-022-11070-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 02/25/2022] [Indexed: 11/09/2022] Open
Abstract
Drusen are a hallmark lesion of age-related macular degeneration (AMD) and changes in their area and/or volume are strongly associated with disease progression. Assessment of longitudinal change in drusen size in clinical practice however is limited to a single commercial tool or manual inspection by clinicians. In this study we analysed change in drusen area in 33 eyes with intermediate AMD across two separate visits using a novel technique known as multispectral pattern recognition for en face retinal images from various imaging modalities (infrared (815 nm), fundus autofluorescence (488 nm) and green (532 nm) scanning laser ophthalmoscopy). We found 91% (30/33 eyes) agreement in the direction of drusen change for multispectral pattern recognition relative to expert graders who graded eyes as having drusen progression, regression or being stable. Multispectral pattern recognition showed 100% sensitivity (22/22 eyes) and 73% specificity (8/11 eyes). In comparison, we found only 70% (23/33 eyes) agreement in the direction of drusen change with a commercially available change analysis software, the Cirrus Advanced RPE Analysis relative to expert graders, with a sensitivity 64% (14/22 eyes) and specificity of 82% (9/11 eyes). Total drusen area or amount of change between visits had no significant effect on agreement. This suggests multispectral pattern recognition can quantify longitudinal change in drusen area from multimodal imaging with greater congruency to expert graders than a commercially available platform based on a single imaging modality. Considering the association of drusen area and disease progression, this method could aid clinical assessment and monitoring of AMD.
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Affiliation(s)
- Judy Nam
- Centre for Eye Health, University of New South Wales, Sydney, NSW, 2052, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Angelica Ly
- Centre for Eye Health, University of New South Wales, Sydney, NSW, 2052, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Sydney, NSW, 2052, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Lisa Nivison-Smith
- Centre for Eye Health, University of New South Wales, Sydney, NSW, 2052, Australia.
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, 2052, Australia.
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21
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Zhang C, Owen LA, Lillvis JH, Zhang SX, Kim IK, DeAngelis MM. AMD Genomics: Non-Coding RNAs as Biomarkers and Therapeutic Targets. J Clin Med 2022; 11:jcm11061484. [PMID: 35329812 PMCID: PMC8954267 DOI: 10.3390/jcm11061484] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 12/04/2022] Open
Abstract
Age-related macular degeneration (AMD) is a progressive neurodegenerative disease that is the world’s leading cause of blindness in the aging population. Although the clinical stages and forms of AMD have been elucidated, more specific prognostic tools are required to determine when patients with early and intermediate AMD will progress into the advanced stages of AMD. Another challenge in the field has been the appropriate development of therapies for intermediate AMD and advanced atrophic AMD. After numerous negative clinical trials, an anti-C5 agent and anti-C3 agent have recently shown promising results in phase 3 clinical trials, in terms of slowing the growth of geographic atrophy, an advanced form of AMD. Interestingly, both drugs appear to be associated with an increased incidence of wet AMD, another advanced form of the disease, and will require frequent intravitreal injections. Certainly, there remains a need for other therapeutic agents with the potential to prevent progression to advanced stages of the disease. Investigation of the role and clinical utility of non-coding RNAs (ncRNAs) is a major advancement in biology that has only been minimally applied to AMD. In the following review, we discuss the clinical relevance of ncRNAs in AMD as both biomarkers and therapeutic targets.
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Affiliation(s)
- Charles Zhang
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (C.Z.); (L.A.O.); (J.H.L.); (S.X.Z.)
| | - Leah A. Owen
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (C.Z.); (L.A.O.); (J.H.L.); (S.X.Z.)
- Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, The University of Utah, Salt Lake City, UT 84132, USA
- Department of Population Health Sciences, University of Utah School of Medicine, The University of Utah, Salt Lake City, UT 84132, USA
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, The University of Utah, Salt Lake City, UT 84132, USA
| | - John H. Lillvis
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (C.Z.); (L.A.O.); (J.H.L.); (S.X.Z.)
- Veterans Administration Western New York Healthcare System, Buffalo, NY 14212, USA
| | - Sarah X. Zhang
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (C.Z.); (L.A.O.); (J.H.L.); (S.X.Z.)
- Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA
- Neuroscience Graduate Program, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA
| | - Ivana K. Kim
- Retina Service, Massachusetts Eye & Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114, USA
- Correspondence: (I.K.K.); (M.M.D.)
| | - Margaret M. DeAngelis
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA; (C.Z.); (L.A.O.); (J.H.L.); (S.X.Z.)
- Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, The University of Utah, Salt Lake City, UT 84132, USA
- Department of Population Health Sciences, University of Utah School of Medicine, The University of Utah, Salt Lake City, UT 84132, USA
- Veterans Administration Western New York Healthcare System, Buffalo, NY 14212, USA
- Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA
- Neuroscience Graduate Program, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA
- Genetics, Genomics and Bioinformatics Graduate Program, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA
- Correspondence: (I.K.K.); (M.M.D.)
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22
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OCT Angiography Fractal Analysis of Choroidal Neovessels Secondary to Central Serous Chorioretinopathy, in a Caucasian Cohort. J Clin Med 2022; 11:jcm11051443. [PMID: 35268534 PMCID: PMC8911390 DOI: 10.3390/jcm11051443] [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: 01/31/2022] [Revised: 02/27/2022] [Accepted: 03/02/2022] [Indexed: 02/06/2023] Open
Abstract
Central serous chorioretinopathy (CSCR) can be complicated by different types of choroidal neovascularization (CNV). The purpose of this study was to investigate the incidence and quantitative optical coherence tomography angiography (OCT-A) features of CSCR-related CNVs. Methods: This was a retrospective multicenter study including 102 eyes of 102 Caucasian patients with acute or complex CSCR. All patients underwent a comprehensive ophthalmological examination. Quantitative OCT-A parameters, including vascular perfusion density (VPD), fractal dimension (FD), and lacunarity (LAC), were measured in CNV eyes. Results: Forty eyes (39.2%) had acute CSCR, whereas the remaining sixty-two (60.8%) had complex CSCR. CNV was observed in 37 (36.27%) eyes, all of which had the complex form. CNVs were classified as type 1 CNV in 11/37 (29.73%) cases and as polypoidal choroidal vasculopathy (PCV) in the remaining 26/37 (70.27%). Overall, the mean VPD, FD, and LAC of CSCR-related CNVs were 0.52 ± 0.20%, 1.44 ± 0.12, and 2.40 ± 1.1, respectively. No significant difference between type 1 CNV and PCV was found. Conclusion: Complex CSCR is often complicated by type 1 CNV and PCV with similar neovascular architecture and branching complexity, a finding supporting the idea that they might be different stages of the same neovascular process. Future OCT-A fractal analysis-based studies that also include other relevant parameters, such as demographics, presentation, morphology on multimodal imaging, and response to treatment, are necessary before drawing any definitive conclusions.
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Lem DW, Davey PG, Gierhart DL, Rosen RB. A Systematic Review of Carotenoids in the Management of Age-Related Macular Degeneration. Antioxidants (Basel) 2021; 10:1255. [PMID: 34439503 PMCID: PMC8389280 DOI: 10.3390/antiox10081255] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 01/14/2023] Open
Abstract
Age-related macular degeneration (AMD) remains a leading cause of modifiable vision loss in older adults. Chronic oxidative injury and compromised antioxidant defenses represent essential drivers in the development of retinal neurodegeneration. Overwhelming free radical species formation results in mitochondrial dysfunction, as well as cellular and metabolic imbalance, which becomes exacerbated with increasing age. Thus, the depletion of systemic antioxidant capacity further proliferates oxidative stress in AMD-affected eyes, resulting in loss of photoreceptors, neuroinflammation, and ultimately atrophy within the retinal tissue. The aim of this systematic review is to examine the neuroprotective potential of the xanthophyll carotenoids lutein, zeaxanthin, and meso-zeaxanthin on retinal neurodegeneration for the purpose of adjunctive nutraceutical strategy in the management of AMD. A comprehensive literature review was performed to retrieve 55 eligible publications, using four database searches from PubMed, Embase, Cochrane Library, and the Web of Science. Epidemiology studies indicated an enhanced risk reduction against late AMD with greater dietary consumption of carotenoids, meanwhile greater concentrations in macular pigment demonstrated significant improvements in visual function among AMD patients. Collectively, evidence strongly suggests that carotenoid vitamin therapies offer remarkable synergic protection in the neurosensory retina, with the potential to serve as adjunctive nutraceutical therapy in the management of established AMD, albeit these benefits may vary among different stages of disease.
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Affiliation(s)
- Drake W. Lem
- College of Optometry, Western University of Health Sciences, Pomona, CA 91766, USA;
| | | | | | - Richard B. Rosen
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
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24
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Complement Inhibitors in Age-Related Macular Degeneration: A Potential Therapeutic Option. J Immunol Res 2021; 2021:9945725. [PMID: 34368372 PMCID: PMC8346298 DOI: 10.1155/2021/9945725] [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] [Received: 03/15/2021] [Revised: 07/07/2021] [Accepted: 07/14/2021] [Indexed: 11/18/2022] Open
Abstract
Age-related macular degeneration (AMD) is a multifactorial disease, which can culminate in irreversible vision loss and blindness in elderly. Nowadays, there is a big gap between dry AMD and wet AMD on treatment. Accounting for nearly 90% of AMD, dry AMD still lacks effective treatment. Numerous genetic and molecular researches have confirmed the significant role of the complement system in the pathogenesis of AMD, leading to a deeper exploration of complement inhibitors in the treatment of AMD. To date, at least 14 different complement inhibitors have been or are being explored in AMD in almost 40 clinical trials. While most complement inhibitors fail to treat AMD successfully, two of them are effective in inhibiting the rate of GA progression in phase II clinical trials, and both of them successfully entered phase III trials. Furthermore, recently emerging complement gene therapy and combination therapy also offer new opportunities to treat AMD in the future. In this review, we aim to introduce genetic and molecular associations between the complement system and AMD, provide the updated progress in complement inhibitors in AMD on clinical trials, and discuss the challenges and prospects of complement therapeutic strategies in AMD.
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25
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Pollreisz A, Reiter GS, Bogunovic H, Baumann L, Jakob A, Schlanitz FG, Sacu S, Owsley C, Sloan KR, Curcio CA, Schmidt-Erfurth U. Topographic Distribution and Progression of Soft Drusen Volume in Age-Related Macular Degeneration Implicate Neurobiology of Fovea. Invest Ophthalmol Vis Sci 2021; 62:26. [PMID: 33605982 PMCID: PMC7900846 DOI: 10.1167/iovs.62.2.26] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose To refine estimates of macular soft drusen abundance in eyes with age-related macular degeneration (AMD) and evaluate hypotheses about drusen biogenesis, we investigated topographic distribution and growth rates of drusen by optical coherence tomography (OCT). We compared results to retinal features with similar topographies (cone density and macular pigment) in healthy eyes. Methods In a prospective study, distribution and growth rates of soft drusen in eyes with AMD were identified by human observers in OCT volumes and analyzed with computer-assistance. Published histologic data for macular cone densities (n = 12 eyes) and in vivo macular pigment optical density (MPOD) measurements in older adults with unremarkable maculae (n = 31; 62 paired eyes, averaged) were revisited. All values were normalized to Early Treatment Diabetic Retinopathy Study (ETDRS) subfield areas. Results Sixty-two eyes of 44 patients were imaged for periods up to 78 months. Soft drusen volume per unit volume at baseline is 24.6-fold and 2.3-fold higher in the central ETDRS subfield than in outer and inner rings, respectively, and grows most prominently there. Corresponding ratios (central versus inner and central versus outer) for cone density in donor eyes is 13.3-fold and 5.1-fold and for MPOD, 24.6 and 23.9-fold, and 3.6 and 3.6-fold. Conclusions Normalized soft drusen volume in AMD eyes as assessed by OCT is ≥ 20-fold higher in central ETDRS subfields than in outer rings, paralleling MPOD distribution in healthy eyes. Data on drusen volume support this metric for AMD risk assessment and clinical trial outcome measure. Alignment of different data modalities support the ETDRS grid for standardizing retinal topography in mechanistic studies of drusen biogenesis.
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Affiliation(s)
- Andreas Pollreisz
- Department of Ophthalmology and Optometry, Medical University Vienna, Vienna, Austria
| | - Gregor S Reiter
- Department of Ophthalmology and Optometry, Medical University Vienna, Vienna, Austria
| | - Hrvoje Bogunovic
- Department of Ophthalmology and Optometry, Medical University Vienna, Vienna, Austria
| | - Lukas Baumann
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Vienna, Austria
| | - Astrid Jakob
- Department of Ophthalmology and Optometry, Medical University Vienna, Vienna, Austria
| | - Ferdinand G Schlanitz
- Department of Ophthalmology and Optometry, Medical University Vienna, Vienna, Austria
| | - Stefan Sacu
- Department of Ophthalmology and Optometry, Medical University Vienna, Vienna, Austria
| | - Cynthia Owsley
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Kenneth R Sloan
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Christine A Curcio
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States
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INVESTIGATING A GROWTH PREDICTION MODEL IN ADVANCED AGE-RELATED MACULAR DEGENERATION WITH SOLITARY GEOGRAPHIC ATROPHY USING QUANTITATIVE AUTOFLUORESCENCE. Retina 2021; 40:1657-1664. [PMID: 31584560 DOI: 10.1097/iae.0000000000002653] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To investigate geographic atrophy (GA) progression using quantitative autofluorescence (qAF) in eyes with solitary GA. METHODS Forty-three eyes of 26 patients (age 79.7 ± 7.2 years; 28 women; 16 pseudophakic) underwent spectral-domain optical coherence tomography and qAF imaging at baseline and after 12 months. The junctional zone (AJZ) and a nonaffected 300-µm-wide control area (AC) were delineated on spectral-domain optical coherence tomography scans and transferred to the qAF image. Linear mixed models were calculated to investigate the association between GA progression and qAF, age, and baseline GA area. Mixed model analyses of variance were used to investigate differences in qAF between areas. RESULTS Quantitative autofluorescence of the three inferior sections of both the AJZ (P = 0.028; P = 0.014 and P = 0.032) and the AC (P = 0.043; P = 0.02 and P = 0.028) were significantly associated with GA progression after 12 months. However, qAF measurements were not associated with GA progression in the overall model (P > 0.05). Mean qAF was significantly lower in the AJZ and growth area (AG12) than in the AC (both P ≤ 0.001). CONCLUSION The authors report a statistically significant association between GA growth area and qAF measurements at specific retinal locations and a significant difference in qAF between the GA border and unaffected areas outside the lesion. Quantitative autofluorescence measurements may be limitedly useful for predicting GA progression.
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Chen Q, Keenan TD, Allot A, Peng Y, Agrón E, Domalpally A, Klaver CCW, Luttikhuizen DT, Colyer MH, Cukras CA, Wiley HE, Teresa Magone M, Cousineau-Krieger C, Wong WT, Zhu Y, Chew EY, Lu Z. Multimodal, multitask, multiattention (M3) deep learning detection of reticular pseudodrusen: Toward automated and accessible classification of age-related macular degeneration. J Am Med Inform Assoc 2021; 28:1135-1148. [PMID: 33792724 PMCID: PMC8200273 DOI: 10.1093/jamia/ocaa302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 11/16/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Reticular pseudodrusen (RPD), a key feature of age-related macular degeneration (AMD), are poorly detected by human experts on standard color fundus photography (CFP) and typically require advanced imaging modalities such as fundus autofluorescence (FAF). The objective was to develop and evaluate the performance of a novel multimodal, multitask, multiattention (M3) deep learning framework on RPD detection. MATERIALS AND METHODS A deep learning framework (M3) was developed to detect RPD presence accurately using CFP alone, FAF alone, or both, employing >8000 CFP-FAF image pairs obtained prospectively (Age-Related Eye Disease Study 2). The M3 framework includes multimodal (detection from single or multiple image modalities), multitask (training different tasks simultaneously to improve generalizability), and multiattention (improving ensembled feature representation) operation. Performance on RPD detection was compared with state-of-the-art deep learning models and 13 ophthalmologists; performance on detection of 2 other AMD features (geographic atrophy and pigmentary abnormalities) was also evaluated. RESULTS For RPD detection, M3 achieved an area under the receiver-operating characteristic curve (AUROC) of 0.832, 0.931, and 0.933 for CFP alone, FAF alone, and both, respectively. M3 performance on CFP was very substantially superior to human retinal specialists (median F1 score = 0.644 vs 0.350). External validation (the Rotterdam Study) demonstrated high accuracy on CFP alone (AUROC, 0.965). The M3 framework also accurately detected geographic atrophy and pigmentary abnormalities (AUROC, 0.909 and 0.912, respectively), demonstrating its generalizability. CONCLUSIONS This study demonstrates the successful development, robust evaluation, and external validation of a novel deep learning framework that enables accessible, accurate, and automated AMD diagnosis and prognosis.
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Affiliation(s)
- Qingyu Chen
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Tiarnan D.L Keenan
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alexis Allot
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Yifan Peng
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Elvira Agrón
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Amitha Domalpally
- Fundus Photograph Reading Center, University of Wisconsin, Madison, Wisconsin, USA
| | | | | | - Marcus H Colyer
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Catherine A Cukras
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Henry E Wiley
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - M Teresa Magone
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Chantal Cousineau-Krieger
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Wai T Wong
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
- Section on Neuron-Glia Interactions in Retinal Disease, Laboratory of Retinal Cell and Molecular Biology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Yingying Zhu
- Department of Computer Science and Engineering, University of Texas at Arlington, Arlington, Texas, USA
- Department of Radiology, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Zhiyong Lu
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, Maryland, USA
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Chichan H, Maus M, Heindl LM. Subthreshold Nanosecond Laser, from Trials to Real-Life Clinical Practice: A Cohort Study. Clin Ophthalmol 2021; 15:1887-1895. [PMID: 33986589 PMCID: PMC8110265 DOI: 10.2147/opth.s307671] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background Age-related macular degeneration (AMD), a degenerative disorder, is a major cause of irreversible severe visual deterioration in the older Western population. Thus, treatments that resolve drusen may prove helpful in limiting the progression of AMD. The study aimed to evaluate the clinical outcome of sub-threshold nanosecond laser therapy (SNL) using a double-frequency nanosecond-pulsed laser with discontinuous energy beam distribution in the early stages of age-related macular degeneration (AMD). Methods In a single-center cohort study, 64 eyes with early or intermediate AMD were treated using SNL and then compared to 77 untreated, control eyes. The primary outcome measures included the area and amount of drusen, and the secondary outcome measures included change in visual acuity and rate of drusen progression within 6 months of follow-up. Results A total of 64 patients’ eyes following SNL treatment showed a significant reduction in the area and amount of drusen after 6 months in comparison to the corresponding values in the control group (p<0.001, respectively). There was no significant difference in visual acuity change after 6 months in both groups (p\documentclass[12pt]{minimal}
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Affiliation(s)
- Hasan Chichan
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, 50923, Germany.,Sehkraft Eye Center, Cologne, 50667, Germany
| | | | - Ludwig M Heindl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, 50923, Germany.,Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Duesseldorf, Cologne, 50937, Germany
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Kumar Dubey S, Pradhan R, Hejmady S, Singhvi G, Choudhury H, Gorain B, Kesharwani P. Emerging innovations in nano-enabled therapy against age-related macular degeneration: A paradigm shift. Int J Pharm 2021; 600:120499. [PMID: 33753164 DOI: 10.1016/j.ijpharm.2021.120499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/03/2021] [Accepted: 03/14/2021] [Indexed: 12/16/2022]
Abstract
Age-related macular degeneration (AMD), a degenerative eye disease, is the major cause of irreversible loss of vision among individuals aged 50 and older. Both genetic and environmental factors are responsible for the progressive damage to central vision. It is a multifactorial retinal disease with features such as drusen, hypopigmentation and/or hyperpigmentation of the retinal pigment epithelium, and even choroidal neovascularization in certain patients. AMD is of two major forms: exudative (wet) and atrophic (dry) with changes affecting the macula leading to impaired vision. Although the retina remains an accessible portion for delivering drugs, there are no current options to cure or treat AMD. The existing expensive therapeutics are unable to treat the underlying pathology but display several side effects. However, recent innovations in nanotherapeutics provide an optimal alternative of drug delivery to treat the neovascular condition. These new-age technologies in the nanometer scale would enhance bioactivity and improve the bioavailability of drugs at the site of action to treat AMD. The nanomedicine also provides sustained release of the drug with prolonged retention after penetrating across the ocular tissues. In this review, the insights into the cellular and molecular mechanisms associated with the pathophysiology of AMD are provided. It also serves to review the current progress in nanoparticle-based drug delivery systems that offer feasible treatments in AMD.
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Affiliation(s)
- Sunil Kumar Dubey
- Department of Pharmacy, Birla Institute of Technology and Science, Pilani (BITS-PILANI), Pilani Campus, Rajasthan, India; Medical Research, R&D Healthcare Division, Emami Ltd, 13, BT Road, Belgharia, Kolkata 700056, India.
| | - Rajesh Pradhan
- Department of Pharmacy, Birla Institute of Technology and Science, Pilani (BITS-PILANI), Pilani Campus, Rajasthan, India
| | - Siddhanth Hejmady
- Department of Pharmacy, Birla Institute of Technology and Science, Pilani (BITS-PILANI), Pilani Campus, Rajasthan, India
| | - Gautam Singhvi
- Department of Pharmacy, Birla Institute of Technology and Science, Pilani (BITS-PILANI), Pilani Campus, Rajasthan, India
| | - Hira Choudhury
- Department of Pharmaceutical Technology, School of Pharmacy, International Medical University, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
| | - Bapi Gorain
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor 47500, Malaysia; Center for Drug Delivery and Molecular Pharmacology, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor 47500, Malaysia
| | - Prashant Kesharwani
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia, Hamdard, New Delhi 110062, India.
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30
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Thomseth VM, Engelsvold DH, Ushakova A, Forsaa VA. EN FACE IMAGING OF OUTER RETINAL PATHOLOGY AFTER RETINAL DETACHMENT. Retina 2021; 41:324-330. [PMID: 32282661 DOI: 10.1097/iae.0000000000002814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To explore the potentials of multicolor (MC) confocal scanning laser ophthalmoscopy (cSLO) to detect structural retinal pathology after macula-off rhegmatogenous retinal detachment (RRD) and to describe their appearances. METHODS Thirty MC cSLO images of 30 eyes after RRD repair were prospectively studied for the presence of RRD-related pathology. All MC cSLO findings were verified using swept source optical coherence tomography. Positive percent agreements were calculated using swept source optical coherence tomography as reference. RESULTS Eight RRD-related structural pathologies were identified and characterized: ellipsoid zone (EZ) disruption, foveal EZ rosette, outer retinal fold, retinal detachment line, subretinal fluid blebs, subretinal fluid layer, retinal striae, and intraretinal cysts. Multicolor cSLO positive percent agreements were as follows: EZ disruption: 79%, foveal EZ rosette: 73%, outer retinal fold: 67%, retinal detachment line: 84%, subretinal fluid blebs: 0.70%, subretinal fluid layer: 50%, intraretinal cysts: 60%, and retinal striae: 100%. CONCLUSION En face MC cSLO imaging detected and delineated RRD-related structural pathology in high agreement with cross-sectional swept source optical coherence tomography and can supplement optical coherence tomography in the documentation and monitoring of outer retinal remodeling processes after macula-off RRD. Foveal EZ rosette is a new finding of the foveal EZ.
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Affiliation(s)
- Vilde M Thomseth
- Department of Ophthalmology, Stavanger University Hospital, Stavanger, Norway ; and
| | - David H Engelsvold
- Department of Ophthalmology, Stavanger University Hospital, Stavanger, Norway ; and
| | - Anastasia Ushakova
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Vegard A Forsaa
- Department of Ophthalmology, Stavanger University Hospital, Stavanger, Norway ; and
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31
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Montesano G, Ometto G, Higgins BE, Iester C, Balaskas K, Tufail A, Chakravarthy U, Hogg RE, Crabb DP. Structure-Function Analysis in Macular Drusen With Mesopic and Scotopic Microperimetry. Transl Vis Sci Technol 2021; 9:43. [PMID: 33442497 PMCID: PMC7774115 DOI: 10.1167/tvst.9.13.43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/18/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose To investigate the structure–function relationship in eyes with drusen with mesopic and scotopic microperimetry. Methods We analyzed structural and functional data from 43 eyes with drusen. Functional data were acquired with mesopic and scotopic two-color (red and cyan) microperimetry. Normative values were calculated using data from 56 healthy eyes. Structural measurements were green autofluorescence and dense macular optical coherence tomography scans. The latter were used to calculate the retinal pigment epithelium elevation (RPE-E) and the photoreceptor reflectivity ratio (PRR). The pointwise structure–function relationship was measured with linear mixed models having the log-transformed structural parameters as predictors and the sensitivity loss (SL, deviation from normal) as the response variable. Results In the univariable analysis, the structural predictors were all significantly correlated (P < 0.05) with the SL in the mesopic and scotopic tests. In a multivariable model, mesopic microperimetry yielded the best structure–function relationship. All predictors were significant (P < 0.05), but the predictive power was weak (best R2 = 0.09). The relationship was improved when analyzing locations with abnormal RPE-E (best R2 = 0.18). Conclusions Mesopic microperimetry shows better structure–function relationship compared to scotopic microperimetry; the relationship is weak, likely due to the early functional damage and the small number of tested locations affected by drusen. The relationship is stronger when locations with drusen are isolated for the mesopic and scotopic cyan test. Translational Relevance These results could be useful to devise integrated structure–function methods to detect disease progression in intermediate age-related macular degeneration.
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Affiliation(s)
- Giovanni Montesano
- City, University of London-Optometry and Visual Sciences, London, UK.,NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Giovanni Ometto
- City, University of London-Optometry and Visual Sciences, London, UK.,NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Bethany E Higgins
- City, University of London-Optometry and Visual Sciences, London, UK
| | - Costanza Iester
- City, University of London-Optometry and Visual Sciences, London, UK
| | - Konstantinos Balaskas
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Adnan Tufail
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Usha Chakravarthy
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Ruth E Hogg
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - David P Crabb
- City, University of London-Optometry and Visual Sciences, London, UK
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Ocular Imaging for Enhancing the Understanding, Assessment, and Management of Age-Related Macular Degeneration. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1256:33-66. [PMID: 33847997 DOI: 10.1007/978-3-030-66014-7_2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Age-related macular degeneration (AMD) is a progressive neuro-retinal disease and the leading cause of central vision loss among elderly individuals in the developed countries. Modern ocular imaging technologies constitute an essential component of the evaluation of these patients and have contributed extensively to our understanding of the disease. A challenge with any review of ocular imaging technologies is the rapid pace of progress and evolution of these instruments. Nonetheless, for proper and optimal use of these technologies, it is essential for the user to understand the technical principles underlying the imaging modality and their role in assessing the disease in various settings. Indeed, AMD, like many other retinal diseases, benefits from a multimodal imaging approach to optimally characterize the disease. In this chapter, we will review the various imaging technologies currently used in the assessment and management of AMD.
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33
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Therapeutic Options Under Development for Nonneovascular Age-Related Macular Degeneration and Geographic Atrophy. Drugs Aging 2020; 38:17-27. [PMID: 33355716 DOI: 10.1007/s40266-020-00822-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 01/05/2023]
Abstract
Age-related macular degeneration (AMD) is a chronic, multifactorial disease and a leading cause of irreversible blindness in the elderly population in the Western Hemisphere. Among the two major subtypes of AMD, the prevalence of the nonneovascular (dry) type is approximately 85-90% and the neovascular (wet) type is 10-15%. Healthy lifestyle and nutritional supplements of anti-oxidative micronutrients have been shown to delay the progression of dry AMD and lower the risk of development of wet AMD, and anti-vascular endothelial growth factor (anti-VEGF) injections have been shown to improve visual acuity for wet AMD patients. However, to date, there is no approved treatment for geographic atrophy (GA), a debilitating late stage of dry AMD. Thus, this represents a large unmet need in this patient population. This review focuses on the current management and treatment of nonneovascular AMD, the drugs and devices that have been under investigation for the treatment of GA, and the latest clinical trial results. A few therapeutic options have shown initial promising clinical trial results, but failed to show efficacy in larger trials, while others are awaiting future clinical trial results and long-term follow-up to evaluate safety and efficacy.
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Jaffe GJ, Chakravarthy U, Freund KB, Guymer RH, Holz FG, Liakopoulos S, Monés JM, Rosenfeld PJ, Sadda SR, Sarraf D, Schmitz-Valckenberg S, Spaide RF, Staurenghi G, Tufail A, Curcio CA. Imaging Features Associated with Progression to Geographic Atrophy in Age-Related Macular Degeneration: Classification of Atrophy Meeting Report 5. Ophthalmol Retina 2020; 5:855-867. [PMID: 33348085 DOI: 10.1016/j.oret.2020.12.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To provide an image-based description of retinal features associated with risk for development of geographic atrophy (GA) in eyes with age-related macular degeneration (AMD), as visualized with multimodal imaging anchored by structural OCT. DESIGN Consensus meeting. PARTICIPANTS International group that included those with expertise in imaging and AMD basic science and histology, and those with Reading Center experience in AMD clinical trials. METHODS As part of the Classification of Atrophy Meeting program, an international group of experts analyzed and discussed retinal multimodal imaging features in eyes with AMD associated with GA, risk of progression to GA, or both. Attendees undertook premeeting grading exercises that were reviewed during the meeting sessions. Meeting presentations illustrated established and investigational multimodal imaging features and associated histologic features. Each of these different features were then discussed openly by the entire group to arrive at consensus definitions. These definitions were applied to 40 additional images that were graded independently by attendees to refine the consensus definitions and descriptions further. RESULTS Consensus was reached on images with descriptors for 12 features. These features included components of outer retinal atrophy (e.g., ellipsoid zone disruption), components of complete retinal pigment epithelium (RPE) and outer retinal atrophy (e.g., RPE perturbation with associated hypotransmission or hypertransmission), features frequently seen in eyes with atrophy (e.g., refractile drusen), and features conferring risk for atrophy development (e.g., hyperreflective foci, drusen, and subretinal drusenoid deposits). CONCLUSIONS An international consensus on terms and descriptions was reached on multimodal imaging features associated GA and with risk for GA progression in eyes with AMD. We believe this information will be useful to clinicians who manage patients with AMD, researchers who study AMD disease interventions and pathogenesis, and those who design clinical trials for therapies targeting earlier AMD stages than GA expansion.
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Affiliation(s)
- Glenn J Jaffe
- Department of Ophthalmology, Duke University, Durham, North Carolina.
| | - Usha Chakravarthy
- Center for Public Health, The Queen's University of Belfast, Belfast, United Kingdom
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Australia
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Sandra Liakopoulos
- Department of Ophthalmology, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Jordi M Monés
- Institut de la Màcula and Barcelona Macula Foundation, Barcelona, Spain
| | - Philip J Rosenfeld
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Srinivas R Sadda
- Doheny Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - David Sarraf
- Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | | | - Richard F Spaide
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Adnan Tufail
- Moorfields Eye Hospital NHS Trust and Institute of Ophthalmology, University College London, London, United Kingdom
| | - Christine A Curcio
- Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Montorio D, D'Andrea L, Mirto N, Cennamo G. The role of optical coherence tomography angiography in reticular pseudodrusen. Photodiagnosis Photodyn Ther 2020; 33:102094. [PMID: 33188940 DOI: 10.1016/j.pdpdt.2020.102094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND To investigate the changes in retinal and choriocapillaris vessel density (VD) in patients effected by early age-related macular degeneration (AMD) and reticular pseudodrusen (RPD), using Optical Coherence Tomography Angiography (OCTA). METHODS A total of seventy-eight eyes of 78 patients (43 male, 35 female, mean age 72.61 ± 5.15) with non-neovascular AMD (38 eyes with early AMD and 40 eyes with RPD) was recruited in this observational prospective study. Forty eyes of 40 healthy subjects represented the control group. The VD was measured in superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris in different macular regions. RESULTS There were no significant differences in VD of the SCP and DCP among the controls and the two study groups (p > 0.05). The VD of the choriocapillaris revealed a statistically significant reduction in early AMD and RPD groups respect to controls (p < 0.001). Furthermore, the patients with RPD showed a significantly decreased VD respect to patients with early AMD in different macular regions (p < 0.001). CONCLUSIONS The quantitative analysis of retinal and choriocapillaris blood flow by OCTA provided useful information regarding the vascular changes in non-neovascular AMD patients suggesting that the choriocapillaris loss is mainly involved in the pathogenesis of RPD.
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Affiliation(s)
- Daniela Montorio
- Department of Neurosciences, Reproductive and Dentistry Sciences, University of Naples Federico II, Naples, Italy
| | - Luca D'Andrea
- Department of Neurosciences, Reproductive and Dentistry Sciences, University of Naples Federico II, Naples, Italy
| | - Nicola Mirto
- Department of Neurosciences, Reproductive and Dentistry Sciences, University of Naples Federico II, Naples, Italy
| | - Gilda Cennamo
- Eye Clinic, Public Health Department, University of Naples Federico II, Via S. Pansini 5, 80133 Naples, Italy.
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An exploratory study to evaluate visual function endpoints in non-advanced age-related macular degeneration. BMC Ophthalmol 2020; 20:424. [PMID: 33092549 PMCID: PMC7579935 DOI: 10.1186/s12886-020-01683-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 10/06/2020] [Indexed: 02/07/2023] Open
Abstract
Background To prevent irreversible vision loss in age-related macular degeneration (AMD), it is critical to detect retinal dysfunction before permanent structural loss occurs. In the current study we evaluated a series of visual function tests to identify potential endpoints to detect visual dysfunction in non-advanced AMD. Methods A series of visual function tests were performed on 23 non-advanced AMD subjects (AREDS grade 1–4 on simplified scale) and 34 age-matched normals (AREDS grade 0). Tests included some commonly used endpoints such as ETDRS visual acuity (VA), low luminance (LL) 2.0ND ETDRS VA, MNREAD as well as newly developed tests such as the Ora-VCF™ test, Ora-tablet reading test, color sensitivity etc. Differences between the two groups were compared for each test. Test-retest repeatability and reproducibility was assessed on a subset of subjects and percent agreement was calculated. Results There was no difference in standard ETDRS VA between non-advanced AMD (0.06 ± 0.02 logMAR) and normal groups (0.04 ± 0.02 logMAR) (p = 0.57). LL 2.0 ETDRS VA and MNREAD showed no difference between the groups (p > 0.05). Ora-VCF™ test was significantly worse in the non-advanced AMD group compared to normals (0.67 ± 0.07 in AMD; 0.45 ± 0.04 in normals, p = 0.005). Non-advanced AMD subjects also had significantly worse reading performance using the Ora-tablet with LL 2.0ND (114.55 ± 11.22 wpm in AMD; 145.17 ± 9.55 wpm in normals p = 0.049). No significant difference between the groups was noted using other tests. Repeatability was 82% for Ora-VCF™ test and 92% for Ora-tablet LL 2.0ND reading. Reproducibility was 89% for both Ora-VCF™ test and Ora-tablet LL 2.0ND reading. Conclusion While there was no significant difference between non-advanced AMD and normal groups using some current common endpoints such as ETDRS VA, LL 2.0 ETDRS VA or MNREAD, Ora-VCF™ test and Ora-tablet LL 2.0ND reading tests were able to identify significant visual dysfunction in non-advanced AMD subjects. These tests show promise as endpoints for AMD studies.
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Arslan J, Samarasinghe G, Benke KK, Sowmya A, Wu Z, Guymer RH, Baird PN. Artificial Intelligence Algorithms for Analysis of Geographic Atrophy: A Review and Evaluation. Transl Vis Sci Technol 2020; 9:57. [PMID: 33173613 PMCID: PMC7594588 DOI: 10.1167/tvst.9.2.57] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/28/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose The purpose of this study was to summarize and evaluate artificial intelligence (AI) algorithms used in geographic atrophy (GA) diagnostic processes (e.g. isolating lesions or disease progression). Methods The search strategy and selection of publications were both conducted in accordance with the Preferred of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and Web of Science were used to extract literary data. The algorithms were summarized by objective, performance, and scope of coverage of GA diagnosis (e.g. lesion automation and GA progression). Results Twenty-seven studies were identified for this review. A total of 18 publications focused on lesion segmentation only, 2 were designed to detect and classify GA, 2 were designed to predict future overall GA progression, 3 focused on prediction of future spatial GA progression, and 2 focused on prediction of visual function in GA. GA-related algorithms reported sensitivities from 0.47 to 0.98, specificities from 0.73 to 0.99, accuracies from 0.42 to 0.995, and Dice coefficients from 0.66 to 0.89. Conclusions Current GA-AI publications have a predominant focus on lesion segmentation and a minor focus on classification and progression analysis. AI could be applied to other facets of GA diagnoses, such as understanding the role of hyperfluorescent areas in GA. Using AI for GA has several advantages, including improved diagnostic accuracy and faster processing speeds. Translational Relevance AI can be used to quantify GA lesions and therefore allows one to impute visual function and quality-of-life. However, there is a need for the development of reliable and objective models and software to predict the rate of GA progression and to quantify improvements due to interventions.
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Affiliation(s)
- Janan Arslan
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Department of Surgery, Ophthalmology, University of Melbourne, Victoria, Australia
| | - Gihan Samarasinghe
- School of Computer Science and Engineering, University of New South Wales, Kensington, New South Wales, Australia
| | - Kurt K. Benke
- School of Engineering, University of Melbourne, Parkville, Victoria, Australia
- Centre for AgriBioscience, AgriBio, Bundoora, Victoria, Australia
| | - Arcot Sowmya
- School of Computer Science and Engineering, University of New South Wales, Kensington, New South Wales, Australia
| | - Zhichao Wu
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Robyn H. Guymer
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Department of Surgery, Ophthalmology, University of Melbourne, Victoria, Australia
| | - Paul N. Baird
- Department of Surgery, Ophthalmology, University of Melbourne, Victoria, Australia
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Winkler TW, Grassmann F, Brandl C, Kiel C, Günther F, Strunz T, Weidner L, Zimmermann ME, Korb CA, Poplawski A, Schuster AK, Müller-Nurasyid M, Peters A, Rauscher FG, Elze T, Horn K, Scholz M, Cañadas-Garre M, McKnight AJ, Quinn N, Hogg RE, Küchenhoff H, Heid IM, Stark KJ, Weber BHF. Genome-wide association meta-analysis for early age-related macular degeneration highlights novel loci and insights for advanced disease. BMC Med Genomics 2020; 13:120. [PMID: 32843070 PMCID: PMC7449002 DOI: 10.1186/s12920-020-00760-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 08/04/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Advanced age-related macular degeneration (AMD) is a leading cause of blindness. While around half of the genetic contribution to advanced AMD has been uncovered, little is known about the genetic architecture of early AMD. METHODS To identify genetic factors for early AMD, we conducted a genome-wide association study (GWAS) meta-analysis (14,034 cases, 91,214 controls, 11 sources of data including the International AMD Genomics Consortium, IAMDGC, and UK Biobank, UKBB). We ascertained early AMD via color fundus photographs by manual grading for 10 sources and via an automated machine learning approach for > 170,000 photographs from UKBB. We searched for early AMD loci via GWAS and via a candidate approach based on 14 previously suggested early AMD variants. RESULTS Altogether, we identified 10 independent loci with statistical significance for early AMD: (i) 8 from our GWAS with genome-wide significance (P < 5 × 10- 8), (ii) one previously suggested locus with experiment-wise significance (P < 0.05/14) in our non-overlapping data and with genome-wide significance when combining the reported and our non-overlapping data (together 17,539 cases, 105,395 controls), and (iii) one further previously suggested locus with experiment-wise significance in our non-overlapping data. Of these 10 identified loci, 8 were novel and 2 known for early AMD. Most of the 10 loci overlapped with known advanced AMD loci (near ARMS2/HTRA1, CFH, C2, C3, CETP, TNFRSF10A, VEGFA, APOE), except two that have not yet been identified with statistical significance for any AMD. Among the 17 genes within these two loci, in-silico functional annotation suggested CD46 and TYR as the most likely responsible genes. Presence or absence of an early AMD effect distinguished the known pathways of advanced AMD genetics (complement/lipid pathways versus extracellular matrix metabolism). CONCLUSIONS Our GWAS on early AMD identified novel loci, highlighted shared and distinct genetics between early and advanced AMD and provides insights into AMD etiology. Our data provide a resource comparable in size to the existing IAMDGC data on advanced AMD genetics enabling a joint view. The biological relevance of this joint view is underscored by the ability of early AMD effects to differentiate the major pathways for advanced AMD.
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Affiliation(s)
- Thomas W Winkler
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany.
| | - Felix Grassmann
- Institute of Human Genetics, University of Regensburg, Regensburg, Germany
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - Caroline Brandl
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
- Institute of Human Genetics, University of Regensburg, Regensburg, Germany
- Department of Ophthalmology, University Hospital Regensburg, Regensburg, Germany
| | - Christina Kiel
- Institute of Human Genetics, University of Regensburg, Regensburg, Germany
| | - Felix Günther
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
- Statistical Consulting Unit StaBLab, Department of Statistics, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Tobias Strunz
- Institute of Human Genetics, University of Regensburg, Regensburg, Germany
| | - Lorraine Weidner
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
| | - Martina E Zimmermann
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
| | - Christina A Korb
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Alicia Poplawski
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Alexander K Schuster
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Martina Müller-Nurasyid
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Institute of Genetic Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Department of Internal Medicine I (Cardiology), Hospital of the Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
- Genetic Epidemiology, IBE, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Annette Peters
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum München Research Center for Environmental Health, Neuherberg, Germany
| | - Franziska G Rauscher
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), Leipzig University, Leipzig, Germany
| | - Tobias Elze
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA
| | - Katrin Horn
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), Leipzig University, Leipzig, Germany
| | - Markus Scholz
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
- Institute for Medical Informatics, Statistics, and Epidemiology (IMISE), Leipzig University, Leipzig, Germany
| | | | | | - Nicola Quinn
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
| | - Ruth E Hogg
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
| | - Helmut Küchenhoff
- Statistical Consulting Unit StaBLab, Department of Statistics, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Iris M Heid
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
| | - Klaus J Stark
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
| | - Bernhard H F Weber
- Institute of Human Genetics, University of Regensburg, Regensburg, Germany
- Institute of Clinical Human Genetics, University Hospital Regensburg, Regensburg, Germany
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Spectrally Resolved Fundus Autofluorescence in Healthy Eyes: Repeatability and Topographical Analysis of the Green-Emitting Fluorophores. J Clin Med 2020; 9:jcm9082388. [PMID: 32726903 PMCID: PMC7464110 DOI: 10.3390/jcm9082388] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 12/03/2022] Open
Abstract
The aim of this study was to report normal measurements of green-emitting fluorophores in the macula of healthy young individuals and to assess the repeatability of these quantitative metrics. To do so, healthy young volunteers were imaged twice (7 ± 3 days apart) using a confocal blue-light fundus autofluorescence (FAF) device with a shorter excitation wavelength (peak at 450 nm) and the capability for separately detecting the red and green components of the emission spectrum. The main outcome measure was the percentage of area occupied by green-emitting fluorophores in the macula. In addition, this measure was performed in separate regions providing a topographical assessment in the foveal, parafoveal and perifoveal regions. Furthermore, the level of agreement between repeated measurements was evaluated. Thirty eyes from 30 healthy volunteers were included in this analysis. Mean age was 26.2 ± 2.8 years (median: 25.0 years; range: 23.0–32.0 years). Median (interquartile range—IQR) area occupied by green-emitting fluorophores was 3.6% (1.9–4.7%) in the macular region. In the topographical analysis, this percentage was higher in the foveal area (median = 33.3%, IQR = 21.9–41.2%), as compared with both the parafoveal (median = 5.3%; IQR = 2.4–8.1%; p < 0.0001) and perifoveal (median = 0.5%, IQR = 0.2–0.8%; p < 0.0001) regions. The coefficient of variation (CV; ranging from 1.1% to 1.7% in the analyzed regions) and the intraclass correlation coefficient (ICC; ranging from 0.93 to 0.97) indicated high levels of repeatability. In conclusion, the assessment of green-emitting fluorophores is repeatable. The distribution of these fluorophores is highest in the foveal region. Assuming that flavin adenine dinucleotide (FAD) emits in the green autofluorescence spectrum, this variability could be secondary to an increased quantity of mitochondria in the foveal region.
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40
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Farinha C, Cachulo ML, Coimbra R, Alves D, Nunes S, Pires I, Marques JP, Costa J, Martins A, Sobral I, Barreto P, Laíns I, Figueira J, Ribeiro L, Cunha-Vaz J, Silva R. Age-Related Macular Degeneration Staging by Color Fundus Photography vs. Multimodal Imaging-Epidemiological Implications ( The Coimbra Eye Study-Report 6). J Clin Med 2020; 9:jcm9051329. [PMID: 32370299 PMCID: PMC7291224 DOI: 10.3390/jcm9051329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/23/2020] [Accepted: 04/26/2020] [Indexed: 11/16/2022] Open
Abstract
Epidemiology of age-related macular degeneration (AMD) is based on staging systems relying on color fundus photography (CFP). We aim to compare AMD staging using CFP to multimodal imaging with optical coherence tomography (OCT), infra-red (IR), and fundus autofluorescence (FAF), in a large cohort from the Epidemiologic AMD Coimbra Eye Study. All imaging exams from the participants of this population-based study were classified by a central reading center. CFP images were graded according to the International Classification and Grading System for AMD and staged with Rotterdam classification. Afterward, CFP images were reviewed with OCT, IR, and FAF and stage update was performed if necessary. Early and late AMD prevalence was compared in a total of 1616 included subjects. In CFP-based grading, the prevalence was 14.11% for early AMD (n = 228) and 1.05% (n = 17) for late AMD, nine cases (0.56%) had neovascular AMD (nAMD) and eight (0.50%) geographic atrophy (GA). Using multimodal grading, the prevalence increased to 14.60% for early AMD (n = 236) and 1.61% (n = 26) for late AMD, with 14 cases (0.87%) of nAMD and 12 (0.74%) of GA. AMD staging was more accurate with the multimodal approach and this was especially relevant for late AMD. We propose that multimodal imaging should be adopted in the future to better estimate and compare epidemiological data in different populations.
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Affiliation(s)
- Cláudia Farinha
- AIBILI—Association for Innovation and Biomedical Research on Light and Image, 3000-548 Coimbra, Portugal; (M.L.C.); (R.C.); (D.A.); (S.N.); (I.P.); (J.P.M.); (J.C.); (A.M.); (I.S.); (P.B.); (J.F.); (L.R.); (J.C.-V.); (R.S.)
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), 3004-561 Coimbra, Portugal
- Faculty of Medicine—University of Coimbra (FMUC), 3000-370 Coimbra, Portugal
- Correspondence:
| | - Maria Luz Cachulo
- AIBILI—Association for Innovation and Biomedical Research on Light and Image, 3000-548 Coimbra, Portugal; (M.L.C.); (R.C.); (D.A.); (S.N.); (I.P.); (J.P.M.); (J.C.); (A.M.); (I.S.); (P.B.); (J.F.); (L.R.); (J.C.-V.); (R.S.)
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), 3004-561 Coimbra, Portugal
- Faculty of Medicine—University of Coimbra (FMUC), 3000-370 Coimbra, Portugal
| | - Rita Coimbra
- AIBILI—Association for Innovation and Biomedical Research on Light and Image, 3000-548 Coimbra, Portugal; (M.L.C.); (R.C.); (D.A.); (S.N.); (I.P.); (J.P.M.); (J.C.); (A.M.); (I.S.); (P.B.); (J.F.); (L.R.); (J.C.-V.); (R.S.)
| | - Dalila Alves
- AIBILI—Association for Innovation and Biomedical Research on Light and Image, 3000-548 Coimbra, Portugal; (M.L.C.); (R.C.); (D.A.); (S.N.); (I.P.); (J.P.M.); (J.C.); (A.M.); (I.S.); (P.B.); (J.F.); (L.R.); (J.C.-V.); (R.S.)
| | - Sandrina Nunes
- AIBILI—Association for Innovation and Biomedical Research on Light and Image, 3000-548 Coimbra, Portugal; (M.L.C.); (R.C.); (D.A.); (S.N.); (I.P.); (J.P.M.); (J.C.); (A.M.); (I.S.); (P.B.); (J.F.); (L.R.); (J.C.-V.); (R.S.)
| | - Isabel Pires
- AIBILI—Association for Innovation and Biomedical Research on Light and Image, 3000-548 Coimbra, Portugal; (M.L.C.); (R.C.); (D.A.); (S.N.); (I.P.); (J.P.M.); (J.C.); (A.M.); (I.S.); (P.B.); (J.F.); (L.R.); (J.C.-V.); (R.S.)
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), 3004-561 Coimbra, Portugal
- Faculty of Medicine—University of Coimbra (FMUC), 3000-370 Coimbra, Portugal
| | - João Pedro Marques
- AIBILI—Association for Innovation and Biomedical Research on Light and Image, 3000-548 Coimbra, Portugal; (M.L.C.); (R.C.); (D.A.); (S.N.); (I.P.); (J.P.M.); (J.C.); (A.M.); (I.S.); (P.B.); (J.F.); (L.R.); (J.C.-V.); (R.S.)
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), 3004-561 Coimbra, Portugal
- Faculty of Medicine—University of Coimbra (FMUC), 3000-370 Coimbra, Portugal
| | - José Costa
- AIBILI—Association for Innovation and Biomedical Research on Light and Image, 3000-548 Coimbra, Portugal; (M.L.C.); (R.C.); (D.A.); (S.N.); (I.P.); (J.P.M.); (J.C.); (A.M.); (I.S.); (P.B.); (J.F.); (L.R.); (J.C.-V.); (R.S.)
- Faculty of Medicine—University of Coimbra (FMUC), 3000-370 Coimbra, Portugal
| | - Amélia Martins
- AIBILI—Association for Innovation and Biomedical Research on Light and Image, 3000-548 Coimbra, Portugal; (M.L.C.); (R.C.); (D.A.); (S.N.); (I.P.); (J.P.M.); (J.C.); (A.M.); (I.S.); (P.B.); (J.F.); (L.R.); (J.C.-V.); (R.S.)
| | - Isa Sobral
- AIBILI—Association for Innovation and Biomedical Research on Light and Image, 3000-548 Coimbra, Portugal; (M.L.C.); (R.C.); (D.A.); (S.N.); (I.P.); (J.P.M.); (J.C.); (A.M.); (I.S.); (P.B.); (J.F.); (L.R.); (J.C.-V.); (R.S.)
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), 3004-561 Coimbra, Portugal
| | - Patrícia Barreto
- AIBILI—Association for Innovation and Biomedical Research on Light and Image, 3000-548 Coimbra, Portugal; (M.L.C.); (R.C.); (D.A.); (S.N.); (I.P.); (J.P.M.); (J.C.); (A.M.); (I.S.); (P.B.); (J.F.); (L.R.); (J.C.-V.); (R.S.)
| | - Inês Laíns
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA 02114, USA;
| | - João Figueira
- AIBILI—Association for Innovation and Biomedical Research on Light and Image, 3000-548 Coimbra, Portugal; (M.L.C.); (R.C.); (D.A.); (S.N.); (I.P.); (J.P.M.); (J.C.); (A.M.); (I.S.); (P.B.); (J.F.); (L.R.); (J.C.-V.); (R.S.)
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), 3004-561 Coimbra, Portugal
- Faculty of Medicine—University of Coimbra (FMUC), 3000-370 Coimbra, Portugal
| | - Luisa Ribeiro
- AIBILI—Association for Innovation and Biomedical Research on Light and Image, 3000-548 Coimbra, Portugal; (M.L.C.); (R.C.); (D.A.); (S.N.); (I.P.); (J.P.M.); (J.C.); (A.M.); (I.S.); (P.B.); (J.F.); (L.R.); (J.C.-V.); (R.S.)
- Faculty of Medicine—University of Coimbra (FMUC), 3000-370 Coimbra, Portugal
| | - José Cunha-Vaz
- AIBILI—Association for Innovation and Biomedical Research on Light and Image, 3000-548 Coimbra, Portugal; (M.L.C.); (R.C.); (D.A.); (S.N.); (I.P.); (J.P.M.); (J.C.); (A.M.); (I.S.); (P.B.); (J.F.); (L.R.); (J.C.-V.); (R.S.)
- Faculty of Medicine—University of Coimbra (FMUC), 3000-370 Coimbra, Portugal
| | - Rufino Silva
- AIBILI—Association for Innovation and Biomedical Research on Light and Image, 3000-548 Coimbra, Portugal; (M.L.C.); (R.C.); (D.A.); (S.N.); (I.P.); (J.P.M.); (J.C.); (A.M.); (I.S.); (P.B.); (J.F.); (L.R.); (J.C.-V.); (R.S.)
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), 3004-561 Coimbra, Portugal
- Faculty of Medicine—University of Coimbra (FMUC), 3000-370 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra (iCBR- FMUC), 3000-548 Coimbra, Portugal
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Gil-Martínez M, Santos-Ramos P, Fernández-Rodríguez M, Abraldes MJ, Rodríguez-Cid MJ, Santiago-Varela M, Fernández-Ferreiro A, Gómez-Ulla F. Pharmacological Advances in the Treatment of Age-related Macular Degeneration. Curr Med Chem 2020; 27:583-598. [PMID: 31362645 DOI: 10.2174/0929867326666190726121711] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 07/05/2019] [Accepted: 07/19/2019] [Indexed: 12/16/2022]
Abstract
Age-related macular degeneration is an acquired degenerative disease that is responsible for severe loss of vision in elderly people. There are two types: dry age-related macular degeneration and wet age-related macular degeneration. Its treatment has been improved and tries to be tailored in the future. The aim of this review is to summarize the pharmacological advances in the treatment of age-related macular degeneration. Regarding dry AMD, there is no effective treatment to reduce its progression. However, some molecules such as lampalizumab and eculizumab were under investigation, although they have shown low efficacy. Herein, in an attempt to prevent dry AMD progression, the most important studies suggested increasing the antioxidants intake and quitting the smoke habit. On the other hand, wet AMD has more developed treatment. Nowadays, the gold standard treatment is anti-VEGF injections. However, more effective molecules are currently under investigation. There are different molecules under research for dry AMD and wet AMD. This fact could help us treat our patients with more effective and lasting drugs but more clinical trials and safety studies are required in order to achieve an optimal treatment.
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Affiliation(s)
- María Gil-Martínez
- Department of Ophthalmology, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain.,Instituto Oftalmológico Gómez-Ulla, Santiago de Compostela, Spain
| | - Paz Santos-Ramos
- Department of Ophthalmology, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - Maribel Fernández-Rodríguez
- Department of Ophthalmology, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain.,Instituto Oftalmológico Gómez-Ulla, Santiago de Compostela, Spain.,Department of Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Maximino J Abraldes
- Department of Ophthalmology, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain.,Instituto Oftalmológico Gómez-Ulla, Santiago de Compostela, Spain.,Department of Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Maria José Rodríguez-Cid
- Department of Ophthalmology, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain.,Department of Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - María Santiago-Varela
- Department of Ophthalmology, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - Anxo Fernández-Ferreiro
- Pharmacy Department and Pharmacology Group, Univ Hospital of Santiago de Compostela (SERGAS) and Health Research Intitute (IDIS), Santiago de Compostela, Spain
| | - Francisco Gómez-Ulla
- Instituto Oftalmológico Gómez-Ulla, Santiago de Compostela, Spain.,Department of Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain
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Cozzi M, Monteduro D, Parrulli S, Corvi F, Zicarelli F, Corradetti G, Sadda SR, Staurenghi G. Sensitivity and Specificity of Multimodal Imaging in Characterizing Drusen. Ophthalmol Retina 2020; 4:987-995. [PMID: 32771389 DOI: 10.1016/j.oret.2020.04.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To calculate the measures of accuracy of different imaging modalities in patients with early/intermediate age-related macular degeneration (AMD). DESIGN Prospective, observational, cross-sectional study. PARTICIPANTS Patients with early or intermediate AMD. METHODS All participants underwent a complete multimodal imaging assessment with a confocal scanning laser ophthalmoscope, including near-infrared reflectance (NIR), green fundus autofluorescence (G-FAF), confocal pseudocolor, and retromode deviated to right (DR) and left (DL). Drusen were topographically divided as small and medium (≤125 μ diameter) and large (>125 μ diameter), whereas subretinal drusenoid deposits (SDDs) were divided into dot and ribbon phenotypes. Multimodal imaging was considered the reference standard for detecting different subtypes of drusen and SDDs. Cohen's kappa (k) was used to test interobserver agreement for each imaging modality. MAIN OUTCOME MEASURES Capability to differentiate subtypes of drusen and SDDs with different imaging modalities. RESULTS A total of 100 eyes (62% were female participants) were evaluated. The inter-rate reliability between 2 readers for each imaging modality ranged between 0.76 and 0.95. Overall, large drusen were better identified with confocal pseudocolor imaging (96.6% sensitivity; 77.8% specificity). Smaller drusen were better detected with retromode modalities DR or DL (92% sensitivity; 58.3% specificity and 85.2% sensitivity; 83.3% specificity, respectively). Ribbon SDDs were better detected by color imaging (80.5% sensitivity; 98.3% specificity). Dot SDDs were well identified with NIR (83.1% sensitivity; 91.4% specificity) and G-FAF (84.6% sensitivity; 77.1% specificity). CONCLUSIONS Near-infrared reflectance and G-FAF should be considered for classification of dot SDDs, and confocal pseudocolor is optimal for characterizing ribbon SDDs. Among all imaging modalities, retromode technology DR and DL may be a potential supplementary modality to detect even smaller drusen.
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Affiliation(s)
- Mariano Cozzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy.
| | - Davide Monteduro
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Salvatore Parrulli
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Federico Corvi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Federico Zicarelli
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Giulia Corradetti
- Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, University of California - Los Angeles, Los Angeles, California
| | - SriniVas R Sadda
- Doheny Eye Institute, Los Angeles, California; Department of Ophthalmology, University of California - Los Angeles, Los Angeles, California
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy
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43
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Braun PX, Mehta N, Gendelman I, Alibhai AY, Moult EM, Zhao Y, Ishibazawa A, Sorour O, Konstantinou EK, Baumal CR, Witkin AJ, Fujimoto JG, Duker JS, Waheed NK. Global Analysis of Macular Choriocapillaris Perfusion in Dry Age-Related Macular Degeneration using Swept-Source Optical Coherence Tomography Angiography. Invest Ophthalmol Vis Sci 2020; 60:4985-4990. [PMID: 31791062 PMCID: PMC6890395 DOI: 10.1167/iovs.19-27861] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose Swept-source optical coherence tomography angiography (SS-OCTA) was used to investigate if the clinical stage of dry age-related macular degeneration (AMD) was correlated with global and regional macular choriocapillaris (CC) perfusion. Methods In this retrospective, cross-sectional study, 6 × 6-mm SS-OCTA images from eyes with early, intermediate, and advanced dry AMD (56 eyes, 41 patients) were analyzed using algorithms described in the literature to assess regional flow deficit percentage (FD%) and average flow deficit size. Regions were defined by concentric areas centered on the fovea: a 1-mm-diameter area, 3-mm-diameter ring, 5-mm-diameter area, 5-mm-diameter ring, and 6 × 6-mm whole image. Data were modeled using the generalized estimating equations approach. Results The relationship between age and CC FD% and average flow deficit size was statistically significant (P ≤ 0.05) in all regions of analysis by linear modeling. The relationship between dry AMD stage and FD% was statistically significant by linear modeling in the 5-mm ring, and between dry AMD stage and average flow deficit size in the 3-mm ring, 5-mm area, 5-mm ring, and 6 × 6-mm whole image. Conclusions Linear modeling suggests a statistically significant relationship between dry AMD stage and CC perfusion, most prominent in the more peripheral regions of the macula.
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Affiliation(s)
- Phillip X Braun
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States.,Yale University School of Medicine, New Haven, Connecticut, United States
| | - Nihaal Mehta
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States.,Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Isaac Gendelman
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States.,Tufts University School of Medicine, Boston, Massachusetts, United States
| | - A Yasin Alibhai
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - Eric M Moult
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States
| | - Yi Zhao
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States
| | - Akihiro Ishibazawa
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States.,Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Osama Sorour
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States.,Department of Ophthalmology, Tanta University, Tanta, Egypt
| | - Eleni K Konstantinou
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - Caroline R Baumal
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - Andre J Witkin
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - James G Fujimoto
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States
| | - Jay S Duker
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts, United States
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44
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Multimodal Retinal Image Analysis via Deep Learning for the Diagnosis of Intermediate Dry Age-Related Macular Degeneration: A Feasibility Study. J Ophthalmol 2020; 2020:7493419. [PMID: 32411434 PMCID: PMC7201607 DOI: 10.1155/2020/7493419] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/28/2019] [Accepted: 12/19/2019] [Indexed: 02/06/2023] Open
Abstract
Results The CNN trained using OCT alone showed a diagnostic accuracy of 94%, whilst the OCT-A trained CNN resulted in an accuracy of 91%. When multiple modalities were combined, the CNN accuracy increased to 96% in the AMD cohort. Conclusions Here we demonstrate that superior diagnostic accuracy can be achieved when deep learning is combined with multimodal image analysis.
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45
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Luaces-Rodríguez A, Mondelo-García C, Zarra-Ferro I, González-Barcia M, Aguiar P, Fernández-Ferreiro A, Otero-Espinar FJ. Intravitreal anti-VEGF drug delivery systems for age-related macular degeneration. Int J Pharm 2019; 573:118767. [PMID: 31669558 DOI: 10.1016/j.ijpharm.2019.118767] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 01/07/2023]
Abstract
Age-related macular degeneration is the most common cause of vision loss in elderly people in developed countries. Nowadays, in clinical practice, three anti-VEGF drugs are commonly used (bevacizumab, aflibercept and ranibizumab), requiring repeated intravitreal injections. In order to minimise the number of injections, research on intravitreal drug delivery systems (DDSs) is needed. In this review, the DDSs developed up to date regarding intravitreal anti-VEGF drugs have been summarised, which include systems as hydrogels, liposomes, microparticles, nanoparticles or implants. Most of the studies have focused on the extended in vitro release behaviour of the developed DDSs, but data as antibody bioactivity, biocompatibility or in vivo stability is sometimes scarce. Moreover, as DDS development relies on in vivo pharmacokinetic analyses to evaluate the extended drug release, all the information regarding anti-VEGF intravitreal pharmacokinetics in different animal species have been compiled.
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Affiliation(s)
- Andrea Luaces-Rodríguez
- Pharmacology, Pharmacy and Pharmaceutical Technology Department, Faculty of Pharmacy, University of Santiago de Compostela (USC), Santiago de Compostela, Spain; Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), Santiago de Compostela, Spain
| | - Cristina Mondelo-García
- Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), Santiago de Compostela, Spain; Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, Spain
| | - Irene Zarra-Ferro
- Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), Santiago de Compostela, Spain; Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, Spain
| | - Miguel González-Barcia
- Pharmacology, Pharmacy and Pharmaceutical Technology Department, Faculty of Pharmacy, University of Santiago de Compostela (USC), Santiago de Compostela, Spain; Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), Santiago de Compostela, Spain; Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, Spain
| | - Pablo Aguiar
- Nuclear Medicine Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, Spain; Molecular Imaging Group, Health Research Institute of Santiago de Compostela (FIDIS), Santiago de Compostela, Spain
| | - Anxo Fernández-Ferreiro
- Pharmacology, Pharmacy and Pharmaceutical Technology Department, Faculty of Pharmacy, University of Santiago de Compostela (USC), Santiago de Compostela, Spain; Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), Santiago de Compostela, Spain; Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), Santiago de Compostela, Spain.
| | - Francisco J Otero-Espinar
- Pharmacology, Pharmacy and Pharmaceutical Technology Department, Faculty of Pharmacy, University of Santiago de Compostela (USC), Santiago de Compostela, Spain; Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), Santiago de Compostela, Spain.
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46
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Brandl C, Brücklmayer C, Günther F, Zimmermann ME, Küchenhoff H, Helbig H, Weber BHF, Heid IM, Stark KJ. Retinal Layer Thicknesses in Early Age-Related Macular Degeneration: Results From the German AugUR Study. Invest Ophthalmol Vis Sci 2019; 60:1581-1594. [PMID: 30995315 PMCID: PMC6892378 DOI: 10.1167/iovs.18-25332] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose To systematically analyze thicknesses of retinal layers in an older population and their link to early age-related macular degeneration (AMD). Methods In the AugUR baseline survey from a population aged ≥70 years, we conducted multimodal retinal imaging, including spectral-domain optical coherence tomography. Autosegmentation of eight distinct retinal layers was followed by manual correction of segmentation errors. AMD status was graded on color fundus images according to the Three Continent AMD Consortium Severity Scale. We tested the association of early AMD on retinal layer thicknesses by using linear mixed models and replicated significant results in independent data also from the AugUR platform. Results When comparing layer thicknesses between early AMD and no AMD (822 eyes, 449 participants), the retinal pigment epithelium/Bruch's membrane complex demonstrated a statistically significant thickening (e.g., P = 6.41 × 10−92 for severe early versus no AMD) and photoreceptor layers showed a significant thinning. Autosegmented retinal layer thicknesses revealed similar associations as manually corrected values but underestimated some effects. Independent replication analysis in 1026 eyes (546 participants) confirmed associations (e.g., P = 9.38 × 10−36 for retinal pigment epithelium/Bruch's membrane complex, severe early versus no AMD). Conclusions This first population-based study on spectral-domain optical coherence tomography-derived retinal layer thicknesses in a total of ∼1000 individuals provides insights into the reliability of autosegmentation and layer-specific reference values for an older population. Our findings show a difference in thicknesses between early AMD and no AMD for some retinal layers, suggesting these as potential imaging biomarkers. The thinning of photoreceptor layers substantiates a photoreceptor cell loss/damage already occurring in early AMD.
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Affiliation(s)
- Caroline Brandl
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany.,Department of Ophthalmology, University Hospital Regensburg, Regensburg, Germany.,Institute of Human Genetics, University of Regensburg, Regensburg, Germany
| | | | - Felix Günther
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany.,Statistical Consulting Unit StaBLab, Department of Statistics, Ludwig-Maximilians-University Munich, Germany
| | - Martina E Zimmermann
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
| | - Helmut Küchenhoff
- Statistical Consulting Unit StaBLab, Department of Statistics, Ludwig-Maximilians-University Munich, Germany
| | - Horst Helbig
- Department of Ophthalmology, University Hospital Regensburg, Regensburg, Germany
| | - Bernhard H F Weber
- Institute of Human Genetics, University of Regensburg, Regensburg, Germany
| | - Iris M Heid
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
| | - Klaus J Stark
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
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47
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Wu J, Sun X. Complement system and age-related macular degeneration: drugs and challenges. DRUG DESIGN DEVELOPMENT AND THERAPY 2019; 13:2413-2425. [PMID: 31409975 PMCID: PMC6650090 DOI: 10.2147/dddt.s206355] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/01/2019] [Indexed: 01/08/2023]
Abstract
Age-related macular degeneration (AMD) is directly attributable to vision loss, posing significant pressure on public health. AMD is recognized to be a multi-factorial disease and among them, complement system is under heated discussion in recent years. In this review, we start with an overview of complement pathways involved in AMD and their therapies correspondingly. Finally, we discuss the development of the therapeutics existed now. Also, we enclose a list of drugs undergoing clinical trials.
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Affiliation(s)
- Jiali Wu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Fundus Disease, Shanghai, People's Republic of China.,Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, People's Republic of China
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48
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Brantley MA, Handa JT. Foreword: Dry Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci 2019; 59:AMDi. [PMID: 30576399 DOI: 10.1167/iovs.18-26218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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49
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Owen LA, Shakoor A, Morgan DJ, Hejazi AA, McEntire MW, Brown JJ, Farrer LA, Kim I, Vitale A, DeAngelis MM. The Utah Protocol for Postmortem Eye Phenotyping and Molecular Biochemical Analysis. Invest Ophthalmol Vis Sci 2019; 60:1204-1212. [PMID: 30924847 PMCID: PMC6440527 DOI: 10.1167/iovs.18-24254] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 01/31/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose Current understanding of local disease pathophysiology in AMD is limited. Analysis of the human disease-affected tissue is most informative, as gene expression, expressed quantitative trait loci, microenvironmental, and epigenetic changes can be tissue, cell type, and location specific. Development of a novel translational treatment and prevention strategies particularly for earlier forms of AMD are needed, although access to human ocular tissue analysis is challenging. We present a standardized protocol to study rapidly processed postmortem donor eyes for molecular biochemical and genomic studies. Methods We partnered with the Utah Lions Eye Bank to obtain donor human eyes, blood, and vitreous, within 6 hours postmortem. Phenotypic analysis was performed using spectral-domain optical coherence tomography (SD-OCT) and color fundus photography. Macular and extramacular tissues were immediately isolated, and the neural retina and retinal pigment epithelium/choroid from each specimen were separated and preserved. Ocular disease phenotype was analyzed using clinically relevant grading criteria by a group of four ophthalmologists incorporating data from SD-OCT retinal images, fundus photographs, and medical records. Results The use of multimodal imaging leads to greater resolution of retinal pathology, allowing greater phenotypic rigor for both interobserver phenotype and known clinical diagnoses. Further, our analysis resulted in excellent quality RNA, which demonstrated appropriate tissue segregation. Conclusions The Utah protocol is a standardized methodology for analysis of disease mechanisms in AMD. It uniquely allows for simultaneous rigorous phenotypic, molecular biochemical, and genomic analysis of both systemic and local tissues. This better enables the development of disease biomarkers and therapeutic interventions.
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Affiliation(s)
- Leah A. Owen
- Department of Ophthalmology and Visual Sciences, University of Utah, School of Medicine, Salt Lake City, Utah, United States
| | - Akbar Shakoor
- Department of Ophthalmology and Visual Sciences, University of Utah, School of Medicine, Salt Lake City, Utah, United States
| | - Denise J. Morgan
- Department of Ophthalmology and Visual Sciences, University of Utah, School of Medicine, Salt Lake City, Utah, United States
| | - Andre A. Hejazi
- Department of Ophthalmology and Visual Sciences, University of Utah, School of Medicine, Salt Lake City, Utah, United States
| | | | - Jared J. Brown
- Utah Lions Eye Bank, Salt Lake City, Utah, United States
| | - Lindsay A. Farrer
- Departments of Medicine (Biomedical Genetics), Neurology, Ophthalmology, Epidemiology, and Biostatistics, Boston University Schools of Medicine and Public Health, Boston, Massachusetts, United States
| | - Ivana Kim
- Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States
| | - Albert Vitale
- Department of Ophthalmology and Visual Sciences, University of Utah, School of Medicine, Salt Lake City, Utah, United States
| | - Margaret M. DeAngelis
- Department of Ophthalmology and Visual Sciences, University of Utah, School of Medicine, Salt Lake City, Utah, United States
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, United States
- Department of Population Health Sciences, University of Utah, School of Medicine, Salt Lake City, Utah, United States
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50
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Tan ACS, Pilgrim MG, Fearn S, Bertazzo S, Tsolaki E, Morrell AP, Li M, Messinger JD, Dolz-Marco R, Lei J, Nittala MG, Sadda SR, Lengyel I, Freund KB, Curcio CA. Calcified nodules in retinal drusen are associated with disease progression in age-related macular degeneration. Sci Transl Med 2018; 10:eaat4544. [PMID: 30404862 PMCID: PMC10721335 DOI: 10.1126/scitranslmed.aat4544] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/10/2018] [Accepted: 10/17/2018] [Indexed: 12/17/2023]
Abstract
Drusen are lipid-, mineral-, and protein-containing extracellular deposits that accumulate between the basal lamina of the retinal pigment epithelium (RPE) and Bruch's membrane (BrM) of the human eye. They are a defining feature of age-related macular degeneration (AMD), a common sight-threatening disease of older adults. The appearance of heterogeneous internal reflectivity within drusen (HIRD) on optical coherence tomography (OCT) images has been suggested to indicate an increased risk of progression to advanced AMD. Here, in a cohort of patients with AMD and drusen, we show that HIRD indicated an increased risk of developing advanced AMD within 1 year. Using multimodal imaging in an independent cohort, we demonstrate that progression to AMD was associated with increasing degeneration of the RPE overlying HIRD. Morphological analysis of clinically imaged cadaveric human eye samples revealed that HIRD was formed by multilobular nodules. Nanoanalytical methods showed that nodules were composed of hydroxyapatite and that they differed from spherules and BrM plaques, other refractile features also found in the retinas of patients with AMD. These findings suggest that hydroxyapatite nodules may be indicators of progression to advanced AMD and that using multimodal clinical imaging to determine the composition of macular calcifications may help to direct therapeutic strategies and outcome measures in AMD.
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Affiliation(s)
- Anna C S Tan
- Vitreous Retina Macula Consultants of New York, New York, NY 10022, USA
- LuEsther T. Mertz Retinal Research Center, Manhattan, Eye, Ear and Throat Hospital, New York, NY 10075, USA
- Singapore National Eye Center/Singapore Eye Research Institute Singapore, Singapore 168751, Singapore
- Duke-NUS Singapore, Singapore 168751, Singapore
| | - Matthew G Pilgrim
- UCL Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK
- Division of Biomaterials and Tissue Engineering, UCL Eastman Dental Institute, University College London, London WC1X 8LD, UK
| | - Sarah Fearn
- Department of Materials, Imperial College London, London SW7 2AZ, UK
| | - Sergio Bertazzo
- Department of Medical Physics and Biomedical Engineering, University College London, Malet Place Engineering Building, London WC1E 6BT, UK
| | - Elena Tsolaki
- Department of Medical Physics and Biomedical Engineering, University College London, Malet Place Engineering Building, London WC1E 6BT, UK
| | - Alexander P Morrell
- Material Physics, Aston University, Aston Express Way, Birmingham B4 7ET, UK
| | - Miaoling Li
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 32594-0019, USA
| | - Jeffrey D Messinger
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 32594-0019, USA
| | - Rosa Dolz-Marco
- Vitreous Retina Macula Consultants of New York, New York, NY 10022, USA
- LuEsther T. Mertz Retinal Research Center, Manhattan, Eye, Ear and Throat Hospital, New York, NY 10075, USA
| | - Jianqin Lei
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA 90033, USA
| | - Muneeswar G Nittala
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA 90033, USA
| | - Srinivas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, CA 90033, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Imre Lengyel
- UCL Institute of Ophthalmology, 11-43 Bath Street, London EC1V 9EL, UK.
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast BT9 7BL, UK
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY 10022, USA
- LuEsther T. Mertz Retinal Research Center, Manhattan, Eye, Ear and Throat Hospital, New York, NY 10075, USA
- Department of Ophthalmology, New York University Langone School of Medicine, New York, NY 10016, USA
| | - Christine A Curcio
- Department of Ophthalmology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 32594-0019, USA
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