1
|
Mohammadzadeh V, Liang Y, Moghimi S, Xie P, Nishida T, Mahmoudinezhad G, Eslani M, Walker E, Kamalipour A, Micheletti E, Wu JH, Christopher M, Zangwill LM, Javidi T, Weinreb RN. Detection of glaucoma progression on longitudinal series of en-face macular optical coherence tomography angiography images with a deep learning model. Br J Ophthalmol 2024:bjo-2023-324528. [PMID: 39117359 DOI: 10.1136/bjo-2023-324528] [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: 09/20/2023] [Accepted: 05/05/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND/AIMS To design a deep learning (DL) model for the detection of glaucoma progression with a longitudinal series of macular optical coherence tomography angiography (OCTA) images. METHODS 202 eyes of 134 patients with open-angle glaucoma with ≥4 OCTA visits were followed for an average of 3.5 years. Glaucoma progression was defined as having a statistically significant negative 24-2 visual field (VF) mean deviation (MD) rate. The baseline and final macular OCTA images were aligned according to centre of fovea avascular zone automatically, by checking the highest value of correlation between the two images. A customised convolutional neural network (CNN) was designed for classification. A comparison of the CNN to logistic regression model for whole image vessel density (wiVD) loss on detection of glaucoma progression was performed. The performance of the model was defined based on the confusion matrix of the validation dataset and the area under receiver operating characteristics (AUC). RESULTS The average (95% CI) baseline VF MD was -3.4 (-4.1 to -2.7) dB. 28 (14%) eyes demonstrated glaucoma progression. The AUC (95% CI) of the DL model for the detection of glaucoma progression was 0.81 (0.59 to 0.93). The sensitivity, specificity and accuracy (95% CI) of DL model were 67% (34% to 78%), 83% (42% to 97%) and 80% (52% to 95%), respectively. The AUC (95% CI) for the detection of glaucoma progression based on the logistic regression model was lower than the DL model (0.69 (0.50 to 0.88)). CONCLUSION The optimised DL model detected glaucoma progression based on longitudinal macular OCTA images showed good performance. With external validation, it could enhance detection of glaucoma progression. TRIAL REGISTRATION NUMBER NCT00221897.
Collapse
Affiliation(s)
- Vahid Mohammadzadeh
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
- Ophthalmology and Vision Science, University of Louisville, Louisville, Kentucky, USA
| | - Youwei Liang
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, California, USA
| | - Sasan Moghimi
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Pengtao Xie
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, California, USA
| | - Takashi Nishida
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Golnoush Mahmoudinezhad
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Medi Eslani
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Evan Walker
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Alireza Kamalipour
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Eleonora Micheletti
- Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia, Pavia, Lombardia, Italy
| | - Jo-Hsuan Wu
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Mark Christopher
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Linda M Zangwill
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| | - Tara Javidi
- Department of Electrical and Computer Engineering, University of California San Diego, La Jolla, California, USA
| | - Robert N Weinreb
- Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
| |
Collapse
|
2
|
Mohammadi M, Su E, Mohammadzadeh V, Besharati S, Martinyan A, Coleman AL, Law SK, Caprioli J, Weiss RE, Nouri-Mahdavi K. Comparison of Retinal Nerve Fiber Layer and Ganglion Cell Complex Rates of Change in Patients With Moderate to Advanced Glaucoma. Am J Ophthalmol 2024; 268:190-198. [PMID: 39111519 DOI: 10.1016/j.ajo.2024.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/16/2024] [Accepted: 07/24/2024] [Indexed: 09/01/2024]
Abstract
PURPOSE To compare ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL) rates of change (RoC) in eyes with central or moderate to advanced glaucoma. DESIGN Prospective cohort study. PARTICIPANTS A total of 918 matched macular and RNFL OCT scan pairs from 109 eyes (109 patients) enrolled in the Advanced Glaucoma Progression Study with ≥2 years of follow-up and ≥4 OCT scans. METHODS We exported GCC and RNFL thickness measurements in 49 central macular superpixels and 12 RNFL clock-hour sectors, respectively. We applied our latest Bayesian hierarchical longitudinal model to estimate population and subject-specific baseline thickness (intercepts) and rates of change (RoC) in macular superpixels and RNFL sectors. Global RNFL and GCC RoC were analyzed in a single bivariate longitudinal model to properly compare them accounting for the correlation between their RoC. MAIN OUTCOME MEASURES Proportion of significant negative (deteriorating) and positive (improving) RoC expressed in μm/year. Standardized RoC were calculated by dividing RoC by the corresponding population SD. Analyses were repeated in eyes with visual field mean deviation (MD) ≤-6 and > -6 dB. RESULTS Average (SD) 24-2 visual field MD and follow-up length were -8.6 (6.3) dB and 4.2 (0.5) years, respectively. Global RNFL RoC (-0.70 µm/year) were faster than GCC (-0.44 µm/year) (P < .001); corresponding normalized RoC were not significantly different (P = .052). In bivariate analysis, patients with a significant negative global RNFL RoC (n = 63, 57%) or GCC (n = 56, 51%) frequently did so for both outcomes (n = 49, 45%). The average proportion of significantly decreasing RNFL sectors within an eye was 30.7% in eyes with MD > -6 dB compared to 20.5% in those with MD ≤ -6 dB (P = .014); the proportions for GCC superpixels were 21.1% versus 18.7%, respectively (P = .63). CONCLUSIONS Both GCC and RNFL measures can detect structural progression in glaucoma patients with central damage or moderate to advanced glaucoma. The clinical utility of RNFL imaging decreases with worsening severity of glaucoma.
Collapse
Affiliation(s)
- Massood Mohammadi
- Glaucoma Division, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles (M.M., E.S., V.M., S.B., A.M., A.L.C., S.K.L., J.C., and K.N.-M.), Los Angeles, California, USA
| | - Erica Su
- Glaucoma Division, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles (M.M., E.S., V.M., S.B., A.M., A.L.C., S.K.L., J.C., and K.N.-M.), Los Angeles, California, USA
| | - Vahid Mohammadzadeh
- Glaucoma Division, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles (M.M., E.S., V.M., S.B., A.M., A.L.C., S.K.L., J.C., and K.N.-M.), Los Angeles, California, USA
| | - Sajad Besharati
- Glaucoma Division, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles (M.M., E.S., V.M., S.B., A.M., A.L.C., S.K.L., J.C., and K.N.-M.), Los Angeles, California, USA
| | - Arthur Martinyan
- Glaucoma Division, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles (M.M., E.S., V.M., S.B., A.M., A.L.C., S.K.L., J.C., and K.N.-M.), Los Angeles, California, USA
| | - Anne L Coleman
- Glaucoma Division, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles (M.M., E.S., V.M., S.B., A.M., A.L.C., S.K.L., J.C., and K.N.-M.), Los Angeles, California, USA
| | - Simon K Law
- Glaucoma Division, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles (M.M., E.S., V.M., S.B., A.M., A.L.C., S.K.L., J.C., and K.N.-M.), Los Angeles, California, USA
| | - Joseph Caprioli
- Glaucoma Division, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles (M.M., E.S., V.M., S.B., A.M., A.L.C., S.K.L., J.C., and K.N.-M.), Los Angeles, California, USA
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles (R.E.W.), Los Angeles, California, USA
| | - Kouros Nouri-Mahdavi
- Glaucoma Division, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles (M.M., E.S., V.M., S.B., A.M., A.L.C., S.K.L., J.C., and K.N.-M.), Los Angeles, California, USA.
| |
Collapse
|
3
|
Besharati S, Su E, Mohammadzadeh V, Mohammadi M, Caprioli J, Weiss RE, Nouri-Mahdavi K. Detecting Fast Progressors: Comparing a Bayesian Longitudinal Model to Linear Regression for Detecting Structural Changes in Glaucoma. Am J Ophthalmol 2024; 261:85-94. [PMID: 38281568 DOI: 10.1016/j.ajo.2024.01.024] [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: 08/20/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 01/30/2024]
Abstract
PURPOSE Demonstrate that a novel Bayesian hierarchical spatial longitudinal (HSL) model identifies macular superpixels with rapidly deteriorating ganglion cell complex (GCC) thickness more efficiently than simple linear regression (SLR). DESIGN Prospective cohort study. SETTING Tertiary Glaucoma Center. SUBJECTS One hundred eleven eyes (111 patients) with moderate to severe glaucoma at baseline and ≥4 macular optical coherence tomography scans and ≥2 years of follow-up. OBSERVATION PROCEDURE Superpixel-patient-specific GCC slopes and their posterior variances in 49 superpixels were derived from our latest Bayesian HSL model and Bayesian SLR. A simulation cohort was created with known intercepts, slopes, and residual variances in individual superpixels. MAIN OUTCOME MEASURES We compared HSL and SLR in the fastest progressing deciles on (1) proportion of superpixels identified as significantly progressing in the simulation study and compared to SLR slopes in cohort data; (2) root mean square error (RMSE), and SLR/HSL RMSE ratios. RESULTS Cohort- In the fastest decile of slopes per SLR, 77% and 80% of superpixels progressed significantly according to SLR and HSL, respectively. The SLR/HSL posterior SD ratio had a median of 1.83, with 90% of ratios favoring HSL. Simulation- HSL identified 89% significant negative slopes in the fastest progressing decile vs 64% for SLR. SLR/HSL RMSE ratio was 1.36 for the fastest decile of slopes, with 83% of RMSE ratios favoring HSL. CONCLUSION The Bayesian HSL model improves the estimation efficiency of local GCC rates of change regardless of underlying true rates of change, particularly in fast progressors.
Collapse
Affiliation(s)
- Sajad Besharati
- From the Glaucoma Division (S.B., V.M., M.M., J.C., K.N-M.), Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Erica Su
- Department of Biostatistics (R.E.W.), Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Vahid Mohammadzadeh
- From the Glaucoma Division (S.B., V.M., M.M., J.C., K.N-M.), Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Massood Mohammadi
- From the Glaucoma Division (S.B., V.M., M.M., J.C., K.N-M.), Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Joseph Caprioli
- From the Glaucoma Division (S.B., V.M., M.M., J.C., K.N-M.), Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Robert E Weiss
- Department of Biostatistics (R.E.W.), Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Kouros Nouri-Mahdavi
- From the Glaucoma Division (S.B., V.M., M.M., J.C., K.N-M.), Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
| |
Collapse
|
4
|
Su E, Mohammadzadeh V, Mohammadi M, Shi L, Law SK, Coleman AL, Caprioli J, Weiss RE, Nouri-Mahdavi K. A Bayesian Hierarchical Spatial Longitudinal Model Improves Estimation of Local Macular Rates of Change in Glaucomatous Eyes. Transl Vis Sci Technol 2024; 13:26. [PMID: 38285459 PMCID: PMC10829804 DOI: 10.1167/tvst.13.1.26] [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: 11/13/2022] [Accepted: 12/06/2023] [Indexed: 01/30/2024] Open
Abstract
Purpose Demonstrate that a novel Bayesian hierarchical spatial longitudinal (HSL) model improves estimation of local macular ganglion cell complex (GCC) rates of change compared to simple linear regression (SLR) and a conditional autoregressive (CAR) model. Methods We analyzed GCC thickness measurements within 49 macular superpixels in 111 eyes (111 patients) with four or more macular optical coherence tomography scans and two or more years of follow-up. We compared superpixel-patient-specific estimates and their posterior variances derived from the latest version of a recently developed Bayesian HSL model, CAR, and SLR. We performed a simulation study to compare the accuracy of intercept and slope estimates in individual superpixels. Results HSL identified a significantly higher proportion of significant negative slopes in 13/49 superpixels and a significantly lower proportion of significant positive slopes in 21/49 superpixels than SLR. In the simulation study, the median (tenth, ninetieth percentile) ratio of mean squared error of SLR [CAR] over HSL for intercepts and slopes were 1.91 (1.23, 2.75) [1.51 (1.05, 2.20)] and 3.25 (1.40, 10.14) [2.36 (1.17, 5.56)], respectively. Conclusions A novel Bayesian HSL model improves estimation accuracy of patient-specific local GCC rates of change. The proposed model is more than twice as efficient as SLR for estimating superpixel-patient slopes and identifies a higher proportion of deteriorating superpixels than SLR while minimizing false-positive detection rates. Translational Relevance The proposed HSL model can be used to model macular structural measurements to detect individual glaucoma progression earlier and more efficiently in clinical and research settings.
Collapse
Affiliation(s)
- Erica Su
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Vahid Mohammadzadeh
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Massood Mohammadi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Lynn Shi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Simon K Law
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Anne L Coleman
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Joseph Caprioli
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Kouros Nouri-Mahdavi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| |
Collapse
|
5
|
Eraslan M, Çerman E, Bozkurt S, Genç D, Virlan AT, Demir CS, Akkoç T, Karaöz E, Akkoç T. Mesenchymal stem cells differentiate to retinal ganglion-like cells in rat glaucoma model induced by polystyrene microspheres. Tissue Cell 2023; 84:102199. [PMID: 37633122 DOI: 10.1016/j.tice.2023.102199] [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: 03/06/2023] [Revised: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 08/28/2023]
Abstract
AIM The study aimed to evaluate the differentiation ability of intravitreally injected rat bone marrow-derived mesenchymal stem cells (rBM-MSCs) to retinal ganglion-like cells in a polystyrene microsphere induced rat glaucoma model. MATERIALS AND METHODS The glaucoma rat model was generated via intracameral injection of 7 microliter polystyrene microspheres. Green fluorescence protein-labeled (GFP) rBM-MSCs were transplanted intravitreally at or after induction of ocular hypertension (OHT), depending on the groups. By the end of the fourth week, flat-mount retinal dissection was performed, and labeled against Brn3a, CD90, GFAP, CD11b, Vimentin, and localization of GFP positive rBM-MSCs was used for evaluation through immunofluorescence staining and to count differentiated retinal cells by flow cytometry. From 34 male Wistar albino rats, 56 eyes were investigated. RESULTS Flow cytometry revealed significantly increased CD90 and Brn3a positive cells in glaucoma induced and with rBM-MSC injected groups compared to control(P = 0.006 and P = 0.003 respectively), sham-operated (P = 0.007 and P < 0.001 respectively), and only rBM-MSCs injected groups (P = 0.002 and P = 0.009 respectively). Immunofluorescence microscopy revealed differentiation of GFP labeled stem cells to various retinal cells, including ganglion-like cells. rBM-MSCs were observable in ganglion cells, inner and outer nuclear retinal layers in rBM-MSCs injected eyes. CONCLUSION Intravitreally transplanted rBM-MSCs differentiated into retinal cells, including ganglion-like cells, which successfully created a glaucoma model damaged with polystyrene microspheres. Promisingly, MSCs may have a role in neuro-protection and neuro-regeneration treatment of glaucoma in the future.
Collapse
Affiliation(s)
- Muhsin Eraslan
- Department of Ophthalmology, Marmara University Faculty of Medicine, Istanbul, Turkey.
| | - Eren Çerman
- Department of Ophthalmology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Süheyla Bozkurt
- Department of Pathology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Deniz Genç
- Department of Pediatric Diseases, Faculty of Health Sciences, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Aysın Tulunay Virlan
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, Scotland, UK
| | - Cansu Subaşı Demir
- Center for Regenerative Medicine and Stem Cell Research & Manufacturing (LivMedCell), Istanbul, Turkey
| | - Tolga Akkoç
- Genetic Engineering and Biotechnology Institute, Tubitak Marmara Research Center, Kocaeli, Turkey
| | - Erdal Karaöz
- Department of Histology & Embryology, Istinye University Faculty of Medicine, Istanbul, Turkey; Center for Stem Cell and Tissue Engineering Research & Practice, Istinye University, Istanbul, Turkey
| | - Tunç Akkoç
- Department of Pediatric Allergy and Immunology, Marmara University Faculty of Medicine, Istanbul, Turkey; Department of Immunology, Marmara University Faculty of Medicine, Istanbul, Turkey; Marstem Cell Technologies, Marmara University Technopark, İstanbul, Turkey
| |
Collapse
|
6
|
Mohammadzadeh V, Su E, Mohammadi M, Law SK, Coleman AL, Caprioli J, Weiss RE, Nouri-Mahdavi K. Association of Blood Pressure With Rates of Macular Ganglion Cell Complex Thinning in Patients With Glaucoma. JAMA Ophthalmol 2023; 141:251-257. [PMID: 36757702 PMCID: PMC9912170 DOI: 10.1001/jamaophthalmol.2022.6092] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/25/2022] [Indexed: 02/10/2023]
Abstract
Importance There are scarce data on the association of blood pressure measures with subsequent macular structural rates of change in patients with glaucoma. Objective To investigate the association of baseline blood pressure measures with rates of change of the macular ganglion cell complex in patients with central or moderate to advanced glaucoma damage at baseline. Design, Setting, and Participants This prospective cohort study, conducted from August 2021 to August 2022, used data from patients in the Advanced Glaucoma Progression Study at the University of California, Los Angeles. Participants were between 39 and 80 years of age and had more than 4 macular imaging tests and 2 or more years of follow-up. Exposures A diagnosis of glaucoma with either central damage or a visual field mean deviation worse than -6 dB. Main Outcomes and Measures The main outcome was the association of blood pressure measures with ganglion cell complex rates of change. Macular ganglion cell complex thickness rates of change were estimated with a bayesian hierarchical model. This model included relevant demographic and clinical factors. Blood pressure measures, intraocular pressure, and their interactions were added to the model to assess the association of baseline blood pressure measures with global ganglion cell complex rates of change. Results The cohort included 105 eyes from 105 participants. The mean (SD) age, 10-2 visual field mean deviation, and follow-up time were 66.9 (8.5) years, -8.3 (5.3) dB, and 3.6 (0.4) years, respectively, and 67 patients (63.8%) were female. The racial and ethnic makeup of the cohort was 15 African American (14.3%), 23 Asian (21.9%), 12 Hispanic (11.4%), and 55 White (52.4%) individuals based on patient self-report. In multivariable analyses, female sex, history of taking blood pressure medications, higher intraocular pressure, thicker central corneal thickness, shorter axial length, higher contrast sensitivity at 12 cycles per degree, and higher baseline 10-2 visual field mean deviation were associated with faster ganglion cell complex thinning. Lower diastolic blood pressure was associated with faster rates of ganglion cell complex thinning at higher intraocular pressures. For intraocular pressures of 8 and of 16 mm Hg (10% and 90% quantiles, respectively), every 10 mm Hg-lower increment of diastolic blood pressure was associated with 0.011 μm/y slower and -0.130 μm/y faster rates of ganglion cell complex thinning, respectively. Conclusions and Relevance In this cohort study, a combination of lower diastolic blood pressure and higher intraocular pressure at baseline was associated with faster rates of ganglion cell complex thinning. These findings support consideration of evaluating and addressing diastolic blood pressure as a therapeutic measure in patients with glaucoma if supported by appropriate clinical trials.
Collapse
Affiliation(s)
- Vahid Mohammadzadeh
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles
| | - Erica Su
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles
| | - Massood Mohammadi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles
| | - Simon K. Law
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles
| | - Anne L. Coleman
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles
| | - Joseph Caprioli
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles
| | - Robert E. Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles
| | - Kouros Nouri-Mahdavi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles
| |
Collapse
|
7
|
Mohammadi M, Su E, Chew L, Mohammadzadeh V, Caprioli J, Weiss RE, Nouri-Mahdavi K. Comparison of Ganglion Cell Layer and Inner Plexiform Layer Rates of Change in Suspected and Established Glaucoma. Am J Ophthalmol 2022; 249:12-20. [PMID: 36516918 PMCID: PMC10106372 DOI: 10.1016/j.ajo.2022.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/28/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE We compared ganglion cell layer (GCL) and inner plexiform layer (IPL) rates of change (RoC) in patients with glaucoma suspect (GS) and established glaucoma (EG) to test the hypothesis that IPL thickness changes would occur earlier than GCL changes in eyes with early damage. DESIGN Prospective, cohort study. METHODS A total of 64 GS eyes (46 patients) and 112 EG eyes (112 patients) with ≥2 years of follow-up and ≥3 macular optical coherence tomography scans were included. GCL and IPL superpixel thickness measurements were exported. A Bayesian hierarchical model with random intercepts/slopes and random residual variances was fitted to estimate RoC in individual superpixels. Normalized RoC and proportions of superpixels with significantly negative and positive GCL and IPL RoC were compared within the groups. RESULTS The average (SD) follow-up time and number of scans were 3.5 (0.7) years and 4.2 (1.0), respectively, in the GS group and 3.6 (0.4) years and 7.3 (1.1) in the EG group. Mean (SD) normalized RoC was faster for GCL than IPL (-0.69 [0.05] vs -0.33 [0.04]) in the GS group, whereas it was faster for IPL (-0.47 [0.03] vs -0.28 [0.02]) in EG eyes. GCL RoC were significantly negative in 24 of 36 superpixels compared with 8 of 36 for IPL (P < .001) in GS eyes. In the EG group, 23 of 36 superpixels had significant negative IPL RoC compared with 13 of 36 superpixels for GCL (P = .006). CONCLUSIONS GCL thickness is more likely to demonstrate change over time compared with IPL in glaucoma suspects. There is no evidence of preferential IPL thinning in eyes with suspected early glaucoma damage.
Collapse
Affiliation(s)
- Massood Mohammadi
- From the Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine (M.M., L.C., V.M., J.C., K.N-M.), University of California Los Angeles, Los Angeles, California, USA
| | - Erica Su
- Department of Biostatistics, Fielding School of Public Health (E.S., R.E.W.), University of California Los Angeles, Los Angeles, California, USA
| | - Leila Chew
- From the Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine (M.M., L.C., V.M., J.C., K.N-M.), University of California Los Angeles, Los Angeles, California, USA
| | - Vahid Mohammadzadeh
- From the Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine (M.M., L.C., V.M., J.C., K.N-M.), University of California Los Angeles, Los Angeles, California, USA
| | - Joseph Caprioli
- From the Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine (M.M., L.C., V.M., J.C., K.N-M.), University of California Los Angeles, Los Angeles, California, USA
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health (E.S., R.E.W.), University of California Los Angeles, Los Angeles, California, USA
| | - Kouros Nouri-Mahdavi
- From the Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine (M.M., L.C., V.M., J.C., K.N-M.), University of California Los Angeles, Los Angeles, California, USA.
| |
Collapse
|
8
|
Nunez R, Harris A, Ibrahim O, Keller J, Wikle CK, Robinson E, Zukerman R, Siesky B, Verticchio A, Rowe L, Guidoboni G. Artificial Intelligence to Aid Glaucoma Diagnosis and Monitoring: State of the Art and New Directions. PHOTONICS 2022; 9:810. [PMID: 36816462 PMCID: PMC9934292 DOI: 10.3390/photonics9110810] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Recent developments in the use of artificial intelligence in the diagnosis and monitoring of glaucoma are discussed. To set the context and fix terminology, a brief historic overview of artificial intelligence is provided, along with some fundamentals of statistical modeling. Next, recent applications of artificial intelligence techniques in glaucoma diagnosis and the monitoring of glaucoma progression are reviewed, including the classification of visual field images and the detection of glaucomatous change in retinal nerve fiber layer thickness. Current challenges in the direct application of artificial intelligence to further our understating of this disease are also outlined. The article also discusses how the combined use of mathematical modeling and artificial intelligence may help to address these challenges, along with stronger communication between data scientists and clinicians.
Collapse
Affiliation(s)
- Roberto Nunez
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO 65211, USA
| | - Alon Harris
- Department of Ophthalmology, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, USA
| | - Omar Ibrahim
- Department of Electrical Engineering, Tikrit University, Tikrit P.O. Box 42, Iraq
| | - James Keller
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO 65211, USA
| | | | - Erin Robinson
- Department of Social Work, University of Missouri, Columbia, MO 65211, USA
| | - Ryan Zukerman
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY 10034, USA
| | - Brent Siesky
- Department of Ophthalmology, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, USA
| | - Alice Verticchio
- Department of Ophthalmology, Icahn School of Medicine at Mt. Sinai, New York, NY 10029, USA
| | - Lucas Rowe
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Giovanna Guidoboni
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO 65211, USA
- Department of Mathematics, University of Missouri, Columbia, MO 65211, USA
| |
Collapse
|
9
|
Mohammadzadeh V, Su E, Shi L, Coleman AL, Law SK, Caprioli J, Weiss RE, Nouri-Mahdavi K. Multivariate Longitudinal Modeling of Macular Ganglion Cell Complex: Spatiotemporal Correlations and Patterns of Longitudinal Change. OPHTHALMOLOGY SCIENCE 2022; 2:100187. [PMID: 36245763 PMCID: PMC9559093 DOI: 10.1016/j.xops.2022.100187] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 05/20/2022] [Accepted: 06/09/2022] [Indexed: 01/11/2023]
Abstract
Purpose To investigate spatiotemporal correlations among ganglion cell complex (GCC) superpixel thickness measurements and explore underlying patterns of longitudinal change across the macular region. Design Longitudinal cohort study. Subjects One hundred eleven eyes from 111 subjects from the Advanced Glaucoma Progression Study with ≥ 4 visits and ≥ 2 years of follow-up. Methods We further developed our proposed Bayesian hierarchical model for studying longitudinal GCC thickness changes across macular superpixels in a cohort of glaucoma patients. Global priors were introduced for macular superpixel parameters to combine data across superpixels and better estimate population slopes and intercepts. Main Outcome Measures Bayesian residual analysis to inspect cross-superpixel correlations for subject random effects and residuals. Principal component analysis (PCA) to explore underlying patterns of longitudinal macular change. Results Average (standard deviation [SD]) follow-up and baseline 10-2 visual field mean deviation were 3.6 (0.4) years and -8.9 (5.9) dB, respectively. Superpixel-level random effects and residuals had the greatest correlations with nearest neighbors; correlations were higher in the superior than in the inferior region and strongest among random intercepts, followed by random slopes, residuals, and residual SDs. PCA of random intercepts showed a first large principal component (PC) across superpixels that approximated a global intercept, a second PC that contrasted the superior and inferior macula, and a third PC, contrasting inner and nasal superpixels with temporal and peripheral superpixels. PCs for slopes, residual SDs, and residuals were remarkably similar to those of random intercepts. Conclusions Introduction of cross-superpixel random intercepts and slopes is expected to improve estimation of population and subject parameters. Further model enhancement may be possible by including cross-superpixel random effects and correlations to address spatiotemporal relationships in longitudinal data sets.
Collapse
Affiliation(s)
- Vahid Mohammadzadeh
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Erica Su
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Lynn Shi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Anne L. Coleman
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Simon K. Law
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Joseph Caprioli
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Robert E. Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
| | - Kouros Nouri-Mahdavi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California,Correspondence: Kouros Nouri-Mahdavi, MD, MS, 100 Stein Plaza, Los Angeles, CA, 90095.
| |
Collapse
|
10
|
MOHAMMADZADEH VAHID, SU ERICA, RABIOLO ALESSANDRO, SHI LYNN, ZADEH SEPIDEHHEYDAR, LAW SIMONK, COLEMAN ANNEL, CAPRIOLI JOSEPH, WEISS ROBERTE, NOURI-MAHDAVI KOUROS. Ganglion Cell Complex: The Optimal Measure for Detection of Structural Progression in the Macula. Am J Ophthalmol 2022; 237:71-82. [PMID: 34942111 PMCID: PMC9035060 DOI: 10.1016/j.ajo.2021.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To test the hypothesis that macular ganglion cell complex (GCC) thickness from optical coherence tomography (OCT) provides a stronger change signal regardless of glaucoma severity compared with other macular measures. DESIGN Prospective cohort study. METHODS Eyes were from 112 patients with moderate to severe glaucoma at baseline from a tertiary glaucoma center. In each 3° × 3° macular superpixel, a hierarchical Bayesian random intercept and slope model with random residual variance was fit to longitudinal full macular thickness (FMT), outer retina layers, GCC, ganglion cell-inner plexiform layer (GCIPL), and ganglion cell layer (GCL) measurements. We estimated population- and individual-level slopes and intercepts. Proportions of substantial worsening and improving superpixel slopes were compared between layers and in superpixels with mild to moderate vs severe damage (total deviation of corresponding visual field location ≥ -8 vs < -8 dB). RESULTS Mean (SD) follow-up time and baseline 10-2 visual field mean deviation were 3.6 (0.4) years and -8.9 (5.9) dB, respectively. FMT displayed the highest proportion of significant negative slopes (1932/3519 [54.9%]), followed by GCC (1286/3519 [36.5%]), outer retina layers (1254/3519 [35.6%]), (GCIPL) (1075/3518 [30.6%]), and (GCL) (698/3518 [19.8%]). Inner macular measures detected less worsening in the severe glaucoma group; yet GCC (223/985 [22.6%]) identified the highest proportion (GCIPL: 183/985 [18.6%]; GCL: 106/985 [10.8%]). Proportions of positive rates were small and comparable among all measures. CONCLUSIONS GCC is the optimal macular measure for detection of structural change in eyes with moderate to severe glaucoma. Although a higher proportion of worsening superpixels was observed for FMT, a large portion of FMT change could be attributed to changes in outer retina layers.
Collapse
|