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Venkatesh R, Mangla R, Handa A, Chitturi SP, Parmar Y, Sangoram R, Yadav NK, Chhablani J. Vitreomacular interface abnormalities in type 2 macular telangiectasia (MacTel). Graefes Arch Clin Exp Ophthalmol 2024; 262:1455-1463. [PMID: 38108907 DOI: 10.1007/s00417-023-06330-8] [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: 02/20/2023] [Revised: 11/20/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023] Open
Abstract
PURPOSE To describe the different types of vitreomacular interface abnormalities (VMIA) seen on optical coherence tomography (OCT) in type 2 macular telangiectasia (MacTel) and explain the possible reasons for its development. METHODS In this retrospective cross-sectional study, type 2 MacTel eyes with macular volumetric OCT imaging protocol were included to identify different types of VMIA such as abnormal PVD, vitreomacular traction (VMT), ERM, and lamellar and full-thickness macular hole. The VMIA findings were then correlated with different MacTel disease stages and visual acuity. RESULTS One thousand forty-three OCTs of 332 type 2 MacTel eyes from 169 patients at different visits were examined. VMIA was detected in 709 (68%) of those OCT scans in 216 (65%) eyes. There were 273 (39%), 31 (4%), 89 (13%), 7 (1%), and 381 (54%) OCT scans with vitreomacular adhesion, VMT, ERM, and inner and outer lamellar macular holes discovered respectively. VMIA eyes had a high frequency of abnormal PVD (p = 0.001) and retinal pigment clumps (RPCs) [p = 0.032]. Eyes with abnormal PVD (p = 0.034) and RPC (p = 0.000) had a higher rate of ERM development. RPC was linked to an increased risk of developing ERM (odd ratio 2.472; 95% CI 1.488-4.052). RPC and ERM contributed significantly to poor visual acuity (0.661 ± 0.416, 20/92). CONCLUSION OCT reveals a high frequency of VMIA in advanced type 2 MacTel eyes. RPC could be responsible for the development of anomalous PVD, as well as subsequent VMIAs and ERM. Additional work is required to examine the long-term changes and surgical outcomes of these eyes.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1stR Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India.
| | - Rubble Mangla
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1stR Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Ashit Handa
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1stR Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Sai Prashanti Chitturi
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1stR Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Yash Parmar
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1stR Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Rohini Sangoram
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1stR Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Naresh Kumar Yadav
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1stR Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Jay Chhablani
- University of Pittsburgh School of Medicine, Medical Retina and Vitreoretinal Surgery, 203 Lothrop Street, Suite 800, Pittsburgh, PA, 15213, USA
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Govindaraj I, Mahalingam M, Maheswari U, Kumar HSY, Suganya BS, Subramanian V, Rajendran A. Quantification of vascular changes in macular telangiectasia type 2 with AngioTool software. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06487-w. [PMID: 38676751 DOI: 10.1007/s00417-024-06487-w] [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: 10/30/2023] [Revised: 03/04/2024] [Accepted: 04/04/2024] [Indexed: 04/29/2024] Open
Abstract
PURPOSE To compare AngioTool (AT) vascular parameters (VP) between MacTel2 eyes and normal eyes. Secondary outcome measures were to correlate VP with BCVA and to analyze VP between various grades of Simple MacTel Classification. METHODS This is a retrospective study. SD OCTA images of the superficial vascular complex (SVC) and deep capillary complex (DVC) were exported into Image J and AT. The explant area (EA), vessel area (VA), vessel percentage area (VPA), total number of junctions (TNJ), junction density (JD), total vessel length (TVL), average vessel length (AVL), total number of endpoints (TNE) and mean E lacunarity (MEL) were studied. RESULTS Group 1 had 120 MacTel2 eyes. Group 2 had 60 age-matched normal eyes. All VP were significantly different between the two groups except EA and TNE in both complexes. None of the VP had a correlation with BCVA. Interquadrant analysis (IQA) in SVC and DVC showed statistical significance in VPA, AVL and JD and in AVL, TNE, JD, VPA respectively. Post hoc analysis in SVC and DVC showed statistical significance in TNJ, JD, TVL and AVL between grade 1 and grade 3, and in VA, VPA, TNJ, JD, TVL and MEL between grade 0 and grade 3 respectively. CONCLUSION VP were affected in MacTel2 eyes. VP did not correlate with BCVA. Occurrence of pigmentation is an important event in the progression of disease. AT may provide quantitative markers to measure disease progression.
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Affiliation(s)
- Indu Govindaraj
- Department of Vitreo-Retina Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Maanasi Mahalingam
- Department of Vitreo-Retina Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Uma Maheswari
- Department of Vitreo-Retina Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - H S Yeshwanth Kumar
- Department of Vitreo-Retina Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - B S Suganya
- Department of Vitreo-Retina Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Vishnu Subramanian
- Department of Vitreo-Retina Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India
| | - Anand Rajendran
- Department of Vitreo-Retina Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India.
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Venkatesh R, Handa A, Chitturi SP, Choudhary A, Prabhu V, Acharya I, Mangla R, Yadav NK, Chhablani J. Right-angled vessel characteristics in different stages of type 2 macular telangiectasia (MacTel). Eye (Lond) 2024; 38:1162-1167. [PMID: 38012385 PMCID: PMC11009321 DOI: 10.1038/s41433-023-02853-w] [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: 04/22/2023] [Revised: 10/30/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE To study right-angled vessels (RAV) in disease progression and macular neovascularization in type 2 macular telangiectasia (MacTel) eyes. METHODS This retrospective image analysis study examined type 2 MacTel patients' multicolour® and OCT imaging records from January 2015 to March 2023. Age, gender, laterality, visual acuity, systemic disease, and follow-up duration were recorded. RAV characteristics were assessed using OCT and multicolour® images. This study examined RAV characteristics and type 2 MacTel disease stage. RESULTS In total, 270 eyes of 146 patients (97 females, 66%) with a mean age of 60.77 ± 9.34 years were studied. 153 (57%) eyes showed RAV. The non-proliferative stage of type 2 MacTel had either no RAV or a normal-calibre right-angled vein, while the proliferative stage had a right-angled artery and a dilated or normal-calibre RAV [p < 0.001]. RAV characteristics differed at the final follow-up (p < 0.001). 11 eyes transitioned from non-proliferative to proliferative after a median period of 26 months (range: 5-96 months). RAV characteristics changed from a normal calibre right-angled vein at presentation to a normal calibre vein and artery in 6 (55%) eyes and to a dilated vein and artery in 5 (45%) eyes respectively. CONCLUSION RAV characteristics may indicate type 2 MacTel stages. A right-angled artery in type 2 MacTel may indicate proliferative disease.
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Affiliation(s)
- Ramesh Venkatesh
- Dept. of Retina and Vitreous Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India.
| | - Ashit Handa
- Dept. of Retina and Vitreous Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Sai Prashanti Chitturi
- Dept. of Retina and Vitreous Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Ayushi Choudhary
- Dept. of Retina and Vitreous Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Vishma Prabhu
- Dept. of Retina and Vitreous Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Isha Acharya
- Dept. of Retina and Vitreous Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Rubble Mangla
- Dept. of Retina and Vitreous Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Naresh Kumar Yadav
- Dept. of Retina and Vitreous Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, 560010, Karnataka, India
| | - Jay Chhablani
- University of Pittsburgh School of Medicine, Medical Retina and Vitreoretinal Surgery, 203 Lothrop Street, Suite 800, Pittsburg, PA, 15213, USA
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Gholami S, Scheppke L, Kshirsagar M, Wu Y, Dodhia R, Bonelli R, Leung I, Sallo FB, Muldrew A, Jamison C, Peto T, Lavista Ferres J, Weeks WB, Friedlander M, Lee AY. Self-Supervised Learning for Improved Optical Coherence Tomography Detection of Macular Telangiectasia Type 2. JAMA Ophthalmol 2024; 142:226-233. [PMID: 38329740 PMCID: PMC10853868 DOI: 10.1001/jamaophthalmol.2023.6454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/29/2023] [Indexed: 02/09/2024]
Abstract
Importance Deep learning image analysis often depends on large, labeled datasets, which are difficult to obtain for rare diseases. Objective To develop a self-supervised approach for automated classification of macular telangiectasia type 2 (MacTel) on optical coherence tomography (OCT) with limited labeled data. Design, Setting, and Participants This was a retrospective comparative study. OCT images from May 2014 to May 2019 were collected by the Lowy Medical Research Institute, La Jolla, California, and the University of Washington, Seattle, from January 2016 to October 2022. Clinical diagnoses of patients with and without MacTel were confirmed by retina specialists. Data were analyzed from January to September 2023. Exposures Two convolutional neural networks were pretrained using the Bootstrap Your Own Latent algorithm on unlabeled training data and fine-tuned with labeled training data to predict MacTel (self-supervised method). ResNet18 and ResNet50 models were also trained using all labeled data (supervised method). Main Outcomes and Measures The ground truth yes vs no MacTel diagnosis is determined by retinal specialists based on spectral-domain OCT. The models' predictions were compared against human graders using accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), area under precision recall curve (AUPRC), and area under the receiver operating characteristic curve (AUROC). Uniform manifold approximation and projection was performed for dimension reduction and GradCAM visualizations for supervised and self-supervised methods. Results A total of 2636 OCT scans from 780 patients with MacTel and 131 patients without MacTel were included from the MacTel Project (mean [SD] age, 60.8 [11.7] years; 63.8% female), and another 2564 from 1769 patients without MacTel from the University of Washington (mean [SD] age, 61.2 [18.1] years; 53.4% female). The self-supervised approach fine-tuned on 100% of the labeled training data with ResNet50 as the feature extractor performed the best, achieving an AUPRC of 0.971 (95% CI, 0.969-0.972), an AUROC of 0.970 (95% CI, 0.970-0.973), accuracy of 0.898%, sensitivity of 0.898, specificity of 0.949, PPV of 0.935, and NPV of 0.919. With only 419 OCT volumes (185 MacTel patients in 10% of labeled training dataset), the ResNet18 self-supervised model achieved comparable performance, with an AUPRC of 0.958 (95% CI, 0.957-0.960), an AUROC of 0.966 (95% CI, 0.964-0.967), and accuracy, sensitivity, specificity, PPV, and NPV of 90.2%, 0.884, 0.916, 0.896, and 0.906, respectively. The self-supervised models showed better agreement with the more experienced human expert graders. Conclusions and Relevance The findings suggest that self-supervised learning may improve the accuracy of automated MacTel vs non-MacTel binary classification on OCT with limited labeled training data, and these approaches may be applicable to other rare diseases, although further research is warranted.
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Affiliation(s)
| | - Lea Scheppke
- The Lowy Medical Research Institute, La Jolla, California
| | | | - Yue Wu
- Department of Ophthalmology, University of Washington, Seattle
- Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
| | - Rahul Dodhia
- AI for Good Lab, Microsoft Research, Redmond, Washington
| | | | - Irene Leung
- Moorfields Eye Hospital, London, United Kingdom
| | - Ferenc B. Sallo
- Hôpital Ophtalmique Jules-Gonin, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | | | | | - Tunde Peto
- Queen’s University Belfast, Belfast, Northern Ireland
| | | | | | - Martin Friedlander
- The Lowy Medical Research Institute, La Jolla, California
- The Scripps Research Institute, La Jolla, California
| | - Aaron Y. Lee
- Department of Ophthalmology, University of Washington, Seattle
- Roger and Angie Karalis Johnson Retina Center, Seattle, Washington
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Nawaz M, Uvaliyev A, Bibi K, Wei H, Abaxi SMD, Masood A, Shi P, Ho HP, Yuan W. Unraveling the complexity of Optical Coherence Tomography image segmentation using machine and deep learning techniques: A review. Comput Med Imaging Graph 2023; 108:102269. [PMID: 37487362 DOI: 10.1016/j.compmedimag.2023.102269] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/26/2023]
Abstract
Optical Coherence Tomography (OCT) is an emerging technology that provides three-dimensional images of the microanatomy of biological tissue in-vivo and at micrometer-scale resolution. OCT imaging has been widely used to diagnose and manage various medical diseases, such as macular degeneration, glaucoma, and coronary artery disease. Despite its wide range of applications, the segmentation of OCT images remains difficult due to the complexity of tissue structures and the presence of artifacts. In recent years, different approaches have been used for OCT image segmentation, such as intensity-based, region-based, and deep learning-based methods. This paper reviews the major advances in state-of-the-art OCT image segmentation techniques. It provides an overview of the advantages and limitations of each method and presents the most relevant research works related to OCT image segmentation. It also provides an overview of existing datasets and discusses potential clinical applications. Additionally, this review gives an in-depth analysis of machine learning and deep learning approaches for OCT image segmentation. It outlines challenges and opportunities for further research in this field.
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Affiliation(s)
- Mehmood Nawaz
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Adilet Uvaliyev
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Khadija Bibi
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Hao Wei
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Sai Mu Dalike Abaxi
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Anum Masood
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Peilun Shi
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Ho-Pui Ho
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Wu Yuan
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China.
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Reddy NG, Prabhu V, Sharma SV, Acharya I, Mangla R, Yadav NK, Chhablani J, Narayanan R, Venkatesh R. Baseline demographic, clinical and multimodal imaging features of young patients with type 2 macular telangiectasia. Int J Retina Vitreous 2023; 9:47. [PMID: 37559099 PMCID: PMC10413760 DOI: 10.1186/s40942-023-00485-6] [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: 06/25/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE Macular telangiectasia (MacTel) type 2 is observed in patients in their 5th-8th decades of life. The clinical and imaging findings in younger patients is unknown in larger cohorts. The study purpose is to report prevalence, baseline clinical and spectral domain optical coherence tomography (SDOCT) findings in young MacTel patients below 40 years. METHODS This hospital-based, multicentre, retrospective, cross-sectional study included patients between 2011 and 2023. Retinal photographs from multiple imaging techniques were evaluated to diagnose and stage type 2 MacTel and describe their SDOCT findings. Imaging characteristics were correlated with clinical stages and visual acuity. RESULTS Among all MacTel patients seen in hospital, prevalence of young MacTel cases less than age 40 was 1.77% (32/1806; 62 eyes). Youngest participant was 34 years, while mean age was 38.44 ± 1.795 years. Sixteen patients (50%) were diabetics. Perifoveal greying (n = 56, 90%) and perifoveal hyperreflective middle retinal layers (n = 47, 76%) were the most prevalent clinical and SDOCT imaging finding respectively. Less than 10% (n = 6) eyes had proliferative disease. Presence of retinal pigment clumps (RPC) (7% vs. 67%; p = 0.002) coincided with proliferative MacTel. Poor vision was associated with presence of outer retinal layer SDOCT findings like outward bending of inner retinal layers (p = 0.047), RPC (p = 0.007), subfoveal neurosensory detachment (p = 0.048) and subretinal neovascular membrane (p = 0.001). CONCLUSION Type 2 MacTel before age 40 is rare, common in women and diabetics, and affects vision in advanced stage. Disease symmetry, comparison with older cases, and longitudinal SDOCT changes in such patients require further study.
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Affiliation(s)
- Nikitha Gurram Reddy
- Anand Bajaj Retina Institute, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, 500034, India
| | - Vishma Prabhu
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, Karnataka, 560010, India
| | - Sumanth Vinayak Sharma
- Anand Bajaj Retina Institute, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, 500034, India
| | - Isha Acharya
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, Karnataka, 560010, India
| | - Rubble Mangla
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, Karnataka, 560010, India
| | - Naresh Kumar Yadav
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, Karnataka, 560010, India
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, 203 Lothrop Street, Suite 800, Pittsburgh, PA, 15213, USA
| | - Raja Narayanan
- Anand Bajaj Retina Institute, L V Prasad Eye Institute, Indian Health Outcomes, Public Health and Economics Research Centre (IHOPE), Kallam Anji Reddy Campus, Hyderabad, 500034, India.
| | - Ramesh Venkatesh
- Dept. of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru, Karnataka, 560010, India.
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Goździewska E, Wichrowska M, Kocięcki J. Early Optical Coherence Tomography Biomarkers for Selected Retinal Diseases-A Review. Diagnostics (Basel) 2023; 13:2444. [PMID: 37510188 PMCID: PMC10378475 DOI: 10.3390/diagnostics13142444] [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: 06/08/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Optical coherence tomography (OCT) is a non-invasive, easily accessible imaging technique that enables diagnosing several retinal diseases at various stages of development. This review discusses early OCT findings as non-invasive imaging biomarkers for predicting the future development of selected retinal diseases, with emphasis on age-related macular degeneration, macular telangiectasia, and drug-induced maculopathies. Practitioners, by being able to predict the development of many conditions and start treatment at the earliest stage, may thus achieve better treatment outcomes.
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Affiliation(s)
- Ewa Goździewska
- Department of Ophthalmology, Poznan University of Medical Sciences, 60-569 Poznań, Poland
| | - Małgorzata Wichrowska
- Department of Ophthalmology, Poznan University of Medical Sciences, 60-569 Poznań, Poland
- Doctoral School, Poznan University of Medical Sciences, 61-701 Poznań, Poland
| | - Jarosław Kocięcki
- Department of Ophthalmology, Poznan University of Medical Sciences, 60-569 Poznań, Poland
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Zhang L, Van Dijk EHC, Borrelli E, Fragiotta S, Breazzano MP. OCT and OCT Angiography Update: Clinical Application to Age-Related Macular Degeneration, Central Serous Chorioretinopathy, Macular Telangiectasia, and Diabetic Retinopathy. Diagnostics (Basel) 2023; 13:diagnostics13020232. [PMID: 36673042 PMCID: PMC9858550 DOI: 10.3390/diagnostics13020232] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Similar to ultrasound adapting soundwaves to depict the inner structures and tissues, optical coherence tomography (OCT) utilizes low coherence light waves to assess characteristics in the eye. Compared to the previous gold standard diagnostic imaging fluorescein angiography, OCT is a noninvasive imaging modality that generates images of ocular tissues at a rapid speed. Two commonly used iterations of OCT include spectral-domain (SD) and swept-source (SS). Each comes with different wavelengths and tissue penetration capacities. OCT angiography (OCTA) is a functional extension of the OCT. It generates a large number of pixels to capture the tissue and underlying blood flow. This allows OCTA to measure ischemia and demarcation of the vasculature in a wide range of conditions. This review focused on the study of four commonly encountered diseases involving the retina including age-related macular degeneration (AMD), diabetic retinopathy (DR), central serous chorioretinopathy (CSC), and macular telangiectasia (MacTel). Modern imaging techniques including SD-OCT, TD-OCT, SS-OCT, and OCTA assist with understanding the disease pathogenesis and natural history of disease progression, in addition to routine diagnosis and management in the clinical setting. Finally, this review compares each imaging technique's limitations and potential refinements.
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Affiliation(s)
- Lyvia Zhang
- Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY 13210, USA
| | | | - Enrico Borrelli
- Ophthalmology Department, San Raffaele University Hospital, 20132 Milan, Italy
| | - Serena Fragiotta
- Ophthalmology Unit, Department NESMOS, S. Andrea Hospital, University of Rome “La Sapienza”, 00189 Rome, Italy
| | - Mark P. Breazzano
- Department of Ophthalmology & Visual Sciences, State University of New York Upstate Medical University, Syracuse, NY 13210, USA
- Retina-Vitreous Surgeons of Central New York, Liverpool, NY 13088, USA
- Correspondence: ; Tel.: +1-(315)-445-8166
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Macular Telangiectasia Type 2: A Classification System Using MultiModal Imaging MacTel Project Report Number 10. OPHTHALMOLOGY SCIENCE 2022; 3:100261. [PMID: 36846105 PMCID: PMC9944556 DOI: 10.1016/j.xops.2022.100261] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
Purpose To develop a severity classification for macular telangiectasia type 2 (MacTel) disease using multimodal imaging. Design An algorithm was used on data from a prospective natural history study of MacTel for classification development. Subjects A total of 1733 participants enrolled in an international natural history study of MacTel. Methods The Classification and Regression Trees (CART), a predictive nonparametric algorithm used in machine learning, analyzed the features of the multimodal imaging important for the development of a classification, including reading center gradings of the following digital images: stereoscopic color and red-free fundus photographs, fluorescein angiographic images, fundus autofluorescence images, and spectral-domain (SD)-OCT images. Regression models that used least square method created a decision tree using features of the ocular images into different categories of disease severity. Main Outcome Measures The primary target of interest for the algorithm development by CART was the change in best-corrected visual acuity (BCVA) at baseline for the right and left eyes. These analyses using the algorithm were repeated for the BCVA obtained at the last study visit of the natural history study for the right and left eyes. Results The CART analyses demonstrated 3 important features from the multimodal imaging for the classification: OCT hyper-reflectivity, pigment, and ellipsoid zone loss. By combining these 3 features (as absent, present, noncentral involvement, and central involvement of the macula), a 7-step scale was created, ranging from excellent to poor visual acuity. At grade 0, 3 features are not present. At the most severe grade, pigment and exudative neovascularization are present. To further validate the classification, using the Generalized Estimating Equation regression models, analyses for the annual relative risk of progression over a period of 5 years for vision loss and for progression along the scale were performed. Conclusions This analysis using the data from current imaging modalities in participants followed in the MacTel natural history study informed a classification for MacTel disease severity featuring variables from SD-OCT. This classification is designed to provide better communications to other clinicians, researchers, and patients. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Key Words
- BCVA, best-corrected visual acuity
- BLR, blue light reflectance
- CART, Classification and Regression Trees
- CF, color fundus
- Classification
- Classification and Regression Trees (CART)
- EZ, ellipsoid zone
- FAF, fundus autoflorescence
- FLIO, fluorescence lifetime imaging ophthalmoscopy
- MacTel, macular telangiectasia type 2
- Machine learning
- Macular telangiectasia type 2
- NHOR, natural history observation registry
- NHOS, natural history observation study
- Neurovascular degeneration
- OCTA, OCT angiography
- SD-OCT, spectral domain-OCT
- VA, visual acuity
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Venkatesh R, Nahata H, Reddy NG, Mishra P, Mangla R, Yadav NK, Chhablani J. Is Type 2 Macular Telangiectasia a Bilateral and Symmetrical Disease Entity? J Curr Ophthalmol 2022; 34:428-435. [PMID: 37180535 PMCID: PMC10170975 DOI: 10.4103/joco.joco_68_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 05/16/2023] Open
Abstract
Purpose To study the inter-eye asymmetry in cases diagnosed with type 2 macular telangiectasia (MacTel). Methods Herein, type 2 MacTel cases were staged as per Gass and Blodi classification with multiple imaging techniques. Based on disease stage symmetry, two groups identified. Group 1: Symmetrical stage and Group 2: Asymmetrical stage MacTel disease. Prevalence, demography, and clinical features of MacTel cases showing inter-eye asymmetry were analyzed. Results Two hundred and eighty eyes of 140 patients diagnosed clinically with type 2 MacTel (84-Group 1 and 56-Group 2) were evaluated. Eighty-nine (64%) were female, and the median age of the entire cohort was 62.5 years (inter-quartile range: 57.0-68.75). MacTel disease with asymmetric stage was seen in 56 (40%) of the 140 patients. At presentation, a two-stage difference was noted in 46% (n = 26) of the patients with asymmetrical MacTel disease. A 10% conversion from symmetrical to asymmetrical disease stage was noted at the final visit. Of the 280 eyes evaluated for type 2 MacTel disease, 12 (4%) eyes showed no findings suggestive of MacTel on clinical examination and fluorescein angiography, optical coherence tomography (OCT), and OCT angiography when available and were labeled as unilateral type 2 MacTel disease. Conclusions Type 2 MacTel can show inter-eye disease stage asymmetry. Unilateral type 2 MacTel disease is a distinct stage in MacTel which would need further evaluation and consideration while staging.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, Karnataka, India
- Address for correspondence: Ramesh Venkatesh, Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1 R Block, Chord Road, Rajaji Nagar, Bengaluru - 560 010, Karnataka, India. E-mail:
| | - Harshita Nahata
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Nikitha Gurram Reddy
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Pranjal Mishra
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Rubble Mangla
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Naresh Kumar Yadav
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Jay Chhablani
- Department of Retina and Vitreous, University of Pittsburgh School of Medicine, Medical Retina and Vitreoretinal Surgery, Pittsburg, PA, USA
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