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Ishibashi F, Kosaka A, Tavakoli M. The Impact of Glycemic Control on Retinal Photoreceptor Layers and Retinal Pigment Epithelium in Patients With Type 2 Diabetes Without Diabetic Retinopathy: A Follow-Up Study. Front Endocrinol (Lausanne) 2021; 12:614161. [PMID: 33967950 PMCID: PMC8102981 DOI: 10.3389/fendo.2021.614161] [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] [Received: 10/05/2020] [Accepted: 03/19/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS To establish the sequential changes by glycemic control in the mean thickness, volume and reflectance of the macular photoreceptor layers (MPRLs) and retinal pigment epithelium in patients with type 2 diabetes without diabetic retinopathy. METHODS Thirty-one poorly controlled (HbA1c > 8.0%) patients with type 2 diabetes without diabetic retinopathy undergoing glycemic control and 39 control subjects with normal HbA1c levels (< 5.9%) underwent periodical full medical, neurological and ophthalmological examinations over 2 years. Glycemic variability was evaluated by standard deviation and coefficient of variation of monthly measured HbA1c levels and casual plasma glucose. 3D swept source-optical coherence tomography (OCT) and OCT-Explorer-generated enface thickness, volume and reflectance images for 9 subfields defined by Early Treatment Diabetic Retinopathy Study of 4 MPRLs {outer nuclear layer, ellipsoid zone, photoreceptor outer segment (PROS) and interdigitation zone} and retinal pigment epithelium were acquired every 3 months. RESULTS Glycemic control sequentially restored the thickness and volume at 6, 4 and 5 subfields of outer nuclear layer, ellipsoid zone and PROS, respectively. The thickness and volume of outer nuclear layer were restored related to the decrease in HbA1c and casual plasma glucose levels, but not related to glycemic variability and neurological tests. The reflectance of MPRLs and retinal pigment epithelium in patients was marginally weaker than controls, and further decreased at 6 or 15 months during glycemic control. The reduction at 6 months coincided with high HbA1c levels. CONCLUSION Glycemic control sequentially restored the some MPRL thickness, especially of outer nuclear layer. In contrast, high glucose during glycemic control decreased reflectance and may lead to the development of diabetic retinopathy induced by glycemic control. The repeated OCT examinations can clarify the benefit and hazard of glycemic control to the diabetic retinopathy.
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Affiliation(s)
| | - Aiko Kosaka
- Internal Medicine, Ishibashi Clinic, Hiroshima, Japan
| | - Mitra Tavakoli
- Diabetes and Vascular Research Centre (DVRC), NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, United Kingdom
- *Correspondence: Mitra Tavakoli,
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Beyond Performance Metrics: Automatic Deep Learning Retinal OCT Analysis Reproduces Clinical Trial Outcome. Ophthalmology 2019; 127:793-801. [PMID: 32019699 DOI: 10.1016/j.ophtha.2019.12.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 12/10/2019] [Accepted: 12/17/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To validate the efficacy of a fully automatic, deep learning-based segmentation algorithm beyond conventional performance metrics by measuring the primary outcome of a clinical trial for macular telangiectasia type 2 (MacTel2). DESIGN Evaluation of diagnostic test or technology. PARTICIPANTS A total of 92 eyes from 62 participants with MacTel2 from a phase 2 clinical trial (NCT01949324) randomized to 1 of 2 treatment groups METHODS: The ellipsoid zone (EZ) defect areas were measured on spectral domain OCT images of each eye at 2 time points (baseline and month 24) by a fully automatic, deep learning-based segmentation algorithm. The change in EZ defect area from baseline to month 24 was calculated and analyzed according to the clinical trial protocol. MAIN OUTCOME MEASURE Difference in the change in EZ defect area from baseline to month 24 between the 2 treatment groups. RESULTS The difference in the change in EZ defect area from baseline to month 24 between the 2 treatment groups measured by the fully automatic segmentation algorithm was 0.072±0.035 mm2 (P = 0.021). This was comparable to the outcome of the clinical trial using semiautomatic measurements by expert readers, 0.065±0.033 mm2 (P = 0.025). CONCLUSIONS The fully automatic segmentation algorithm was as accurate as semiautomatic expert segmentation to assess EZ defect areas and was able to reliably reproduce the statistically significant primary outcome measure of the clinical trial. This approach, to validate the performance of an automatic segmentation algorithm on the primary clinical trial end point, provides a robust gauge of its clinical applicability.
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Park JJ, Chung CS, Fawzi AA. Visualizing Structure and Vascular Interactions: Macular Nonperfusion in Three Capillary Plexuses. Ophthalmic Surg Lasers Imaging Retina 2019; 49:e182-e190. [PMID: 30457654 DOI: 10.3928/23258160-20181101-16] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/10/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To assess the relationship between retinal vascular and structural changes in the superficial, middle, and deep capillary plexuses (SCP, MCP, DCP) using optical coherence tomography angiography (OCTA) and en face OCT. PATIENTS AND METHODS Patients with diabetic retinopathy were imaged using the Cirrus HD-OCT with AngioPlex. Using manual segmentation of the retinal layers, the authors compared OCTA to en face OCT images to examine corresponding patterns in each of the three capillary plexuses. RESULTS Areas of decreased perfusion and capillary dropout on OCTA were found to be associated with three corresponding lesions on en face OCT: hyporeflectivity, cystic edema, and hard exudates. Vascular changes in individual capillary plexuses corresponded with structural changes in their respective perfused retinal layers. CONCLUSIONS Using manual segmentation on OCTA, the authors provide a framework to visualize the relationship between vascular pathology on OCTA and structural changes on en face OCT within specific capillary plexuses. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e182-e190.].
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Loo J, Fang L, Cunefare D, Jaffe GJ, Farsiu S. Deep longitudinal transfer learning-based automatic segmentation of photoreceptor ellipsoid zone defects on optical coherence tomography images of macular telangiectasia type 2. BIOMEDICAL OPTICS EXPRESS 2018; 9:2681-2698. [PMID: 30258683 PMCID: PMC6154208 DOI: 10.1364/boe.9.002681] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/10/2018] [Accepted: 05/11/2018] [Indexed: 05/20/2023]
Abstract
Photoreceptor ellipsoid zone (EZ) defects visible on optical coherence tomography (OCT) are important imaging biomarkers for the onset and progression of macular diseases. As such, accurate quantification of EZ defects is paramount to monitor disease progression and treatment efficacy over time. We developed and trained a novel deep learning-based method called Deep OCT Atrophy Detection (DOCTAD) to automatically segment EZ defect areas by classifying 3-dimensional A-scan clusters as normal or defective. Furthermore, we introduce a longitudinal transfer learning paradigm in which the algorithm learns from segmentation errors on images obtained at one time point to segment subsequent images with higher accuracy. We evaluated the performance of this method on 134 eyes of 67 subjects enrolled in a clinical trial of a novel macular telangiectasia type 2 (MacTel2) therapeutic agent. Our method compared favorably to other deep learning-based and non-deep learning-based methods in matching expert manual segmentations. To the best of our knowledge, this is the first automatic segmentation method developed for EZ defects on OCT images of MacTel2.
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Affiliation(s)
- Jessica Loo
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Leyuan Fang
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - David Cunefare
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Glenn J. Jaffe
- Department of Ophthalmology, Duke University, Durham, NC 27708, USA
| | - Sina Farsiu
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
- Department of Ophthalmology, Duke University, Durham, NC 27708, USA
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Francis AW, Wanek J, Shahidi M. Assessment of Global and Local Alterations in Retinal Layer Thickness in Ins2 (Akita) Diabetic Mice by Spectral Domain Optical Coherence Tomography. J Ophthalmol 2018; 2018:7253498. [PMID: 29675273 PMCID: PMC5838457 DOI: 10.1155/2018/7253498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 12/24/2017] [Indexed: 12/27/2022] Open
Abstract
PURPOSE/AIM The Ins2 (Akita) mouse is a spontaneous diabetic mouse model with a heterozygous mutation in the insulin 2 gene that results in sustained hyperglycemia. The purpose of the study was to assess global and local retinal layer thickness alterations in Akita mice by analysis of spectral domain optical coherence tomography (SD-OCT) images. MATERIALS AND METHODS SD-OCT imaging was performed in Akita and wild-type mice at 12 and 24 weeks of age. Inner retinal thickness (IRT), outer retinal thickness (ORT), total retinal thickness (TRT), and photoreceptor outer segment length (OSL) were measured. Mean global thickness values were compared between Akita and wild-type mice. Local thickness variations in Akita mice were assessed based on normative values in wild-type mice. RESULTS Akita mice had higher blood glucose levels and lower body weights (p < 0.001). On average, IRT, ORT, and TRT were approximately 2% lower in Akita mice than in wild-type mice (p ≤ 0.02). In Akita mice, the percent difference between retinal areas with thickness below and above normative values for IRT, ORT, and TRT was 22%, 32%, and 38%, respectively. CONCLUSIONS These findings support the use of the Akita mouse model to study the retinal neurodegenerative effects of hyperglycemia.
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Affiliation(s)
- Andrew W. Francis
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Justin Wanek
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Mahnaz Shahidi
- Department of Ophthalmology, University of Southern California, Los Angeles, CA, USA
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Wang Z, Camino A, Zhang M, Wang J, Hwang TS, Wilson DJ, Huang D, Li D, Jia Y. Automated detection of photoreceptor disruption in mild diabetic retinopathy on volumetric optical coherence tomography. BIOMEDICAL OPTICS EXPRESS 2017; 8:5384-5398. [PMID: 29296475 PMCID: PMC5745090 DOI: 10.1364/boe.8.005384] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/27/2017] [Accepted: 10/27/2017] [Indexed: 05/22/2023]
Abstract
Diabetic retinopathy is a pathology where microvascular circulation abnormalities ultimately result in photoreceptor disruption and, consequently, permanent loss of vision. Here, we developed a method that automatically detects photoreceptor disruption in mild diabetic retinopathy by mapping ellipsoid zone reflectance abnormalities from en face optical coherence tomography images. The algorithm uses a fuzzy c-means scheme with a redefined membership function to assign a defect severity level on each pixel and generate a probability map of defect category affiliation. A novel scheme of unsupervised clustering optimization allows accurate detection of the affected area. The achieved accuracy, sensitivity and specificity were about 90% on a population of thirteen diseased subjects. This method shows potential for accurate and fast detection of early biomarkers in diabetic retinopathy evolution.
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Affiliation(s)
- Zhuo Wang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
- Shandong Province Key Laboratory of Medical Physics and Image Processing Technology, School of Physics and Electronics, Shandong Normal University, Jinan, 250014, China
- These authors contributed equally to this manuscript
| | - Acner Camino
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
- These authors contributed equally to this manuscript
| | - Miao Zhang
- Optovue, Inc. 2800 Bayview Dr., Fremont, CA 94538, USA
| | - Jie Wang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Thomas S Hwang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - David J Wilson
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - David Huang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Dengwang Li
- Shandong Province Key Laboratory of Medical Physics and Image Processing Technology, School of Physics and Electronics, Shandong Normal University, Jinan, 250014, China
| | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, 97239, USA
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Wanek J, Blair NP, Chau FY, Lim JI, Leiderman YI, Shahidi M. Alterations in Retinal Layer Thickness and Reflectance at Different Stages of Diabetic Retinopathy by En Face Optical Coherence Tomography. Invest Ophthalmol Vis Sci 2017; 57:OCT341-7. [PMID: 27409491 PMCID: PMC4968784 DOI: 10.1167/iovs.15-18715] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose This article reports a method for en face optical coherence tomography (OCT) imaging and quantitative assessment of alterations in both thickness and reflectance of individual retinal layers at different stages of diabetic retinopathy (DR). Methods High-density OCT raster volume scans were acquired in 29 diabetic subjects divided into no DR (NDR) or non-proliferative DR (NPDR) groups and 22 control subjects (CNTL). A customized image segmentation method identified eight retinal layer interfaces and generated en face thickness maps and reflectance images for nerve fiber layer (NFL), ganglion cell and inner plexiform layers (GCLIPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), photoreceptor outer segment layer (OSL), and retinal pigment epithelium (RPE). Mean thickness and intensity values were calculated in nine macular subfields for each retinal layer. Results En face thickness maps and reflectance images of retinal layers in CNTL subjects corresponded to normal retinal anatomy. Total retinal thickness correlated negatively with age in nasal subfields (R ≤−0.31; P ≤ 0.03, N = 51). In NDR subjects, NFL and OPL thickness were decreased (P = 0.05), and ONL thickness was increased (P = 0.04) compared to CNTL. In NPDR subjects, GCLIPL thickness was increased in perifoveal subfields (P< 0.05) and INL intensity was higher in all macular subfields (P = 0.04) compared to CNTL. Conclusions Depth and spatially resolved retinal thickness and reflectance measurements are potential biomarkers for assessment and monitoring of DR.
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Sampson DM, Alonso-Caneiro D, Chew AL, Lamey T, McLaren T, De Roach J, Chen FK. Enhanced Visualization of Subtle Outer Retinal Pathology by En Face Optical Coherence Tomography and Correlation with Multi-Modal Imaging. PLoS One 2016; 11:e0168275. [PMID: 27959968 PMCID: PMC5154571 DOI: 10.1371/journal.pone.0168275] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 11/29/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To present en face optical coherence tomography (OCT) images generated by graph-search theory algorithm-based custom software and examine correlation with other imaging modalities. METHODS En face OCT images derived from high density OCT volumetric scans of 3 healthy subjects and 4 patients using a custom algorithm (graph-search theory) and commercial software (Heidelberg Eye Explorer software (Heidelberg Engineering)) were compared and correlated with near infrared reflectance, fundus autofluorescence, adaptive optics flood-illumination ophthalmoscopy (AO-FIO) and microperimetry. RESULTS Commercial software was unable to generate accurate en face OCT images in eyes with retinal pigment epithelium (RPE) pathology due to segmentation error at the level of Bruch's membrane (BM). Accurate segmentation of the basal RPE and BM was achieved using custom software. The en face OCT images from eyes with isolated interdigitation or ellipsoid zone pathology were of similar quality between custom software and Heidelberg Eye Explorer software in the absence of any other significant outer retinal pathology. En face OCT images demonstrated angioid streaks, lesions of acute macular neuroretinopathy, hydroxychloroquine toxicity and Bietti crystalline deposits that correlated with other imaging modalities. CONCLUSIONS Graph-search theory algorithm helps to overcome the limitations of outer retinal segmentation inaccuracies in commercial software. En face OCT images can provide detailed topography of the reflectivity within a specific layer of the retina which correlates with other forms of fundus imaging. Our results highlight the need for standardization of image reflectivity to facilitate quantification of en face OCT images and longitudinal analysis.
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Affiliation(s)
- Danuta M. Sampson
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Crawley, Western Australia, Australia
- Lions Eye Institute, Nedlands, Western Australia, Australia
| | - David Alonso-Caneiro
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Avenell L. Chew
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Crawley, Western Australia, Australia
- Lions Eye Institute, Nedlands, Western Australia, Australia
| | - Tina Lamey
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, Western Australia, Australia
| | - Terri McLaren
- Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, Western Australia, Australia
| | - John De Roach
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Hospital Ave, Nedlands, Western Australia, Australia
| | - Fred K. Chen
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Crawley, Western Australia, Australia
- Lions Eye Institute, Nedlands, Western Australia, Australia
- Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia
- * E-mail:
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