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He HL, Liu YX, Liu H, Zhang X, Song H, Xu TZ, Fang Y, Ma Y, Ren HY, Ling SG, Dong Z, Xu J, Qin L, Wong TY, Ang M, Jin ZB. Deep Learning-Enabled Vasculometry Depicts Phased Lesion Patterns in High Myopia Progression. Asia Pac J Ophthalmol (Phila) 2024:100086. [PMID: 39053733 DOI: 10.1016/j.apjo.2024.100086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 07/10/2024] [Accepted: 07/21/2024] [Indexed: 07/27/2024] Open
Abstract
PURPOSE To investigate the potential phases in myopic retinal vascular alterations for further elucidating the mechanisms underlying the progression of high myopia (HM). METHODS For this retrospective study, participants diagnosed with high myopia at Beijing Tongren Hospital were recruited. Based on bionic mechanisms of human vision, an intelligent image processing model was developed and utilized to extract and quantify the morphological characteristics of retinal vasculatures in different regions measured by papilla-diameter (PD), including vascular caliber, arteriole-to-venule ratio (AVR), tortuosity, the angle of the vascular arch (AVA), the distance of the vascular arch (DVA), density, fractal dimension, and venular length. In addition, the optic disc and the area of peripapillary atrophy (PPA) were also quantified. The characteristics of the overall population, as well as patients aged less than 25 years old, were compared by different genders. Univariate and multiple linear regression analyses were conducted to investigate the correlation of retinal vasculature parameters with PPA width, and the detailed trends of the vascular indicators were analyzed to explore the potential existence of staged morphological changes. FINDINGS The study included 14,066 fundus photographs of 5,775 patients (aged 41.2 ± 18.6 years), of whom 7,379 (61.2%) were female. The study included 12,067 fundus photographs of 5,320 patients (aged 41.2 ± 18.6 years). Significant variations in the morphological parameters of retinal vessels were observed between males and females. After adjusting for age and sex, multiple linear regression analysis showed that an increased PPA width ratio was associated with lower AVA (1PD), DVA (1PD), vascular caliber (0.5-1.0 PD), tortuosity (0.5-1.0 PD), density and fractal dimension (all P < 0.001, Spearman's ρ < 0). Overall, the changes in retinal vascular morphology showed two phases: tortuosity (0.5-1.0PD) and AVA (1PD) decreased rapidly in the first stage but significantly slowly in the second stage, while vascular density and fractal dimension showed a completely opposite trend with an initial slow and a subsequent rapid decline. CONCLUSIONS This study identified two distinct phases of retinal vascular morphological changes during the progression of HM. Traction lesions were predominant in the initial stage, while atrophic lesions were predominant in the later stage. These findings provide further insight into the development mechanism of HM from the perspective of retinal vasculature.
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Affiliation(s)
- Hai-Long He
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Yi-Xin Liu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Hanruo Liu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Xiaomei Zhang
- School of Statistics, University of International Business and Economics, Beijing, China
| | - Hao Song
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Tian-Ze Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Yuxin Fang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Ya Ma
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Hao-Ying Ren
- School of Statistics, University of International Business and Economics, Beijing, China
| | - Sai-Guang Ling
- EVision technology (Beijing) co. LTD, Beijing 100085, China
| | - Zhou Dong
- EVision technology (Beijing) co. LTD, Beijing 100085, China
| | - Jie Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Lei Qin
- School of Statistics, University of International Business and Economics, Beijing, China; Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China
| | - Tien Yin Wong
- Tsinghua Medicine, Tsinghua University, Beijing, China; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Zi-Bing Jin
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
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Shi H, Guo N, Zhao Z, He X, Li J, Duan J. Global prevalence of myopic macular degeneration in general population and patients with high myopia: A systematic review and meta-analysis. Eur J Ophthalmol 2024; 34:631-640. [PMID: 37439028 DOI: 10.1177/11206721231185816] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
The prevalence of myopic macular degeneration (MMD) in the general population and patients with high myopia worldwide has not been fully investigated. Therefore, we screened all population-based studies that reported the prevalence of MMD, and pooled prevalence of MMD using a random-effect model. Subgroup analyses were performed to explore the differences in MMD prevalence in the general population and patients with high myopia according to ethnicity, region of residence (urban/rural), and grading system. Finally, 16 studies were included in this meta-analysis. Results obtained from 2,963 patients from seven countries on four continents indicated that the pooled prevalence of MMD in patients with high myopia was 49.0% (95% CI: 31.5%-66.7%). Results obtained from 71,052 participants from 10 countries on four continents suggested that the pooled prevalence of MMD in the general population was 1.7% (95% CI: 1.1%-2.6%). In the general population, living in urban areas and East Asians were associated with a high prevalence of MMD. Among patients with high myopia, only East Asians were at a higher risk of developing MMD. In conclusion, MMD was particularly prevalent in patients with high myopia. Compared with Europeans, East Asians (Chinese and Japanese) have a higher propensity of developing MMD, both in the general population and in patients with high myopia. It remains unclear whether the higher prevalence of MMD in patients with high myopia in East Asia is caused by differences in given age or given degree of myopia.Systematic review registration number: 202270014 (INPLASY.COM).
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Affiliation(s)
- Hekai Shi
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Nuojin Guo
- School of Basic Medicine, Hebei Medical University, Shijiazhuang, China
| | - Zeming Zhao
- School of Basic Medicine, Hebei Medical University, Shijiazhuang, China
| | - Xiaoyu He
- School of Basic Medicine, Hebei Medical University, Shijiazhuang, China
| | - Jiahang Li
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jialiang Duan
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Shuaib A, Salem SA, Elnahry AG, Ghalwash DA, Mohalhal AA. Correlation of the macular microvasculature to the axial length in pediatric patients with high axial refractive errors. Eye (Lond) 2024; 38:507-513. [PMID: 37660199 PMCID: PMC10858025 DOI: 10.1038/s41433-023-02712-8] [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: 03/14/2023] [Revised: 08/07/2023] [Accepted: 08/11/2023] [Indexed: 09/04/2023] Open
Abstract
AIMS To compare the vascular density (VD) of the macular superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC), and the foveal avascular zone (FAZ) among high hyperopic, high myopic, and emmetropic children using optical coherence tomography angiography (OCTA). METHODS This was a cross sectional comparative study of otherwise healthy children with different refractive errors. Patients were recruited from Cairo University Children's Hospital. OCTA imaging was performed using the RTVue XR Avanti device with AngioVue software. Both the 3 × 3 and 6 × 6 mm macular scans were utilized. Automated measurements were obtained from the built-in machine software. Axial length (AL) measurements were done using Lenstar LS 900 optical biometer. RESULTS Ninety eyes from 51 healthy children were included. Among high myopes, there was significant thinning of the parafovea (p < 0.001). SCP-VD was also lower in high myopes in all areas except the fovea (all p < 0.001). The DCP-VD was significantly lower in high myopes in the parafovea and perifovea. High hyperopes had lower subfoveal CC-VD. Despite high myopes showing a significantly lower OCTA signal strength, linear regression analysis revealed that AL was an independent and significant predictor for the FAZ-area, as well as parafoveal and perifoveal SCP and DCP-VD. CONCLUSION High myopia results in a reduction of VD in both the SCP and DCP, which can be non-invasively detected and monitored using OCTA. While lower VD may, in part, be attributed to lower OCTA image quality, our findings demonstrate that AL independently and significantly predicts macular vascular parameters on OCTA in children.
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Affiliation(s)
- Asmaa Shuaib
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Somaya A Salem
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman G Elnahry
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt.
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Dalia A Ghalwash
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed A Mohalhal
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Li S, Li F, Sun J, Yang M, Zhang D, Wu S. Microvasculature and microstructure alteration in dry-type high myopia. JOURNAL OF BIOPHOTONICS 2023; 16:e202200390. [PMID: 37099397 DOI: 10.1002/jbio.202200390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 04/03/2023] [Accepted: 04/20/2023] [Indexed: 06/11/2023]
Abstract
BACKGROUND To investigate the alterations in the retinal vasculature and microstructure in dry-type high myopia. METHODS One hundred and eighty-nine dry-type high myopia eyes were classified into three groups. Group 1 consisted of 86 eyes with no myopic retinal degenerative lesion (C0). Group 2 consisted of 71 eyes with tessellated fundus (C1). Group 3 consisted of 32 eyes with diffuse chorioretinal atrophy (C2). Retinal vascular density and retinal thickness were measured with optical coherence tomography angiography. The scanning area was a 3 × 3 mm2 ring with the fovea of the macular. All data were analyzed with the SPSS 23.0 by one-way ANOVA test among comparison groups. Pearson's correlation analysis was used to determine the relations among measurements. Univariate linear regression showed a correlation between the vascular densities and retinal thicknesses. RESULTS The microvessel density significantly decreased and significant thinning of the superior and temporal macular thickness in the C2 group. The vascular densities of macular decreased significantly with the increase of axial length (AL) and refractive diopter in the C2 group. The retinal thicknesses of the macular fovea increased significantly with the increase of vascular densities in the C0 group and C1 group. CONCLUSIONS The impairment of retinal microstructure is more likely related to reduced oxygen and nutrients due to microvessel density decreases.
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Affiliation(s)
- Shanshan Li
- Department of Ophthalmology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Fengshuang Li
- Department of Ophthalmology, Dalian Women and Children's Medical Group, Dalian, China
| | - Jiao Sun
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Min Yang
- Department of Ophthalmology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Dawei Zhang
- Department of Ophthalmology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Shengwei Wu
- Department of Ophthalmology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
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Liang J, Xie T, Chen L, Huang C, Wei P, Li P, Liu K, Zou Z, Fang D, Zhang S. Retinal Artery Angles in High Axial Myopia and Its Relationship With Visual Function. Transl Vis Sci Technol 2023; 12:22. [PMID: 37642634 PMCID: PMC10476439 DOI: 10.1167/tvst.12.8.22] [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: 02/19/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose To evaluate the retinal artery angles in high axial myopia and assess the correlation with other morphometric and functional parameters. Methods This cross-sectional study included 112 eyes of 112 patients with high axial myopia. Based on axial length (AL), the participants were divided into three groups: group 1 (26 ≤ AL < 28 mm), group 2 (28 ≤ AL < 31 mm), and group 3 (≥31 mm). Scanning laser ophthalmoscopy imaging was used to analyze the retinal artery angle (Yugami correlated angle [YCA]). Retinal vascular densities (VDs) in both superficial capillary plexuses (SCPs) and deep capillary plexuses were evaluated. Fixation behavior, including retinal mean sensitivity (MS), macular fovea 2°, 4° fixation rate (P1, P2), and 68.2% bivariate contour ellipse area, were analyzed by microperimetry. Finally, the correlation between YCAs and AL, VDs, best-corrected visual acuity (BCVA), and fixation behavior was assessed. Results The YCAs showed significant differences among the three groups (all P < 0.001, respectively). Compared to group 1, the YCA decreased in group 2 (P < 0.001) and continued to decrease in group 3 (P = 0.043). The correlation analysis revealed that smaller YCAs (YCA, YCA1/2, YCA1/4) were positively correlated with the longer AL (ρ = 0.580, 0.545, 0.448, P < 0.001) and lower VDs in any sector in SCPs (all P ≤ 0.05). Furthermore, smaller YCAs were positively correlated with decreased BCVA (ρ = 0.392, 0.387, 0.262; all P < 0.001) and reduced MS (ρ= 0.300, 0.269, 0.244; all P < 0.05). Conclusions Smaller YCAs were correlated with longer AL, lower VD in SCP, decreased BCVA, and reduced MS. The YCAs might reflect vascular deformation caused by axial elongation and could potentially be useful in predicting visual function in high axial myopia. Translational Relevance The quantitative analysis of YCAs in fundus photography holds potential clinical value in predicting visual function in high axial myopia.
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Affiliation(s)
- Jia Liang
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, Guangdong, China
| | - Ting Xie
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, Guangdong, China
- Guizhou Medical University, Guiyang, Guizhou, China
| | - Lu Chen
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, Guangdong, China
| | - Canfeng Huang
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, Guangdong, China
| | - Pengxue Wei
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, Guangdong, China
| | - Pengfeng Li
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, Guangdong, China
| | - Ke Liu
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, Guangdong, China
| | - Zhenhua Zou
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, Guangdong, China
| | - Dong Fang
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, Guangdong, China
| | - Shaochong Zhang
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, Guangdong, China
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Živković ML, Lazić L, Zlatanovic M, Zlatanović N, Brzaković M, Jovanović M, Barišić S, Darabus DM. The Influence of Myopia on the Foveal Avascular Zone and Density of Blood Vessels of the Macula—An OCTA Study. Medicina (B Aires) 2023; 59:medicina59030452. [PMID: 36984453 PMCID: PMC10057575 DOI: 10.3390/medicina59030452] [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: 01/29/2023] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 02/26/2023] Open
Abstract
Background and Objectives: Myopia is the most common refractive eye anomaly with a prevalence that is constantly increasing. High myopia is associated with numerous complications that can lead to permanent vision loss. It is believed that the basis of these complications lies in changes in the microvasculature of the retina caused by an increase in the longitudinal axis of the eye. Materials and Methods: Optical coherence tomography angiography (OCTA) was used to analyze differences in macular zone vascular and perfusion density and foveal avascular zone (FAZ) parameters in myopic subjects. The following OCTA parameters were analyzed: the vessel and perfusion density of retinal blood vessels in the superficial plexus; the area, perimeter, and index of circularity of the foveal avascular zone (FAZ); and foveal and ganglion cell complex (GCC) thickness. Results: Subjects with low myopia did not show statistically significant differences compared to the control for any of the analyzed parameters. Groups with moderate and high myopia showed a significant decrease in vessel and perfusion density in the parafoveal and the entire 3 × 3 mm analyzed field. Foveal vessel and perfusion densities in the myopic groups were similar to those of the control regardless of the degree of myopia. The area and perimeter of the FAZ, as well as foveal and mean GCC thickness, did not differ significantly no matter the degree of myopia, while the index of circularity was lower in highly myopic subjects. The minimal thickness of the GCC was also lower in the high myopia group. Conclusions: High and moderate myopia led to a loss of blood vessels in the macular region. Perfusion and vascular densities were preserved in the foveal region and were not affected by different degrees of myopia. The FAZ was not significantly larger in myopic subjects, but its circularity was lower in subjects with high myopia.
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Affiliation(s)
- Maja L.J. Živković
- Ophthalmology Clinic, Clinical Center Niš, Bulevar dr Zorana Đinđića 48, 18000 Niš, Serbia
- Department of Ophthalmology, Faculty of Medicine, University of Niš, Bulevar dr Zorana Đinđića 81, 18000 Niš, Serbia
- Correspondence: ; Tel.: +381-18-4570029; Fax: +381-18-4238770
| | - Lazar Lazić
- Department of Ophthalmology, Faculty of Medicine, University of Niš, Bulevar dr Zorana Đinđića 81, 18000 Niš, Serbia
| | - Marko Zlatanovic
- Ophthalmology Clinic, Clinical Center Niš, Bulevar dr Zorana Đinđića 48, 18000 Niš, Serbia
- Department of Ophthalmology, Faculty of Medicine, University of Niš, Bulevar dr Zorana Đinđića 81, 18000 Niš, Serbia
| | - Nevena Zlatanović
- Community Health Center Niš in Niš, Vojvode Tankosića 15, 18000 Niš, Serbia
| | - Mladen Brzaković
- Special Hospital for Ophthalmology “Clinic Maja”, Vizantijski Bulevar 8, 18000 Nis, Serbia
| | - Mihailo Jovanović
- Department of Clinical and Experimental Surgery, Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovića 69, 34000 Kragujevac, Serbia
| | - Sava Barišić
- Eye Clinic, Clinical Center Vojvodina, Hajduk Veljkova 1-9, 21000 Novi Sad, Serbia
| | - Diana-Maria Darabus
- Department of Ophthalmology, University of Medicine and Pharmacy “Victor Babes”, Piata Eftimie Murgu, No. 2, 300041 Timisoara, Romania
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Ji Y, Huang SQ, Cheng Q, Fu WW, Zhong PP, Chen XL, Shu BL, Wei B, Huang QY, Wu XR. Exploration of static functional connectivity and dynamic functional connectivity alterations in the primary visual cortex among patients with high myopia via seed-based functional connectivity analysis. Front Neurosci 2023; 17:1126262. [PMID: 36816124 PMCID: PMC9932907 DOI: 10.3389/fnins.2023.1126262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 01/09/2023] [Indexed: 02/05/2023] Open
Abstract
Aim This study was conducted to explore differences in static functional connectivity (sFC) and dynamic functional connectivity (dFC) alteration patterns in the primary visual area (V1) among high myopia (HM) patients and healthy controls (HCs) via seed-based functional connectivity (FC) analysis. Methods Resting-state functional magnetic resonance imaging (fMRI) scans were performed on 82 HM patients and 59 HCs who were closely matched for age, sex, and weight. Seed-based FC analysis was performed to identify alterations in the sFC and dFC patterns of the V1 in HM patients and HCs. Associations between mean sFC and dFC signal values and clinical symptoms in distinct brain areas among HM patients were identified via correlation analysis. Static and dynamic changes in brain activity in HM patients were investigated by assessments of sFC and dFC via calculation of the total time series mean and sliding-window analysis. Results In the left anterior cingulate gyrus (L-ACG)/left superior parietal gyrus (L-SPG) and left V1, sFC values were significantly greater in HM patients than in HCs. In the L-ACG and right V1, sFC values were also significantly greater in HM patients than in HCs [two-tailed, voxel-level P < 0.01, Gaussian random field (GRF) correction, cluster-level P < 0.05]. In the left calcarine cortex (L-CAL) and left V1, dFC values were significantly lower in HM patients than in HCs. In the right lingual gyrus (R-LING) and right V1, dFC values were also significantly lower in HM patients than in HCs (two-tailed, voxel-level P < 0.01, GRF correction, cluster-level P < 0.05). Conclusion Patients with HM exhibited significantly disturbed FC between the V1 and various brain regions, including L-ACG, L-SPG, L-CAL, and R-LING. This disturbance suggests that patients with HM could exhibit impaired cognitive and emotional processing functions, top-down control of visual attention, and visual information processing functions. HM patients and HCs could be distinguished from each other with high accuracy using sFC and dFC variabilities. These findings may help to identify the neural mechanism of decreased visual performance in HM patients.
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Hemodynamic and morphological changes of the central retinal artery in myopic eyes. Sci Rep 2022; 12:7104. [PMID: 35501327 PMCID: PMC9061854 DOI: 10.1038/s41598-022-11087-x] [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: 11/08/2021] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
Due to excessive elongation of the eyeball, myopia-related vascular abnormalities are frequently observed in the central retinal artery (CRA) and its intraretinal branches. In addition to inconsistency in previously reported findings, hemodynamic (reduced flow velocity, increased vascular resistance) and morphological changes (narrower vessel diameter) were usually studied separately. This cross-sectional study evaluated the hemodynamic and morphological characteristics concurrently in a large sample of healthy myopes, by using the color Doppler ultrasound and adaptive optics retinal camera. Results showed that the retrobulbar segment of CRA had a tendency of slightly reduced flow velocity in eyeballs with longer axial length, but the correlation was not significant after adjusting for the multiple correlations. Vascular resistance was not affected by the axial elongation. With respect to the intraretinal branches, no significant changes in longer eyes of total diameter or lumen diameter were observed, while both the wall thickness and the wall cross-sectional area were significantly increased, but only a marginally increase in the wall to lumen ratio was found with increasing axial length. This implies some potential small artery remodeling in the intraretinal CRA branches. Overall, blood supply of the inner retina in healthy young myopes is likely to be maintained. Additionally, morphological parameters of vascular microstructure could be potential biomarkers to monitor myopia progression and understand myopia-related vascular abnormalities in future studies.
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Edo A, Ibrahim DG, Hirooka K, Toda R, Kamaruddin MI, Kawano R, Nagao A, Ohno H, Yoneda M, Kiuchi Y. Dietary Vitamins A, C, and Potassium Intake Is Associated With Narrower Retinal Venular Caliber. Front Med (Lausanne) 2022; 9:818139. [PMID: 35223917 PMCID: PMC8866761 DOI: 10.3389/fmed.2022.818139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/11/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction The retinal vasculature, a surrogate for the systemic microvasculature, can be observed non-invasively, providing an opportunity to examine the effects of modifiable factors, such as nutrient intake, on microcirculation. We aimed to investigate the possible associations of dietary nutrient intake with the retinal vessel caliber. Methods In this cross-sectional study, a total of 584 participants in a medical survey of Japanese descendants living in Los Angeles in 2015 underwent a dietary assessment, fundus photographic examination, and comprehensive physical and blood examinations. Retinal vessel caliber was measured using fundus photographs with a semi-automated computer system and summarized as central retinal artery and vein equivalents (CRAE and CRVE). The association between dietary nutrient intake and retinal vessel caliber was analyzed using a multivariate linear regression model adjusted for two models including potential confounders. The first model was adjusted for age and sex. The second model was adjusted for age, sex, smoking status, body mass index, hypertension, diabetes, dyslipidemia, history of coronary heart disease, and history of stroke. Results After adjustment of potential confounders, compared to the quartile with the lowest intake, the difference in CRVE for the highest quartile was −5.33 μm [95% confidence interval (CI): −9.91 to −0.76, P for trend = 0.02] for vitamin A, −4.93 μm (95% CI: −9.54 to −0.32, P for trend = 0.02) for vitamin C and −3.90 μm (95% CI: −8.48 to 0.69, P for trend = 0.04) for potassium. Conclusions A significant association was observed between higher vitamins A, C and potassium intakes and narrower retinal venular caliber.
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Affiliation(s)
- Ayaka Edo
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- *Correspondence: Ayaka Edo
| | | | - Kazuyuki Hirooka
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Rie Toda
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | - Reo Kawano
- Clinical Research Center in Hiroshima, Hiroshima University Hospital, Hiroshima, Japan
| | - Akiko Nagao
- Division of Nutrition Management, Hiroshima University Hospital, Hiroshima, Japan
| | - Haruya Ohno
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masayasu Yoneda
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Mao J, Deng X, Ye Y, Liu H, Fang Y, Zhang Z, Chen N, Sun M, Shen L. Morphological characteristics of retinal vessels in eyes with high myopia: Ultra-wide field images analyzed by artificial intelligence using a transfer learning system. Front Med (Lausanne) 2022; 9:956179. [PMID: 36874950 PMCID: PMC9982751 DOI: 10.3389/fmed.2022.956179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 12/27/2022] [Indexed: 02/18/2023] Open
Abstract
Purpose The purpose of this study is to investigate the retinal vascular morphological characteristics in high myopia patients of different severity. Methods 317 eyes of high myopia patients and 104 eyes of healthy control subjects were included in this study. The severity of high myopia patients is classified into C0-C4 according to the Meta Analysis of the Pathologic Myopia (META-PM) classification and their vascular morphological characteristics in ultra-wide field imaging were analyzed using transfer learning methods and RU-net. Correlation with axial length (AL), best corrected visual acuity (BCVA) and age was analyzed. In addition, the vascular morphological characteristics of myopic choroidal neovascularization (mCNV) patients and their matched high myopia patients were compared. Results The RU-net and transfer learning system of blood vessel segmentation had an accuracy of 98.24%, a sensitivity of 71.42%, a specificity of 99.37%, a precision of 73.68% and a F1 score of 72.29. Compared with healthy control group, high myopia group had smaller vessel angle (31.12 ± 2.27 vs. 32.33 ± 2.14), smaller fractal dimension (Df) (1.383 ± 0.060 vs. 1.424 ± 0.038), smaller vessel density (2.57 ± 0.96 vs. 3.92 ± 0.93) and fewer vascular branches (201.87 ± 75.92 vs. 271.31 ± 67.37), all P < 0.001. With the increase of myopia maculopathy severity, vessel angle, Df, vessel density and vascular branches significantly decreased (all P < 0.001). There were significant correlations of these characteristics with AL, BCVA and age. Patients with mCNV tended to have larger vessel density (P < 0.001) and more vascular branches (P = 0.045). Conclusion The RU-net and transfer learning technology used in this study has an accuracy of 98.24%, thus has good performance in quantitative analysis of vascular morphological characteristics in Ultra-wide field images. Along with the increase of myopic maculopathy severity and the elongation of eyeball, vessel angle, Df, vessel density and vascular branches decreased. Myopic CNV patients have larger vessel density and more vascular branches.
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Affiliation(s)
- Jianbo Mao
- Department of Ophthalmology, Center for Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China.,Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xinyi Deng
- Department of Ophthalmology, Center for Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China.,Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yu Ye
- Department of Precision Machinery and Instrumentation, University of Science and Technology of China, Hefei, China
| | - Hui Liu
- Department of Precision Machinery and Instrumentation, University of Science and Technology of China, Hefei, China
| | - Yuyan Fang
- Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhengxi Zhang
- Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Nuo Chen
- Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Mingzhai Sun
- Department of Precision Machinery and Instrumentation, University of Science and Technology of China, Hefei, China
| | - Lijun Shen
- Department of Ophthalmology, Center for Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China.,Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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11
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Arnould L, Guenancia C, Binquet C, Delcourt C, Chiquet C, Daien V, Cottin Y, Bron AM, Acar N, Creuzot-Garcher C. [Retinal vascular network: Changes with aging and systemic vascular disease (cardiac and cerebral)]. J Fr Ophtalmol 2021; 45:104-118. [PMID: 34836702 DOI: 10.1016/j.jfo.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 11/17/2022]
Abstract
For over 10 years, the description of the retinal microvascular network has benefited from the development of new imaging techniques. Automated retinal image analysis software, as well as OCT angiography (OCT-A), are able to highlight subtle, early changes in the retinal vascular network thanks to a large amount of microvascular quantitative data. The challenge of current research is to demonstrate the association between these microvascular changes, the systemic vascular aging process, and cerebrovascular and cardiovascular disease. Indeed, a pathophysiological continuum exists between retinal microvascular changes and systemic vascular diseases. In the Montrachet study, we found that a suboptimal retinal vascular network, as identified by the Singapore I Vessel Assessment (SIVA) software, was significantly associated with treated diabetes and an increased risk of cardiovascular mortality. In addition, we supplemented our research on the retinal vascular network with the use of OCT-A. In the EYE-MI study, we showed the potential role of quantitative characterization of the retinal microvascular network by OCT-A in order to assess the cardiovascular risk profile of patients with a history of myocardial infarction. A high AHA (American Heart Association) risk score was associated with low retinal vascular density independently of hemodynamic changes. Thus, a better understanding of the association between the retinal microvasculature and macrovascular disease might make its use conceivable for early identification of at-risk patients and to suggest a personalized program of preventative care. The retinal vascular network could therefore represent an indicator of systemic vascular disease as well as an interesting predictive biomarker for vascular events.
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Affiliation(s)
- L Arnould
- Service d'ophtalmologie, CHU de Dijon, Dijon, France; Centre d'investigation clinique 1432, Dijon, France; Laboratoire œil et nutrition, CSGA, UMR 1324 INRA, Dijon, France.
| | - C Guenancia
- Service de cardiologie, CHU de Dijon, Dijon, France; Laboratoire PEC 2, Dijon, France
| | - C Binquet
- Centre d'investigation clinique 1432, Dijon, France
| | - C Delcourt
- Inserm U1219, équipe LEHA, université de Bordeaux, Bordeaux, France
| | - C Chiquet
- Service d'ophtalmologie, CHU de Grenoble, Grenoble, France
| | - V Daien
- Service d'ophtalmologie, CHU de Montpellier, Montpellier, France
| | - Y Cottin
- Service de cardiologie, CHU de Dijon, Dijon, France
| | - A M Bron
- Service d'ophtalmologie, CHU de Dijon, Dijon, France; Laboratoire œil et nutrition, CSGA, UMR 1324 INRA, Dijon, France
| | - N Acar
- Laboratoire œil et nutrition, CSGA, UMR 1324 INRA, Dijon, France
| | - C Creuzot-Garcher
- Service d'ophtalmologie, CHU de Dijon, Dijon, France; Laboratoire œil et nutrition, CSGA, UMR 1324 INRA, Dijon, France
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12
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Zhao M, Lam AK, Cheong AM. Structural and haemodynamic properties of ocular vasculature in axial myopia. Clin Exp Optom 2021; 105:247-262. [PMID: 34343434 DOI: 10.1080/08164622.2021.1943320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The high prevalence of myopia has become a global concern, especially in East and Southeast Asia. Alarmingly, the prevalence of high myopia is increasing. Mechanical stretching caused by excessive eyeball elongation leads to various anatomical changes in the fundus. This stretching force may also lead to the development of vascular abnormalities, which tend to be subtle and easily overlooked. A healthy ocular vasculature is a prerequisite of adequate oxygen supply for normal retinal functions. This review summarises previous findings on structural and haemodynamic aspects of myopia-related vascular changes.
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Affiliation(s)
- Mei Zhao
- Centre for Myopia Research, School of Optometry, Faculty of Health and Social Science, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Andrew Kc Lam
- Centre for Myopia Research, School of Optometry, Faculty of Health and Social Science, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Allen My Cheong
- Centre for Myopia Research, School of Optometry, Faculty of Health and Social Science, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
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13
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Shi Y, Ye L, Chen Q, Hu G, Yin Y, Fan Y, Zhu J, He J, Zheng Z, Zou H, Xu X. Macular Vessel Density Changes in Young Adults With High Myopia: A Longitudinal Study. Front Med (Lausanne) 2021; 8:648644. [PMID: 34169082 PMCID: PMC8217628 DOI: 10.3389/fmed.2021.648644] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 05/18/2021] [Indexed: 11/29/2022] Open
Abstract
Background: To characterize the longitudinal changes of macular vessel density in young adults and its associated factors. Methods: The right eyes of 309 participants (75 high myopic, 194 mild-to-moderate myopic, and 40 healthy) were followed up for 21 months. OCTA images were acquired at two visits using follow-up scans. Macular vessel density was calculated globally and in the nine early treatment diabetic retinopathy study (ETDRS) subfields of the macula superficial layer. Results: The macular vessel density significantly decreased in young myopes after a 21-month follow up (p < 0.05), with variations among sectors. Compared with healthy eyes, HM group exhibited a faster reduction in global macular vessel density (p = 0.0307) as well as in sectors of inner-inferior (II), inner-temporal (IT), and outer-temporal (OT) (all p < 0.05). Multivariate regression analysis showed that longer baseline axial length (AL) was significantly associated with larger reduction of macular vessel density in the inner-inferior, inner-temporal and outer-temporal sectors (all p < 0.05). Conclusions: Compared with emmetropes, high myopes presented greater loss of macular vessel density over time in global and in the inner-inferior, inner-temporal and outer-temporal sectors. A longer baseline AL was associated with larger changes of macular vessel density in the inner-inferior, inner-temporal and outer-temporal sectors.
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Affiliation(s)
- Ya Shi
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photo Medicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China.,Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Luyao Ye
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photo Medicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China.,Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Qiuying Chen
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photo Medicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China.,Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Guangyi Hu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photo Medicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China.,Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Yao Yin
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Ying Fan
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photo Medicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Jianfeng Zhu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Jiangnan He
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Zhi Zheng
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photo Medicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Haidong Zou
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photo Medicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China.,Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
| | - Xun Xu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photo Medicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China.,Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China
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14
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Liu J, Tonk RS, Huang AM, Han E, Karp CL, Zeng M, Zou H, Zheng Y, Luo W, Sha X, Liu Z. Transient effect of suction on the retinal neurovasculature in myopic patients after small-incision lenticule extraction. J Cataract Refract Surg 2021; 46:250-259. [PMID: 32126039 DOI: 10.1016/j.jcrs.2019.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To characterize retinal neurovasculature changes after small-incision lenticule extraction (SMILE) in myopic patients. SETTING Ophthalmic Center, the Second Affiliated Hospital of Guangzhou Medical University, China. DESIGN Prospective interventional study. METHODS The corrected distance visual acuity/uncorrected distance visual acuity, corrected intraocular pressure (CIOP), and corneal tomography were evaluated at baseline (PRE), postoperative day (POD) 1, and POD 7. Ganglion cell-inner plexiform layer (GCIPL) and peripapillary retinal nerve fiber layer (pRNFL) thicknesses were measured. The vessel area densities (VADs, %), vessel skeleton densities (VSDs, %), vessel diameter index (VDI), and fractal dimensions (Dbox) of the superficial vascular plexus (SVP) and deep vascular plexus (DVP) were measured in a circular area (ϕ 2.5 mm) centered on the fovea. RESULTS A total of 38 myopic patients were recruited. The GCIPL thickness was increased after SMILE at POD 1 and POD 7 (P < .01) but no significant changes in the pRNFL thickness. The VAD, VSD, and Dbox of the SVP were decreased at POD 1 (P < .01), but not at POD 7. The VDI in small vessels of the SVP and DVP was decreased at POD 1 (P < .05) and increased at POD 7 (P < .05). Changes in CIOP were positively correlated with changes in the GCIPL thickness. Changes in CIOP were negatively correlated with changes in the VAD of small vessels and the Dbox of total vessels in the DVP. Changes in CIOP were negatively correlated with the VSD and VDI of small vessels in the DVP and changes in the VDI of big vessels in the SVP. CONCLUSIONS The transient fluctuations in the retinal neurovasculature after SMILE may represent a characteristic homeostasis pattern in patients after refractive surgery.
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Affiliation(s)
- Jiayan Liu
- Ophthalmic Center, the Second Affiliated Hospital of Guangzhou Medical University (Liu, Zeng, Zou, Zheng, Luo, Sha, Liu), Department of Ophthalmology, the Sixth Affiliated Hospital of Guangzhou Medical University (Liu), Qingyuan, China; and Bascom Palmer Eye Institute, University of Miami Miller School of Medicine (Tonk, Huang, Han, Karp), Miami, Florida, USA
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15
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Laíns I, Wang JC, Cui Y, Katz R, Vingopoulos F, Staurenghi G, Vavvas DG, Miller JW, Miller JB. Retinal applications of swept source optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Prog Retin Eye Res 2021; 84:100951. [PMID: 33516833 DOI: 10.1016/j.preteyeres.2021.100951] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 02/08/2023]
Abstract
The advent of optical coherence tomography (OCT) revolutionized both clinical assessment and research of vitreoretinal conditions. Since then, extraordinary advances have been made in this imaging technology, including the relatively recent development of swept-source OCT (SS-OCT). SS-OCT enables a fast scan rate and utilizes a tunable swept laser, thus enabling the incorporation of longer wavelengths than conventional spectral-domain devices. These features enable imaging of larger areas with reduced motion artifact, and a better visualization of the choroidal vasculature, respectively. Building on the principles of OCT, swept-source OCT has also been applied to OCT angiography (SS-OCTA), thus enabling a non-invasive in depth-resolved imaging of the retinal and choroidal microvasculature. Despite their advantages, the widespread use of SS-OCT and SS-OCTA remains relatively limited. In this review, we summarize the technical details, advantages and limitations of SS-OCT and SS-OCTA, with a particular emphasis on their relevance for the study of retinal conditions. Additionally, we comprehensively review relevant studies performed to date to the study of retinal health and disease, and highlight current gaps in knowledge and opportunities to take advantage of swept source technology to improve our current understanding of many medical and surgical chorioretinal conditions. We anticipate that SS-OCT and SS-OCTA will continue to evolve rapidly, contributing to a paradigm shift to more widespread adoption of new imaging technology to clinical practice.
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Affiliation(s)
- Inês Laíns
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Jay C Wang
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Ying Cui
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA; Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Raviv Katz
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Filippos Vingopoulos
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", University of Milan, Italy
| | - Demetrios G Vavvas
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Joan W Miller
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - John B Miller
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA.
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16
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Meng J, Wei L, Zhang K, He W, Lu Y, Zhu X. Cilioretinal Arteries in Highly Myopic Eyes: A Photographic Classification System and Its Association With Myopic Macular Degeneration. Front Med (Lausanne) 2020; 7:595544. [PMID: 33344480 PMCID: PMC7738318 DOI: 10.3389/fmed.2020.595544] [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: 08/17/2020] [Accepted: 11/09/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose: To develop a photographic classification for cilioretinal arteries and to investigate its association with myopic macular degeneration (MMD). Methods: One thousand six hundred ninety-two highly myopic eyes of 1,692 patients were included. The presence of a cilioretinal artery was determined by fundus photographs, and a photographic classification was proposed. MMD was classified according to the International META-PM Classification. Associations of the cilioretinal artery and its classifications with MMD and visual acuity were analyzed. Results: Of the eyes tested, 245 (14.5%) had a cilioretinal artery. The cilioretinal arteries were classified into four categories (temporal "cake-fork," 35.92%; temporal "ribbon," 53.47%; "multiple," 6.53%; "nasal," 4.08%) and 3 distributions based on whether its visible branches reached the central foveal area. Eyes with cilioretinal arteries had significantly less MMD of grade ≥3 and better visual acuity than those without (P < 0.01). Multiple linear regression analysis showed that younger age, male sex, shorter axial length, and the presence of a cilioretinal artery were associated with better visual acuity in highly myopic eyes (all P < 0.05). The "nasal" category presented more MMD with grade ≥3 and worse visual acuity than the other categories (P < 0.05), whereas the "multiple" category contained no eyes with MMD grade ≥3. The cilioretinal arteries reaching the central foveal area showed less MMD of grade ≥3 and better visual acuity than those not (P < 0.05). Conclusions: We propose a photographic classification for cilioretinal arteries that has good clinical relevance to visual functions. The cilioretinal artery may potentially afford protection against MMD.
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Affiliation(s)
- Jiaqi Meng
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Ling Wei
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Keke Zhang
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Myopia (Fudan University), Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Wenwen He
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Myopia (Fudan University), Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Yi Lu
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Myopia (Fudan University), Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Xiangjia Zhu
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China
- National Health Commission Key Laboratory of Myopia (Fudan University), Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
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17
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Liu M, Wang P, Hu X, Zhu C, Yuan Y, Ke B. Myopia-related stepwise and quadrant retinal microvascular alteration and its correlation with axial length. Eye (Lond) 2020; 35:2196-2205. [PMID: 33087885 DOI: 10.1038/s41433-020-01225-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/01/2020] [Accepted: 10/05/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To investigate the characteristics of retinal vascular alterations in patients with varying degrees of myopia, and to determine correlated variables and alteration patterns over different retinal zones. METHODS A total of 208 right eyes of 208 patients with myopia were enrolled and divided into mild, moderate, high, and extreme myopia groups. The macular vasculature in superficial, deep, and whole retinal layers was imaged with optical coherence tomography angiography (OCTA). The vessel densities over the whole annular zone, four quadrants, and six annuli were quantified as fractal dimension using a customized software. Simple linear regressions and ridge regression were used to determine and compare explanatory variables of microvascular density. RESULTS The microvascular density within the superficial, deep and whole retinal layers was highest in mild myopia group, second highest in moderate myopia group, second lowest in high myopia group and lowest in extreme myopia group. Within the same layer, differences between any two groups were significant (all p < 0.05). Among the four quadrants, only the inferior nasal (IN) quadrant showed no difference in microvascular density between mild and moderate groups. Ridge regression indicated that microvascular density values in all three layers were more strongly correlated with axial length (AL) (scaled estimates -0.139, -0.103, -0.154; all p < 0.001) than with spherical equivalent (SE) (scaled estimates -0.052, -0.096, -0.057; all p < 0.05). CONCLUSIONS We characterized a stepwise and quadrant alteration of retinal microvascular density from mild to extreme myopia, which was more strongly affected by axial elongation, although both AL and SE were meaningful indicators.
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Affiliation(s)
- Mingming Liu
- Institution: Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng Wang
- Institution: Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojun Hu
- Institution: Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengcheng Zhu
- Institution: Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Yuan
- Institution: Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bilian Ke
- Institution: Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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18
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Cilioretinal Arteries and Macular Vasculature in Highly Myopic Eyes: An OCT Angiography-Based Study. Ophthalmol Retina 2020; 4:965-972. [PMID: 32470652 DOI: 10.1016/j.oret.2020.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE To determine the association between the presence of cilioretinal arteries and the macular vasculature in highly myopic eyes using OCT angiography (OCTA). DESIGN Retrospective, observational case series. PARTICIPANTS Four hundred eighty-one highly myopic eyes of 481 patients. METHODS Fundus photographs were reviewed to determine the presence of a cilioretinal artery and its distribution, based on whether its path or visible branches reached the region within 500 μm of the foveal center. The macular vasculature was analyzed in OCTA images, including the vessel density (VD), fractal dimension (FD), and foveal avascular zone (FAZ). The associations between the presence of a cilioretinal artery and its distribution and between the macular vasculature and visual acuity were evaluated. MAIN OUTCOME MEASURES Cilioretinal arteries, macular vasculature, and their associations. RESULTS Of the eyes included, 17.05% (82/481) had a cilioretinal artery. Based on the OCTA analysis, the eyes with cilioretinal arteries showed significantly higher VD and FD in both superficial and deep capillary plexuses and smaller FAZ than those without (all P < 0.001). However, these differences were not found in the subgroup of eyes with an axial length of more than 30 mm. Eyes with cilioretinal arteries that reached the central foveal area showed significantly higher VD and FD in both capillary plexuses and smaller FAZ than those that did not (all P < 0.05). Better best-corrected visual acuity was identified in the eyes with cilioretinal arteries than in those without (0.09 ± 0.14 logarithm of the minimum angle of resolution [logMAR] vs. 0.21 ± 0.27 logMAR, respectively; P < 0.001). In particular, eyes with cilioretinal arteries that reached the central foveal area had better visual acuity than those without (0.05 ± 0.06 logMAR vs. 0.16 ± 0.20logMAR, respectively; P = 0.005). CONCLUSIONS This OCTA-based study suggested that cilioretinal arteries in highly myopic eyes potentially may improve the macular vasculature and influence visual function.
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19
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Zou M, Wang S, Chen A, Liu Z, Young CA, Zhang Y, Jin G, Zheng D. Prevalence of myopic macular degeneration worldwide: a systematic review and meta-analysis. Br J Ophthalmol 2020; 104:1748-1754. [PMID: 32188679 DOI: 10.1136/bjophthalmol-2019-315298] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 11/04/2022]
Abstract
PURPOSE To investigate the prevalence of myopic macular degeneration (MMD) in the global population. METHODS All published literature of population-based studies on MMD prevalence worldwide were searched and only those with clear definitions to diagnose and classify MMD lesions by standardised grading methods were selected. Meta-analysis methods were used to calculate the pooled prevalence of MMD and its 95% CI in a random-effects model. The prevalence of MMD lesions would also be reported, together with the subgroup analysis of age, region and gender. Correlation between MMD prevalence and spherical equivalent levels and axial length were also evaluated. RESULTS 12 studies with 58 558 subjects were included in this meta-analysis. The pooled prevalence of MMD in the world population was 2.1% (95% CI: 1.3% to 3.3%). In the subgroup analysis, people with the following characteristics were at higher risk of developing MMD: female, urban life, living in Asia, older age, longer axial length and severer myopia. CONCLUSIONS MMD is a serious public health concern worldwide, particularly in subjects who are women, subjects living in urban areas, subjects living in Asia, and subjects with longer axial lengths and severer myopia. Further studies from other continents/ethnicities are needed for comprehensive estimates of the prevalence of MMD globally.
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Affiliation(s)
- Minjie Zou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.,Department of Clinical Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Shibin Wang
- Guangdong Mental Health Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Aiming Chen
- Department of Pharmacy, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Zhenzhen Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Charlotte Aimee Young
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Yichi Zhang
- Department of Ophthalmology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen University, Guangzhou, China
| | - Guangming Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Danying Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
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20
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Zhu Q, Xing X, Wang M, Zhu M, Ma L, Yuan Y, Song E. Characterization of the Three Distinct Retinal Capillary Plexuses Using Optical Coherence Tomography Angiography in Myopic Eyes. Transl Vis Sci Technol 2020; 9:8. [PMID: 32818096 PMCID: PMC7396166 DOI: 10.1167/tvst.9.4.8] [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: 09/22/2019] [Accepted: 11/19/2019] [Indexed: 01/01/2023] Open
Abstract
Purpose To segment and quantify three distinct retinal capillary plexuses using optical coherence tomography angiography (OCTA) in myopic eyes. Methods We analyzed 96 eyes from 62 subjects with myopia (27.76 ± 7.05 years of age) and evaluated 30 normal eyes from 15 subjects (28.33 ± 3.13 years of age) for controls. En face OCTA images generated by AngioPlex (Carl Zeiss; Oberkochen, Germany) were manually segmented by the progressive matching method into superficial, middle, and deep capillary plexuses (SCPs, MCPs, and DCPs, respectively). Estimated positions for each plexus relative to the reference line were calculated. After strict artifact removal and magnification correction, vessel density (VD) and skeleton density (SD) analyses were performed on each capillary plexus. Results Myopic eyes were divided into three groups according to their degree of myopia. We defined the relative estimated positions of the MCP outer boundary to the retinal pigment epithelium fit layer as MCP = –89.317 – 0.178 (central retinal thickness) – 0.580 (ganglion cell inner plexiform thickness); the DCP outer boundary was 38.48 ± 6.24 µm below the inner plexiform layer. VDs were significantly higher in the super-high myopia group than in the control and moderate myopia groups for the DCP (all P < 0.05). SDs in the SCPs were significantly lower in the high myopia and super-high myopia groups than in the control groups (all P < 0.001). Conclusions With progressive matching, we segmented three capillary plexuses and defined the relative estimated positions of each capillary plexus to the reference line in myopic eyes. The VD of the DCP increased for more myopic eyes. Translational Relevance Our study provides a visual method for OCTA image vascular segmentation for myopic eyes.
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Affiliation(s)
- Qiujian Zhu
- Department of Ophthalmology, Lixiang Eye Hospital of Soochow University, Suzhou, China
| | | | - Mengyu Wang
- Department of Ophthalmology, Lixiang Eye Hospital of Soochow University, Suzhou, China
| | - Manhui Zhu
- Department of Ophthalmology, Lixiang Eye Hospital of Soochow University, Suzhou, China
| | - Lie Ma
- Department of Ophthalmology, Lixiang Eye Hospital of Soochow University, Suzhou, China
| | - You Yuan
- Department of Ophthalmology, Lixiang Eye Hospital of Soochow University, Suzhou, China
| | - E Song
- Department of Ophthalmology, Lixiang Eye Hospital of Soochow University, Suzhou, China
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21
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Ucak T, Icel E, Yilmaz H, Karakurt Y, Tasli G, Ugurlu A, Bozkurt E. Alterations in optical coherence tomography angiography findings in patients with high myopia. Eye (Lond) 2020; 34:1129-1135. [PMID: 32094474 DOI: 10.1038/s41433-020-0824-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/08/2020] [Accepted: 02/12/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The aim of this study was to determine the macular changes using optical coherence tomography (OCT) and OCT-angiography (OCT-A) in eyes with high myopia. Determining the alterations in vascular structures can provide a clearer understanding of the pathophysiological mechanisms of this disease and help define new treatment options and preventive measures. MATERIALS AND METHODS Ninety-two patients with high myopia (axial length ≥ 26 mm) and 70 control cases without any known systemic or ocular diseases were enrolled in this prospective study. One eye of each patient was included in the statistical analyses. RESULTS Retinal nerve fiber layer (RNFL) thickness and Early Treatment Diabetic Retinopathy Study (ETDRS) macula map values were lower in myopia compared with the controls. Both superior and inferior ganglion cell complex (GCC) thicknesses were significantly thinner in the high myopia compared with the controls (p < 0.001). Regarding the OCT-A findings, although superficial or deep foveal avascular zones (FAZ) did not significantly differ between the two groups, the density values of superficial and deep microvessels were significantly lower in the high myopia group compared with the control cases. CONCLUSIONS In patients with high myopia, with an increase in the axial length and a decrease in RNFL and GCC thicknesses, the vascular densities of the superficial and deep retina were reduced in the macular region.
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Affiliation(s)
- Turgay Ucak
- Department of Ophthalmology, Faculty of Medicine, Erzincan University, Erzincan, Turkey.
| | - Erel Icel
- Department of Ophthalmology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Hayati Yilmaz
- Department of Ophthalmology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Yucel Karakurt
- Department of Ophthalmology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Gamze Tasli
- Department of Ophthalmology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Adem Ugurlu
- Department of Ophthalmology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Erdinc Bozkurt
- Department of Ophthalmology, Faculty of Medicine, Kafkas University, Kars, Turkey
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22
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Cheng D, Chen Q, Wu Y, Yu X, Shen M, Zhuang X, Tian Z, Yang Y, Wang J, Lu F, Shen L. Deep perifoveal vessel density as an indicator of capillary loss in high myopia. Eye (Lond) 2019; 33:1961-1968. [PMID: 31527763 DOI: 10.1038/s41433-019-0573-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 05/22/2019] [Accepted: 08/15/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES This study investigates the macular vasculature of both vascular layers in different degrees of myopia by optical coherence tomography angiography (OCTA). METHODS One hundred and forty-five eyes of 145 healthy subjects with spherical equivalents (SE) ranging from +0.50 to -16.50 dioptres were divided into three groups. The foveal avascular zone (FAZ) area and vessel density (VD) of OCTA images were compared. RESULTS Compared with other groups, high myopia had a larger FAZ and less perifoveal VD in both layers and less deep total VD. Compared with other myopia, high myopia had less total VD in the superficial layer and parafoveal VD in the deep layer. Between emmetropia and low myopia, there was a difference only in the deep parafoveal VD. Except for the parafoveal VD in both layers and the superficial total VD, there were significant correlations of the FAZ with axial length (AL) and SE as well as VD. The deep perifoveal VD was most associated with high myopia. CONCLUSIONS An increased FAZ and decreased VD in both layers were correlated with AL elongation. The decreasing deep perifoveal VD was most associated with high myopia. OCTA may provide additional information regarding the progression of pathologies in high myopia.
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Affiliation(s)
- Dan Cheng
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qi Chen
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yufei Wu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xueting Yu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Meixiao Shen
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiran Zhuang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhongxu Tian
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ye Yang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jianhua Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Fan Lu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lijun Shen
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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23
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Lim LS, Lim XH, Tan L. Retinal Vascular Oxygen Saturation and Its Variation With Refractive Error and Axial Length. Transl Vis Sci Technol 2019; 8:22. [PMID: 31403000 PMCID: PMC6685695 DOI: 10.1167/tvst.8.4.22] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 06/18/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the relationships between refractive error, axial length (AL), and retinal vascular oxygen saturation in an adult population. Methods This was a hospital-based, prospective observational study. The left eyes of phakic adult subjects without media opacity were analyzed. Subjective undilated manifest refraction was performed, and refractive errors were defined as myopia (spherical equivalent [SE], <−1 D), emmetropia (SE between −1 D and +1 D) and hyperopia (SE >+1 D). Retinal oximetry was performed using the Oxymap system (Oxymap Inc., Reykjavik, Iceland). Multivariate linear regression models were constructed to assess the relationship between retinal vascular oxygen saturation, SE, and AL obtained with optical biometry, with adjustments for age, sex, race, blood pressure, hyperlipidemia, and diabetes mellitus. Results There were 85 subjects, with mean age of 66.1 ± 11.3 years. The majority were female (60%) and Chinese (84%). A total of 60% were myopic, 28% emmetropic, and 12% hyperopic. Mean SE was −5.29 ± 6.51 D and mean AL was 25.30 ± 2.99 mm. In multivariate analyses, more myopic SE and longer AL were associated with lower retinal arteriolar oxygen saturation (regression coefficient B = 0.61 [95% confidence interval, 0.28, 0.95], P = 0.001; and B = −1.13 [95% confidence interval, −1.71, −0.56], P < 0.001, respectively). Subjects with myopic SE and AL also had lower retinal arteriolar oxygen saturation than emmetropes and hyperopes (P = 0.03 and P = 0.02, respectively). Conclusions Eyes with more myopic SE and longer AL have lower retinal arteriolar oxygen saturation. Translational Relevance This study provides direct evidence of a link between retinal oxygenation and hypoxia and myopia by using a novel device that quantifies retinal vascular oxygenation in vivo.
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Affiliation(s)
- Laurence Shen Lim
- Singapore National Eye Centre, 11 Third Hospital Ave, Singapore 168751, Singapore.,Singapore Eye Research Institute, 11 Third Hospital Ave, Singapore 168751, Singapore
| | - Xian Hui Lim
- Singapore National Eye Centre, 11 Third Hospital Ave, Singapore 168751, Singapore
| | - Licia Tan
- Singapore National Eye Centre, 11 Third Hospital Ave, Singapore 168751, Singapore
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24
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Tsui CK, Yang B, Yu S, Li J, Lu X, Xu Y, Lv L, Liang X. The Relationship between Macular Vessel Density and Thickness with Light Sensitivity in Myopic Eyes. Curr Eye Res 2019; 44:1104-1111. [DOI: 10.1080/02713683.2019.1627461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Ching-Kit Tsui
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Boyu Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Shanshan Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jia Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xi Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yue Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lin Lv
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaoling Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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25
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He J, Chen Q, Yin Y, Zhou H, Fan Y, Zhu J, Zou H, Xu X. Association between retinal microvasculature and optic disc alterations in high myopia. Eye (Lond) 2019; 33:1494-1503. [PMID: 31019262 PMCID: PMC7002767 DOI: 10.1038/s41433-019-0438-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 01/29/2019] [Accepted: 03/22/2019] [Indexed: 12/31/2022] Open
Abstract
Purpose This study aimed to explore the characteristics of retinal perfusion and its associations with high myopia. Methods A total of 760 participants were included. Peripapillary radial peripapillary capillary perfusion, foveal avascular zone, and parafoveal perfusion were measured using optical coherence tomography angiography (OCTA). Tilted disc ratio and parapapillary atrophy were determined using swept-source optical coherence tomography. Results A total of 760 young healthy participants with myopic eyes were included in the analysis. The mean axial length and titled disc ratio were 26.43 ± 1.14 and 0.76 ± 0.08 mm in the high-myopia group and 24.79 ± 0.75 and 0.80 ± 0.09 mm in the control group, respectively. The high-myopia group exhibited significantly larger parapapillary atrophy, lower tilted disc ratio, lower radial peripapillary capillary vessel density, larger area of foveal avascular zone, and lower deep parafoveal vessel density. In the multivariate analysis, titled disc ratio significantly correlated with radial peripapillary capillary vessel density (P = 0.0134), larger foveal avascular zone (P = 0.0062), and lower deep parafoveal vessel density (P < 0.0001). Conclusions Reduced radial peripapillary capillary and deep parafoveal vessel density and enlarged area of foveal avascular zone were observed in high myopia. Tilted disc ratio correlated with retinal perfusion.
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Affiliation(s)
- Jiangnan He
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China.,Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Engineering Center for Visual Science and Photo medicine, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qiuying Chen
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China.,Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Engineering Center for Visual Science and Photo medicine, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yao Yin
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China.,Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Engineering Center for Visual Science and Photo medicine, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hongfeng Zhou
- School Hospital, Shanghai University, Shanghai, China
| | - Ying Fan
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China. .,Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China. .,Shanghai Jiaotong University School of Medicine, Shanghai, China. .,Shanghai Engineering Center for Visual Science and Photo medicine, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Jianfeng Zhu
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China. .,Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China. .,Shanghai Jiaotong University School of Medicine, Shanghai, China. .,Shanghai Engineering Center for Visual Science and Photo medicine, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Haidong Zou
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China.,Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Engineering Center for Visual Science and Photo medicine, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xun Xu
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, China.,Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Jiaotong University School of Medicine, Shanghai, China.,Shanghai Engineering Center for Visual Science and Photo medicine, Shanghai Jiaotong University School of Medicine, Shanghai, China
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26
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Leng Y, Tam EK, Falavarjani KG, Tsui I. Effect of Age and Myopia on Retinal Microvasculature. Ophthalmic Surg Lasers Imaging Retina 2019; 49:925-931. [PMID: 30566699 DOI: 10.3928/23258160-20181203-03] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 11/02/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To investigate the effect of age and refractive error on changes in the retinal microvascular network. PATIENTS AND METHODS Subjects were recruited from the Doheny Eye Institute. Refractive error and axial length were measured. High myopia was defined as refractive error greater than -6 diopters (D). Optical coherence tomography angiography (OCTA) imaging was performed and images were analyzed using fractal analysis. Primary outcomes were superficial capillary plexus (SCP) vessel density, deep capillary plexus (DCP) vessel density, and foveal avascular zone (FAZ) area. RESULTS One hundred thirty-eight eyes of 69 subjects were included. Twenty-eight (41%) subjects were male and 41 (59%) subjects were female. Mean age was 42.81 years ± 19.91 years (range: 8 years to 87 years). Mean refractive error was -1.74 D ± 3.18 D (range: -15.78 D to 4.25 D), and mean axial length (AL) was 24.29 mm ± 1.35 mm (range: 21.73 mm to 28.32 mm). SCP and DCP vessel densities were negatively correlated to age (r = -0.22, P = .011; and r = -0.49, P < .001). Controlling for age, patients with high myopia and longer AL had decreased SCP density (P = .021 and P = .027, respectively), but no difference in DCP vessel density was observed (P = .065 and P = .058, respectively). FAZ area was not significantly correlated to age, gender, refraction, or AL. CONCLUSIONS SCP and DCP vessel densities decreased with age. In addition, SCP density but not DCP vessel density was reduced in eyes with high myopia and longer AL. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:925-931.].
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Fluorescein Leakage within Recent Subretinal Hemorrhage in Pathologic Myopia: Suggestive of CNV? J Ophthalmol 2018; 2018:4707832. [PMID: 30186627 PMCID: PMC6110035 DOI: 10.1155/2018/4707832] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/23/2018] [Indexed: 11/22/2022] Open
Abstract
Purpose To determine whether fluorescein leakage within subretinal hemorrhage is definitely suggestive of choroidal neovascularization (CNV) by multimodal imaging including optical coherence tomography angiography (OCTA). Methods Twenty-five consecutive highly myopic patients (25 eyes) with fluorescein leakage within subretinal hemorrhage detected within 1 month were prospectively included. All patients underwent OCTA and spectral-domain optical coherence tomography (SD-OCT). The OCTA and SD-OCT findings at the site of fluorescein leakage were analyzed. In cases of a doubtful diagnosis, indocyanine green angiography (ICGA) was also performed to differentiate myopic CNV from lacquer crack if necessary; all patients were followed up by SD-OCT and/or OCTA for at least 2 weeks. Results In terms of the site of fluorescein leakage, OCTA revealed an abnormal vascular network in the outer retina and a choriocapillaris slab in 22 out of 25 eyes (88%), which were confirmed to be CNV. However, no high-flow signal was observed in 3 of 25 eyes (12%). In these 3 cases, SD-OCT showed a focal rupture of the retinal pigment epithelium-Bruch's membrane-choriocapillaris (RPE-BM-CC) complex and a columnar hyperreflective signal of blood originating from defects with a volcanic geyser-like appearance, and no exudative signs were detected. Notably, all ruptures of the RPE-BM-CC complex were located exactly at lacquer crack sites. Moreover, with the absorption of subretinal hemorrhage, ruptures of the RPE-BM-CC complex spontaneously resolved without any intervention. Considering the multimodal imaging appearance and follow-up outcomes, these 3 eyes were eventually diagnosed as simple bleeding associated with lacquer cracks. Conclusions Dye leakage within recent subretinal hemorrhage on FA could be caused by new-onset lacquer cracks in pathologic myopia. Multimodal imaging including OCTA is helpful to differentiate lacquer cracks from myopic CNV.
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Li M, Yang Y, Jiang H, Gregori G, Roisman L, Zheng F, Ke B, Qu D, Wang J. Retinal Microvascular Network and Microcirculation Assessments in High Myopia. Am J Ophthalmol 2017; 174:56-67. [PMID: 27818204 DOI: 10.1016/j.ajo.2016.10.018] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/23/2016] [Accepted: 10/26/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE To investigate the changes of the retinal microvascular network and microcirculation in high myopia. DESIGN A cross-sectional, matched, comparative clinical study. PARTICIPANTS Twenty eyes of 20 subjects with nonpathological high myopia (28 ± 5 years of age) with a refractive error of -6.31 ± 1.23 D (mean ± SD) and 20 eyes of 20 age- and sex-matched control subjects (30 ± 6 years of age) with a refractive error of -1.40 ± 1.00 D were recruited. METHODS Optical coherence tomography angiography (OCTA) was used to image the retinal microvascular network, which was later quantified by fractal analysis (box counting [Dbox], representing vessel density) in both superficial and deep vascular plexuses. The Retinal Function Imager was used to image the retinal microvessel blood flow velocity (BFV). The BFV and microvascular density in the myopia group were corrected for ocular magnification using Bennett's formula. RESULTS The density of both superficial and deep microvascular plexuses was significantly decreased in the myopia group in comparison to the controls (P < .05). The decrease of the microvessel density of the annular zone (0.6-2.5 mm), measured as Dbox, was 2.1% and 2.9% in the superficial and deep vascular plexuses, respectively. Microvessel density reached a plateau from 0.5 mm to 1.25 mm from the fovea in both groups, but that in the myopic group was about 3% lower than the control group. No significant differences were detected between the groups in retinal microvascular BFV in either arterioles or venules (P > .05). Microvascular densities in both superficial (r = -0.45, P = .047) and deep (r = -0.54, P = .01) vascular plexuses were negatively correlated with the axial lengths in the myopic eye. No correlations were observed between BFV and vessel density (P > .05). CONCLUSIONS Retinal microvascular decrease was observed in the high myopia subjects, whereas the retinal microvessel BFV remained unchanged. The retinal microvascular network alteration may be attributed to ocular elongation that occurs with the progression of myopia. The novel quantitative analyses of the retinal microvasculature may help to characterize the underlying pathophysiology of myopia and enable early detection and prevention of myopic retinopathy.
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