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Roy R, Chattree S, Kala U, Majumdar B, Desai J, Bhattacharya S, Sen A, Goel S, Thomas NR, Chowdhury M, Das K, Nigam E, Das D, Saurabh K. Multicolor imaging: Current clinical applications. Surv Ophthalmol 2024; 69:378-402. [PMID: 38122907 DOI: 10.1016/j.survophthal.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
Multicolor (MC) imaging is an innovative pseudocolor fundus imaging modality based on confocal scanning laser ophthalmoscopy. It effectively scans the retina at different depths to create a composite image. The green reflectance image depicts the middle retinal while blue reflectance image provides images of the retinal surface. The infrared reflectance image depicts retinal structures at the level of outer retina and choroid. We systematically analyze published case reports, case series, and original articles on MC imaging where it has helped in discovering additional clinical features of retinal diseases not readily apparent on conventional color fundus photography and played a role in monitoring the response to treatment.
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Affiliation(s)
- Rupak Roy
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M.Bypass, Kolkata 700099, West Bengal, India.
| | - Surabhi Chattree
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M.Bypass, Kolkata 700099, West Bengal, India
| | - Urvashi Kala
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M.Bypass, Kolkata 700099, West Bengal, India
| | - Bristi Majumdar
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M.Bypass, Kolkata 700099, West Bengal, India
| | - Janhavi Desai
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M.Bypass, Kolkata 700099, West Bengal, India
| | - Sampurna Bhattacharya
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M.Bypass, Kolkata 700099, West Bengal, India
| | - Ahana Sen
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M.Bypass, Kolkata 700099, West Bengal, India
| | | | | | - Maitreyi Chowdhury
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M.Bypass, Kolkata 700099, West Bengal, India
| | - Kalpita Das
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M.Bypass, Kolkata 700099, West Bengal, India
| | - Eesh Nigam
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M.Bypass, Kolkata 700099, West Bengal, India
| | - Debmalya Das
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, 147, Mukundapur, E.M.Bypass, Kolkata 700099, West Bengal, India
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Venkatesh R, Agrawal S, Reddy NG, Mangla R, Yadav NK, Chhablani J. Choroidal Melanocytic Hamartoma. J Clin Med 2022; 11:5983. [PMID: 36294307 PMCID: PMC9604492 DOI: 10.3390/jcm11205983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 09/18/2022] [Accepted: 10/10/2022] [Indexed: 01/05/2024] Open
Abstract
We report on a case series that revealed flat, choroidal lesions on optical coherence tomography (OCT) and on enface MultiColor® (MCI) imaging of the fundus but were not noticeable on clinical examination or conventional color fundus images. This observational study included 12 eyes from 11 patients who had distinct, orange-colored lesions on MCI. Retinal imaging was conducted using conventional color fundus photography and OCT. On the color fundus images and the blue and green reflectance channels of MCI, each of the lesions was difficult to distinguish. On the infrared channel, the lesion was identified as bright white in color and bright orange on the multicolor image. The lesion was identified on OCT as a flat, homogeneous hyperreflective lesion involving the choroid, with an intact overlying retinal pigment epithelium and retinal layers. A comparison of the clinical and imaging features with other known entities led to the conclusion that the lesion was a distinct clinical entity. The presence of melanin in the lesion was confirmed based on the retinal imaging findings and the light absorption properties of melanin. As a result, the lesion was named as 'choroidal melanocytic hamartoma'. A longer follow-up is required to confirm the benign nature of this clinical entity.
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Affiliation(s)
- Ramesh Venkatesh
- Narayana Nethralaya, Department of Retina and Vitreous, #121/C, Chord Road, 1st R Block Rajaji Nagar, Bangalore 560010, India
| | - Sameeksha Agrawal
- Narayana Nethralaya, Department of Retina and Vitreous, #121/C, Chord Road, 1st R Block Rajaji Nagar, Bangalore 560010, India
| | - Nikitha Gurram Reddy
- Narayana Nethralaya, Department of Retina and Vitreous, #121/C, Chord Road, 1st R Block Rajaji Nagar, Bangalore 560010, India
| | - Rubble Mangla
- Narayana Nethralaya, Department of Retina and Vitreous, #121/C, Chord Road, 1st R Block Rajaji Nagar, Bangalore 560010, India
| | - Naresh Kumar Yadav
- Narayana Nethralaya, Department of Retina and Vitreous, #121/C, Chord Road, 1st R Block Rajaji Nagar, Bangalore 560010, India
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, 203 Lothrop Street, Suite 800, Pittsburg, PA 15213, USA
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Munk MR, Somfai GM, de Smet MD, Donati G, Menke MN, Garweg JG, Ceklic L. The Role of Intravitreal Corticosteroids in the Treatment of DME: Predictive OCT Biomarkers. Int J Mol Sci 2022; 23:ijms23147585. [PMID: 35886930 PMCID: PMC9319632 DOI: 10.3390/ijms23147585] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/18/2022] Open
Abstract
This work aims to summarize predictive biomarkers to guide treatment choice in DME. Intravitreal anti-VEGF is considered the gold standard treatment for centers involving DME, while intravitreal steroid treatment has been established as a second-line treatment in DME. However, more than 1/3 of the patients do not adequately respond to anti-VEGF treatment despite up to 4-weekly injections. Not surprisingly, insufficient response to anti-VEGF therapy has been linked to low-normal VEGF levels in the serum and aqueous humor. These patients may well benefit from an early switch to intravitreal steroid treatment. In these patients, morphological biomarkers visible in OCT may predict treatment response and guide treatment decisions. Namely, the presence of a large amount of retinal and choroidal hyperreflective foci, disruption of the outer retinal layers and other signs of chronicity such as intraretinal cysts extending into the outer retina and a lower choroidal vascular index are all signs suggestive of a favorable treatment response of steroids compared to anti-VEGF. This paper summarizes predictive biomarkers in DME in order to assist individual treatment decisions in DME. These markers will help to identify DME patients who may benefit from primary dexamethasone treatment or an early switch.
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Affiliation(s)
- Marion R. Munk
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, 3010 Bern, Switzerland
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60208, USA
- Correspondence: ; Tel.: +41-31-632-25-01
| | - Gabor Mark Somfai
- Department of Ophthalmology, Stadtspital Zürich, 8063 Zurich, Switzerland;
- Spross Research Institute, 8063 Zurich, Switzerland
- Department of Ophthalmology, Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Marc D. de Smet
- Medical/Surgical Retina and Ocular Inflammation, University of Lausanne, MIOS SA, 1015 Lausanne, Switzerland;
| | - Guy Donati
- Centre Ophtalmologique de la Colline, University of Geneve, 1205 Geneve, Switzerland;
| | - Marcel N. Menke
- Department of Ophthalmology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland;
| | - Justus G. Garweg
- Swiss Eye Institute, Berner Augenklinik am Lindenhofspital, 3012 Bern, Switzerland;
| | - Lala Ceklic
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland;
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, 3010 Bern, Switzerland
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Bair H, Lin CJ, Li YL, Hsia NY, Lai CT, Lin JM, Chen WL, Chiang CC, Tsai YY. MultiColor imaging in urticarial vasculitis with recurrent branch retinal artery occlusion in a case with positive toxoplasma IgG and interferon-gamma release assay - Case report. Am J Ophthalmol Case Rep 2022; 26:101437. [PMID: 35243172 PMCID: PMC8881411 DOI: 10.1016/j.ajoc.2022.101437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction We report a male who presented with acute visual defect and was diagnosed with urticarial vasculitis with recurrent branch retinal artery occlusion (BRAO) after systemic disease survey, fluorescein angiography (FA), and MultiColor imaging (MCI). Case report A 47-year-old male with a history of urticarial vasculitis presented with visual defect OD. Fundus examination showed two foci of ischemic retinal whitening beneath the inferior arcade and above the superior arcade. MCI demonstrated a greenish tinge in the corresponding area. FA revealed segmental arteriolar staining and arterial occlusive changes. BRAO with retinal arteritis was diagnosed. Toxoplasma IgG was positive. Sulfamethoxazole 400mg plus trimethoprim 80mg was given. His vision worsened after 1-week of treatment. The established lesions improved, but new lesions occurred. Interferon-gamma release assay was positive but tuberculosis DNA qualitative amplification test of sputum was negative. Sputum acid-fast stain was positive and culture revealed nontuberculous mycobacteria. Left facial itching and reactive lymphadenopathy developed. Prednisolone and cyclophosphamide were started. The initial retinal artery lesions regained perfusion. Conclusions Urticarial vasculitis with recurrent BRAO is an immune complex-mediated disease. Greenish-tinged occlusive lesions were noted from MCI with high resolution and contrast. MCI could be a valuable method for retinal vessel occlusive disease detection before FA and follow up.
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Attiku Y, He Y, Nittala MG, Sadda SR. Current status and future possibilities of retinal imaging in diabetic retinopathy care applicable to low- and medium-income countries. Indian J Ophthalmol 2021; 69:2968-2976. [PMID: 34708731 PMCID: PMC8725126 DOI: 10.4103/ijo.ijo_1212_21] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Diabetic retinopathy (DR) is a leading cause of blindness among adults and the numbers are projected to rise. There have been dramatic advances in the field of retinal imaging since the first fundus image was captured by Jackman and Webster in 1886. The currently available imaging modalities in the management of DR include fundus photography, fluorescein angiography, autofluorescence imaging, optical coherence tomography, optical coherence tomography angiography, and near-infrared reflectance imaging. These images are obtained using traditional fundus cameras, widefield fundus cameras, handheld fundus cameras, or smartphone-based fundus cameras. Fluorescence lifetime ophthalmoscopy, adaptive optics, multispectral and hyperspectral imaging, and multicolor imaging are the evolving technologies which are being researched for their potential applications in DR. Telemedicine has gained popularity in recent years as remote screening of DR has been made possible. Retinal imaging technologies integrated with artificial intelligence/deep-learning algorithms will likely be the way forward in the screening and grading of DR. We provide an overview of the current and upcoming imaging modalities which are relevant to the management of DR.
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Affiliation(s)
- Yamini Attiku
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California
| | - Ye He
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California; Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | | | - SriniVas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute; Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Sakono T, Terasaki H, Sonoda S, Funatsu R, Shiihara H, Uchino E, Yamashita T, Sakamoto T. Comparison of multicolor scanning laser ophthalmoscopy and optical coherence tomography angiography for detection of microaneurysms in diabetic retinopathy. Sci Rep 2021; 11:17017. [PMID: 34426631 PMCID: PMC8382757 DOI: 10.1038/s41598-021-96371-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/30/2021] [Indexed: 11/09/2022] Open
Abstract
This study aimed to evaluate the usefulness of multicolor (MC) scanning laser ophthalmoscopy (MC-SLO) in detecting microaneurysm (MA) in eyes with diabetic retinopathy (DR). This was a retrospective cross-sectional study. Eyes with DR underwent fluorescein angiography (FA), MC-SLO, optical coherence tomography angiography (OCTA), and color fundus photography (CFP) were analyzed. The foveal region was cut in an 6 × 6 mm image and the number of MA in each image was counted by retina specialists to determine the sensitivity and positive predictive value. FA results were used as the ground standard. MAs were classified as those with early, late, or no dye leakage based on FA images. Fifty-four eyes of 35 patients with an average age of 64.5 ± 1.24 years were included. The sensitivity of MA detection was 37.3%, 15.3%, and 4.12% in MC-SLO, OCTA, and CFP, respectively (P < 0.01 in each pair).The positive predictive value was 66.4%, 46.4%, and 27.6% in MC, OCTA, and CFP, respectively (P < 0.01 in each pair). Sensitivity for MAs with early leakage was 36.4% in MC-SLO, which was significantly higher than 4.02% in OCTA. MC-SLO was more useful in detecting MA in eyes with DR than OCTA.
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Affiliation(s)
- Takato Sakono
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hiroto Terasaki
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shozo Sonoda
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.,Kagoshima Sonoda Eye and Plastic Surgery Clinic, Kagoshima, Japan
| | - Ryoh Funatsu
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hideki Shiihara
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Eisuke Uchino
- Kagoshima Sonoda Eye and Plastic Surgery Clinic, Kagoshima, Japan
| | - Toshifumi Yamashita
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
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Review of retinal cameras for global coverage of diabetic retinopathy screening. Eye (Lond) 2020; 35:162-172. [PMID: 33168977 DOI: 10.1038/s41433-020-01262-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/10/2020] [Accepted: 10/27/2020] [Indexed: 12/16/2022] Open
Abstract
The global burden of diabetes has resulted in an increase in the prevalence of diabetic retinopathy (DR), a microvascular complication of diabetes. Lifelong repetitive screening for DR is essential for early detection and timely management to prevent visual impairment due to the silent sight-threatening disorder. Colour fundus photography (CFP) is helpful for documentation of the retinopathy as well as for counselling the patient. CFP has established roles in DR screening, detection, progression and monitoring of treatment response. DR screening programmes use validated mydriatic or non-mydriatic fundus cameras for retinal imaging and trained image graders identify referable DR. Smartphone-based fundus cameras and handheld fundus cameras that are cost-effective, portable and easy to handle in remote places are gaining popularity in recent years. The images captured with these low-cost devices can be immediately sent to trained ophthalmologists for grading of DR. Recent increase in numbers of telemedicine programmes based on imaging with digital fundus cameras and remote interpretation has facilitated larger population coverage of DR screening and timely referral of those with sight-threatening DR to ophthalmologists. Good-quality retinal imaging and accurate diagnosis are essential to reduce inappropriate referrals. Advances in digital imaging such as ultra-wide field imaging and multi-modal imaging have opened new avenues for assessing DR. Fundus cameras with integrated artificial intelligence (AI)-based automated algorithms can also provide instant DR diagnosis and reduce the burden of healthcare systems. We review the different types of fundus cameras currently used in DR screening and management around the world.
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Bansal M. Commentary: Subthreshold micropulse yellow laser in diabetic macular edema. Indian J Ophthalmol 2019; 68:151-152. [PMID: 31856494 PMCID: PMC6951174 DOI: 10.4103/ijo.ijo_1543_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Mayank Bansal
- Fortis Memorial Research Institute, Gurugram, Haryana, India
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