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Guo M, Higashita R, Lin C, Hu L, Chen W, Li F, Lai GWK, Nguyen A, Sakata R, Okamoto K, Tang B, Xu Y, Fu H, Gao F, Aihara M, Zhang X, Yuan J, Lin S, Leung CKS, Liu J. Crystalline lens nuclear age prediction as a new biomarker of nucleus degeneration. Br J Ophthalmol 2024; 108:513-521. [PMID: 37495263 DOI: 10.1136/bjo-2023-323176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/22/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND The crystalline lens is a transparent structure of the eye to focus light on the retina. It becomes muddy, hard and dense with increasing age, which makes the crystalline lens gradually lose its function. We aim to develop a nuclear age predictor to reflect the degeneration of the crystalline lens nucleus. METHODS First we trained and internally validated the nuclear age predictor with a deep-learning algorithm, using 12 904 anterior segment optical coherence tomography (AS-OCT) images from four diverse Asian and American cohorts: Zhongshan Ophthalmic Center with Machine0 (ZOM0), Tomey Corporation (TOMEY), University of California San Francisco and the Chinese University of Hong Kong. External testing was done on three independent datasets: Tokyo University (TU), ZOM1 and Shenzhen People's Hospital (SPH). We also demonstrate the possibility of detecting nuclear cataracts (NCs) from the nuclear age gap. FINDINGS In the internal validation dataset, the nuclear age could be predicted with a mean absolute error (MAE) of 2.570 years (95% CI 1.886 to 2.863). Across the three external testing datasets, the algorithm achieved MAEs of 4.261 years (95% CI 3.391 to 5.094) in TU, 3.920 years (95% CI 3.332 to 4.637) in ZOM1-NonCata and 4.380 years (95% CI 3.730 to 5.061) in SPH-NonCata. The MAEs for NC eyes were 8.490 years (95% CI 7.219 to 9.766) in ZOM1-NC and 9.998 years (95% CI 5.673 to 14.642) in SPH-NC. The nuclear age gap outperformed both ophthalmologists in detecting NCs, with areas under the receiver operating characteristic curves of 0.853 years (95% CI 0.787 to 0.917) in ZOM1 and 0.909 years (95% CI 0.828 to 0.978) in SPH. INTERPRETATION The nuclear age predictor shows good performance, validating the feasibility of using AS-OCT images as an effective screening tool for nucleus degeneration. Our work also demonstrates the potential use of the nuclear age gap to detect NCs.
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Affiliation(s)
- Mengjie Guo
- Research Institute of Trustworthy Autonomous Systems, Southern University of Science and Technology, Shenzhen, Guangdong, China
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Risa Higashita
- Department of Computer Science and Engineering, Southern University of Science and Technology, Shenzhen, Guangdong, China
- Tomey Corporation, Nagoya, Aichi, Japan
| | - Chen Lin
- Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Lingxi Hu
- Research Institute of Trustworthy Autonomous Systems, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Wan Chen
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Fei Li
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Gilda Wing Ki Lai
- Department of Ophthalmology, The University of Hong Kong, Hong Kong, Hong Kong
| | - Anwell Nguyen
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Rei Sakata
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | | | - Bo Tang
- Research Institute of Trustworthy Autonomous Systems, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Yanwu Xu
- Intelligent Healthcare Unit, Baidu Inc, Beijing, China
| | - Huazhu Fu
- Institute of High Performance Computing, Agency for Science, Technology and Research, Singapore
| | - Fei Gao
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Makoto Aihara
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Xiulan Zhang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jin Yuan
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Shan Lin
- Department of Ophthalmology, University of California, San Francisco, California, USA
- Glaucoma Center of San Francisco, San Francisco, California, USA
| | - Christopher Kai-Shun Leung
- Department of Ophthalmology, The University of Hong Kong, Hong Kong, Hong Kong
- Department of Ophthalmology and Visual Sciences, The Chinese University, Hong Kong, Hong Kong
| | - Jiang Liu
- Research Institute of Trustworthy Autonomous Systems, Southern University of Science and Technology, Shenzhen, Guangdong, China
- Department of Computer Science and Engineering, Southern University of Science and Technology, Shenzhen, Guangdong, China
- Cixi Institute of Biomedical Engineering, Chinese Academy of Sciences, Cixi, Zhejiang, China
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Leung CKS, Lam AKN, Weinreb RN, Garway-Heath DF, Yu M, Guo PY, Chiu VSM, Wan KHN, Wong M, Wu KZ, Cheung CYL, Lin C, Chan CKM, Chan NCY, Kam KW, Lai GWK. Diagnostic assessment of glaucoma and non-glaucomatous optic neuropathies via optical texture analysis of the retinal nerve fibre layer. Nat Biomed Eng 2022; 6:593-604. [PMID: 34992272 DOI: 10.1038/s41551-021-00813-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 09/17/2021] [Indexed: 01/14/2023]
Abstract
The clinical diagnostic evaluation of optic neuropathies relies on the analysis of the thickness of the retinal nerve fibre layer (RNFL) by optical coherence tomography (OCT). However, false positives and false negatives in the detection of RNFL abnormalities are common. Here we show that an algorithm integrating measurements of RNFL thickness and reflectance from standard wide-field OCT scans can be used to uncover the trajectories and optical texture of individual axonal fibre bundles in the retina and to discern distinctive patterns of loss of axonal fibre bundles in glaucoma, compressive optic neuropathy, optic neuritis and non-arteritic anterior ischaemic optic neuropathy. Such optical texture analysis can detect focal RNFL defects in early optic neuropathy, as well as residual axonal fibre bundles in end-stage optic neuropathy that were indiscernible by conventional OCT analysis and by red-free RNFL photography. In a diagnostic-performance study, optical texture analysis of the RNFL outperformed conventional OCT in the detection of glaucoma, as defined by visual-field testing or red-free photography. Our findings show that optical texture analysis of the RNFL for the detection of optic neuropathies is highly sensitive and specific.
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Affiliation(s)
- Christopher Kai Shun Leung
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong. .,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong. .,Queen Mary Hospital, Pok Fu Lam, Hong Kong. .,Hong Kong Eye Hospital, Kowloon City, Hong Kong.
| | - Alexander Ka Ngai Lam
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Robert Neal Weinreb
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California, San Diego, CA, USA
| | - David F Garway-Heath
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Marco Yu
- Singapore Eye Research Institute, Singapore, Singapore
| | - Philip Yawen Guo
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Vivian Sheung Man Chiu
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Kelvin Ho Nam Wan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong.,Hong Kong Eye Hospital, Kowloon City, Hong Kong.,Department of Ophthalmology, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Mandy Wong
- Hong Kong Eye Hospital, Kowloon City, Hong Kong
| | - Ken Zhongheng Wu
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Carol Yim Lui Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chen Lin
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Carmen Kar Mun Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong.,Hong Kong Eye Hospital, Kowloon City, Hong Kong
| | - Noel Ching Yan Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong.,Department of Ophthalmology, Prince of Wales Hospital, Shatin, Hong Kong
| | - Ka Wai Kam
- Department of Ophthalmology, Prince of Wales Hospital, Shatin, Hong Kong
| | - Gilda Wing Ki Lai
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
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Leung CKS, Ren ST, Chan PPM, Wan KHN, Kam AKW, Lai GWK, Chiu VSM, Ko MWL, Yiu CKF, Yu MCY. Correction to: Nicotinamide riboside as a neuroprotective therapy for glaucoma: study protocol for a randomized, double-blind, placebo-control trial. Trials 2022; 23:134. [PMID: 35144657 PMCID: PMC8832638 DOI: 10.1186/s13063-022-06079-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Christopher Kai Shun Leung
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China. .,Hong Kong Eye Hospital, Hong Kong, People's Republic of China. .,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, People's Republic of China.
| | - Seraph Tianmin Ren
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Poemen Pui Man Chan
- Hong Kong Eye Hospital, Hong Kong, People's Republic of China.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Kelvin Ho Nam Wan
- Hong Kong Eye Hospital, Hong Kong, People's Republic of China.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Aziz Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Gilda Wing Ki Lai
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Vivian Sheung Man Chiu
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Match Wai Lun Ko
- Department of Mechanical Engineering, University of Hong Kong, Hong Kong, People's Republic of China
| | - Cedric Ka Fai Yiu
- Department of Applied Mathematics, Hong Kong Polytechnic University, Hong Kong, People's Republic of China
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Leung CKS, Ren ST, Chan PPM, Wan KHN, Kam AKW, Lai GWK, Chiu VSM, Ko MWL, Yiu CKF, Yu MCY. Nicotinamide riboside as a neuroprotective therapy for glaucoma: study protocol for a randomized, double-blind, placebo-control trial. Trials 2022; 23:45. [PMID: 35039056 PMCID: PMC8762963 DOI: 10.1186/s13063-021-05968-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 12/23/2021] [Indexed: 12/18/2022] Open
Abstract
Background Whereas lowering the intraocular pressure (IOP) can slow optic nerve degeneration in glaucoma, many patients with glaucoma continue to develop progressive loss in vision despite a significant reduction in IOP. No treatment has been shown to be effective for neuroprotection in glaucoma. We set out to conduct a randomized controlled trial to investigate whether nicotinamide riboside (NR), a nicotinamide adenine dinucleotide precursor, is effective to slow optic nerve degeneration in patients with primary open-angle glaucoma (POAG). We hypothesize that patients treated with NR have a slower rate of progressive retinal nerve fiber layer (RNFL) thinning compared with those treated with placebo. Methods This is a randomized, double-blind, placebo-controlled, parallel-group, multi-center study including 125 patients with POAG. Patients will be randomized to receive 300 mg NR or placebo for 24 months. Clinical examination, optical coherence tomography imaging of the RNFL, and visual field (VF) test will be performed at the baseline, 1 month, 4 months, and then at 2-month intervals until 24 months. The primary outcome measure is the rate of RNFL thinning measured over 24 months. The secondary outcome measures include (1) time to VF progression, (2) time to progressive RNFL/ganglion cell inner plexiform layer (GCIPL) thinning, and (3) the rate of change of VF sensitivity over 24 months (to investigate neuroprotection) and 1 month (to investigate neuroenhancement). The rates of RNFL thinning and VF sensitivity decline between treatment groups will be compared with linear mixed modeling. Survival analysis will be performed to compare the differences in time from baseline to VF progression and time from baseline to progressive RNFL/GCIPL thinning between treatment groups using Cox proportional hazards models. Discussion Outcome measures in glaucoma neuroprotection trials have been centered on the detection of VF progression, which may take years to develop and confirm. In addition to addressing whether NR has a neuroprotective/neuroenhancement effect in glaucoma patients, this study will demonstrate the feasibility of studying neuroprotection in a relatively short trial period (24 months) by comparing the rates of progressive RNFL thinning, a more reproducible and objective outcome measure compared with VF endpoints, between treatment groups. Trial registration Chinese Clinical Trial Registry 1900021998
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Affiliation(s)
- Christopher Kai Shun Leung
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China. .,Hong Kong Eye Hospital, Hong Kong, People's Republic of China. .,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, People's Republic of China.
| | - Seraph Tianmin Ren
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Poemen Pui Man Chan
- Hong Kong Eye Hospital, Hong Kong, People's Republic of China.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Kelvin Ho Nam Wan
- Hong Kong Eye Hospital, Hong Kong, People's Republic of China.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Aziz Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Gilda Wing Ki Lai
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Vivian Sheung Man Chiu
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Match Wai Lun Ko
- Department of Mechanical Engineering, University of Hong Kong, Hong Kong, People's Republic of China
| | - Cedric Ka Fai Yiu
- Department of Applied Mathematics, Hong Kong Polytechnic University, Hong Kong, People's Republic of China
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