1
|
Tansuebchueasai N, Nishida T, Moghimi S, Wu JH, Mahmoudinezhad G, Gunasegaran G, Kamalipour A, Zangwill LM, Weinreb RN. Rate of Initial Optic Nerve Head Capillary Density Loss and Risk of Visual Field Progression. JAMA Ophthalmol 2024:2818266. [PMID: 38696186 PMCID: PMC11066764 DOI: 10.1001/jamaophthalmol.2024.0906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/17/2024] [Indexed: 05/05/2024]
Abstract
Importance Rapid initial optic nerve head capillary density loss may be used to assess the risk of glaucoma visual field progression. Objective To investigate the association between the rate of initial optic nerve head capillary density loss from optical coherence tomography angiography (OCTA) and visual field progression. Design, Setting, Participants This was a retrospective study of a longitudinal cohort at a glaucoma referral center. A total of 167 eyes (96 with primary open-angle glaucoma and 71 with glaucoma suspect) of 109 patients were monitored for a mean (SD) of 5.7 (1.4) years from January 2015 to December 2022. Data analysis was undertaken in April 2023. Main Outcomes and Measures The rates of initial capillary density and average retinal nerve fiber layer loss were calculated from the first 3 optic nerve head OCTA and OCT scans, respectively, during the initial follow-up (mean [SD], 2.0 [1.0] years). Based on the median rate, eyes were categorized into fast and slow progressor groups. The association between initial capillary density change or retinal nerve fiber layer thinning and visual field progression was evaluated using linear-mixed and time-varying Cox models. Results A total of 167 eyes of 109 patients (mean [SD] age, 69.0 [11.1] years; 56 [51.4%] female and 53 [48.6%] male) were assessed. Eighty-three eyes were slow OCTA progressors, while 84 eyes were fast with mean capillary density loss of -0.45% per year and -1.17% per year, respectively (mean difference, -0.72%/year; 95% CI,-0.84 to -0.60; P < .001). Similarly, 83 eyes were slow OCT progressors, while 84 eyes were fast with mean retinal nerve fiber layer thinning of -0.09 μm per year and -0.60 μm per year, respectively (mean difference, -0.51 μm/year; 95% CI,-0.59 to -0.43; P < .001). The fast OCTA and OCT progressors were associated with more rapid visual field loss (mean difference, -0.18 dB/year; 95% CI,-0.30 to -0.06; P = .004 and -0.17 dB/year; 95% CI,-0.29 to -0.06; P = .002, respectively). Fast OCTA progressing eyes were more likely to have visual field progression (hazard ratio, 1.96; 95% CI, 1.04-3.69; P = .04). Seventeen of 52 eyes (32.7%; 95% CI, 32.5-32.8) with fast OCTA and OCT progression developed subsequent visual field likely progression. Conclusion and Relevance Rapid initial optic nerve head capillary density loss from OCTA was associated with a faster rate of visual field progression and a doubling of the risk of developing event progression in this study. These findings may support clinical use of OCTA and OCT optic nerve head measurements for risk assessment of glaucoma progression.
Collapse
Affiliation(s)
- Natchada Tansuebchueasai
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Takashi Nishida
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Jo-Hsuan Wu
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Golnoush Mahmoudinezhad
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Gopikasree Gunasegaran
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Alireza Kamalipour
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Linda M. Zangwill
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| | - Robert N. Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla
| |
Collapse
|
2
|
Nishida T, Weinreb RN, Tansuebchueasai N, Wu JH, Meller L, Mahmoudinezhad G, Gunasegaran G, Adelpour M, Moghimi S. Smoking Intensity is Associated with Progressive Optic Nerve Head Vessel Density loss in Glaucoma. J Glaucoma 2024:00061198-990000000-00379. [PMID: 38647412 DOI: 10.1097/ijg.0000000000002410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/24/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE To investigate the relationship of smoking and smoking intensity, with the rate of optic nerve head (ONH) whole image capillary density (wiCD) loss in primary open angle glaucoma (POAG) and glaucoma suspect patients. METHODS In this longitudinal study, POAG patients who had at least 2 years of follow-up and optical coherence tomography angiography (OCTA) performed at a minimum of 4 visits were selected for study. The smoking intensity was calculated as the pack-year at the baseline OCTA. Univariable and multivariable linear mixed models were used to determine the effect of each parameter on the rates of wiCD loss over time. Nonlinear least-squares estimation with piecewise regression model was used to investigate the cutoff point for the relationship between wiCD loss and smoking intensity. RESULTS 164 eyes (69 glaucoma suspect and 95 POAG) of 110 patients were included with a mean (95% CI) follow-up of 4.0 (3.9 to 4.1) years. Of the 110 patients, 50 (45.5%) had a reported history of smoking. Greater smoking intensity was associated with faster wiCD loss (-0.11 (-0.23 to 0.00)) %/year per 10 pack-year higher; P=0.048) after adjusting for covariates. The wiCD thinning became significantly faster when smoking intensity was greater than 22.2 pack-years. Smoking had no effect on the rate of wiCD thinning in patients who smoked < 22.2 pack-years during their lifetime. CONCLUSIONS A history of greater smoking consumption was associated with faster vessel density loss, suggesting smoking intensity as a potential risk factor for glaucoma.
Collapse
Affiliation(s)
- Takashi Nishida
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Natchada Tansuebchueasai
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Jo-Hsuan Wu
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Leo Meller
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Golnoush Mahmoudinezhad
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Gopikasree Gunasegaran
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Mohsen Adelpour
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, United States
| |
Collapse
|
3
|
Gunasegaran G, Moghimi S, Nishida T, Walker E, Kamalipour A, Wu JH, Mahmoudinezhad G, Zangwill LM, Weinreb RN. Racial Differences in the Diagnostic Accuracy of OCT Angiography Macular Vessel Density for Glaucoma. Ophthalmol Glaucoma 2024; 7:197-205. [PMID: 37783272 DOI: 10.1016/j.ogla.2023.09.003] [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: 05/19/2023] [Revised: 08/29/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To evaluate and compare the diagnostic accuracy of macular vessel density (VD) measured by OCT angiography (OCTA) in individuals of African descent (AD) and European descent (ED) with open-angle glaucoma. DESIGN Observational, cross sectional study. PARTICIPANTS A total of 176 eyes of 123 patients with glaucoma and 140 eyes of 88 healthy participants from the Diagnostic Innovations in Glaucoma Study. METHODS Whole-image ganglion cell complex (wiGCC) thickness and macular VD (parafoveal VD and perifoveal VD) were obtained from 6 × 6 macula scans. Area under the receiver operating characteristic (AUROC) curves were used to evaluate the diagnostic accuracy of macular VD and ganglion cell complex (GCC) thickness in AD and ED participants after adjusting for confounders such as age, visual field mean deviation (VF MD), signal strength index, axial length, self-reported hypertension and diabetes. MAIN OUTCOME MEASURES Macular VD and wiGCC measurements. RESULTS Parafoveal and perifoveal VD were significantly lower in ED than AD patients with glaucoma. Parafoveal and perifoveal VD performed significantly worse in AD participants compared with ED participants for detection of glaucoma (adjusted AUROC, 0.75 [95% confidence interval (CI), 0.62, 0.87], 0.85 [95% CI, 0.79, 0.90], P = 0.035; and 0.82 [95% CI, 0.70, 0.92], 0.91 [95% CI, 0.87, 0.94], respectively; P = 0.020). In contrast to VD, diagnostic accuracy of GCC thickness was similar in AD and ED individuals (adjusted AUROC, 0.89 [95% CI, 0.79, 0.96], 0.92 [95% CI, 0.86, 0.96], respectively; P = 0.313). The diagnostic accuracies of both macular VD and GCC thickness for differentiating between glaucoma and healthy eyes increased with increasing VF MD in both AD and ED participants. CONCLUSIONS Diagnostic performance of OCTA macular VD, but not GCC thickness, for glaucoma detection varies by race. Moreover, macular VD parameters had lower accuracy for detecting glaucoma in AD individuals than in ED individuals. The diagnostic performance of macular VD is race-dependent, and, therefore, race should be taken into consideration when interpreting macular OCTA results. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Collapse
Affiliation(s)
- Gopikasree Gunasegaran
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Sasan Moghimi
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Takashi Nishida
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Evan Walker
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Alireza Kamalipour
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Jo-Hsuan Wu
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Golnoush Mahmoudinezhad
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Linda M Zangwill
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California
| | - Robert N Weinreb
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, California.
| |
Collapse
|
4
|
Mahmoudinezhad G, Moghimi S, Cheng J, Ru L, Yang D, Agrawal K, Dixit R, Beheshtaein S, Du KH, Latif K, Gunasegaran G, Micheletti E, Nishida T, Kamalipour A, Walker E, Christopher M, Zangwill L, Vasconcelos N, Weinreb RN. Deep Learning Estimation of 10-2 Visual Field Map Based on Macular Optical Coherence Tomography Angiography Measurements. Am J Ophthalmol 2024; 257:187-200. [PMID: 37734638 DOI: 10.1016/j.ajo.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE To develop deep learning (DL) models estimating the central visual field (VF) from optical coherence tomography angiography (OCTA) vessel density (VD) measurements. DESIGN Development and validation of a deep learning model. METHODS A total of 1051 10-2 VF OCTA pairs from healthy, glaucoma suspects, and glaucoma eyes were included. DL models were trained on en face macula VD images from OCTA to estimate 10-2 mean deviation (MD), pattern standard deviation (PSD), 68 total deviation (TD) and pattern deviation (PD) values and compared with a linear regression (LR) model with the same input. Accuracy of the models was evaluated by calculating the average mean absolute error (MAE) and the R2 (squared Pearson correlation coefficients) of the estimated and actual VF values. RESULTS DL models predicting 10-2 MD achieved R2 of 0.85 (95% confidence interval [CI], 74-0.92) for 10-2 MD and MAEs of 1.76 dB (95% CI, 1.39-2.17 dB) for MD. This was significantly better than mean linear estimates for 10-2 MD. The DL model outperformed the LR model for the estimation of pointwise TD values with an average MAE of 2.48 dB (95% CI, 1.99-3.02) and R2 of 0.69 (95% CI, 0.57-0.76) over all test points. The DL model outperformed the LR model for the estimation of all sectors. CONCLUSIONS DL models enable the estimation of VF loss from OCTA images with high accuracy. Applying DL to the OCTA images may enhance clinical decision making. It also may improve individualized patient care and risk stratification of patients who are at risk for central VF damage.
Collapse
Affiliation(s)
- Golnoush Mahmoudinezhad
- From the Hamilton Glaucoma Center (G.M., S.M., K.H.D., K.L., G.G., E.M., T.N., A.K., E.W., M.C., L.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California
| | - Sasan Moghimi
- From the Hamilton Glaucoma Center (G.M., S.M., K.H.D., K.L., G.G., E.M., T.N., A.K., E.W., M.C., L.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California
| | - Jiacheng Cheng
- Department of Electrical and Computer Engineering (J.C., L.R., K.A., R.D., N.V.), University of California San Diego, La Jolla, California
| | - Liyang Ru
- Department of Electrical and Computer Engineering (J.C., L.R., K.A., R.D., N.V.), University of California San Diego, La Jolla, California
| | - Dongchen Yang
- Department of Computer Science and Engineering (D.Y.), University of California San Diego, La Jolla, California
| | - Kushagra Agrawal
- Department of Electrical and Computer Engineering (J.C., L.R., K.A., R.D., N.V.), University of California San Diego, La Jolla, California
| | - Rajeev Dixit
- Department of Electrical and Computer Engineering (J.C., L.R., K.A., R.D., N.V.), University of California San Diego, La Jolla, California
| | | | - Kelvin H Du
- From the Hamilton Glaucoma Center (G.M., S.M., K.H.D., K.L., G.G., E.M., T.N., A.K., E.W., M.C., L.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California
| | - Kareem Latif
- From the Hamilton Glaucoma Center (G.M., S.M., K.H.D., K.L., G.G., E.M., T.N., A.K., E.W., M.C., L.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California
| | - Gopikasree Gunasegaran
- From the Hamilton Glaucoma Center (G.M., S.M., K.H.D., K.L., G.G., E.M., T.N., A.K., E.W., M.C., L.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California
| | - Eleonora Micheletti
- From the Hamilton Glaucoma Center (G.M., S.M., K.H.D., K.L., G.G., E.M., T.N., A.K., E.W., M.C., L.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California
| | - Takashi Nishida
- From the Hamilton Glaucoma Center (G.M., S.M., K.H.D., K.L., G.G., E.M., T.N., A.K., E.W., M.C., L.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California
| | - Alireza Kamalipour
- From the Hamilton Glaucoma Center (G.M., S.M., K.H.D., K.L., G.G., E.M., T.N., A.K., E.W., M.C., L.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California
| | - Evan Walker
- From the Hamilton Glaucoma Center (G.M., S.M., K.H.D., K.L., G.G., E.M., T.N., A.K., E.W., M.C., L.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California
| | - Mark Christopher
- From the Hamilton Glaucoma Center (G.M., S.M., K.H.D., K.L., G.G., E.M., T.N., A.K., E.W., M.C., L.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California
| | - Linda Zangwill
- From the Hamilton Glaucoma Center (G.M., S.M., K.H.D., K.L., G.G., E.M., T.N., A.K., E.W., M.C., L.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California
| | - Nuno Vasconcelos
- Department of Electrical and Computer Engineering (J.C., L.R., K.A., R.D., N.V.), University of California San Diego, La Jolla, California
| | - Robert N Weinreb
- From the Hamilton Glaucoma Center (G.M., S.M., K.H.D., K.L., G.G., E.M., T.N., A.K., E.W., M.C., L.Z., R.N.W.), Shiley Eye Institute, Viterbi Family Department of Ophthalmology, UC San Diego, La Jolla, California.
| |
Collapse
|
5
|
Nishida T, Moghimi S, Walker E, Gunasegaran G, Wu JH, Kamalipour A, Mahmoudinezhad G, Zangwill LM, Weinreb RN. Association of foveal avascular zone change and glaucoma progression. Br J Ophthalmol 2023:bjo-2023-323970. [PMID: 38164585 DOI: 10.1136/bjo-2023-323970] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/02/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND/AIMS To investigate the association between longitudinal changes of foveal avascular zone (FAZ) area and the rate of structural and functional progression in glaucoma. METHODS A longitudinal cohort included 115 eyes (46 glaucoma suspect and 66 primary open-angle glaucoma) of 81 patients having ≥2 year follow-up, and ≥4 visits with optical coherence tomography angiography and visual field (VF). Eyes in the longitudinal cohort with a slope greater than that found in 95 percentile of separate healthy test-retest series for FAZ area were categorised into FAZ progressors; all other eyes were defined as FAZ non-progressors. A generalised linear mixed-effect model was used to investigate the association of FAZ progressors with demographic and clinical characteristics. RESULTS Faster ganglion cell complex (GCC) thinning and faster VF mean deviation (MD) loss were found in eyes with FAZ progressors compared with FAZ non-progressors (mean difference: -0.7 (95% CI, -1.4 to -0.1) µm/y; p=0.026, -0.3 (-0.5 to -0.1) dB/y; p=0.017, respectively), while whole image vessel density was not associated with FAZ progressors (p=0.929). SD of intraocular pressure (IOP) and IOP range were also associated with FAZ progressors in separate multivariable models (OR: 1.54 (1.02 to 2.32) per 1 mm Hg higher, p=0.041; OR: 1.20 (1.01 to 1.41) per 1 mm Hg higher; p=0.035, respectively). CONCLUSIONS Significant FAZ increase was weakly associated with moderately faster rates of both GCC thinning and VF MD loss, but not macular vessel density change in glaucoma eyes. Additional studies are needed to elucidate the pathophysiological associations between macula GCC thinning and FAZ area increases in glaucoma.
Collapse
Affiliation(s)
- Takashi Nishida
- University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| | - Sasan Moghimi
- University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| | - Evan Walker
- University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| | - Gopikasree Gunasegaran
- University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| | - Jo-Hsuan Wu
- University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| | - Alireza Kamalipour
- University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| | - Golnoush Mahmoudinezhad
- University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| | - Linda M Zangwill
- University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| | - Robert N Weinreb
- University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| |
Collapse
|