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Moon JY, Garg I, Miller JB, Ludwig CA. SUDDEN MONOCULAR VISION LOSS AFTER SNEEZING AS CAPTURED ON WIDEFIELD SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY-ANGIOGRAPHY. Retin Cases Brief Rep 2024; 18:407-410. [PMID: 36729527 PMCID: PMC11027971 DOI: 10.1097/icb.0000000000001395] [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] [Indexed: 02/03/2023]
Abstract
PURPOSE We report an unusual case of likely combined retinal artery occlusion and retinal vein occlusion after a sneeze. Widefield swept-source optical coherence tomography-angiography was used to analyze retinal changes at one-month follow-up. METHODS The patient reported visual symptoms in his left eye immediately after sneezing five times in a row. Fundus examination showed an embolus along the superior arcade. Stroke workup revealed moderate carotid artery stenosis and a subtherapeutic INR. At one-month follow-up, fundus photography and swept-source optical coherence tomography-angiography were obtained. RESULTS Fundus photography showed superior retinal whitening and arteriole attenuation, an inferior perifoveal cotton wool spot, and inferotemporal intraretinal hemorrhages. Swept-source optical coherence tomography-angiography showed loss of the deep capillary plexus superiorly and inferotemporally, most consistent with combined retinal artery and retinal vein occlusion. CONCLUSION We report the first case of sneeze-induced combined retinal artery and retinal vein occlusion. The retina is a uniquely accessible window that provides insight into human physiology, and swept-source optical coherence tomography-angiography is a powerful tool that can give further insight into the pathophysiology of an occlusion.
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Affiliation(s)
- Jade Y. Moon
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Itika Garg
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts
- Department of Ophthalmology, Tulane University, New Orleans, Louisiana
| | - John B. Miller
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; and
| | - Cassie A. Ludwig
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; and
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Meshkin RS, Blumenthal J, Hoyek S, Strand E, Manz S, Akrobetu D, Feng Y, Miller JB, Patel N. Academic vs Community Retinal Surgery for Primary Retinal Detachment- Characteristics, Duration, and Value Analysis of Teaching Modifier. Ophthalmol Retina 2024:S2468-6530(24)00223-9. [PMID: 38697515 DOI: 10.1016/j.oret.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/05/2024]
Abstract
PURPOSE To compare operative time and case characteristics of primary rhegmatogenous retinal detachment (RRD) repairs between academic and community vitreoretinal surgeons. DESIGN A retrospective, observational clinical study. SUBJECTS Patients who underwent primary RRD repair surgeries at Massachusetts Eye and Ear between 2019-2021. METHODS A random sample of 20 vitreoretinal surgeons distributed evenly among the "academic" or "community" setting was selected. Fifteen consecutive cases of primary RRD repair surgeries were included from each surgeon. A cost analysis was performed for the teaching modifier for the physician fee and for hospital costs. MAIN OUTCOME MEASURES Length of surgery. RESULTS Of 300 primary RRD repairs, fellows were present in 75%, which comprised all academic surgeon cases and 50% of community surgeon cases, p<0.001. Mean operation length was shorter for non-fellow community surgeon cases (55.0±24.1) than either academic (73.0±30.8) or community surgeon cases with fellows (75.7±32.5) (p<0.001). There was a higher percentage of macula-off RRDs in academic versus community surgeon cases (52.7% vs 38.0%, p=0.002) and higher rates of combined scleral buckle (SB)/PPV repairs (14% vs. 3%, p<0.001). When excluding combined SB/PPV cases, there was no difference in operative time between academic and community surgeon cases. Among RRDs repaired by PPV only, there was a 31.4% (16.6 minutes) greater procedure duration in cases with fellows compared to cases without fellows (p<0.001). Covariates associated with greater surgery time: addition of a scleral buckle (β=32.6), membrane peel (β=18.5), presence of a fellow (β=14.5), proliferative vitreoretinopathy (β=12.8), and greater number of retinal breaks (β=2.4). The teaching modifier adds 16% extra reimbursement ($184.16) to the physician fee which is 50.9% of what is necessary to cover the percentage increase in surgeon time (31.4%). Using a time-driven activity-based costing for hospital costs, the extra 16.6 minutes leads to an additional $1038.00, which is 5.6 times more than the reimbursement for the modifier. CONCLUSIONS Retinal detachment repair cases performed by academic surgeons are more likely to be macula-off and include the addition of a scleral buckle, which drive longer operative times. Medicare's reimbursement of the assistant modifier in a teaching facility significantly under compensates the time-driven activity-based costing of trainee participation.
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Keshtkarjahromi M, Rebman AW, Antar AAR, Manabe YC, Gutierrez-Alamillo L, Casciola-Rosen LA, Aucott JN, Miller JB. Autoantibodies in post-treatment Lyme disease and association with clinical symptoms. Clin Exp Rheumatol 2024:20178. [PMID: 38607687 DOI: 10.55563/clinexprheumatol/qcupkk] [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: 07/21/2023] [Accepted: 10/31/2023] [Indexed: 04/14/2024]
Abstract
OBJECTIVES Autoantibodies have been described in the post-infectious state, specifically after Lyme disease and COVID-19. We aimed to describe the prevalence and potential clinical utility of several commercially available autoantibodies after these infections. METHODS Euroimmun panels (myositis, scleroderma and ANA5) were assayed using sera from patients with Lyme disease with return to health (RTH) (n=70), post-treatment Lyme disease (n=58), COVID-19 RTH (n=47) and post-acute symptoms of COVID-19 (n=22). The post-Lyme questionnaire of symptoms (PLQS) was used to determine symptom burden after Lyme disease. RESULTS There was no statistically significant difference in autoantibody prevalence across the four groups (p=0.746). A total of 21 different antibodies were found in the Lyme cohorts and 8 different antibodies in the COVID-19 cohorts. The prevalence of scleroderma-associated antibodies was higher after Lyme disease than COVID-19 (12.5% vs. 2.9%, p=0.026). There was no statistically significant difference in symptom burden based on antibody status. CONCLUSIONS Several autoantibodies were found after Borrelia burgdorferi and SARS-CoV2 infection, although the prevalence was similar in those with persistent symptoms and those who returned to health. While our data show no difference in autoantibody prevalence across the four post-infectious states, we do not imply that autoantibodies are irrelevant in this setting. Rather, this study highlights the need for novel antibody discovery in larger cohorts of well-defined patient populations.
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Affiliation(s)
| | - Alison W Rebman
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Annukka A R Antar
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yukari C Manabe
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Livia A Casciola-Rosen
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John N Aucott
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John B Miller
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Lu ES, Cui Y, Le R, Zhu Y, Wang JC, Laíns I, Katz R, Lu Y, Zeng R, Garg I, Wu DM, Husain D, Kim LA, Miller JB. Widefield swept-source optical coherence tomography angiography metrics associated with neovascular glaucoma in patients with proliferative diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 2024; 262:1111-1120. [PMID: 37962666 DOI: 10.1007/s00417-023-06290-z] [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: 04/21/2023] [Revised: 10/12/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
PURPOSE To explore the association between widefield swept-source optical coherence tomography angiography (WF SS-OCTA) metrics, including nonperfusion area (NPA) and neovascularization (NV), and presence of neovascular glaucoma (NVG) in patients with proliferative diabetic retinopathy (PDR). METHODS A prospective, cross-sectional study was conducted from November 2018 to February 2020. A total of 85 eyes of 60 PDR patients without NVG and 9 eyes of 8 PDR patients with NVG were included. Retinal ischemic parameters (NPA; ischemia index [NPA/total retinal area]) and NV features (NV number; NV area; NV vessel density) were evaluated. Foveal avascular zone (FAZ), macular thickness/volume, and choroidal thickness/volume were obtained using the Zeiss ARI Network. WF SS-OCTA retinal and choroidal metrics, systemic, and ocular parameters were screened using Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression for variable selection. Firth's bias-reduced logistic regression (outcome: presence of NVG) was subsequently used to identify parameters associated with NVG. RESULTS After LASSO variable selection, 8 variables were significantly associated with the presence of NVG: DM duration (years), insulin (yes/no), best-corrected visual acuity (BCVA) (logMAR), IOP, ischemia index, skeletonized vessel density, macular thickness (inner inferior, outer temporal regions). Firth's bias-reduced logistic regression showed ischemia index (odds ratio [OR]=13.2, 95% confidence interval [CI]:5.3-30.7, P<0.001) and BCVA (OR=5.8, 95%CI:1.2-28.8, P<0.05) were associated with the presence of NVG. NV metrics, FAZ, and choroidal parameters were not related to NVG. CONCLUSIONS Retinal ischemia but not NV was associated with the presence of NVG in patients with PDR using WF SS-OCTA. Larger, longitudinal studies are needed to validate imaging biomarkers associated with diabetic NVG.
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Affiliation(s)
- Edward S Lu
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Ying Cui
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 243 Charles St, Boston, MA, 02114, USA
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Rongrong Le
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 243 Charles St, Boston, MA, 02114, USA
- Wenzhou Medical University Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ying Zhu
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 243 Charles St, Boston, MA, 02114, USA
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jay C Wang
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 243 Charles St, Boston, MA, 02114, USA
| | - Inês Laíns
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 243 Charles St, Boston, MA, 02114, USA
| | - Raviv Katz
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 243 Charles St, Boston, MA, 02114, USA
| | - Yifan Lu
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | | | - Itika Garg
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 243 Charles St, Boston, MA, 02114, USA
| | - David M Wu
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 243 Charles St, Boston, MA, 02114, USA
| | - Deeba Husain
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 243 Charles St, Boston, MA, 02114, USA
| | - Leo A Kim
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 243 Charles St, Boston, MA, 02114, USA
| | - John B Miller
- Harvard Retinal Imaging Lab, Boston, MA, USA.
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 243 Charles St, Boston, MA, 02114, USA.
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Bleicher I, Miller JB. Giant Retinal Tears: A Review With a Focus on Trauma. Int Ophthalmol Clin 2024; 64:107-123. [PMID: 38525985 DOI: 10.1097/iio.0000000000000491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Affiliation(s)
- Isaac Bleicher
- Department of Ophthalmology, Mass Eye and Ear, Harvard University, Boston, MA
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Gong D, Ross C, Hall N, Ivanov A, Elze T, Sobrin L, Miller JW, Lorch A, Miller JB. Fellow Eyes Conversion Rates in Patients With Unilateral Exudative Age-Related Macular Degeneration: An Academy IRIS ® Registry Analysis. Ophthalmic Surg Lasers Imaging Retina 2024; 55:220-226. [PMID: 38319061 DOI: 10.3928/23258160-20240125-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND AND OBJECTIVE This study aimed to examine conversion rates from non-exudative to exudative age-related macular degeneration (AMD) in the fellow eye of patients with unilateral exudative AMD using the Academy IRIS® Registry. PATIENTS AND METHODS This study was a retrospective, cohort analysis from 2016 to 2019. Patient and disease characteristics including initial AMD stage were collected. Cox proportional-hazard (PH) and logistic regression modeling were performed. RESULTS The risk of conversion was lower for men relative to women and for Asians and Blacks relative to Whites. Compared to never-smokers, active smokers were at increased risk of conversion, and compared to initially early non-exudative AMD eyes, intermediate and advanced non-exudative AMD eyes had higher rates of conversion. Compared to active choroidal neovascularization eyes, eyes with inactive choroidal neovascularization and inactive scars had lower rates of fellow eye conversion. CONCLUSIONS In this cohort analysis of unilateral exudative AMD patients, women, Whites, and active smokers had higher rates of non-exudative to exudative AMD conversion in the fellow eye. [Ophthalmic Surg Lasers Imaging Retina 2024;55:220-226.].
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Choi H, Vingopoulos F, Razavi P, Garcia MD, Garg I, Rodriguez J, Finn M, Baldwin G, Romano F, Ding X, Bannerman A, Tracy J, Wescott H, Husain D, Kim LA, Vavvas DG, Miller JB. Quantitative Contrast Sensitivity Function and the Effect of Aging in Healthy Adult Eyes: A Normative Database. Ophthalmic Surg Lasers Imaging Retina 2024; 55:212-219. [PMID: 38319059 DOI: 10.3928/23258160-20240124-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND AND OBJECTIVE We sought to establish normative quantitative contrast sensitivity function (qCSF) values in healthy adult eyes and investigate the effect of age on qCSF. PATIENTS AND METHODS Healthy eyes underwent qCSF testing (adaptive sensory technology) and Snellen's visual acuity (VA). Descriptive statistics and mixed-effects multivariable linear regressions were evaluated. RESULTS A total of 334 eyes (290 patients) with median age 61 years (range 21 to 88) had qCSF values as follows: area under the log contrast sensitivity function curve: 1.18; contrast acuity: 1.32; contrast sensitivity (CS) at 1 cycle per degree (cpd): 1.32; CS at 1.5 cpd: 1.37; CS at 3 cpd: 1.38; CS at 6 cpd: 1.20; CS at 12 cpd: 0.69; CS at 18 cpd: 0.22. Linear reductions in qCSF values per decade of age ranged from -0.02 to -0.07 vs 0.01 for visual acuity (VA). Age had a greater effect on the majority of qCSF values than VA (beta standardized regression coefficient ranged from -0.309 to -0.141 for qCSF values vs 0.177 for VA). CONCLUSIONS We herein establish a normative database for qCSF and quantify the effect of age on qCSF values, adding evidence towards the validation of qCSF as a clinical endpoint. [Ophthalmic Surg Lasers Imaging Retina 2024;55:212-219.].
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Akotoye C, Hoyek S, Garg I, Singh N, Miller JB, Sobrin L, Patel NA. En Face Depth Resolved OCTA Monitoring of Macular Outer Retinal Deposits in a Case of Multifocal Choroiditis Mimicking Syphilitic Uveitis. Retin Cases Brief Rep 2024:01271216-990000000-00312. [PMID: 38569172 DOI: 10.1097/icb.0000000000001576] [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] [Indexed: 04/05/2024]
Abstract
PURPOSE Multifocal choroiditis (MFC) is a rare inflammatory condition characterized by retinal and choroidal lesions that may present similarly to ocular pathology of various etiologies. Here we present a case of MFC mimicking syphilitic uveitis with unique en face optical coherence tomography angiography (OCTA) imaging characteristics. METHODS Case report. RESULTS A 61-year-old woman presented with blurry vision, floaters and multiple whitish subretinal deposits on en face swept-source OCTA in the left eye. Fluorescent treponemal antibody test absorption was positive which led to the initial diagnosis of syphilitic uveitis and subsequent treatment with intravenous penicillin. During follow-up, OCTA of the left eye revealed the development of new choroidal neovascular membrane and new punched-out lesions in the posterior pole. The patient was eventually diagnosed with MFC and treated with aflibercept injections. CONCLUSIONS Immune-mediated uveitis can simulate infectious and neoplastic uveitis. En face OCTA is unique imaging modality that allowed for the complete characterization and monitoring of the sub-macular deposits. This expands the clinical spectrum of multifocal choroiditis.
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Affiliation(s)
- Christian Akotoye
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Sandra Hoyek
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Itika Garg
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Nakul Singh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - John B Miller
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Lucia Sobrin
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Nimesh A Patel
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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Finn MJ, Baldwin G, Lains I, Garg I, Wescott H, Vingopoulos F, Zeng R, Choi H, Tracy J, Razavi P, Sayeh D, Patel NA, Wu DM, Vavvas DG, Miller JB. Widefield, Swept-Source Optical Coherence Tomography Angiography Metrics as Predictors of Anti-VEGF Treatment in Retinal Vein Occlusions. Ophthalmic Surg Lasers Imaging Retina 2024:1-9. [PMID: 38531003 DOI: 10.3928/23258160-20240208-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND AND OBJECTIVE Our objective was to assess baseline widefield swept-source optical coherence tomography angiography (WF SSOCTA) microvascular metrics as predictors for the number of anti-vascular endothelial growth factor (VEGF) injections and visual acuity (VA) at 12-months follow-up in patients with retinal vein occlusion (RVO). PATIENTS AND METHODS This was a prospective study including 49 RVO eyes from 49 patients who had not received an anti-VEGF injection for at least 3 months prior to imaging. Microvascular metrics from 6×6-mm and 12×12-mm angiograms were assessed using linear regression models, adjusting for age. RESULTS Reductions in the vessel density (VD) and vessel skeletonized density (VSD) vascular metrics were associated both with a higher number of anti-VEGF injections at all follow-up time points and reduced VA 12 months after imaging in all RVO eyes. CONCLUSIONS WF SS-OCTA VD and VSD micro-vascular metrics at baseline can prognosticate VA and number of anti-VEGF injections required at 3, 6, and 12 months in RVO eyes. [Ophthalmic Surg Lasers Imaging Retina 2024;55:xx-xx.].
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Razavi P, Baldwin G, Vingopoulos F, Garg I, Tracy J, Wescott H, Choi H, Zeng R, Lains I, Husain D, Kim LA, Vavvas DG, Miller JB. Associations of quantitative contrast sensitivity with wide-field swept-source optical coherence tomography angiography in retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 2024; 262:789-799. [PMID: 37955700 DOI: 10.1007/s00417-023-06288-7] [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: 05/08/2023] [Revised: 09/20/2023] [Accepted: 10/19/2023] [Indexed: 11/14/2023] Open
Abstract
PURPOSE To investigate associations between contrast sensitivity (CS) and vascular metrics on wide-field swept-source optical coherence tomography angiography (WF-SS-OCTA) in patients with retinal vein occlusion (RVO). METHODS This prospectively recruited, cross-sectional observational study included RVO patients who underwent quantitative CS function (qCSF) testing and WF-SS-OCTA using 3 × 3, 6 × 6, and 12 × 12 mm angiograms on the same day. The study measured several qCSF outcomes and WF-SS-OCTA vascular metrics, including vessel density (VD), vessel skeletonized density (VSD), and foveal avascular zone (FAZ). The data were analyzed using multivariable regression analysis controlling for age and central subfield thickness (CST). RESULTS A total of 43 RVO eyes of 43 patients and 30 fellow eyes were included. In RVO eyes, multiple vascular metrics were associated with CS outcomes but not visual acuity (VA). On 12 × 12 images, CS thresholds at 1 cpd, 1.5 cpd, and 3 cpd were significantly associated with VD and VSD, but VA was not. When comparing standardized regression coefficients, we found that vascular metrics had a larger effect size on CS than on VA. For instance, the standardized beta coefficient for FAZ area and CS at 6 cpd (β* = - 0.46, p = 0.007) was larger than logMAR VA (β* = 0.40, p = 0.011). CONCLUSION Microvascular changes on WF-SS-OCTA in RVO had a larger effect size on CS than VA. This suggests CS may better reflect the microvascular changes of RVO compared to VA. qCSF-measured CS might be a valuable adjunct functional metric in evaluating RVO patients.
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Affiliation(s)
| | | | | | - Itika Garg
- Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Jack Tracy
- Harvard Retinal Imaging Lab, Boston, MA, USA
| | | | - Hanna Choi
- Harvard Retinal Imaging Lab, Boston, MA, USA
| | | | - Ines Lains
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Deeba Husain
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Leo A Kim
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | | | - John B Miller
- Harvard Retinal Imaging Lab, Boston, MA, USA.
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA.
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Finn M, Vingopoulos F, Zhao Y, Zhou P, Bannerman A, Romano F, Ding X, Hassan Z, Patel NA, Wu DM, Miller JB. Test-retest repeatability and agreement of the quantitative contrast sensitivity function test: towards the validation of a new clinical endpoint. Graefes Arch Clin Exp Ophthalmol 2024; 262:813-822. [PMID: 37955702 DOI: 10.1007/s00417-023-06291-y] [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: 09/18/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023] Open
Abstract
PURPOSE The purpose of this study is to investigate test-retest reliability and agreement of the quantitative contrast sensitivity function test (qCSF) in the retina clinic. METHODS A total of 121 right eyes of 121 patients were tested and consecutively re-tested with qCSF in the retina clinic. Outcomes included area under the logarithm of contrast sensitivity function curve (AULCSF), contrast acuity, and contrast sensitivity thresholds at 1-18 cycles per degree (cpd). Test-retest means were compared with paired t-test, variability was compared with the Brown-Forsythe test, and intraclass correlation coefficient (ICC) and Bland Altman plots evaluated reliability and agreement. RESULTS Mean test-retest differences for all qCSF metrics ranged from 0.02 to 0.05 log units without statistically significant differences in variability. Standard deviations ranged from 0.08 to 0.14. Coefficients of repeatability ranged from 0.16 to 0.27 log units. ICC > 0.9 for all metrics except 1cpd (ICC = 0.84, all p < 0.001); AULCSF ICC = 0.971. CONCLUSION qCSF-measured contrast sensitivity shows great test-retest repeatability and agreement in the retina clinic.
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Affiliation(s)
- Matthew Finn
- Harvard Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA
| | - Filippos Vingopoulos
- Harvard Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA
| | - Yan Zhao
- Harvard Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Paul Zhou
- Harvard Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA
| | - Augustine Bannerman
- Harvard Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA
| | - Francesco Romano
- Harvard Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA
| | - Xinyi Ding
- Harvard Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA
| | - Zakariyya Hassan
- Harvard Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA
| | - Nimesh A Patel
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA
| | - David M Wu
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA
| | - John B Miller
- Harvard Retinal Imaging Lab, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA.
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Tandias R, Garg I, Duich MJ, Vingopoulos F, Katz R, Zeng R, Kim LA, Husain D, Eliott D, Patel NA, Miller JB. Assessment of Microvascular Changes After Rhegmatogenous Retinal Detachment Repair Using Wide-Field Swept-Source Optical Coherence Tomography Angiography. Ophthalmic Surg Lasers Imaging Retina 2024:1-8. [PMID: 38530997 DOI: 10.3928/23258160-20240130-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND AND OBJECTIVE Our objective was to evaluate retinal microvascular changes and visual outcomes following rhegmatogenous retinal detachment (RRD) repair using wide-field swept-source optical coherence tomography angiography (WF SS-OCTA). PATIENTS AND METHODS The study included 116 eyes of 111 patients with macula-off (n = 68) or macula-on (n = 48) RRD treated with a single successful procedure, 79 fellow eyes, and 183 eyes of control patients imaged with WF SS-OCTA (3 ×3, 6 ×6, and 12 ×12 mm images). Mixed-effects multiple linear regression models were used for statistical analysis. RESULTS Vessel density (VD) and vessel skeletonized density (VSD) of the superficial capillary plexus (3 ×3 mm scans) and full-thickness retina (12 ×12 mm) were significantly reduced in RRD eyes compared to fellow and control eyes. Decreased VSD and VD in all layers (3 ×3 mm and 6 ×6 mm) were significantly associated with greater preoperative extent of retinal detachment (P < 0.05) and poorer postoperative best-corrected visual acuity (BCVA) in RRD eyes (P < 0.05). Macula-off status was associated with increased foveal avascular zone irregularity (12 ×12 mm, P = 0.02). CONCLUSIONS Decreased VD on WF SS-OCTA is associated with poorer postoperative BCVA following RRD repair. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].
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Cakir B, Peacker BL, Zeng R, Tracy JH, Feng Y, Miller JB. Extensive Endolaser During Vitrectomy for Primary Rhegmatogenous Retinal Detachment Is Associated with Epiretinal Membrane Formation. Ophthalmic Surg Lasers Imaging Retina 2024:1-8. [PMID: 38531000 DOI: 10.3928/23258160-20240131-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND AND OBJECTIVE Epiretinal membrane (ERM) formation, a common complication following pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD) repair, is associated with vision loss and metamorphopsias. Although laser retinopexy is generally associated with ERM formation, the correlation between the extent of laser treatment and ERM formation during PPV is not well established. The aim of this study was to identify risk factors associated with ERM formation including extend of endolaser retinopexy after PPV for primary RRD. PATIENTS AND METHODS A retrospective, observational case series of 181 consecutive patients (185 eyes) who underwent PPV for primary RRD repair by a single surgeon was performed. Charts were reviewed by two independent reviewers, and de-identified data including patient characteristics and intraoperative findings such as number of laser spots placed were recorded. RESULTS Postoperative ERM formation occurred in 75 eyes (40.5%) of which 68 (90.6%) were Stage 1, two (2.6%) were Stage 2, three (4%) were Stage 3, and two (2.6%) were Stage 4. Only one patient required secondary PPV for visually significant ERM. Patients with ERM had significantly more laser spots compared with patients with no ERM, with a mean of 807 and 519 laser spots respectively (95% CI: 387.6 to -187.3; P < 0.0001). Univariable analysis identified ≥750 endolaser spots (odds ratio [OR] = 4.0, 95% CI: 2.0 to 8.4; P < 0.0001), ≥4 retinal tears (OR = 2.8, 95%: CI 1.4 to 6.4; P = 0.005), and female sex (OR = 2.0, 95% CI: 1.1 to 3.7; P = 0.02) as significantly associated factors. After adjusting for potential confounding factors (ie, age, sex, macula status, lattice degeneration, length of symptoms, vitreous hemorrhage, number of endolaser spots, number of retinal tears) in multivariable logistic regression, ≥ 750 endolaser spots (OR = 2.4; P = 0.04) and female sex (OR = 2.4; P = 0.03) persisted as significant independent factors. CONCLUSIONS Our study identified ≥ 750 laser spots and female sex as independent risk factors for ERM formation following PPV for RRD with an OR of 2.4 each. Although the incidence of ERM formation was generally high (40.5%), only one case required secondary PPV with ERM peeling, and visual outcomes were comparable between patients with and without ERM at final follow up. While endolaser photocoagulation is critical for successful RRD repair, consideration of the risk of ERM formation with extensive laser exposure is warranted. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].
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14
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Romano F, Ding X, Miller JB. Expanded field: filling the gap between macula and widefield. Eye (Lond) 2024:10.1038/s41433-024-02978-6. [PMID: 38383635 DOI: 10.1038/s41433-024-02978-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 01/09/2024] [Accepted: 01/31/2024] [Indexed: 02/23/2024] Open
Affiliation(s)
- Francesco Romano
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA
| | - Xinyi Ding
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA
| | - John B Miller
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, USA.
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15
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Razavi P, Baldwin G, Garg I, Velazquez LM, Garcia M, Gan J, Choi H, Zeng R, Vingopoulos F, Husain D, Kim LA, Patel NA, Miller JB. Changes in wider field swept-source OCT angiography vascular metrics with anti-vascular endothelial growth factor therapy in central retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06410-3. [PMID: 38376563 DOI: 10.1007/s00417-024-06410-3] [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: 08/31/2023] [Revised: 01/21/2024] [Accepted: 02/02/2024] [Indexed: 02/21/2024] Open
Abstract
PURPOSE To investigate the impact of anti-VEGF therapy on vascular metrics in eyes with macular edema secondary to central retinal vein occlusion (CRVO) using wider field swept-source OCT angiography (WF SS-OCTA). METHODS We included 23 eyes with macular edema associated with non-ischemic CRVO from 22 patients treated with anti-VEGF therapy (median number of injections: 5 [2-9]). Changes in vessel density (VD), vessel skeletonized density (VSD), and foveal avascular zone (FAZ) parameters were measured using WF SS-OCTA. Visual acuity (VA) and central subfield thickness (CST) were also measured. RESULTS Median CST decreased significantly from 369 µm (305-531) to 267 µm (243-300, p < 0.001). VD and VSD parameters in 12 × 12 mm images showed significant reductions. For instance, VSD in the whole retina decreased from a median of 13.37 (11.22-13.74) to 11.29 (9.36-12.97, p = 0.013). Additionally, a significant increase in FAZ circularity was found, suggesting improved microvascular integrity. Significant inverse correlations were found between the number of anti-VEGF injections and all VSD and VD parameters on the 12 × 12 mm images (p < 0.05). Notably, the reductions in VSD and VD on 12 × 12 mm angiograms in the deep capillary plexus (DCP) after each injection significantly correlated with increased logMAR VA (worse VA). CONCLUSION Anti-VEGF therapy in CRVO patients not only mitigates macular edema but also alters the overall microvascular morphology and functionality as revealed by WF SS-OCTA.
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Affiliation(s)
| | | | - Itika Garg
- Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Luis Martinez Velazquez
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | | | - Jenny Gan
- Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Hanna Choi
- Harvard Retinal Imaging Lab, Boston, MA, USA
| | | | | | - Deeba Husain
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Leo A Kim
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Nimesh A Patel
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - John B Miller
- Harvard Retinal Imaging Lab, Boston, MA, USA.
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA.
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Retinal Imaging Lab, Harvard Medical School, 243 Charles St., Boston, MA, 02114, USA.
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16
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Miller JB, Rebman AW, de Flores MDV, Wang H, Darrah E, Aucott JN. Annexin A2 antibodies in post-treatment Lyme disease. Ther Adv Infect Dis 2024; 11:20499361241242971. [PMID: 38559699 PMCID: PMC10981857 DOI: 10.1177/20499361241242971] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/13/2024] [Indexed: 04/04/2024] Open
Abstract
Background Anti-annexin A2 (AA2) antibodies have been described in Lyme arthritis and erythema migrans, although they have not been described in post-treatment Lyme disease (PTLD). Objectives Determine whether anti-AA2 antibodies are present among patients with PTLD and determine the clinical relevance of these antibodies. Design and methods Anti-AA2 levels were tested serially in a longitudinal cohort of 44 patients with acute Lyme disease, 22 with a return to health (EM RTH), and 22 with PTLD. Anti-AA2 antibodies were also assessed in a cross-sectional group of 281 patients with PTLD. Results Anti-AA2 antibodies were highest after antimicrobial therapy in both the EM RTH and PTLD cohorts. By 6 months, there was no difference between EM RTH and healthy controls. Anti-AA2 antibodies were higher in the cross-sectional PTLD group (79.69 versus 48.22 units, p < 0.0001), though with no difference in total symptom burden. Conclusion Anti-AA2 persists in PTLD, though did not identify a clinical phenotype.
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Affiliation(s)
- John B. Miller
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Mason F Lord Building Center Tower, Suite 4100, Baltimore, MD 21224, USA
| | - Alison W. Rebman
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Hong Wang
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Erika Darrah
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John N. Aucott
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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17
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Lains I, Han X, Gil J, Providencia J, Nigalye A, Alvarez R, Douglas VP, Mendez K, Katz R, Tsougranis G, Li J, Kelly RS, Kim IK, Lasky-Su J, Silva R, Miller JW, Liang L, Vavvas D, Miller JB, Husain D. Plasma Metabolites Associated with OCT Features of Age-Related Macular Degeneration. Ophthalmol Sci 2024; 4:100357. [PMID: 37869026 PMCID: PMC10587636 DOI: 10.1016/j.xops.2023.100357] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/13/2023] [Accepted: 06/06/2023] [Indexed: 10/24/2023]
Abstract
Purpose The most widely used classifications of age-related macular degeneration (AMD) and its severity stages still rely on color fundus photographs (CFPs). However, AMD has a wide phenotypic variability that remains poorly understood and is better characterized by OCT. We and others have shown that patients with AMD have a distinct plasma metabolomic profile compared with controls. However, all studies to date have been performed solely based on CFP classifications. This study aimed to assess if plasma metabolomic profiles are associated with OCT features commonly seen in AMD. Design Prospectively designed, cross-sectional study. Participants Subjects with a diagnosis of AMD and a control group (> 50 years old) from Boston, United States, and Coimbra, Portugal. Methods All participants were imaged with CFP, used for AMD staging (Age-Related Eye Disease Study 2 classification scheme), and with spectral domain OCT (Spectralis, Heidelberg). OCT images were graded by 2 independent graders for the presence of characteristic AMD features, according to a predefined protocol. Fasting blood samples were collected for metabolomic profiling (using nontargeted high-resolution mass spectrometry by Metabolon Inc). Analyses were conducted using logistic regression models including the worst eye of each patient (AREDS2 classification) and adjusting for confounding factors. Each cohort (United States and Portugal) was analyzed separately and then results were combined by meta-analyses. False discovery rate (FDR) was used to account for multiple comparisons. Main Outcome Measures Plasma metabolite levels associated with OCT features. Results We included data on 468 patients, 374 with AMD and 94 controls, and on 725 named endogenous metabolites. Meta-analysis identified significant associations (FDR < 0.05) between plasma metabolites and 3 OCT features: hyperreflective foci (6), atrophy (6), and ellipsoid zone disruption (3). Most associations were seen with amino acids, and all but 1 metabolite presented specific associations with the OCT features assessed. Conclusions To our knowledge, we show for the first time that plasma metabolites have associations with specific OCT features seen in AMD. Our results support that the wide spectrum of presentations of AMD likely include different pathophysiologic mechanisms by identifying specific pathways associated with each OCT feature. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Ines Lains
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Xikun Han
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, Massachusetts
- Program in Genetic Epidemiology and Statistical Genetics, Harvard T H Chan School of Public Health, Boston, Massachusetts
| | - João Gil
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - Joana Providencia
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - Archana Nigalye
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Rodrigo Alvarez
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Vivian Paraskevi Douglas
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Kevin Mendez
- Systems Genetics and Genomics Unit, Channing Division of Network Medicine Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Raviv Katz
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Gregory Tsougranis
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Jinglun Li
- Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, Massachusetts
| | - Rachel S. Kelly
- Systems Genetics and Genomics Unit, Channing Division of Network Medicine Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ivana K. Kim
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Jessica Lasky-Su
- Systems Genetics and Genomics Unit, Channing Division of Network Medicine Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Rufino Silva
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
- Clinical Academic Center of Coimbra (CCAC), Coimbra, Portugal
| | - Joan W. Miller
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Liming Liang
- Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, Massachusetts
| | - Demetrios Vavvas
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - John B. Miller
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Deeba Husain
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
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Kiely C, Douglas KAA, Douglas VP, Miller JB, Lizano P. Overlap between ophthalmology and psychiatry - A narrative review focused on congenital and inherited conditions. Psychiatry Res 2024; 331:115629. [PMID: 38029629 PMCID: PMC10842794 DOI: 10.1016/j.psychres.2023.115629] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 12/01/2023]
Abstract
A number of congenital and inherited diseases present with both ocular and psychiatric features. The genetic inheritance and phenotypic variants play a key role in disease severity. Early recognition of the signs and symptoms of those disorders is critical to earlier intervention and improved prognosis. Typically, the associations between these two medical subspecialties of ophthalmology and psychiatry are poorly understood by most practitioners so we hope to provide a narrative review to improve the identification and management of these disorders. We conducted a comprehensive review of the literature detailing the diseases with ophthalmic and psychiatric overlap that were more widely represented in the literature. Herein, we describe the clinical features, pathophysiology, molecular biology, diagnostic tests, and the most recent approaches for the treatment of these diseases. Recent studies have combined technologies for ocular and brain imaging such as optical coherence tomography (OCT) and functional imaging with genetic testing to identify the genetic basis for eye-brain connections. Additional work is needed to further explore these potential biomarkers. Overall, accurate, efficient, widely distributed and non-invasive tests that can help with early recognition of these diseases will improve the management of these patients using a multidisciplinary approach.
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Affiliation(s)
- Chelsea Kiely
- Department of Psychiatry, Beth Israel Deaconess Medical Center, 75 Fenwood Rd, 612, Boston, MA, United States
| | - Konstantinos A A Douglas
- Department of Psychiatry, Beth Israel Deaconess Medical Center, 75 Fenwood Rd, 612, Boston, MA, United States; Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, United States
| | | | - John B Miller
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, United States; Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA, United States; Department of Ophthalmology, Harvard Medical School, Boston, MA, United States
| | - Paulo Lizano
- Department of Psychiatry, Beth Israel Deaconess Medical Center, 75 Fenwood Rd, 612, Boston, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Division of Translational Neuroscience, Beth Israel Deaconess Medical Center, Boston, MA, United States.
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19
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Bleicher ID, Garg I, Hoyek S, Place E, Miller JB, Patel NA. WIDEFIELD SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FINDINGS IN WAGNER SYNDROME. Retin Cases Brief Rep 2024; 18:80-86. [PMID: 36007184 DOI: 10.1097/icb.0000000000001307] [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: 04/16/2022] [Accepted: 07/19/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To describe novel clinical and angiographic findings in Wagner syndrome. METHODS A retrospective case series of three related patients with Wagner syndrome. Patients underwent standard optical coherence tomography (OCT), B-scan ultrasonography, and fluorescein angiography in addition to wide field swept-source OCT angiography (WF SS-OCTA) (PLEX Elite 9000, Carl Zeiss Meditec Inc). Patients underwent genetic testing for a panel of hereditary vitreoretinopathies. RESULTS Three related patients with Wagner syndrome were identified. All were found to have prominent vitreous strands, abnormal vitreoretinal adhesions, peripheral retinal holes, and varying degrees of myopia. A mid-peripheral tractional ridge was identified in all six eyes. All patients were positive for a known pathologic intron variant in the VCAN gene (4004-5T-A). Wide field swept-source OCT angiography (12 mm × 12 mm) was performed in two patients and demonstrated perivascular capillary loss in the superficial capillary plexus along the arcades bilaterally. One patient demonstrated associated retinal atrophy within the area of capillary loss. The capillary loss extended beyond the margin of retinal atrophy. CONCLUSION The unusual finding of a mid-peripheral tractional ridge of the retina associated with myopia led to a genetic diagnosis of Wagner syndrome. Widefield swept-source OCT angiography demonstrated a novel feature of perivascular loss of the superficial retinal capillary plexus. This result suggests that vitreous traction may cause localized microvasculature dysfunction and subsequent retinal atrophy in Wagner syndrome. This is the first known evaluation of Wagner syndrome using OCT angiography.
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Affiliation(s)
- Isaac D Bleicher
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; and
- Harvard Retinal Imaging Lab, Boston, Massachusetts
| | - Itika Garg
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; and
- Harvard Retinal Imaging Lab, Boston, Massachusetts
| | - Sandra Hoyek
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; and
| | - Emily Place
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; and
| | - John B Miller
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; and
- Harvard Retinal Imaging Lab, Boston, Massachusetts
| | - Nimesh A Patel
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; and
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20
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Sayah DN, Garg I, Katz R, Zhu Y, Cui Y, Zeng R, Tandias R, Moon JY, Vingopoulos F, Wescott HE, Baldwin G, Wang K, Elze T, Ludwig CA, Vavvas DG, Miller JW, Husain D, Kim LA, Patel NA, Miller JB. Characterizing Macular Neovascularization in Myopic Macular Degeneration and Age-Related Macular Degeneration Using Swept Source OCTA. Clin Ophthalmol 2023; 17:3855-3866. [PMID: 38105914 PMCID: PMC10725687 DOI: 10.2147/opth.s440575] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose Visual prognosis and treatment burden for macular neovascularization (MNV) can differ between myopic macular degeneration (MMD) and age-related macular degeneration (AMD). We describe and compare MNV associated with MMD and AMD using swept-source (SS)-OCTA. Patients and Methods Adult patients with documented MNV associated with MMD or AMD were consecutively recruited. Qualitative and quantitative features were assessed from 6x6mm angiograms, including the MNV area and vessel density (VD). Descriptive statistics and linear regression analyses were carried out. Results Out of 75 enrolled eyes with diagnosed MNV (30 MMD-MNV and 45 AMD-MNV; mean age 55±19 and 75±8 years, respectively), 44 eyes had discernible MNV (11 MMD-MNV and 33 AMD-MNV) on SS-OCTA at the time of the study and were included in the analysis. The MMD-MNV group exhibited a three-fold smaller sized MNV (p=0.001), lower greatest linear dimension (p=0.009) and greatest vascular caliber (p<0.001) compared to AMD-MNVs, and had a higher prevalence of tree-in-bud pattern. Eyes with AMD showed a higher prevalence of type 1 MNVs with medusa pattern. There was no difference in the location of the MNV, shape's regularity, margins, presence of core vessel, capillary fringe, peripheral loops, or perilesional dark halo (p>0.05) between both conditions. After adjustment, decreased MNV area and increased VD were associated with the tree-in-bud pattern, whereas the diagnosis did not significantly influence those parameters. Conclusion While larger studies are warranted, this study is the first to describe and compare MMD-MNV and AMD-MNV using SS-OCTA, providing relevant clinical insight on MNV secondary to MMD and AMD. These findings also further validate OCTA as a powerful tool to detect and characterize MNV non-invasively.
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Affiliation(s)
- Diane N Sayah
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- College of Optometry, University of Houston, Houston, TX, USA
| | - Itika Garg
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Raviv Katz
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Ying Zhu
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
| | - Ying Cui
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China
| | - Rebecca Zeng
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Rachel Tandias
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Jade Y Moon
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Filippos Vingopoulos
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Hannah E Wescott
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Grace Baldwin
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Kira Wang
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Tobias Elze
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Cassie Ann Ludwig
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Demetrios G Vavvas
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Joan W Miller
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Deeba Husain
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Leo A Kim
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Nimesh A Patel
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - John B Miller
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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21
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Seddon IA, Rahimy E, Miller JB, Charles S, Kitchens J, Houston SK. Feasibility and Potential for Real-Time 3D Vitreoretinal Surgery Telementoring. Retina 2023; 43:2162-2165. [PMID: 36731001 DOI: 10.1097/iae.0000000000003656] [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] [Indexed: 02/04/2023]
Abstract
PURPOSE To demonstrate the potential for real-time, three-dimensional (3D) surgical telementoring to enhance vitreoretinal surgical education. METHODS The 3D video feed from a high dynamic range surgical camera (NGENUITY) was run through a 4K video capture device (Magewell USB 4K) and set as the video input for a video conferencing application (Zoom). Remote surgical viewing was then performed in two-dimensions (2D) on a computer or in 3D with a virtual reality headset (Oculus Quest 2). RESULTS Ten surgical cases were successfully live streamed in real time to two separate surgeons in the United States. Specific details of the case were visualized with low latency and interaction with the operating surgeon was possible without affecting the surgical display quality. Excluding the NGENUITY system and personal computers, ancillary equipment costs (video capture card and virtual reality headset) were kept to below $1,000. CONCLUSION Our study demonstrates that 3D surgical video streaming can be achieved in real time with minimal latency through the use of low-cost video capture equipment and video conferencing/streaming software. The use of this technology gives educators the ability to mentor trainees without the traditional geographic and physical constraints of in-person surgical viewing.
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Affiliation(s)
- Ian A Seddon
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida
- Florida Retina Institute, Orlando, Florida
| | - Ehsan Rahimy
- Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, California
- Retina Service, Stanford University, Palo Alto, California
| | - John B Miller
- Retina Service, Massachusetts Eye and Ear Institute, Boston, Massachusetts
| | - Steve Charles
- Charles Retina Institute, Germantown, Tennessee; and
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22
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Lu ES, Yuan A, Cohen DA, Katz R, Miller JB, Gaier ED. Detection of Choroidal Hypoperfusion in Giant Cell Arteritis Using Swept-Source Optical Coherence Tomographic Angiography. J Neuroophthalmol 2023; 43:e117-e119. [PMID: 35234684 PMCID: PMC9402803 DOI: 10.1097/wno.0000000000001485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Edward S. Lu
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA
- Department of Ophthalmology, Harvard Medical School, Boston, MA
- Harvard Retinal Imaging Lab
| | - Amy Yuan
- Department of Ophthalmology, University of Washington School of Medicine, Seattle, WA
| | - Devon A. Cohen
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA
- Department of Ophthalmology, Harvard Medical School, Boston, MA
| | - Raviv Katz
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA
- Department of Ophthalmology, Harvard Medical School, Boston, MA
- Harvard Retinal Imaging Lab
| | - John B. Miller
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA
- Department of Ophthalmology, Harvard Medical School, Boston, MA
- Harvard Retinal Imaging Lab
| | - Eric D. Gaier
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA
- Department of Ophthalmology, Harvard Medical School, Boston, MA
- Department of Ophthalmology, Boston Children’s Hospital, Boston, MA
- Picower Institute for Learning and Memory, Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA
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23
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Rudnick ND, Vingopoulos F, Wang JC, Garg I, Cui Y, Zhu Y, Le R, Katz R, Lu Y, Patel NA, Miller JB. Characterising collateral vessels in eyes with branch retinal vein occlusions using widefield swept-source optical coherence tomography angiography. Br J Ophthalmol 2023; 107:1887-1891. [PMID: 36323493 DOI: 10.1136/bjo-2021-320356] [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: 08/31/2021] [Accepted: 10/15/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND/AIMS To characterise the morphology, location and functional significance of both macular and extramacular collateral vessels (CVs) in patients with a history of branch retinal vein occlusion (BRVO) using widefield swept-source optical coherence tomography angiography (WF SS OCTA). METHODS Patients with a history of BRVO underwent WF SS OCTA testing to acquire 12×12 mm images, which were evaluated for CVs and non-perfusion area (NPA). Region of interest analysis of individual CVs was performed to identify correlations between CV size, depth and retinal location. Mixed effects multivariate regression analyses of factors associated with NPA and visual acuity (VA) were performed. RESULTS Fifty-five CVs were identified in 28 BRVO eyes from 27 patients. CVs were identified in 42.9% (12/28) of eyes with a history of BRVO, and of these, 45.5% (25/55) were extramacular. The majority of CVs (87.3%, 48/55) coursed through both the superficial and the deep capillary plexus (DCP), while a subset (12.7%, 7/55) were strictly superficial. No CVs were found to course strictly through the DCP alone. CV depth increased with distance from the optic disc (p=0.011) and CV size increased with distance from the fovea (p=0.005). There were no statistically significant associations between CVs and NPA, or between CVs and VA. CONCLUSIONS WF SS OCTA revealed that a large fraction of CVs that form after BRVO are extramacular, and the morphology of CVs varies as a function of retinal location. Depth-resolved study of CVs may offer valuable insights on the pathophysiological mechanisms leading to the development of macular oedema.
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Affiliation(s)
- Noam D Rudnick
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Retinal Imaging Laboratory, Boston, Massachusetts, USA
| | - Filippos Vingopoulos
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Retinal Imaging Laboratory, Boston, Massachusetts, USA
| | - Jay C Wang
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Retinal Imaging Laboratory, Boston, Massachusetts, USA
- Department of Ophthalmology & Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Itika Garg
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Retinal Imaging Laboratory, Boston, Massachusetts, USA
| | - Ying Cui
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Retinal Imaging Laboratory, Boston, Massachusetts, USA
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ying Zhu
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Retinal Imaging Laboratory, Boston, Massachusetts, USA
- Eye Center of Xiangya Hospital, Department of Ophthalmology, Central South University, Changsha, China
| | - Rongrong Le
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Retinal Imaging Laboratory, Boston, Massachusetts, USA
- Department of Ophthalmology, Wenzhou Medical University, Wenzhou, China
| | - Raviv Katz
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Retinal Imaging Laboratory, Boston, Massachusetts, USA
| | - Yifan Lu
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Retinal Imaging Laboratory, Boston, Massachusetts, USA
| | - Nimesh A Patel
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - John B Miller
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Retinal Imaging Laboratory, Boston, Massachusetts, USA
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24
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Baldwin G, Vingopoulos F, Garg I, Moon JY, Zeng R, Cui Y, Katz R, Le R, Lu ES, Sayah DN, Hassan Z, Kim LA, Elze T, Husain D, Miller JB. Structure-function associations between contrast sensitivity and widefield swept-source optical coherence tomography angiography in diabetic macular edema. Graefes Arch Clin Exp Ophthalmol 2023; 261:3113-3124. [PMID: 37278906 DOI: 10.1007/s00417-023-06086-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/09/2023] [Accepted: 04/21/2023] [Indexed: 06/07/2023] Open
Abstract
PURPOSE To evaluate the relationship between contrast sensitivity (CS) and widefield swept-source optical coherence tomography angiography (WF SS-OCTA) vascular metrics in diabetic macular edema (DME) was the purpose. METHODS This prospectively enrolled cross-sectional observational study included 61 eyes of 48 patients that were tested with the quantitative CS function (qCSF) test on the same day as imaging with WF SS-OCTA (PLEX® Elite 9000, Carl Zeiss Meditec) 3 × 3, 6 × 6, and 12 × 12 mm scans. Outcomes included visual acuity (VA) and multiple qCSF metrics. Vascular metrics included vessel density (VD) and vessel skeletonized density (VSD) in the superficial (SCP) and deep capillary plexus (DCP) and whole retina (WR) and foveal avascular zone (FAZ) parameters. Mixed effects multivariable linear regression models controlling for age, lens status, and diabetic retinopathy stage were performed. Standardized beta coefficients were calculated by refitting the standardized data. RESULTS SS-OCTA metrics had a significant association with CS and VA. The effect size of OCTA metrics was larger on CS compared to VA. For example, the standardized beta coefficients for VSD and CS at 3 cpd (βSCP = 0.76, βDCP = 0.71, βWR = 0.72, p < 0.001) were larger than those for VA (βSCP = - 0.55, p < 0.001; βDCP = - 0.43, p = 0.004; βWR = - 0.50, p < 0.001). On 6 × 6 mm images, AULCSF, CS at 3 cpd, and CS at 6 cpd were significantly associated with VD and VSD in all three slab types (SCP, DCP, and WR), while VA was not. CONCLUSION Structure-function associations in patients with DME leveraging the qCSF device suggest microvascular changes on WF SS-OCTA are associated with larger changes in contrast sensitivity than VA.
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Affiliation(s)
- Grace Baldwin
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA
| | - Filippos Vingopoulos
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA
| | - Itika Garg
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA
| | - Jade Y Moon
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA
| | - Rebecca Zeng
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA
| | - Ying Cui
- 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
- Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Rongrong Le
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Wenzhou Medical University Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Edward S Lu
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA
| | - Diane N Sayah
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA
| | | | - Leo A Kim
- Retina Service, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA
| | - Tobias Elze
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, MA, USA
| | - Deeba Husain
- Retina Service, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA
| | - John B Miller
- Harvard Retinal Imaging Lab, Boston, MA, USA.
- Retina Service, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA.
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25
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Vingopoulos F, Bannerman A, Zhou P, Koch T, Wescott HE, Kim L, Vavvas D, Miller JW, Miller JB. Towards the validation of quantitative contrast sensitivity as a clinical endpoint: correlations with vision-related quality of life in bilateral AMD. Br J Ophthalmol 2023:bjo-2023-323507. [PMID: 37857454 DOI: 10.1136/bjo-2023-323507] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/23/2023] [Indexed: 10/21/2023]
Abstract
AIM To investigate if active learning of contrast sensitivity (CS) in bilateral age-related macular degeneration (AMD) correlates better than visual acuity (VA) with vision-related quality of life (VRQoL) using factor analysis-calibrated National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25). METHODS Prospective cross-sectional observational study in 93 patients (186 eyes) with bilateral AMD. CS was measured in one eye at a time with the quantitative CS function (qCSF) method (Adaptive Sensory Technology). Same-day VRQoL was assessed with factor analysis-calibrated NEI VFQ-25 visual function and socioemotional scales. Mixed-effects multiple linear regression analyses evaluated the associations of the qCSF outcomes and VA with the NEI VFQ-25 scales. A subgroup analysis on patients with AMD with VA more than 20/25 in both eyes was performed. RESULTS Compared with VA, CS outcomes were associated with larger effect on both visual function scale (standardised beta coefficients (β*) for area under the logarithm of CSF (AULCSF) curve and CS thresholds at 1.5, 3 and 6 cycles per degree (cpd): β*=0.50, 0.48, 0.52, 0.46, all p<0.001, respectively, vs β*=-0.45 for VA, all p<0.001) and socioemotional scale (β* for AULCSF and CS threshold at 6 cpd: β*=0.44, 0.44 vs β*=-0.42 for VA, all p<0.001). In patients with AMD with VA more than 20/25 in both eyes (N=20), both VFQ-25 scales and all CS outcomes were significantly reduced. CONCLUSIONS qCSF-measured CS strongly correlates with patient-reported VRQoL in bilateral AMD, even stronger than VA does. This study further validates qCSF-measured CS as a promising functional endpoint for future clinical trials in AMD.
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Affiliation(s)
- Filippos Vingopoulos
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Augustine Bannerman
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Paul Zhou
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Thomas Koch
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Hannah E Wescott
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Leo Kim
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Demetrios Vavvas
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Joan W Miller
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - John B Miller
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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Finn M, Baldwin G, Garg I, Wescott HE, Koch T, Vingopoulos F, Zeng R, Choi H, Sayah D, Husain D, Patel NA, Kim LA, Miller JW, Wu DM, Vavvas DG, Miller JB. Comparative study of widefield swept-source optical coherence tomography angiography in eyes with concomitant age-related macular degeneration and diabetic retinopathy. Br J Ophthalmol 2023:bjo-2023-323792. [PMID: 37844999 DOI: 10.1136/bjo-2023-323792] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/03/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND/AIMS We sought to evaluate widefield swept-source optical coherence tomography angiography (WF SS-OCTA) among eyes with concomitant age-related macular degeneration (AMD) and diabetes mellitus or diabetic retinopathy (DM/DR). METHODS This cross-sectional, comparative study consisted of three study groups: eyes with (1) AMD and DM/DR, (2) AMD alone and (3) DM/DR alone. WF SS-OCTA (3×3, 6×6 and 12×12 mm) images were captured. Vascular metrics included foveal avascular zone (FAZ), vessel density (VD) and vessel skeletonised density (VSD). Mixed-effects multivariable regression models adjusted for age were performed by cohort and subgroup based on AMD and DR stages. RESULTS Our cohort included 287 eyes from 186 patients with an average age of 64±14.0 years old. Results revealed significantly reduced vascular metrics in concomitant AMD and DM/DR eyes (N=68) compared with AMD-only eyes (N=71) on all angiograms but not compared with DM/DR-only eyes (N=148). For example, when compared with AMD-only eyes, AMD and DM/DR eyes had significantly reduced VD (β=-0.03, p=0.016) and VSD (β=-1.09, p=0.022) on 12×12 mm angiograms, increased FAZ perimeter (β=0.51, p=0.025) and FAZ area (β=0.11, p=0.015) on 6×6 mm angiogram, and reductions in all VD and VSD metrics on 3×3 and 6×6 mm angiograms. However, only 3×3 mm angiogram FAZ metrics were significantly different when comparing DM/DR eyes with concomitant AMD and DM/DR eyes. CONCLUSION WF SS-OCTA revealed significant reductions in retinal microvasculature metrics in AMD and DM/DR eyes compared with AMD-only eyes but not compared with DM/DR-only eyes.
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Affiliation(s)
- Matthew Finn
- Harvard Retinal Imaging Lab, Harvard Medical School, Boston, Massachusetts, USA
- Retina, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Grace Baldwin
- Harvard Retinal Imaging Lab, Harvard Medical School, Boston, Massachusetts, USA
- Retina, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Itika Garg
- Harvard Retinal Imaging Lab, Harvard Medical School, Boston, Massachusetts, USA
- Retina, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Hannah E Wescott
- Harvard Retinal Imaging Lab, Harvard Medical School, Boston, Massachusetts, USA
- Retina, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Thomas Koch
- Harvard Retinal Imaging Lab, Harvard Medical School, Boston, Massachusetts, USA
- Retina, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Filippos Vingopoulos
- Harvard Retinal Imaging Lab, Harvard Medical School, Boston, Massachusetts, USA
- Retina, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Rebecca Zeng
- Harvard Retinal Imaging Lab, Harvard Medical School, Boston, Massachusetts, USA
- Retina, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Hanna Choi
- Harvard Retinal Imaging Lab, Harvard Medical School, Boston, Massachusetts, USA
- Retina, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Diane Sayah
- Harvard Retinal Imaging Lab, Harvard Medical School, Boston, Massachusetts, USA
- Retina, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Deeba Husain
- Retina, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Nimesh A Patel
- Retina, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Leo A Kim
- Retina, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Joan W Miller
- Retina, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - David M Wu
- Retina, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | | | - John B Miller
- Harvard Retinal Imaging Lab, Harvard Medical School, Boston, Massachusetts, USA
- Retina, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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Gatti LV, Cunha CL, Marani L, Cassol HLG, Messias CG, Arai E, Denning AS, Soler LS, Almeida C, Setzer A, Domingues LG, Basso LS, Miller JB, Gloor M, Correia CSC, Tejada G, Neves RAL, Rajao R, Nunes F, Filho BSS, Schmitt J, Nobre C, Corrêa SM, Sanches AH, Aragão LEOC, Anderson L, Von Randow C, Crispim SP, Silva FM, Machado GBM. Increased Amazon carbon emissions mainly from decline in law enforcement. Nature 2023; 621:318-323. [PMID: 37612502 DOI: 10.1038/s41586-023-06390-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/01/2022] [Accepted: 06/30/2023] [Indexed: 08/25/2023]
Abstract
The Amazon forest carbon sink is declining, mainly as a result of land-use and climate change1-4. Here we investigate how changes in law enforcement of environmental protection policies may have affected the Amazonian carbon balance between 2010 and 2018 compared with 2019 and 2020, based on atmospheric CO2 vertical profiles5,6, deforestation7 and fire data8, as well as infraction notices related to illegal deforestation9. We estimate that Amazonia carbon emissions increased from a mean of 0.24 ± 0.08 PgC year-1 in 2010-2018 to 0.44 ± 0.10 PgC year-1 in 2019 and 0.52 ± 0.10 PgC year-1 in 2020 (± uncertainty). The observed increases in deforestation were 82% and 77% (94% accuracy) and burned area were 14% and 42% in 2019 and 2020 compared with the 2010-2018 mean, respectively. We find that the numbers of notifications of infractions against flora decreased by 30% and 54% and fines paid by 74% and 89% in 2019 and 2020, respectively. Carbon losses during 2019-2020 were comparable with those of the record warm El Niño (2015-2016) without an extreme drought event. Statistical tests show that the observed differences between the 2010-2018 mean and 2019-2020 are unlikely to have arisen by chance. The changes in the carbon budget of Amazonia during 2019-2020 were mainly because of western Amazonia becoming a carbon source. Our results indicate that a decline in law enforcement led to increases in deforestation, biomass burning and forest degradation, which increased carbon emissions and enhanced drying and warming of the Amazon forests.
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Affiliation(s)
- Luciana V Gatti
- General Coordination of Earth Science (CGCT), National Institute for Space Research (INPE), São José dos Campos, Brazil.
- Nuclear and Energy Research Institute (IPEN), São Paulo, Brazil.
| | - Camilla L Cunha
- General Coordination of Earth Science (CGCT), National Institute for Space Research (INPE), São José dos Campos, Brazil
| | - Luciano Marani
- General Coordination of Earth Science (CGCT), National Institute for Space Research (INPE), São José dos Campos, Brazil
| | - Henrique L G Cassol
- General Coordination of Earth Science (CGCT), National Institute for Space Research (INPE), São José dos Campos, Brazil
| | - Cassiano Gustavo Messias
- General Coordination of Earth Science (CGCT), National Institute for Space Research (INPE), São José dos Campos, Brazil
| | - Egidio Arai
- General Coordination of Earth Science (CGCT), National Institute for Space Research (INPE), São José dos Campos, Brazil
| | | | - Luciana S Soler
- General Coordination of Earth Science (CGCT), National Institute for Space Research (INPE), São José dos Campos, Brazil
| | - Claudio Almeida
- General Coordination of Earth Science (CGCT), National Institute for Space Research (INPE), São José dos Campos, Brazil
| | - Alberto Setzer
- General Coordination of Earth Science (CGCT), National Institute for Space Research (INPE), São José dos Campos, Brazil
| | - Lucas Gatti Domingues
- Nuclear and Energy Research Institute (IPEN), São Paulo, Brazil
- National Isotope Centre, GNS Science, Lower Hutt, New Zealand
| | - Luana S Basso
- General Coordination of Earth Science (CGCT), National Institute for Space Research (INPE), São José dos Campos, Brazil
| | - John B Miller
- Global Monitoring Laboratory, National Oceanic and Atmospheric Administration (NOAA), Boulder, CO, USA
| | - Manuel Gloor
- School of Geography, University of Leeds, Leeds, UK
| | - Caio S C Correia
- General Coordination of Earth Science (CGCT), National Institute for Space Research (INPE), São José dos Campos, Brazil
- Nuclear and Energy Research Institute (IPEN), São Paulo, Brazil
| | - Graciela Tejada
- General Coordination of Earth Science (CGCT), National Institute for Space Research (INPE), São José dos Campos, Brazil
| | - Raiane A L Neves
- General Coordination of Earth Science (CGCT), National Institute for Space Research (INPE), São José dos Campos, Brazil
| | - Raoni Rajao
- Remote Sensing Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Felipe Nunes
- Remote Sensing Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Britaldo S S Filho
- Remote Sensing Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Jair Schmitt
- Remote Sensing Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Carlos Nobre
- Instituto de Estudos Avançados (IEA), University of São Paulo (USP), São Paulo, Brazil
| | - Sergio M Corrêa
- Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - Alber H Sanches
- General Coordination of Earth Science (CGCT), National Institute for Space Research (INPE), São José dos Campos, Brazil
| | - Luiz E O C Aragão
- General Coordination of Earth Science (CGCT), National Institute for Space Research (INPE), São José dos Campos, Brazil
| | - Liana Anderson
- Centro Nacional de Monitoramento e Alertas de Desastres Naturais (CEMADEN), São José dos Campos, Brazil
| | - Celso Von Randow
- General Coordination of Earth Science (CGCT), National Institute for Space Research (INPE), São José dos Campos, Brazil
| | - Stephane P Crispim
- General Coordination of Earth Science (CGCT), National Institute for Space Research (INPE), São José dos Campos, Brazil
| | - Francine M Silva
- General Coordination of Earth Science (CGCT), National Institute for Space Research (INPE), São José dos Campos, Brazil
| | - Guilherme B M Machado
- General Coordination of Earth Science (CGCT), National Institute for Space Research (INPE), São José dos Campos, Brazil
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Razavi P, Cakir B, Baldwin G, D’Amico DJ, Miller JB. Heads-Up Three-Dimensional Viewing Systems in Vitreoretinal Surgery: An Updated Perspective. Clin Ophthalmol 2023; 17:2539-2552. [PMID: 37662647 PMCID: PMC10473403 DOI: 10.2147/opth.s424229] [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: 06/03/2023] [Accepted: 08/14/2023] [Indexed: 09/05/2023] Open
Abstract
Three-Dimensional (3D) heads-up visualization systems have significantly advanced vitreoretinal surgery, providing enhanced detail and improved ergonomics. This review discusses the application of 3D systems in vitreoretinal surgery, their use in various procedures, their combination with other imaging modalities, and the role of this technology in medical education and telementoring. Furthermore, the review highlights the benefits of 3D systems, such as improved ergonomics, reduced phototoxicity, enhanced depth of field, and the use of color filters. Potential challenges, including the learning curve and additional costs, are also addressed. The review concludes by exploring promising future applications, including teleophthalmology for remote assistance and specialist availability expansion, virtual reality integration for global clinical education, and the combination of remotely robotic-guided surgery with artificial intelligence for precise, efficient surgical procedures. This comprehensive review offers insights into the current state and future potential of 3D heads-up visualization systems in vitreoretinal surgery, underscoring the transformative impact of this technology on ophthalmology.
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Affiliation(s)
- Peyman Razavi
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | | | | | - Donald J D’Amico
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
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Lu Y, Cui Y, Zhu Y, Lu ES, Zeng R, Garg I, Katz R, Le R, Wang JC, Vavvas DG, Husain D, Miller JW, Wu D, Miller JB. Quantitative Wide-Field Swept-Source Optical Coherence Tomography Angiography and Visual Outcomes in RAO. Clin Ophthalmol 2023; 17:2505-2513. [PMID: 37637969 PMCID: PMC10460179 DOI: 10.2147/opth.s418370] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/01/2023] [Indexed: 08/29/2023] Open
Abstract
Purpose Retinal artery occlusion (RAO) is an ophthalmic emergency that can lead to poor visual outcomes and is associated with an increased risk of stroke and cardiovascular events. Wide-field swept-source OCT-A (WF SS-OCTA) can provide quick and non-invasive angiographic information with a wide field of view. Here, we looked for associations between OCT-A vascular imaging metrics and vision in RAO patients. Methods Patients with diagnoses of central (CRAO) or branched retinal artery occlusion (BRAO) were included. 6mm × 6mm Angio and 15mm × 15mm AngioPlex Montage OCT-A images were obtained for both eyes in each patient using Zeiss Plex Elite 9000 WF SS-OCTA device. Each 6mm × 6mm image was divided into nine Early Treatment Diabetic Retinopathy Study (ETDRS) subfields. Non-perfusion area (NPA) was manually measured using 15mm × 15mm images. A linear regression model was utilized to identify correlation between imaging metrics and vision. P-values less than 0.05 were considered as statistically significant. Results Twenty-five subjects were included. For RAO eyes, there was a statistically significant inverse correlation between retinal thickness as well as superficial capillary plexus (SCP) vessel density (VD) and vision. An inverse correlation was found between deep capillary plexus (DCP) VD and vision without statistical significance. There was a positive correlation between choroidal thickness as well as choroidal volume and vision without statistical significance. No significant correlation was found between the metrics and vision in contralateral eyes. For NPA and vision, no significant correlation was identified. Conclusion This is the first study to investigate the utility of WF SS-OCTA in RAO and to demonstrate correlations between retinal vascular imaging metrics and visual outcomes. The results of this study provide a basis to understand the structural changes involved in vision in RAO and may guide management of RAO and prevention of cerebral stroke and cardiovascular accidents.
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Affiliation(s)
- Yifan Lu
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Ying Cui
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, USA
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China
| | - Ying Zhu
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, USA
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
| | - Edward S Lu
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, USA
| | - Rebecca Zeng
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, USA
| | - Itika Garg
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, USA
| | - Raviv Katz
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, USA
| | - Rongrong Le
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, USA
- Wenzhou Medical University Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Jay C Wang
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, USA
| | - Demetrios G Vavvas
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Deeba Husain
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Joan W Miller
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - David Wu
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - John B Miller
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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Garg I, Miller JB. Semi-automated algorithm using directional filter for the precise quantification of non-perfusion area on widefield swept-source optical coherence tomography angiograms. Quant Imaging Med Surg 2023; 13:3688-3702. [PMID: 37284086 PMCID: PMC10239999 DOI: 10.21037/qims-21-1175] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/07/2023] [Indexed: 06/08/2023]
Abstract
Background The clinical application of optical coherence tomography angiography (OCTA) has been well documented in literature with its promising potential in dye-less evaluation of various retinal vascular pathologies. Recent advances in OCTA help us gather wider field of view with 12 mm × 12 mm and montage compared to the standard dye-based scans, which has a higher accuracy and sensitivity in detection of peripheral pathologies. The aim of this study is to build a semi-automated algorithm to precisely quantify the non-perfusion areas (NPAs) on widefield swept-source optical coherence tomography angiography (WF SS-OCTA). Methods All subjects underwent imaging on 100 kHz SS-OCTA device acquiring 12 mm × 12 mm angiograms centered on fovea and optic disc. After a comprehensive literature review, a novel algorithm using FIJI (ImageJ) was designed to calculate the NPAs (mm2) after excluding the threshold and segmentation artifact areas from the total field of view. Segmentation and threshold artifacts were first removed from enface structure images using the spatial variance and mean filter respectively. Vessel enhancement was achieved by using 'Subtract Background' followed by directional filter. The cut off for Huang's fuzzy black and white thresholding was defined from the pixel values based of the foveal avascular zone. Then, the NPAs were calculated using the 'Analyze Particles' command with a minimum size of ~0.15 mm2. Finally, the artifact area was subtracted from to give the corrected NPAs. Results Our cohort had 44 eyes of 30 control patients and 107 eyes of 73 patients with diabetes mellitus (both median age 55 years, P=0.89). Of 107 eyes, 21 eyes had no evidence of diabetic retinopathy (DR), 50 eyes had non-proliferative DR and 36 eyes had proliferative DR. The median NPA was 0.20 (0.07-0.40) in controls, 0.28 (0.12-0.72) in no DR, 5.54 (3.12-9.10) in non-proliferative DR and 13.38 (8.73-26.32) in proliferative DR eyes. Using mixed effects-multiple linear regression analysis adjusting for age, there was significant progressive increase in NPA with increasing DR severity. Conclusions This is one of the first study to use the directional filter for WFSS-OCTA image processing which is known to be superior to other Hessian based multiscale, linear, and non-linear filters especially for vascular analysis. Our method could greatly refine and streamline the calculation of signal void area proportion, while being much quicker and accurate than manual delineation of NPAs and subsequent estimation. This combined with the wide field of view can have a great prognostic and diagnostic clinical impact for future applications in DR and other ischemic retinal pathologies.
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Affiliation(s)
- Itika Garg
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
- Harvard Retinal Imaging Lab, 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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Baldwin G, Vingopoulos F, Zeng R, Wescott H, Bannerman A, Koch T, Wang K, Garg I, Katz R, Kim LA, Miller JB. Association Between Contrast Sensitivity and Central Subfield Thickness in Center-Involving Diabetic Macular Edema. J Vitreoretin Dis 2023; 7:232-238. [PMID: 37188217 PMCID: PMC10170612 DOI: 10.1177/24741264231165611] [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] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Purpose: To evaluate the association between contrast sensitivity (CS) and central subfield thickness (CST) in diabetic macular edema (DME). Methods: This prospectively recruited, cross-sectional study included eyes with DME evaluated from November 2018 to March 2021. CST was measured using spectral-domain optical coherence tomography on the same day as CS testing. Only eyes with center-involving DME (CST >305 µm for women; >320 µm for men) were included. CS was evaluated using the quantitative CS function (qCSF) test. Outcomes included visual acuity (VA) and the following qCSF metrics: area under the log CS function, contrast acuity (CA), and CS thresholds at 1 to 18 cycles per degree (cpd). Pearson correlation and mixed-effects regression analyses were performed. Results: The cohort included 52 eyes of 43 patients. Pearson correlation analysis showed a stronger association between CST and CS thresholds at 6 cpd (r = -0.422, P = 0.002) than CST and VA (r = 0.293, P = 0.035). Mixed-effects univariate and multivariate regression analyses showed significant associations between CST and CA (β = -0.001, P = .030), CS at 6 cpd (β = -0.002, P = .008), and CS at 12 cpd (β = -0.001, P = .049) but no significant associations between CST and VA. Among the visual function metrics, the effect size of CST was largest on CS at 6 cpd (βStandardized = -0.37, P = .008). Conclusions: In patients with DME, CS may be more strongly associated with CST than VA. Including CS as an adjunct visual function outcome measure in eyes with DME may prove clinically valuable.
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Affiliation(s)
- Grace Baldwin
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Filippos Vingopoulos
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Rebecca Zeng
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Hannah Wescott
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Augustine Bannerman
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Thomas Koch
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Kira Wang
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Itika Garg
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Raviv Katz
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Leo A Kim
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - John B Miller
- Harvard Retinal Imaging Lab, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
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Zeng R, Feng Y, Begaj T, Baldwin G, Miller JB. Comparison of the Safety and Efficacy of a 3-Dimensional Heads-up Display vs a Standard Operating Microscope in Retinal Detachment Repair. J Vitreoretin Dis 2023; 7:97-102. [PMID: 37006657 PMCID: PMC10037757 DOI: 10.1177/24741264221150074] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Purpose: To evaluate the safety, efficacy, and efficiency of the Ngenuity 3-dimensional (3D) heads-up display (HUD) visualization system for primary rhegmatogenous retinal detachment (RRD) repair at a large academic medical center in the United States. Methods: This retrospective review comprised consecutive patients aged 18 years or older who had primary RRD repair (pars plana vitrectomy [PPV] alone or combined PPV and scleral buckle) performed by the same fellowship-trained vitreoretinal surgeon using the 3D visualization system and a traditional standard operating microscope (SOM) at Massachusetts Eye and Ear from June 2017 to December 2021. The minimum follow-up was 90 days. Results: The 3D HUD group comprised 50 eyes of 47 patients and the SOM group, 138 eyes of 136 patients. There were no between-group differences in single surgery anatomic success rates at 3 months (98% HUD vs 99% SOM; P = 1.00) or at the last follow-up (94% HUD vs 98% SOM; P = .40). The rate of postoperative proliferative vitreoretinopathy was similar between the 2 groups (3 months: 3% HUD vs 5% SOM, P = .94; last follow-up, 2% HUD vs 3% SOM, P = .93). There was no difference in the mean duration of surgery (57.4 ± 28.9 minutes HUD vs 59.4 ± 29.9 minutes SOM; P = .68). Conclusions: Anatomic and functional outcomes, in addition to surgical efficiency, of noncomplex primary RRD repair with a 3D HUD system were similar to those of surgery performed with an SOM.
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Affiliation(s)
- Rebecca Zeng
- Harvard Retinal Imaging Lab, Department
of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA,
USA
- Retina Service, Department of
Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA,
USA
| | - Yilin Feng
- Harvard Retinal Imaging Lab, Department
of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA,
USA
- Retina Service, Department of
Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA,
USA
| | - Tedi Begaj
- Harvard Retinal Imaging Lab, Department
of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA,
USA
| | - Grace Baldwin
- Harvard Retinal Imaging Lab, Department
of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA,
USA
- Retina Service, Department of
Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA,
USA
| | - John B. Miller
- Harvard Retinal Imaging Lab, Department
of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA,
USA
- Retina Service, Department of
Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA,
USA
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Moon JY, Garg I, Cui Y, Katz R, Zhu Y, Le R, Lu Y, Lu ES, Ludwig CA, Elze T, Wu DM, Eliott D, Miller JW, Kim LA, Husain D, Vavvas DG, Miller JB. Wide-field swept-source optical coherence tomography angiography in the assessment of retinal microvasculature and choroidal thickness in patients with myopia. Br J Ophthalmol 2023; 107:102-108. [PMID: 34385166 DOI: 10.1136/bjophthalmol-2021-319540] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/23/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND/AIMS Pathological myopia (PM) is a leading cause of blindness worldwide. We aimed to evaluate microvascular and chorioretinal changes in different stages of myopia with wide-field (WF) swept-source (SS) optical coherence tomography angiography (OCTA). METHODS This prospective cross-sectional observational study included 186 eyes of 122 patients who had undergone imaging between November 2018 and October 2020. Vessel density (VD) and vessel skeletonised density (VSD) of superficial capillary plexus, deep capillary plexus and whole retina, as well as foveal avascular zone parameters, retinal thickness (RT) and choroidal thickness (CT), were calculated. RESULTS This study evaluated 75 eyes of 48 patients with high myopia (HM), 43 eyes of 31 patients with mild to moderate myopia and 68 eyes of 53 age-matched controls. Controlling for age and the presence of systemic hypertension, we found that HM was associated with decrease in VD and VSD in all layers on 12×12 mm² scans. Furthermore, HM was associated with a VD and VSD decrease in every Early Treatment Diabetic Retinopathy Study grid, with a larger decrease temporally (βVD=-0.39, βVSD=-10.25, p<0.01). HM was associated with decreased RT and CT. Reduction in RT was outside the macular region, while reduction in CT was in the macular region. CONCLUSION Using WF SS-OCTA, we identified reduction in microvasculature and structural changes associated with myopia. Decrease in VD and VSD was greater in the temporal quadrant, and reductions in RT and CT were uneven across the retina. Further work may help identify risk factors for the progression of PM and associated vision-threatening complications.
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Affiliation(s)
- Jade Y Moon
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Harvard Retinal Imaging Lab, Boston, Massachusetts, USA
| | - Itika Garg
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Harvard Retinal Imaging Lab, Boston, Massachusetts, USA
| | - Ying Cui
- Harvard Retinal Imaging Lab, Boston, Massachusetts, USA.,Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Raviv Katz
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Harvard Retinal Imaging Lab, Boston, Massachusetts, USA
| | - Ying Zhu
- Harvard Retinal Imaging Lab, Boston, Massachusetts, USA.,Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Rongrong Le
- Harvard Retinal Imaging Lab, Boston, Massachusetts, USA.,Wenzhou Medical University affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Yifan Lu
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Harvard Retinal Imaging Lab, Boston, Massachusetts, USA
| | - Edward S Lu
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Harvard Retinal Imaging Lab, Boston, Massachusetts, USA
| | - Cassie A Ludwig
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Tobias Elze
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, MA, USA
| | - David M Wu
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Dean Eliott
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Joan W Miller
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Leo A Kim
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, MA, USA
| | - Deeba Husain
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Demetrios G Vavvas
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - John B Miller
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA .,Harvard Retinal Imaging Lab, Boston, Massachusetts, USA
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Moon JY, Wai KM, Patel NS, Katz R, Dahrouj M, Miller JB. Visualization of retinal breaks on ultra-widefield fundus imaging using a digital green filter. Graefes Arch Clin Exp Ophthalmol 2022; 261:935-940. [PMID: 36350430 PMCID: PMC9643990 DOI: 10.1007/s00417-022-05855-8] [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: 07/11/2022] [Revised: 09/07/2022] [Accepted: 09/30/2022] [Indexed: 11/11/2022] Open
Abstract
PURPOSE We compare the ability of resident physicians to identify retinal breaks on ultra-widefield color fundus photos using the traditional image compared to an image with a green filter overlay. METHODS Residents were shown fundus photos of 10 eyes with either a retinal tear or hole. Participants were shown each photo twice-once with traditional color settings and once with a green filter overlay. Participants were scored on whether the break was correctly identified and timed on how long it took to identify the pathology. RESULTS Residents were able to correctly identify more retinal breaks on fundus photos with a green filter overlay compared to photos with traditional settings (P = 0.02). Residents were also able to identify breaks on fundus photos more quickly on images with a green filter overlay compared to the traditional images (P < 0.001). CONCLUSIONS The application of a green filter overlay may help in identifying retinal breaks.
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Affiliation(s)
- Jade Y Moon
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, 02114, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, USA
| | - Karen M Wai
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, 02114, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, USA
| | - Neal S Patel
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, 02114, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, USA
| | - Raviv Katz
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, 02114, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, USA
| | - Mohammad Dahrouj
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, 02114, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, USA
| | - John B Miller
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, 02114, USA.
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, MA, USA.
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Pundlik S, Nigalye A, Laíns I, Mendez KM, Katz R, Kim J, Kim IK, Miller JB, Vavvas D, Miller JW, Luo G, Husain D. Area under the dark adaptation curve as a reliable alternate measure of dark adaptation response. Br J Ophthalmol 2022; 106:1450-1456. [PMID: 33888461 PMCID: PMC9815962 DOI: 10.1136/bjophthalmol-2021-318806] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/28/2021] [Accepted: 04/13/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE Quantification of dark adaptation (DA) response using the conventional rod intercept time (RIT) requires very long testing time and may not be measurable in the presence of impairments due to diseases such as age-related macular degeneration (AMD). The goal of this study was to investigate the advantages of using area under the DA curve (AUDAC) as an alternative to the conventional parameters to quantify DA response. METHODS Data on 136 eyes (AMD: 98, normal controls: 38) from an ongoing longitudinal study on AMD were used. DA was measured using the AdaptDx 20 min protocol. AUDAC was computed from the raw DA characteristic curve at different time points, including 6.5 min and 20 min (default). The presence of AMD in the given eye was predicted using a logistic regression model within the leave-one-out cross-validation framework, with DA response as the predictor while adjusting for age and gender. The DA response variable was either the AUDAC values computed at 6.5 min (AUDAC6.5) or at 20 min (AUDAC20) cut-off, or the conventional RIT. RESULTS AUDAC6.5 was strongly correlated with AUDAC20 (β=86, p<0.001, R2=0.87). The accuracy of predicting the presence of AMD using AUDAC20 was 76%, compared with 79% when using RIT, the current gold standard. In addition, when limiting AUDAC calculation to 6.5 min cut-off, the predictive accuracy of AUDAC6.5 was 80%. CONCLUSIONS AUDAC can be a valuable measure to quantify the overall DA response and can potentially facilitate shorter testing duration while maintaining diagnostic accuracy.
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Affiliation(s)
- Shrinivas Pundlik
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Archana Nigalye
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Retina Service, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA
| | - Inês Laíns
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Retina Service, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA
| | - Kevin M Mendez
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Retina Service, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Raviv Katz
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Retina Service, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA
| | - Janice Kim
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Retina Service, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA
| | - Ivana K Kim
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Retina Service, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA
| | - John B Miller
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Retina Service, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA
| | - Demetrios Vavvas
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Retina Service, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA
| | - Joan W Miller
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Retina Service, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA
| | - Gang Luo
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Deeba Husain
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Retina Service, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA
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Kuai L, Parazoo NC, Shi M, Miller CE, Baker I, Bloom AA, Bowman K, Lee M, Zeng Z, Commane R, Montzka SA, Berry J, Sweeney C, Miller JB, Yung YL. Quantifying Northern High Latitude Gross Primary Productivity (GPP) Using Carbonyl Sulfide (OCS). Global Biogeochem Cycles 2022; 36:e2021GB007216. [PMID: 36590828 PMCID: PMC9787914 DOI: 10.1029/2021gb007216] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 07/21/2022] [Accepted: 08/08/2022] [Indexed: 06/17/2023]
Abstract
The northern high latitude (NHL, 40°N to 90°N) is where the second peak region of gross primary productivity (GPP) other than the tropics. The summer NHL GPP is about 80% of the tropical peak, but both regions are still highly uncertain (Norton et al. 2019, https://doi.org/10.5194/bg-16-3069-2019). Carbonyl sulfide (OCS) provides an important proxy for photosynthetic carbon uptake. Here we optimize the OCS plant uptake fluxes across the NHL by fitting atmospheric concentration simulation with the GEOS-CHEM global transport model to the aircraft profiles acquired over Alaska during NASA's Carbon in Arctic Reservoirs Vulnerability Experiment (2012-2015). We use the empirical biome-specific linear relationship between OCS plant uptake flux and GPP to derive the six plant uptake OCS fluxes from different GPP data. Such GPP-based fluxes are used to drive the concentration simulations. We evaluate the simulations against the independent observations at two ground sites of Alaska. The optimized OCS fluxes suggest the NHL plant uptake OCS flux of -247 Gg S year-1, about 25% stronger than the ensemble mean of the six GPP-based OCS fluxes. GPP-based OCS fluxes systematically underestimate the peak growing season across the NHL, while a subset of models predict early start of season in Alaska, consistent with previous studies of net ecosystem exchange. The OCS optimized GPP of 34 PgC yr-1 for NHL is also about 25% more than the ensembles mean from six GPP data. Further work is needed to fully understand the environmental and biotic drivers and quantify their rate of photosynthetic carbon uptake in Arctic ecosystems.
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Affiliation(s)
- Le Kuai
- Jet Propulsion LaboratoryCalifornia Institute of TechnologyPasadenaCAUSA
| | | | - Mingjie Shi
- Pacific Northwest National LaboratoryRichlandWAUSA
| | - Charles E. Miller
- Jet Propulsion LaboratoryCalifornia Institute of TechnologyPasadenaCAUSA
| | - Ian Baker
- Colorado State UniversityFort CollinsCOUSA
| | - Anthony A. Bloom
- Jet Propulsion LaboratoryCalifornia Institute of TechnologyPasadenaCAUSA
| | - Kevin Bowman
- Jet Propulsion LaboratoryCalifornia Institute of TechnologyPasadenaCAUSA
| | - Meemong Lee
- Jet Propulsion LaboratoryCalifornia Institute of TechnologyPasadenaCAUSA
| | - Zhao‐Cheng Zeng
- University of California Los AngelesJIFRESSELos AngelesCAUSA
| | - Roisin Commane
- Lamont‐Doherty Earth Observatory at Columbia UniversityPalisadesNYUSA
| | | | | | | | | | - Yuk L. Yung
- Jet Propulsion LaboratoryCalifornia Institute of TechnologyPasadenaCAUSA
- California Institute of TechnologyPasadenaCAUSA
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Baldwin G, Sokol JT, Ludwig CA, Miller JB. A Comparative Study of Traditional Scleral Buckling to a New Technique: Guarded Light Pipe with Heads-Up Three-Dimensional Visualization. Clin Ophthalmol 2022; 16:3079-3088. [PMID: 36160731 PMCID: PMC9507285 DOI: 10.2147/opth.s378179] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/26/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose The guarded light pipe is a recently described alternative endoillumination technique to chandelier illumination. We sought to compare the outcomes of scleral buckling (SB) under indirect ophthalmoscopy (ID) to heads-up three-dimensional visualization with a guarded light pipe (3DGLP). Methods A retrospective comparative study was performed, including 47 eyes that underwent SB for rhegmatogenous retinal detachment (RRD) repair with either traditional ID (n = 31) or 3DGLP (n = 16). Results The single surgery anatomic success rate was 87.0% in the ID group and 87.5% in the 3DGLP group. The final anatomic success rate was 100% in both groups. The median (interquartile range) post-operative logMAR was 0.10 (0.0–0.20) in the ID group and 0.08 (0.02–0.69) in the 3DGLP group (p = 0.51). The median operative time was 107 (94–123) minutes in the ID group and 100 (90–111) minutes in the 3DGLP group (p = 0.25). Among eyes that underwent subretinal fluid drainage, the operative time was significantly longer in the ID group compared to the 3DGLP group, 113 (100–135) minutes vs 93 (85–111) minutes (p = 0.035). There were no post-operative complications in the ID group and one complication of self-resolving vitreous hemorrhage associated with a malfunctioning cryoprobe in the 3DGLP group (p = 0.34). There were no cases of post-operative cataract progression in either group. Conclusion Compared to traditional SB, 3DGLP improves ergonomics and educational value with similar anatomical, visual, intra and post-operative outcomes and may result in shorter operative time in cases requiring subretinal fluid drainage.
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Affiliation(s)
- Grace Baldwin
- Retina Service, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Jared T Sokol
- Retina Service, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Cassie A Ludwig
- Retina Service, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - John B Miller
- Retina Service, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
- Correspondence: John B Miller, Retina Service, Mass Eye and Ear, Harvard Medical School, Principal Investigator, Harvard Retinal Imaging Lab, 243 Charles St, Boston, MA, 02114, USA, Tel +1 (617) 573-3750, Fax +1 (617) 573-3698, Email
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Vingopoulos F, Kasetty M, Garg I, Silverman RF, Katz R, Vasan RA, Lorch AC, Luo ZK, Miller JB. Active Learning to Characterize the Full Contrast Sensitivity Function in Cataracts. Clin Ophthalmol 2022; 16:3109-3118. [PMID: 36168557 PMCID: PMC9509679 DOI: 10.2147/opth.s367490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background To characterize contrast sensitivity function (CSF) in cataractous and pseudophakic eyes compared to healthy control eyes using a novel quantitative CSF test with active learning algorithms. Methods This is a prospective observational study at an academic medical center. CSF was measured in eyes with visually significant cataract, at least 2+ nuclear sclerosis (NS) and visual acuity (VA) ≥ 20/50, in pseudophakic eyes and in healthy controls with no more than 1+ NS and no visual complaints, using the Manifold Contrast Vision Meter. Outcomes included Area under the Log CSF (AULCSF) and CS thresholds at 1, 1.5, 3, 6, 12, and 18 cycles per degree (cpd). A subgroup analysis as performed on cataract eyes with VA ≥ 20/25. Results A total of 167 eyes were included, 58 eyes in the cataract group, 77 controls, and 32 pseudophakic eyes with respective median AULCSF of 1.053 (0.352) vs 1.228 (0.318) vs 1.256 (0.360). In our multivariate regression model, cataract was associated with significantly reduced AULCSF (P= 0.04, β= −0.11) and contrast threshold at 6 cpd (P= 0.01, β= −0.16) compared to controls. Contrast threshold at 6 cpd was significantly reduced even in the subgroup of cataractous eyes with VA ≥ 20/25 (P=0.02, β=−0.16). Conclusion The novel qCSF test detected disproportionate significant contrast deficits at 6 cpd in cataract eyes; this remained significant even in the cataractous eyes with VA ≥ 20/25. CSF testing may enhance cataract evaluation and surgical decision-making, particularly in patients with subjective visual complaints despite good VA.
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Affiliation(s)
- Filippos Vingopoulos
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Megan Kasetty
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Itika Garg
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Rebecca F Silverman
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Raviv Katz
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Ryan A Vasan
- Comprehensive Ophthalmology and Cataract Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Alice C Lorch
- Comprehensive Ophthalmology and Cataract Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Zhonghui K Luo
- Comprehensive Ophthalmology and Cataract Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - John B Miller
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Correspondence: John B Miller, Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, 243 Charles St, Boston, MA, USA, Tel +1 617 573-3750, Fax +1 617 573-3698, Email
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Wai KM, Begaj T, Patil S, Chen EM, Miller JB, Kylstra J, Aronow ME, Young LH, Huckfeldt R, Husain D, Kim LA, Vavvas DG, Eliott D, Mukai S, Gragoudas ES, Patel NA, Sobrin L, Miller JW, Parikh R, Wu DM. The Effect of Sample Medication Use on Subsequent Anti-VEGF Agent Selection for Neovascular Age-Related Macular Degeneration. Semin Ophthalmol 2022; 37:902-908. [PMID: 35923110 DOI: 10.1080/08820538.2022.2107398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE Medication samples of anti-VEGF agents can represent a good option for retina specialists to provide timely treatment for newly converted neovascular age-related macular degeneration (nvAMD) while prior-authorizations (PA) are pending. Our study examines the effect of medication sample use (ranibizumab or aflibercept) on future anti-vascular endothelial growth factor (VEGF) agent selection in nvAMD. DESIGN Retrospective cohort study. PARTICIPANTS nvAMD patients who underwent an initial anti-VEGF injection with a sample medication were compared to nvAMD control patients who never received a medication sample. METHODS Charts from 2017 through 2020 were reviewed for data regarding demographics, anti-VEGF agent selection, and visual acuity outcomes for both groups. The utilization of different anti-VEGF agents in each group was compared at various time points using chi-square tests for independence of proportions. MAIN OUTCOME MEASURES Anti-VEGF agent selection for the first four injections and at one year were examined. RESULTS Adherence to the initial agent was high between first and subsequent injections (2nd, 3rd, 4th injection, and 1 year) in sample (96.2%, 95.9%, 91.9%, 93.4%, respectively), and control groups (98.1%, 94.2%, 94.9%, 87.8%, respectively). Bevacizumab usage was significantly lower among eyes receiving samples relative to controls at the second (1.9% vs. 38.7%, p < .001), third (3.1% vs. 41.3%, p < .001), fourth injections (4.7% vs. 40.4%, p < .001), and at 1 year (0% vs. 33.8%, p < .001). Aflibercept usage was significantly higher in sample eyes relative to controls at the second (78.3% vs. 43.4%, p < .001), third (76.3% vs. 41.5%, p < .001), and fourth injections (76.7% vs. 43.4%, p < .001), and at 1 year (77.0% vs. 52.7%, p < .001). CONCLUSIONS Sample medications in nvAMD may be initiated for many reasons, including awaiting PA approval. Our study found that eyes receiving a sample anti-VEGF agent (ranibizumab or aflibercept) for their initial injection were less likely to receive bevacizumab at future visits relative to eyes that did not receive an anti-VEGF sample, even after one year of treatment. Given the persistent use of more expensive medications at subsequent injections for patients who were initiated on samples, insurance payors may consider waiving PA requirements for bevacizumab to avoid a paradoxical increase in health-care costs.
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Affiliation(s)
- Karen M Wai
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Tedi Begaj
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Sachi Patil
- Department of Ophthalmology and Visual Sciences, New York University School of Medicine, New York, New York
| | - Evan M Chen
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - John B Miller
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Jan Kylstra
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Mary E Aronow
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Lucy H Young
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Rachel Huckfeldt
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Deeba Husain
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Leo A Kim
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Demetrios G Vavvas
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Dean Eliott
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Shizuo Mukai
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Evangelos S Gragoudas
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Nimesh A Patel
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Lucia Sobrin
- 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
| | - Ravi Parikh
- Department of Ophthalmology and Visual Sciences, New York University School of Medicine, New York, New York.,Manhattan Retina and Eye Consultants, New York, NY
| | - David M Wu
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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Klug CA, Swift MW, Miller JB, Lyons JL, Albert A, Laskoski M, Hangarter CM. High resolution solid state NMR in paramagnetic metal-organic frameworks. Solid State Nucl Magn Reson 2022; 120:101811. [PMID: 35792451 DOI: 10.1016/j.ssnmr.2022.101811] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/06/2022] [Accepted: 06/24/2022] [Indexed: 06/15/2023]
Abstract
We study the metal-organic framework (MOF) ZIF-67 with 1H and 13C nuclear magnetic resonance (NMR). In addition to the usual orbital chemical shifts, we observe spinning sideband manifolds in the NMR spectrum due to hyperfine interactions of the paramagnetic cobalt with 1H and 13C. Both orbital and paramagnetic chemical shifts are in good agreement with values calculated from first principles, allowing high-confidence assignment of the observed peaks to specific sites within the MOF. Our measured resonance shifts, line shapes, and spin lattice relaxation rates are also consistent with calculated values. We show that molecules in the pores of the MOF can exhibit high-resolution NMR spectra with fast spin lattice relaxation rates due to dipole-dipole couplings to the Co2+ nodes in the ZIF-67 lattice, showcasing NMR spectroscopy as a powerful tool for identification and characterization of "guests" that may be hosted by the MOF in electrochemical and catalytic applications.
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Affiliation(s)
- C A Klug
- Chemistry Division, U.S. Naval Research Laboratory, Washington, DC, USA.
| | - M W Swift
- Materials Science Division, U.S. Naval Research Laboratory, Washington, DC, USA
| | - J B Miller
- Chemistry Division, U.S. Naval Research Laboratory, Washington, DC, USA
| | - J L Lyons
- Materials Science Division, U.S. Naval Research Laboratory, Washington, DC, USA
| | - A Albert
- Chemistry Division, U.S. Naval Research Laboratory, Washington, DC, USA
| | - M Laskoski
- Chemistry Division, U.S. Naval Research Laboratory, Washington, DC, USA
| | - C M Hangarter
- Chemistry Division, U.S. Naval Research Laboratory, Washington, DC, USA
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Martinez-Velazquez LA, Douglas VP, Miller JB. Multimodal Imaging of a Type-1 Retinal Arteriovenous Malformation. Ophthalmol Retina 2022; 6:701. [PMID: 35933122 DOI: 10.1016/j.oret.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Luis A Martinez-Velazquez
- Harvard Retinal Imaging Lab, Boston, Massachusetts; Retina Service, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Vivian Paraskevi Douglas
- Harvard Retinal Imaging Lab, Boston, Massachusetts; Retina Service, Massachusetts Eye and Ear, Boston, Massachusetts
| | - John B Miller
- Harvard Retinal Imaging Lab, Boston, Massachusetts; Retina Service, Massachusetts Eye and Ear, Boston, Massachusetts
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Saini C, Chen TC, Young LH, Vavvas DG, Vangel M, Papaliodis GN, Mukai S, Turalba AV, Rhee DJ, Wu DM, Eliott D, Miller JB, Song BJ, Shen LQ, Pasquale LR, Chodosh J. Restoration of Vision in Severe, Cicatricial, Ocular Surface Disease with the Boston Keratoprosthesis Type II. Am J Ophthalmol 2022; 243:42-54. [PMID: 35850253 DOI: 10.1016/j.ajo.2022.06.022] [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: 12/27/2021] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To assess clinical outcomes of patients with severe, cicatricial ocular surface disease (OSD) implanted with the currently marketed design of the Boston keratoprosthesis type II (BK2). DESIGN Retrospective cohort study. METHODS Records of consecutive patients undergoing BK2 implantation from June 2009 to March 2021 were assessed for postoperative visual acuity, postoperative complications, device replacement, and additional surgeries. RESULTS Fifty-six eyes of 53 patients with a mean follow-up of 45.8 months (range: 0.2-134.7 months) were included. Stevens-Johnson syndrome/toxic epidermal necrolysis was the most common indication (49.1%), followed by mucous membrane pemphigoid (39.6%) and other OSD (11.3%). Visual acuity improved from LogMAR 2.2±0.5 preoperatively to 1.5±1.2 at final follow-up. Fifty of 56 eyes saw ≥20/200 at some point postoperatively. Of the eyes with a follow-up of more than 5 years, 50.0% retained a visual acuity of ≥20/200 at their final follow-up. The most common complications, over the entire postoperative course (mean ∼4 years), were de-novo or worsening glaucoma (41.1%), choroidal effusions (30.3%), retinal detachment (25.0%) and end-stage glaucoma (25.0%). In a univariate analysis, patients who experienced irreversible loss of ≥20/200 visual acuity were more likely to have been previously implanted with an older design of BK2, less likely to be on preoperative systemic immunosuppressive therapy, and less likely to have undergone concurrent glaucoma tube implantation, compared to patients who retained ≥20/200 acuity (p<0.04 for all). CONCLUSIONS Advances in device design and postoperative care have made implantation of BK2 a viable option for corneal blindness in the setting of severe cicatricial OSD.
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Affiliation(s)
- Chhavi Saini
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Teresa C Chen
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Lucy H Young
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Demetrios G Vavvas
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Mark Vangel
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - George N Papaliodis
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Shizuo Mukai
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Angela V Turalba
- Ophthalmology and Visual Services, Atrius Health, Boston, Massachusetts, USA
| | - Douglas J Rhee
- University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | - David M Wu
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Dean Eliott
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - John B Miller
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Brian J Song
- Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Lucy Q Shen
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Louis R Pasquale
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - James Chodosh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
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Li CY, Garg I, Bannai D, Kasetty M, Katz R, Adhan I, Douglas KAA, Wang JC, Kim LA, Keshavan M, Lizano P, Miller JB. Sex-Specific Changes in Choroid Vasculature Among Patients with Schizophrenia and Bipolar Disorder. Clin Ophthalmol 2022; 16:2363-2371. [PMID: 35924185 PMCID: PMC9343178 DOI: 10.2147/opth.s352731] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/17/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose While structural changes within the retina of psychosis patients have been established, no detailed studies of choroidal microvasculature in these patients have been performed. Given evidence of microvascular disruption in psychosis patients, this study sought to determine whether there exists evidence of microvascular disruption in the choroids in these patients. Methods Fifty-six subjects (20 controls and 36 psychosis patients) were recruited from April 2018 to February 2020. Five were excluded due to imaging artifact or missing demographic information. Swept-source optical coherence tomography angiography (SS-OCTA) images were obtained. Choroid vascular enface images (12 mm × 9mm) were exported every 2.6 μm from Bruch’s membrane to the choroid–scleral interface from Topcon to ImageJ. The images were binarized using Otsu’s method, signal from the optic disk and retinal vasculature was removed, and average choroid vascular density (CVD) was calculated as the average of percent area occupied by choroidal vasculature across images in the stack. Choroid vascular volume (CVV) was calculated as the CVD multiplied by maximum CT and image area. During image analysis, study staff were blinded to the phenotype of the study subjects. Results Compared with same-sex controls, male psychiatric patients had significantly lower CVD. Compared with same-sex controls, female psychiatric patients had significantly lower maximum CT with correspondingly decreased CVV, after adjusting for age. When all psychiatric patients were compared with all healthy controls, no significant differences in CT, CVD, or CVV were noted. Conclusion These results suggest that the pathogenesis of psychotic illness affects choroidal microvasculature in a sex-specific manner.
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Affiliation(s)
- Chloe Y Li
- Harvard Retinal Imaging Laboratory, Massachusetts Eye and Ear, Boston, MA, USA
| | - Itika Garg
- Harvard Retinal Imaging Laboratory, Massachusetts Eye and Ear, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Deepthi Bannai
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Megan Kasetty
- Harvard Retinal Imaging Laboratory, Massachusetts Eye and Ear, Boston, MA, USA
| | - Raviv Katz
- Harvard Retinal Imaging Laboratory, Massachusetts Eye and Ear, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Iniya Adhan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Jay C Wang
- Harvard Retinal Imaging Laboratory, Massachusetts Eye and Ear, Boston, MA, USA
| | - Leo A Kim
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Matcheri Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Paulo Lizano
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Paulo Lizano, Harvard Medical School, Department of Psychiatry, Beth Israel Deaconess Medical Center, 75 Fenwood Road, Room 612, Boston, MA, 02115, USA, Tel +1 617-754-1227, Email
| | - John B Miller
- Harvard Retinal Imaging Laboratory, Massachusetts Eye and Ear, Boston, MA, USA
- Retina Service, Massachusetts Eye and Ear, Boston, MA, USA
- Correspondence: John B Miller, Harvard Medical School, Department of Ophthalmology, Massachusetts Eye and Ear, 243 Charles St, Boston, MA, 02114, USA, Tel +1 617-573-3529, Email
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Port AD, Gong D, Shaikh N, Loporchio D, Blaha GR, Eliott D, Miller JB, Ness S. Socioeconomic and Demographic Factors Contributing to COVID-19–Related Delays and Reductions in Primary Retinal Detachment Repair in a US Hot Spot. Journal of VitreoRetinal Diseases 2022; 6:302-307. [PMID: 37007929 PMCID: PMC9976025 DOI: 10.1177/24741264211039960] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: This work evaluates demographic and socioeconomic predictors of delayed care for rhegmatogenous retinal detachments (RRDs) during the spring 2020 COVID-19 shutdown in a US hot spot. Methods: This multicenter, retrospective, case-control study took place in 3 academic vitreoretinal practices in metropolitan Boston. Consecutive patients treated for RRD during the COVID-19 state of emergency were compared with patients treated during the same period in 2018 and 2019. The primary outcome was macula status for RRD. Secondary outcomes included visual acuity, symptom duration, proportion with proliferative vitreoretinopathy, time to procedure, method of repair, and patient demographics. Results: The total number of acute RRD decreased by 13.7% from 2018 to 2020 and 17.2% from 2019 to 2020. Symptom duration was significantly longer in 2020 than 2018 and 2019 (median, 7 vs 4 days) with a higher proportion of macula-off detachments (80 of 125 [64%] in 2020 vs 75 of 145 [51.7%] in 2018 and 78 of 151 [51.6%] in 2019). The 2020 cohort included significantly fewer patients in the racial and/or ethnic minority group than in 2019 ( P = .02), and use of low-income, government-sponsored health insurance was a predictor of macula-off status during the pandemic ( P = .04). Conclusions: RRDs during the spring 2020 COVID-19 lockdown were more likely to be macula-off at presentation. Because sociodemographic factors including race, ethnicity, and income level were associated with deferral of care, ophthalmologists should consider measures targeting vulnerable populations to avoid preventable vision loss as the pandemic continues or in future health care emergencies.
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Affiliation(s)
- Alexander D. Port
- NJ Retina, New Brunswick, NJ, USA
- Retina Service, Department of Ophthalmology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Dan Gong
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Noreen Shaikh
- Retina Service, Beth Israel Lahey Health, Lahey Medical Center, Peabody, MA, USA
| | - Dean Loporchio
- Retina Service, Department of Ophthalmology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Gregory R. Blaha
- Retina Service, Beth Israel Lahey Health, Lahey Medical Center, Peabody, MA, USA
| | - Dean Eliott
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - John B. Miller
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Steven Ness
- Retina Service, Department of Ophthalmology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
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Berkenstock MK, Long K, Miller JB, Burkholder BB, Aucott JN, Jabs DA. Scleritis in Lyme Disease. Am J Ophthalmol 2022; 241:139-144. [PMID: 35513033 DOI: 10.1016/j.ajo.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 04/24/2022] [Accepted: 04/24/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To estimate the incidence of scleritis in Lyme disease and report clinical features. DESIGN Incidence rate estimate and case series. METHODS Data were collected from an electronic medical record on patients with scleritis presenting to the Wilmer Eye Institute between January 1, 2012 and December 31, 2020. A diagnosis of Lyme disease was made using the Infectious Diseases Society of America, American Academy of Neurology, and the American College of Rheumatology 2020 joint criteria plus a response to antibiotic therapy. After identifying all new-onset cases of scleritis in the database, the proportion of new-onset scleritis with Lyme disease was calculated. The proportion of Lyme disease cases with scleritis was estimated using the number of cases with Lyme disease from the Baltimore metropolitan area reported to the Centers for Disease Control and Prevention. After querying other major eye centers in the area for any cases of Lyme disease scleritis, none were identified, and the incidence of Lyme disease scleritis was estimated using published U.S. Census data for the greater Baltimore metropolitan area. RESULTS Six cases of Lyme disease scleritis were identified in the 8-year time frame; 1 additional case was identified in the following year. Lyme disease scleritis accounted for 0.6% of all cases of scleritis, and 0.052% of patients with Lyme disease had scleritis. The estimated incidence of Lyme scleritis was 0.2 per 1,000,000 population per year (95% confidence interval 0-0.4), whereas the estimated incidence of Lyme disease in the area was 3 per 10,000 population per year (95% confidence interval 2.9-3.1). All scleritis cases were anterior, unilateral, without necrosis, and resolved with antibiotic use without relapse in a median of 39.5 days (range 29-57 days). Other features of Lyme disease were present in 4 of 7 patients, including a history of erythema migrans in 2 of 7 patients. CONCLUSIONS Lyme disease is an uncommon cause of scleritis in endemic areas.
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Douglas VP, Douglas KAA, Vavvas DG, Miller JW, Miller JB. Short- and Long-Term Visual Outcomes in Patients Receiving Intravitreal Injections: The Impact of the Coronavirus 2019 Disease (COVID-19)-Related Lockdown. J Clin Med 2022; 11:jcm11082097. [PMID: 35456189 PMCID: PMC9029849 DOI: 10.3390/jcm11082097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 02/01/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 12/10/2022] Open
Abstract
Purpose: To investigate the short- and long-term impact of COVID-19—related lockdown on the vision of patients requiring intravitreal injections (IVI) for neovascular Age-related Macular degeneration (nvAMD), diabetic retinopathy (DR), central retinal vein occlusion (CRVO), or branch retinal vein occlusion (BRVO). Methods: This is a retrospective study from the Retina department of three Mass Eye and Ear centers. Charts of patients age of ≥ 18 years with any of the abovementioned diagnoses who had a scheduled appointment anytime between 17 March 2020 until 18 May 2020 (lockdown period in Boston, Massachusetts) were reviewed at baseline (up to 12 weeks before the lockdown), at first available follow-up (=actual f/u) during or after the lockdown period, at 3 months, 6 months, and at last available completed appointment of 2020. Results: A total of 1001 patients met the inclusion criteria. Of those patients, 479 (47.9%) completed their intended f/u appointment, while 522 missed it (canceled and “no show”). The delay in care of those who missed it was 59.15 days [standard deviation (SD) ± 49.6]. In these patients, significant loss of vision was noted at actual f/u [Best corrected visual acuity (BCVA) in LogMAR (Logarithm of the Minimum Angle of Resolution)—mean (±SD)—completed: 0.45 (±0.46), missed: 0.53 (±0.55); p = 0.01], which was more prominent in the DR group [Visual acuity (VA) change in LogMAR—mean (±SD); completed: 0.04 (±0.28), missed: 0.18 (±0.44); p = 0.02] and CRVO [completed: −0.06 (±0.27), missed: 0.11 (±0.35); p = <0.001] groups followed by nvAMD [completed: 0.006 (±0.16), missed: 0.06 (±0.27); p = 0.004] and BRVO [completed: −0.02 (±0.1), missed: 0.03 (±0.14); p = 0.02] ones. Overall, a higher percent of people who missed their intended f/u experienced vision loss of more than 15 letters at last f/u compared to those who completed it [missed vs. completed; 13.4% vs. 7.4% in nvAMD (p = 0.72), 7.8% vs. 6.3% in DR (0.84), 15.5% vs. 9.9% in CRVO (p < 0.001) and 9.6% vs. 2% in BRVO (p = 0.48)]. Conclusions: Delay in care of about 8.45 weeks can lead to loss of vision in patients who receive IVI with DR and CRVO patients being more vulnerable in the short-term, whereas in the long-term, CRVO patients followed by the nvAMD patients demonstrating the least vision recovery. BRVO patients were less likely to be affected by the delay in care. Adherence to treatment is key for maintaining and improving visual outcomes in patients who require IVI.
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Affiliation(s)
| | | | | | | | - John B. Miller
- Correspondence: ; Tel.: +1-(617)-573-3750; Fax: +1-(617)-573-3698
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Douglas VP, Garg I, Douglas KAA, Miller JB. Subthreshold Exudative Choroidal Neovascularization (CNV): Presentation of This Uncommon Subtype and Other CNVs in Age-Related Macular Degeneration (AMD). J Clin Med 2022; 11:jcm11082083. [PMID: 35456174 PMCID: PMC9031480 DOI: 10.3390/jcm11082083] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 11/16/2022] Open
Abstract
Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss in people over the age of 50 worldwide. Exudative or neovascular AMD is a more severe subset of AMD which is characterized by the presence of choroidal neovascularization (CNV). Recent advancements in multimodal ophthalmic imaging, including optical coherence tomography (OCT) and OCT-angiography (OCT-A), have facilitated the detection and characterization of previously undetectable neovascular lesions and have enabled a more refined classification of CNV in exudative as well as nonexudative AMD patients. Subthreshold exudative CNV is a novel subtype of exudative AMD that typically presents asymptomatically with good visual acuity and is characterized by stable persistent or intermittent subretinal fluid (SRF). This review aims to provide an overview of the clinical as well as multimodal imaging characteristics of CNV in AMD, including this new clinical phenotype, and propose effective approaches for management.
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Affiliation(s)
- Vivian Paraskevi Douglas
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, 243 Charles St., Boston, MA 02114, USA; (V.P.D.); (I.G.); (K.A.A.D.)
| | - Itika Garg
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, 243 Charles St., Boston, MA 02114, USA; (V.P.D.); (I.G.); (K.A.A.D.)
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 243 Charles St., Boston, MA 02114, USA
| | - Konstantinos A. A. Douglas
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, 243 Charles St., Boston, MA 02114, USA; (V.P.D.); (I.G.); (K.A.A.D.)
| | - John B. Miller
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, 243 Charles St., Boston, MA 02114, USA; (V.P.D.); (I.G.); (K.A.A.D.)
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, 243 Charles St., Boston, MA 02114, USA
- Correspondence: ; Tel.: +1-(617)-573-3750; Fax: +1-(617)-573-3698
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Cox JT, Miller JB. Retinal Detachment Associated With Acute Retinal Necrosis. Int Ophthalmol Clin 2022; 62:157-172. [PMID: 35325917 DOI: 10.1097/iio.0000000000000414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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49
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Lu ES, Cui Y, Le R, Zhu Y, Wang JC, Laíns I, Katz R, Lu Y, Zeng R, Garg I, Wu DM, Eliott D, Vavvas DG, Husain D, Miller JW, Kim LA, Miller JB. Detection of neovascularisation in the vitreoretinal interface slab using widefield swept-source optical coherence tomography angiography in diabetic retinopathy. Br J Ophthalmol 2022; 106:534-539. [PMID: 33355148 PMCID: PMC9092312 DOI: 10.1136/bjophthalmol-2020-317983] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/18/2020] [Accepted: 11/21/2020] [Indexed: 11/11/2022]
Abstract
AIMS To compare the efficacy of diabetic retinal neovascularisation (NV) detection using the widefield swept-source optical coherence tomography angiography (WF SS-OCTA) vitreoretinal interface (VRI) Angio slab and SS-OCT VRI Structure slab. METHODS A prospective, observational study was performed at Massachusetts Eye and Ear from January 2019 to June 2020. Patients with proliferative diabetic retinopathy (PDR), patients with non-proliferative diabetic retinopathy and patients with diabetes but without diabetic retinopathy were included. All patients were imaged with WF SS-OCTA using the 12×12 mm Angio scan protocol centred on the fovea and optic disc. The en-face SS-OCTA VRI Angio slab and SS-OCT VRI Structure slab were evaluated for the presence or absence of NV. SS-OCTA B-scan was used to classify NV according to cross-sectional morphology (forward, tabletop or flat). All statistical analyses were performed using SPSS V.26.0. RESULTS One hundred and forty-two eyes of 89 participants were included in the study. VRI Angio detected NV at higher rates compared with VRI Structure (p<0.05). Combining VRI Angio and Structure improved detection rates compared with VRI Angio alone (p<0.05). Due to segmentation errors of the internal limiting membrane, NV with flat morphological classification had lower rates of detection on VRI Angio compared with NV with forward and tabletop morphology (p<0.05). CONCLUSIONS WF SS-OCTA 12×12 mm VRI Angio and SS-OCT VRI Structure imaging centred on the fovea and optic disc detected NV with high sensitivity and low false positives. The VRI slab may be useful to diagnose and monitor PDR in clinical practice.
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Affiliation(s)
- Edward S Lu
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Ying Cui
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Rongrong Le
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Ophthalmology, Wenzhou Medical University Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ying Zhu
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Ophthalmology, Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jay C Wang
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Inês Laíns
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Raviv Katz
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Yifan Lu
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Rebecca Zeng
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Itika Garg
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - David M Wu
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Dean Eliott
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Demetrios G Vavvas
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Deeba Husain
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Joan W Miller
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Leo A Kim
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - John B Miller
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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Garg I, Uwakwe C, Le R, Lu ES, Cui Y, Wai KM, Katz R, Zhu Y, Moon JY, Li CY, Laíns I, Eliott D, Elze T, Kim LA, Wu DM, Miller JW, Husain D, Vavvas DG, Miller JB. Nonperfusion Area and Other Vascular Metrics by Wider Field Swept-Source OCT Angiography as Biomarkers of Diabetic Retinopathy Severity. Ophthalmol Sci 2022; 2:100144. [PMID: 35647573 PMCID: PMC9137369 DOI: 10.1016/j.xops.2022.100144] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Purpose To study the wider field swept-source optical coherence tomography angiography (WF SS-OCTA) metrics, especially non-perfusion area (NPA), in the diagnosing and staging of DR. Design Cross-sectional observational study (November 2018-September 2020). Participants 473 eyes of 286 patients (69 eyes of 49 control patients and 404 eyes of 237 diabetic patients). Methods We imaged using 6mm×6mm and 12mm×12mm angiograms on WF SS-OCTA. Images were analyzed using the ARI Network and FIJI ImageJ. Mixed effects multiple regression models and receiver operator characteristic analysis was used for statistical analyses. Main Outcome Measures Quantitative metrics such as vessel density (VD); vessel skeletonized density (VSD); foveal avascular zone (FAZ) area, circularity, and perimeter; and NPA in DR and their relative performance for its diagnosis and grading. Results Among patients with diabetes (median age 59 years), 51 eyes had no DR, 185 eyes (88 mild, 97 moderate-severe) had non-proliferative DR (NPDR); and 168 eyes had proliferative DR (PDR). Trend analysis revealed a progressive decline in superficial capillary plexus (SCP) VD and VSD, and increased NPA with increasing DR severity. Additionally, there was a significant reduction in deep capillary plexus (DCP) VD and VSD in early DR (mild NPDR), but the progressive reduction in advanced DR stages was not significant. NPA was the best parameter to diagnose DR (AUC:0.96), whereas all parameters combined on both angiograms efficiently diagnosed (AUC:0.97) and differentiated between DR stages (AUC range:0.83-0.97). The presence of diabetic macular edema was associated with reduced SCP and DCP VD and VSD within mild NPDR eyes, whereas an increased VD and VSD in SCP among moderate-severe NPDR group. Conclusions Our work highlights the importance of NPA, which can be more readily and easily measured with WF SS-OCTA compared to fluorescein angiography. It is additionally quick and non-invasive, and hence can be an important adjunct for DR diagnosis and management. In our study, a combination of all OCTA metrics on both 6mm×6mm and 12mm×12mm angiograms had the best diagnostic accuracy for DR and its severity. Further longitudinal studies are needed to assess NPA as a biomarker for progression or regression of DR severity.
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Affiliation(s)
- Itika Garg
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts,Harvard Retinal Imaging Lab, Boston, Massachusetts
| | - Chibuike Uwakwe
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts,Harvard Retinal Imaging Lab, Boston, Massachusetts
| | - Rongrong Le
- Harvard Retinal Imaging Lab, Boston, Massachusetts,Wenzhou Medical University Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Edward S. Lu
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts,Harvard Retinal Imaging Lab, Boston, Massachusetts
| | - Ying Cui
- Harvard Retinal Imaging Lab, Boston, Massachusetts,Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Karen M. Wai
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts,Harvard Retinal Imaging Lab, Boston, Massachusetts
| | - Raviv Katz
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts,Harvard Retinal Imaging Lab, Boston, Massachusetts
| | - Ying Zhu
- Harvard Retinal Imaging Lab, Boston, Massachusetts,Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jade Y. Moon
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts,Harvard Retinal Imaging Lab, Boston, Massachusetts
| | - Chloe Y. Li
- Harvard Retinal Imaging Lab, Boston, Massachusetts
| | - Inês Laíns
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts,Harvard Retinal Imaging Lab, Boston, Massachusetts
| | - Dean Eliott
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Tobias Elze
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, Massachusetts
| | - Leo A. Kim
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts,Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, Massachusetts
| | - David M. Wu
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Joan W. Miller
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Deeba Husain
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Demetrios G. Vavvas
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - John B. Miller
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts,Harvard Retinal Imaging Lab, Boston, Massachusetts,Correspondence: John B. Miller, MD, Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Harvard Retinal Imaging Lab, 243 Charles Street, Boston, MA 02114.
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