1
|
Selvam A, Shah S, Singh SR, Sant V, Harihar S, Arora S, Patel M, Ong J, Yadav S, Ibrahim MN, Sahel JA, Vupparaboina KK, Chhablani J. Longitudinal changes in pigment epithelial detachment composition indices (PEDCI): new biomarkers in neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2024; 262:1489-1498. [PMID: 38141059 DOI: 10.1007/s00417-023-06335-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/06/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
PURPOSE To evaluate novel, automated biomarkers, pigment epithelial detachment composition indices (PEDCI) in eyes with neovascular age-related macular degeneration (nAMD) undergoing anti-vascular endothelial growth factor (anti-VEGF) therapy through 24 months. METHODS Retrospective analysis of 37 eyes (34 patients) with PED associated with nAMD receiving as-needed anti-VEGF treatment was performed. Best-corrected visual acuity (BCVA) and optical coherence tomography images were acquired at a treatment-naïve baseline and 3-, 6-, 12-, 18-, and 24-month visits. Previously validated automated imaging biomarkers, PEDCI-S (serous), PEDCI-N (neovascular), and PEDCI-F (fibrous) within PEDs were measured. ANOVA analysis and Spearman correlation were performed. RESULTS Mean BCVA (in logMAR) was 0.60 ± 0.47, 0.45 ± 0.41, 0.49 ± 0.49, 0.61 ± 0.54, 0.59 ± 0.56, and 0.67 ± 0.57 at baseline, 3, 6, 12, 18, and 24 months respectively. Overall, BCVA showed minimal worsening of 0.07 ± 0.54 logMAR (p = 0.07). 13.38 ± 3.77 anti-VEGF injections were given through 24 months. PEDCI-F showed an increase of 0.116, 0.122, 0.036, and 0.006 at months 3, 6, 12, and 18 respectively and a decrease of 0.004 at month 24 (p = 0.03); PEDCI-S showed a decrease of 0.064, 0.130, 0.091, 0.092, and 0.095 at months 3, 6, 12, 18, and 24 respectively (p = 0.16); PEDCI-N showed a decrease of 0.052 at month 3 and an increase of 0.008, 0.055, 0.086, and 0.099 at months 6, 12, 18, and 24 respectively (p = 0.06). BCVA was negatively correlated with PEDCI-F (r = -0.28, p < 0.01), and positively correlated with PEDCI-N (r = 0.28, p < 0.01) and PEDCI-S (r = 0.15, p = 0.03). CONCLUSION Longitudinal analysis of PEDCI supports their utility as biomarkers that characterize treatment related effects by quantifying the relative composition of PEDs.
Collapse
Affiliation(s)
- Amrish Selvam
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stavan Shah
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sumit Randhir Singh
- Sri Sai Eye Hospital, Kankarbagh, Patna, Bihar, India
- Nilima Sinha Medical College and Hospital, Rampur, India
| | - Vinisha Sant
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sanjana Harihar
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Supriya Arora
- Bahamas Vision Center and Princess Margaret Hospital, Nassau, NP, Bahamas
| | - Manan Patel
- BJ Medical College, Ahmedabad, Gujarat, India
| | - Joshua Ong
- University of Michigan Kellogg Eye Center, Ann Arbor, MI, USA
| | - Sanya Yadav
- Department of Ophthalmology, West Virginia University, Morgantown, WV, USA
| | | | - José-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA.
| |
Collapse
|
2
|
Driban M, Yan A, Selvam A, Ong J, Vupparaboina KK, Chhablani J. Artificial intelligence in chorioretinal pathology through fundoscopy: a comprehensive review. Int J Retina Vitreous 2024; 10:36. [PMID: 38654344 PMCID: PMC11036694 DOI: 10.1186/s40942-024-00554-4] [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: 03/04/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Applications for artificial intelligence (AI) in ophthalmology are continually evolving. Fundoscopy is one of the oldest ocular imaging techniques but remains a mainstay in posterior segment imaging due to its prevalence, ease of use, and ongoing technological advancement. AI has been leveraged for fundoscopy to accomplish core tasks including segmentation, classification, and prediction. MAIN BODY In this article we provide a review of AI in fundoscopy applied to representative chorioretinal pathologies, including diabetic retinopathy and age-related macular degeneration, among others. We conclude with a discussion of future directions and current limitations. SHORT CONCLUSION As AI evolves, it will become increasingly essential for the modern ophthalmologist to understand its applications and limitations to improve patient outcomes and continue to innovate.
Collapse
Affiliation(s)
- Matthew Driban
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Audrey Yan
- Department of Medicine, West Virginia School of Osteopathic Medicine, Lewisburg, WV, USA
| | - Amrish Selvam
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joshua Ong
- Michigan Medicine, University of Michigan, Ann Arbor, USA
| | | | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| |
Collapse
|
3
|
Arora S, Singh SR, Rosario B, Ibrahim MN, Selvam A, Zarnegar A, Harihar S, Sant V, Sahel JA, Vupparaboina KK, Chhablani J. Three-dimensional choroidal contour mapping in healthy population. Sci Rep 2024; 14:6210. [PMID: 38485744 PMCID: PMC10940280 DOI: 10.1038/s41598-024-56376-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 03/05/2024] [Indexed: 03/18/2024] Open
Abstract
Purpose was to study 3-dimensional choroidal contour at choroidal inner boundary (CIB) and choroidal outer boundary (COB) in healthy eyes. Healthy eyes imaged on wide field swept-source optical coherence tomography were included. Delineation of CIB and COB was done based on our previously reported methods. Quantitative analysis of the surfaces of CIB and COB was based on analyzing best fit spherical radius (R) (overall and sectoral). One hundred and seven eyes of 74 subjects with a mean age of 46.4 ± 19.3 years were evaluated. Overall, R COB (mean ± SD: 22.5 ± 4.8 mm) < R CIB (32.4 ± 9.4 mm). Central sector had the least R at COB (7.2 ± 5.9 mm) as well as CIB (25.1 ± 14.3 mm) across all age groups. Regression analysis between R (CIB) and age (r = -0.31, r2 = 0.09) showed negative correlation (P < 0.001) and that between R (COB) and age was positive (r = 0.26, r2 = 0.07) (P = 0.01). To conclude, central sector is the steepest sector in comparison to all the other sectors. This is indicative of a prolate shape of choroidal contour at CIB and COB. Outer boundary of choroid is steeper than inner boundary across all age groups. However, with ageing, outer boundary becomes flatter and inner boundary becomes steeper.
Collapse
Affiliation(s)
- Supriya Arora
- Bahamas Vision Centre and Princess Margaret Hospital, Nassau NP, Bahamas
| | | | - Brian Rosario
- UPMC Eye Center, University of Pittsburgh, Pittsburgh, USA
| | - Mohammed Nasar Ibrahim
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Amrish Selvam
- UPMC Eye Center, University of Pittsburgh, Pittsburgh, USA
| | - Arman Zarnegar
- UPMC Eye Center, University of Pittsburgh, Pittsburgh, USA
| | | | - Vinisha Sant
- UPMC Eye Center, University of Pittsburgh, Pittsburgh, USA
| | | | | | - Jay Chhablani
- UPMC Eye Center, University of Pittsburgh, Pittsburgh, USA.
| |
Collapse
|
4
|
Hasan N, Driban M, Mohammed AR, Schwarz S, Yoosuf S, Barthelmes D, Vupparaboina KK, Al-Sheikh M, Chhablani J. Effects of hydroxychloroquine therapy on choroidal volume and choroidal vascularity index. Eye (Lond) 2024; 38:620-624. [PMID: 37770532 PMCID: PMC10858202 DOI: 10.1038/s41433-023-02747-x] [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] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 08/09/2023] [Accepted: 09/11/2023] [Indexed: 09/30/2023] Open
Abstract
PURPOSE To determine changes in choroidal volume (CV) and choroidal vascularity index (CVI) in patients on hydroxychloroquine (HCQ) therapy. METHODS Retrospective analysis of patients on HCQ therapy. CV and CVI were assessed below the central foveal region on spectral-domain optical coherence tomography using an automatic denoising and localization algorithm. CV and CVI were compared with age-matched controls. Regression analyses were performed to generate associations between CV and CVI with demographics and HCQ treatment parameters. Associations were assessed using a generalized estimating equation model adjusted for intra-subject inter-eye correlations. RESULTS A total of 137 adult patients (23 males and 114 females) were included. Mean age was 45.6 ± 13.7 years and most patients identified as Caucasian (79%). Total duration of HCQ therapy ranged from 3 months to 20 years. Daily HCQ intake varied from 150-600 mg (mean = 304 mg), while cumulative doses ranged from 18-2,800 g. At presentation, the median CV was 0.51 (IQR:0.356-0.747) mm, and median CVI was 0.559 (IQR:0.528-0.578). Increased cumulative HCQ dose was associated with decreased CV (p = 0.006). Compared to age-matched controls, CV, CVI, and luminal area were significantly lower in the study group (p = 0.0003, 0.0001, and 0.0002). CONCLUSION In this study, we present a novel analysis of key biomarkers which predate the occurrence of HCQ retinopathy. Choroidal volume and vascularity index are significantly reduced in patients on HCQ therapy, especially at higher cumulative doses. These findings suggest new tools to guide medical decision-making for patients receiving HCQ therapy for rheumatologic diseases.
Collapse
Affiliation(s)
- Nasiq Hasan
- Dr. Agarwal's Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Matthew Driban
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Swen Schwarz
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Shakira Yoosuf
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | | | - Mayss Al-Sheikh
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| |
Collapse
|
5
|
Moir J, Kaufmann G, Rodriguez SH, Nourian N, Abdul Rasheed M, Vupparaboina KK, Chhablani J, Skondra D. Racial Differences in Choroidal Vascularity Index in Healthy Patients: Novel Insights. Ophthalmic Surg Lasers Imaging Retina 2024; 55:30-38. [PMID: 38189798 DOI: 10.3928/23258160-20231113-01] [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: 01/09/2024]
Abstract
BACKGROUND AND OBJECTIVE Choroidal vascularity index (CVI) measures the ratio of blood vessels in the choroid to the total choroidal area. We aimed to compare CVI between young Black and White patients without a history of ocular or systemic disease. PATIENTS AND METHODS We used a previously validated algorithm for shadow compensation and choroidal vessel binarization to measure CVI across the Early Treatment of Diabetic Retinopathy Study grid. RESULTS Black patients had a lower CVI (ß = -0.05, P < 0.001) compared to White patients. Choroidal volume or luminal volume did not significantly differ with respect to race, whereas there was a trend for Black patients to have a greater stromal volume (ß = 3.08, P = 0.01). CONCLUSIONS Black patients have a lower CVI than do White patients, likely due to a greater proportion of stromal volume. Further study of this parameter is warranted to validate the findings of this exploratory study. [Ophthalmic Surg Lasers Imaging Retina 2024;55:30-38.].
Collapse
|
6
|
Williamson RC, Selvam A, Sant V, Patel M, Bollepalli SC, Vupparaboina KK, Sahel JA, Chhablani J. Radiomics-Based Prediction of Anti-VEGF Treatment Response in Neovascular Age-Related Macular Degeneration With Pigment Epithelial Detachment. Transl Vis Sci Technol 2023; 12:3. [PMID: 37792693 PMCID: PMC10565708 DOI: 10.1167/tvst.12.10.3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/01/2023] [Indexed: 10/06/2023] Open
Abstract
Purpose Machine learning models based on radiomic feature extraction from clinical imaging data provide effective and interpretable means for clinical decision making. This pilot study evaluated whether radiomics features in baseline optical coherence tomography (OCT) images of eyes with pigment epithelial detachment (PED) associated with neovascular age-related macular degeneration (nAMD) can predict treatment response to as-needed anti-vascular endothelial growth factor (VEGF) therapy. Methods Thirty-nine eyes of patients with PED undergoing anti-VEGF therapy were included. All eyes underwent a loading dose followed by as-needed therapy. OCT images at baseline, month 3, and month 6 were analyzed. Images were manually separated into non-responding, recurring, and responding eyes based on the presence or absence of subretinal fluid at month 6. PED radiomics features were then extracted from each image and images were classified as responding or recurring using a machine learning classifier applied to the radiomics features. Results Linear discriminant analysis classification of baseline features as responsive versus recurring resulted in classification performance of 64.0% (95% confidence interval [CI] = 0.63-0.65), area under the curve (AUC = 0.78, 95% CI = 0.72-0.82), sensitivity 0.79 (95% CI = 0.63-0.87), and specificity 0.58 (95% CI = 0.50-0.67). Further analysis of features in recurring eyes identified a significant shift toward non-responding mean feature values over 6 months. Conclusions Our results demonstrate the use of radiomics features as predictors for treatment response to as-needed anti-VEGF therapy. Our study demonstrates the potential for radiomics feature in clinical decision support for personalizing anti-VEGF therapy. Translational Relevance The ability to use PED texture features to predict treatment response facilitates personalized clinical decision making.
Collapse
Affiliation(s)
- Ryan Chace Williamson
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amrish Selvam
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Manan Patel
- BJ Medical College, Ahmedabad, Gujarat, India
| | | | | | - Jose-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
7
|
Ruiz-Moreno JM, Gutiérrez-Bonet R, Chandra A, Vupparaboina KK, Chhablani J, Ruiz-Medrano J. Choroidal Vascularity Index versus Choroidal Thickness as Biomarkers of Acute Central Serous Chorioretinopathy. Ophthalmic Res 2023; 66:627-635. [PMID: 36854282 PMCID: PMC10026188 DOI: 10.1159/000529474] [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: 10/10/2022] [Accepted: 01/01/2023] [Indexed: 03/02/2023]
Abstract
INTRODUCTION The aim of this study was to analyze the choroidal vascularity index (CVI) versus choroidal thickness (CT) as biomarkers in acute central serous chorioretinopathy (CSCR). METHODS In this multicenter retrospective, cross-sectional, noninterventional study carried out at Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain; Jules-Gonin, Lausanne, Switzerland; and Pittsburg University, USA. 40 eyes from 40 patients with acute CSCR, 40 eyes from 40 patients with keratoconus (KC), and 40 eyes from 40 healthy patients were included. The variables analyzed were age, CT, CVI, and the presence of neurosensory retinal detachment. CT and the CVI were obtained from a 12-mm horizontal single-line B-scan (Triton SS-OCT, Topcon Co., Japan). Blinded measurements of the subfoveal CT were performed manually by two independent investigators. The images of the choroid were automatically binarized using a validated algorithm, and a percentage of vascularity was calculated. RESULTS There were no significant differences in age between the three groups (ANOVA, p = 0.092). There were statistically significant differences in CT and the CVI (ANOVA, p < 0.001). After Bonferroni correction, pairwise analysis between CSCR group against the KC group showed no significant differences in age and CT (p = 0.10 and p = 0.27, respectively). CVI was statistically greater among CSCR patients (p = 0.03). CONCLUSION CT does not meet the criteria to be considered a biomarker of acute CSCR, while CVI may prove to be a more specific and reliable biomarker. Further studies with larger sample sizes, standardized procedures, and a wider representation of all CSCR stages are necessary to confirm the validity of CVI as biomarker in this disease. Further studies with larger samples are required in order to validate the use of CVI/CT correlation as a new biomarker.
Collapse
Affiliation(s)
- José M. Ruiz-Moreno
- Department of Ophthalmology, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain
- Department of Ophthalmology, Castilla La Mancha University, Albacete, Spain
- Ocular Microsurgery Insitute (IMO), Miranza Corporation, Madrid, Spain
| | - Rosa Gutiérrez-Bonet
- Department of Ophthalmology, Gregorio Marañón University Hospital, Madrid, Spain
| | - Ashay Chandra
- Department of Ophthalmology, 6595 University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Jay Chhablani
- Department of Ophthalmology, 6595 University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jorge Ruiz-Medrano
- Department of Ophthalmology, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain
- Ocular Microsurgery Insitute (IMO), Miranza Corporation, Madrid, Spain
| |
Collapse
|
8
|
Sacconi R, Borrelli E, Balasubramanian S, Vella G, Battista M, Vupparaboina KK, Chhablani J, Bandello F, Querques G. Choroidal vascularity index in leptochoroid: A comparative analysis between reticular pseudodrusen and high myopia. Eye (Lond) 2023; 37:75-81. [PMID: 35001089 PMCID: PMC9829680 DOI: 10.1038/s41433-021-01889-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 07/17/2021] [Revised: 11/17/2021] [Accepted: 12/01/2021] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To investigate the choroidal vascularity index (CVI) in patients affected by leptochoroid. METHODS Three distinct age-matched cohorts were collected: patients with reticular pseudodrusen (RPD) secondary to age-related macular degeneration, patients with high-myopia, and healthy controls. CVI was calculated in the subfoveal 6000 μm diameter area. RESULTS 54 eyes (54 patients) were included (18 eyes in each cohort). No statistical differences were disclosed in terms of age between controls, RPD patients (p = 0.062), and myopic patients (p = 0.070). Total choroidal area showed a different distribution among the 3 cohorts (p < 0.001), due to the reduction of luminal and stromal choroidal area in both RPD and myopic groups in comparison to controls (p < 0.001). Interestingly, CVI showed a different distribution between the 3 cohorts (p < 0.001). In detail, RPD group showed no changes in CVI in comparison to controls (p = 1.000), whereas the myopic group showed a higher CVI in comparison to both RPD group and controls (p < 0.001 in both analyses). CONCLUSIONS Different changes of the choroidal vascular and stromal components characterize the leptochoroid secondary to RPD eyes and high-myopic eyes. The relative greater impairment of the vascular area in RPD eyes in comparison to myopic eyes could be at the basis of the lower development of RPD in patients with high myopia.
Collapse
Affiliation(s)
- Riccardo Sacconi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrico Borrelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Siva Balasubramanian
- Advanced Clinical, San Francisco, CA, USA
- Genentech, Inc., South San Francisco, San Francisco, CA, USA
| | - Giovanna Vella
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Battista
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Jay Chhablani
- Department of Ophthalmology, The University of Pittsburg, Pittsburg, USA
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Querques
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
- Division of head and neck, Ophthalmology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| |
Collapse
|
9
|
Gujar R, Cagini C, Fruttini D, Corbucci R, Rasheed MA, Vupparaboina KK, Mariotti C, Chhablani J, Lupidi M. Choroidal vascularity profile in diabetic eyes using wide field optical coherence tomography. Eur J Ophthalmol 2022; 33:11206721221143161. [PMID: 36457221 DOI: 10.1177/11206721221143161] [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] [Indexed: 02/17/2024]
Abstract
PURPOSE To report the wide-field choroidal vascularity up to the mid-equator area in diabetic retinopathy (DR) subjects using wide-field optical coherence tomography (WF-OCT). DESIGN Prospective, Cross-sectional study. PARTICIPANTS Forty-seven eyes of 25 DR subjects. METHODS WF-OCT images (55 degrees) were obtained using Spectralis HRA + OCT (Heidelberg Engineering, Germany) in extremes of gazes in all quadrants and manual montages were created to obtain wide field images up to mid equator. A previously reported semi-automated algorithm was used to calculate choroidal vascularity profile (CVI). Regression analysis was performed to identify the factors influencing CVI. RESULTS Forty-seven eyes from 25 patients were enrolled in the study. The mean age was 68.4 ± 10.6 years. The refractive error (spherical equivalent) ranged from -2.25 to +3.75 diopters. Most common DR grade among study subjects was moderate NPDR (29.41%) and 74.5% eyes had diabetic macular edema (DME). The mean CVI in the macular area (58.29 ± 3.63) was significantly lower than in any of the other fundus areas (all p ˂ 0.01). The maximum CVI was seen in the nasal region (66.60 ± 5.61), followed by temporal (65.69 ± 3.81), superior (65.01 ± 4.87), and inferior (63.80 ± 5.42). The vertical macular area had the least coefficient of variation (CV) of CVI (0.06) while the inferior quadrant had the highest CV (0.08). CONCLUSION The current study describes the CVI profile on WF-OCT in DR eyes up to mid-equator. The significant increase of the CVI compared to healthy subjects and its significant regional variations introduce this novel quantitative parameter as a reliable biomarker of the diabetes-induced choroidal microangiopathy.
Collapse
Affiliation(s)
- Ramkailash Gujar
- Department of Medicine and Surgery, Section of Ophthalmology, 60250University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Carlo Cagini
- Department of Medicine and Surgery, Section of Ophthalmology, 60250University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Daniela Fruttini
- Department of Internal Medicine, 60250University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Roberta Corbucci
- Department of Medicine and Surgery, Section of Ophthalmology, 60250University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | | | - Cesare Mariotti
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Jay Chhablani
- Department of Ophthalmology, 6595UPMC Eye Center, University of Pittsburgh, Pittsburgh, USA
| | - Marco Lupidi
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
- Fondazione per la Macula Onlus, Di.N.O.G.Mi., UniversityEye Clinic, Genova, Italy
| |
Collapse
|
10
|
Ibrahim MN, Bashar SB, Rasheed MA, Selvam A, Sant V, Sahel JA, Chhablani J, Vupparaboina KK, Jana S. Volumetric quantification of choroid and Haller's sublayer using OCT scans: An accurate and unified approach based on stratified smoothing. Comput Med Imaging Graph 2022; 99:102086. [PMID: 35717830 DOI: 10.1016/j.compmedimag.2022.102086] [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] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 05/10/2022] [Accepted: 05/31/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVE The choroid, a dense vascular structure in the posterior segment of the eye, maintains the health of the retina by supplying oxygen and nutrients, and assumes clinical significance in screening ocular diseases including age-related macular degeneration (AMD) and central serous chorioretinopathy (CSCR). As a technological assist, algorithmic estimation of choroidal biomarkers has been suggested based on sectional (B-scan) optical coherence tomography (OCT) images. However, most such 2D estimation techniques are compute-intensive, yet enjoy limited accuracy and have only been validated on OCT image datasets of healthy eyes. Not surprisingly, fine-scale analyses, including those involving Haller's sublayer, remain relatively rare and unsophisticated. Against this backdrop, we propose an efficient algorithm to quantify desired biomarkers with improved accuracy based on volume OCT scans. Specifically, we attempted an accurate, computationally light volumetric segmentation method involving stratified smoothing to detect choroid and Haller's sublayer. METHODS For detecting the various boundaries of the choroid and the Haller's sublayer, we propose a common volumetric method that performs suitable exponential enhancement and maintains smooth spatial continuity across 2D B-scans. Further, we achieve suitable volumetric smoothing by primarily deploying light-duty linear regression, and sparingly using compute-intensive tensor voting, and hence significantly reduce overall complexity. The proposed methodology is tested on five health and five diseased OCT volumes considering various metrics including volumetric Dice coefficient and corresponding quotient measures to facilitate comparison vis-à-vis intra-observer repeatability. RESULTS On five healthy and five diseased OCT volumes, respectively, the proposed method for choroid segmentation recorded volumetric Dice coefficients of 93.53 % and 93.30 %, which closely approximate the respective reference observer repeatability values of 95.60 % and 95.49 %. In terms of related quotient measures, our method achieved more than 50 % improvement over a recently reported method. In detecting Haller's sublayer as well, our algorithm records statistical performance closely matching that of reference manual method. CONCLUSION Advancing the state-of-the-art, the proposed volumetric segmentation, tested on both healthy and diseased datasets, demonstrated close match with the manual reference. Our method assumes significance in accurate screening of chorioretinal diseases including AMD, CSCR and pachychoroid. Further, it enables generating accurate training data for developing deep learning models for improved detection of choroid and Haller's sublayer.
Collapse
Affiliation(s)
- M N Ibrahim
- Dept. of Electrical Engg, Indian Institute of Technology Hyderabad, Telangana, India; Dept. of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| | - S Bin Bashar
- L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - M A Rasheed
- School of Optometry and Vision Science, University of Waterloo, Ontario, Canada
| | - A Selvam
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - V Sant
- Fox Chapel Area High School, Pittsburgh, PA, USA
| | - J A Sahel
- Dept. of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| | - J Chhablani
- Dept. of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| | - K K Vupparaboina
- Dept. of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA.
| | - S Jana
- Dept. of Electrical Engg, Indian Institute of Technology Hyderabad, Telangana, India
| |
Collapse
|
11
|
Cerquaglia A, Lupidi M, Chhablani J, Gujar R, Iaccheri B, Fiore T, Fruttini D, Ramundo A, Vupparaboina KK, Castellani L, Simonetti E, De Carolis L, Tiacci E, Falini B, Cagini C. Choroidal vasculature analysis in MEK inhibitor-associated retinopathy. Eur J Ophthalmol 2022; 32:3564-3573. [PMID: 35195471 DOI: 10.1177/11206721221081471] [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] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate choroidal vascularity index (CVI) in patients developing mitogen-activated protein kinase kinase (MEK) inhibitor-associated retinopathy (MEKAR). METHODS In this prospective observational study, extensive ophthalmic examination was performed, including enhanced-depth-imaging-optical coherence tomography (EDI-OCT). EDI-OCT scans of patients receiving Cobimetinib, taken at baseline and at MEKAR manifestation, were considered for choroid analysis. Choroidal thickness (CT) was measured on high-resolution b-scans passing through the fovea at three different locations. Same scans were therefore imported for binarization into a previously reported software and CVI was calculated as the ratio of luminal area (LA) to total choroid area (TCA). RESULTS When compared to baseline, eyes with MEKAR (14 eyes) did not show significative CT variation in subfoveal region (p = 0,57), 750-µm-nasal to the fovea (p = 0,08) and 750-µm-temporal to the fovea (p = 0,07). Similarly, there were no statistically significant differences for TCA (p = 0.54), LA (p = 0.85), stromal area (SA) (p = 0.13), LA/SA (p = 0.34) and CVI (p = 0.47). Best-corrected visual acuity was significantly reduced at fluid accumulation when compared to baseline values (p = 0.03), with complete recovery after fluid resolution (p = 0.73). CONCLUSION Multiple parameters reflecting the status of the choroid seemed not influenced by Cobimetinib administration. Retinal pigment epithelium toxic disfunction likely represents the crucial step in MEKAR pathogenesis.
Collapse
Affiliation(s)
- Alessio Cerquaglia
- Department of Medicine and Surgery, Section of Ophthalmology, 9309University of Perugia, Perugia, Italy
| | - Marco Lupidi
- Department of Medicine and Surgery, Section of Ophthalmology, 9309University of Perugia, Perugia, Italy
| | - Jay Chhablani
- Department of Ophthalmology, 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ramkailash Gujar
- Department of Medicine and Surgery, Section of Ophthalmology, 9309University of Perugia, Perugia, Italy
| | - Barbara Iaccheri
- Department of Medicine and Surgery, Section of Ophthalmology, 9309University of Perugia, Perugia, Italy
| | - Tito Fiore
- Department of Medicine and Surgery, Section of Ophthalmology, 9309University of Perugia, Perugia, Italy
| | - Daniela Fruttini
- Department of Medicine and Surgery, Section of Ophthalmology, 9309University of Perugia, Perugia, Italy
| | - Antonello Ramundo
- Department of Medicine and Surgery, Section of Ophthalmology, 9309University of Perugia, Perugia, Italy
| | | | - Luca Castellani
- Department of Medicine and Surgery, Section of Ophthalmology, 9309University of Perugia, Perugia, Italy
| | - Edoardo Simonetti
- Hematology, Center for Research in Hemato-Oncology (CREO), 9309University of Perugia, Perugia, Italy
| | - Luca De Carolis
- Hematology, Center for Research in Hemato-Oncology (CREO), 9309University of Perugia, Perugia, Italy
| | - Enrico Tiacci
- Hematology, Center for Research in Hemato-Oncology (CREO), 9309University of Perugia, Perugia, Italy
| | - Brunangelo Falini
- Hematology, Center for Research in Hemato-Oncology (CREO), 9309University of Perugia, Perugia, Italy
| | - Carlo Cagini
- Department of Medicine and Surgery, Section of Ophthalmology, 9309University of Perugia, Perugia, Italy
| |
Collapse
|
12
|
Muftuoglu IK, Kalra G, Rasheed MA, Cagini C, Gujar R, Vupparaboina KK, Singh SR, Lupidi M, Chhablani J. Wide-field optical coherence tomography imaging in diabetic retinopathy. Eur J Ophthalmol 2021; 32:2298-2305. [PMID: 34747260 DOI: 10.1177/11206721211054972] [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] [Indexed: 11/15/2022]
Abstract
PURPOSE To report the individual retinal layer thicknesses up to mid-equator in patients with diabetic retinopathy (DR) using Spectralis (Heidelberg Engineering, Heidelberg, Germany) wide-field optical coherence tomography (OCT). METHODS Retinal layers were segmented using a custom designed semi-automated algorithm, where reference points were marked by the examiner to enable software to automatically compute the thickness values of each retinal sublayer at an interval of 1 mm from reference points. The values of individual retinal thicknesses in eyes with varying severity of DR were compared with the values of healthy subjects. Generalized estimating equation was performed to compensate for inclusion of both eyes of patients. RESULTS A total of 64 patients (119 eyes) with a mean age of 68.97 ± 10.27 years were included. Overall, ganglion cell layer (GCL)/ inner plexiform layer (IPL) complex (-31.67 microns, p < 0.001), outer plexiform layer (-6.78 microns, p = 0.002) and photoreceptor layer (-22.90 microns, p < 0.001) showed significant thinning, while outer nuclear layer thickening ( + 68.19 microns, <0.001) was noted in eyes with DM compared to healthy subjects. Thickness changes were significantly more in the macular segment compared to nasal and temporal segments. GCL/ IPL complex and photoreceptor layers were found to be significantly thin in all grades of DR. CONCLUSION Retinal thicknesses vary significantly in patients with diabetic retinopathy and understanding patterns of these changes across different segments of the wide field OCT may help better elucidate the natural progression of the disease in terms of retinal anatomy.
Collapse
Affiliation(s)
- Ilkay Kilic Muftuoglu
- Department of Ophthalmology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Gagan Kalra
- 29746Government Medical College and Hospital, Chandigarh, India
| | - Mohammed Abdul Rasheed
- School of Optometry and Vision Science, 8430University of Waterloo, Waterloo, ON, Canada
| | - Carlo Cagini
- Department of Biochemical and Surgica l Sciences, Section of Ophthalmology, 60250University of Perugia, Perugia, Italy
| | - Ramkailash Gujar
- Department of Biochemical and Surgica l Sciences, Section of Ophthalmology, 60250University of Perugia, Perugia, Italy
| | | | - Sumit Randhir Singh
- Jacobs Retina Center, Shiley Eye Institute, 8784University of California, San Diego, CA, USA
| | - Marco Lupidi
- Department of Biochemical and Surgica l Sciences, Section of Ophthalmology, 60250University of Perugia, Perugia, Italy
| | - Jay Chhablani
- 345156UPMC Eye Center, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
13
|
Vasudeva A, Dhakal R, Vupparaboina KK, Verkicharla PK. Do rectus muscle parameters vary between emmetropes and myopes? Ophthalmic Physiol Opt 2021; 41:1300-1307. [PMID: 34549823 DOI: 10.1111/opo.12890] [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: 05/14/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE This study investigated the thickness, area, and insertion site of the medial (MR) and lateral (LR) rectus muscles in individuals with emmetropia and different degrees of myopia. METHODS Swept-source optical coherence tomography images of the MR and LR muscles in 80 participants including emmetropes (spherical equivalent refractive error [SER] ±0.50 D, N = 14) and myopes (≤ -0.75 D, N = 66), were analysed. Custom-designed, semi-automated software was used to measure parameters such as insertion distance from limbus, muscle thickness at every 1 mm interval to 3 mm periphery and muscle area from insertion site to 3 mm. RESULTS The median (Q1, Q3) SER error and axial length were -6.00 D (-13.25, -2.12) and 25.78 mm (23.78, 28.61), respectively. The MR was significantly thinner (mean ± SE: 137.7 ± 8.9 vs. 159.7 ± 8.9 µm, p < 0.01) and occupied less area than the LR (0.35 ± 0.01 vs. 0.42 ± 0.01 mm2 , respectively, p < 0.01). The thickness of the MR gradually increased from the insertion site to a 3 mm peripheral eccentric location (106.5 3.8 µm at 1 mm, 135.5 ± 4.5 µm at 2 mm and 156.1 ± 5.9 µm at 3 mm, p < 0.01). The overall median thickness of the MR was significantly less in myopes (129 µm [111.5, 152.2]) than emmetropes (158.1 [134.3, 167.7] µm, p = 0.03). However, no such trend was seen in the LR muscle. Muscle area and insertion distance were not different between emmetropes and myopes in both horizontal rectus muscles. CONCLUSION Unlike the LR, the parameters of the MR (thin and occupying less area) show significant association with myopia. While the key finding of this study indicates the possible association of MR parameters with myopia, the clinical relevance of this finding and its role in myopiogenesis/progression needs to be investigated further.
Collapse
Affiliation(s)
- Ashish Vasudeva
- Myopia Research Lab, Brien Holden Institute of Optometry and Vision Sciences, Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Rohit Dhakal
- Myopia Research Lab, Brien Holden Institute of Optometry and Vision Sciences, Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Kiran Kumar Vupparaboina
- Ophthalmic Engineering Group, LVPEI Centre for Innovation, L V Prasad Eye Institute, Hyderabad, India
| | - Pavan K Verkicharla
- Myopia Research Lab, Brien Holden Institute of Optometry and Vision Sciences, Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| |
Collapse
|
14
|
Gallagher D, Kalra G, Rasheed MA, Vupparaboina KK, Singh SR, Chhablani J. Long-term retinal changes in progressive geographic atrophy. Eur J Ophthalmol 2021; 32:1687-1693. [PMID: 34308667 DOI: 10.1177/11206721211035636] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Age-related macular degeneration (AMD) is one of the leading causes of blindness with loss of retinal layers over long term. We aim to evaluate these changes in eyes with progressive non-exudative AMD with geographic atrophy (GA). METHODS This retrospective study included patients with GA with a minimum of 4 years follow up. Retinal layers on spectral domain optical coherence tomography (SD-OCT) were segmented based on their reflectivity patterns using validated semi-automated segmentation algorithm. The thickness of the segmented retinal layers was measured. Horizontal length of GA at baseline and last follow-up were also measured. Regression analysis was performed to correlate changes in RPE layer thickness with other retinal layers and the length of GA on OCT. RESULTS A total of 351-line scans including 17 foveal scans showing presence of GA at final visit that is, a total of 2457 retinal layer bands were analyzed. Outer nuclear layer (ONL) (p = 0.02), outer segment layers (OSL) (p = 0.01), and retinal pigment epithelium (RPE) (p = 0.01) showed a statistically significant variation between baseline and final visit. Regression analysis showed the change in ONL (r = 0.72; p = 0.01) and OSL (r = 0.93, p < 0.01) correlated significantly with change in RPE thickness whereas rest of the layers failed to show significant correlation. CONCLUSION Outer retinal layers (ONL and OSL) show more significant and widespread changes in retinal thickness and correlated most significantly with RPE thickness changes in eyes with GA due to AMD. Assessment of various retinal layer bands can be used as surrogate quantitative parameters to study eyes with GA.
Collapse
Affiliation(s)
| | - Gagan Kalra
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | | | | | - Sumit Randhir Singh
- Jacobs Retina Center at Shiley Eye Institute, University of California, San Diego, La Jolla, CA, USA
| | - Jay Chhablani
- UPMC Eye Center, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
15
|
Rao A, Vupparaboina KK, Padhy D, Raj N, Pradhan A, Goud A, Peguda HK, Jana S, Richariya A. Automated iris volume analysis and trabecular meshwork length using anterior segment optical coherence tomography - Application in pseudoexfoliation and pseudoexfoliation glaucoma. Indian J Ophthalmol 2021; 69:1815-1819. [PMID: 34146036 PMCID: PMC8374829 DOI: 10.4103/ijo.ijo_2403_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/22/2022] Open
Abstract
Purpose: The aim of this study was to evaluate differences in the iris and angle parameters in psuedoexfoliation syndrome (PXF) and pseudoexfoliation glaucoma (PXG) using anterior segment optical coherence tomography (ASOCT). Methods: Patients with PXF or PXG were compared using ASOCT with primary open-angle glaucoma POAG eyes as controls in this noninterventional comparative study conducted at a tertiary eye care center in East India. All angle parameters, TM length, and iris thickness were analyzed from the enhanced depth imaging (EDI) single scans obtained. Quadrant scans were used for the calculation of iris volume using a custom-built in-house software. In particular, the software performs multiple operations including edge detection, connected components, and thresholding to localize and segment the iris. Differences in the iris volume/thickness and TM length in PXF and PXG with POAG were analyzed. Results: A total of 225 eyes were included, which included 75 PXG and 98 PXF cases and 52 POAG with a mean age of 67 ± 9.7 years at presentation. The algorithm repeatability and reproducibility was also established with correlation coefficients more than 99% which was substantiated with Bland-Altman plots. The iris volume (calculated in 197 images of 225 eyes) did not differ significantly in PXF and PXG eyes, although both had significantly greater volume compared to POAG eyes. The iris volume or other angle parameters including TM length did not correlate with clinical variables such as IOP, age, or visual field indices. Conclusion: Iris parameters or TM length do not explain pathogenesis of glaucoma in pseudoexfoliation.
Collapse
Affiliation(s)
- Aparna Rao
- LV Prasad Eye Institute, Patia, Bhubaneswar, Orissa, India
| | | | | | - Niranjan Raj
- LV Prasad Eye Institute, Patia, Bhubaneswar, Orissa, India
| | - Amiya Pradhan
- LV Prasad Eye Institute, Patia, Bhubaneswar, Orissa, India
| | - Abilash Goud
- LV Prasad Eye Institute, Hyderabad, Telangana, India
| | | | - Soumya Jana
- LV Prasad Eye Institute, Hyderabad, Telangana, India
| | | |
Collapse
|
16
|
Goud A, Sahoo NK, Rasheed MA, Singh SR, Ankireddy S, Vupparaboina KK, Lupidi M, Chhablani J. Water-Drinking Test in Central Serous Chorioretinopathy. J Curr Ophthalmol 2021; 33:62-67. [PMID: 34084959 PMCID: PMC8102945 DOI: 10.4103/joco.joco_225_20] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/01/2020] [Accepted: 10/17/2020] [Indexed: 11/04/2022] Open
Abstract
Purpose To evaluate choroidal changes in central serous chorioretinopathy (CSCR) patients after water-drinking test (WDT). Methods This prospective study included treatment-naïve acute and chronic CSCR eyes and healthy controls. Intraocular pressure and optical coherence tomography measurements with choroidal vascular index (CVI) measurements were done at baseline. Patients were asked to drink 1 L of water, and tests were repeated at 15, 30, and 45 min. Results Fifty-six eyes from 42 patients were enrolled. Choroidal area, luminal area, and stromal area were higher at baseline in eyes with acute CSCR compared to healthy controls. Chronic CSCR eyes showed an increase in choroidal area and stromal area and a decrease in the luminal area at 15 min. There was a significant decrease in CVI at 30 and 45 min in chronic CSCR and CVI at 45 min in fellow eyes of acute CSCR. Repeated-measures analysis of variance (ANOVA) showed a significant change in central macular thickness in acute CSCR, choroidal thickness in fellow eyes of acute CSCR, stromal area, and total choroidal area in chronic CSCR. Mixed model ANOVA showed that the change in various choroidal parameters seen had no interaction with the eye type. Conclusion Although change in various parameters was seen in acute CSCR, chronic CSCR, and fellow eyes of acute CSCR following WDT, the change was not significantly different among the groups.
Collapse
Affiliation(s)
- Abhilash Goud
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Niroj Kumar Sahoo
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Mohammed Abdul Rasheed
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sumit Randhir Singh
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Samatha Ankireddy
- Department of Ophthalmology, Kansas City School of Medicine, University of Missouri, Kansas City, MO, USA
| | | | - Marco Lupidi
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, Perugia, Italy
| | - Jay Chhablani
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, Hyderabad, Telangana, India.,UPMC Eye Centre, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
17
|
Sahoo NK, Singh SR, Beale O, Nkrumah G, Rasheed MA, Jabeen A, Vupparaboina KK, Ibrahim MN, Tatti F, Chandra K, Lanza M, Iovino C, Peiretti E, Chhablani J. Choroidal Vascularity Map in Unilateral Central Serous Chorioretinopathy: A Comparison with Fellow and Healthy Eyes. Diagnostics (Basel) 2021; 11:diagnostics11050861. [PMID: 34064718 PMCID: PMC8150964 DOI: 10.3390/diagnostics11050861] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/04/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background: To map the choroidal vascularity index and compare two eyes in patients with unilateral central serous chorioretinopathy (CSCR). Methods: This was a retrospective, observational study performed in patients with unilateral CSCR. Choroidal thickness (CT) and Choroidal vascularity index (CVI) were measured and mapped in various zones according to the early treatment diabetic retinopathy (ETDRS) grid. Results: A total of 20 CSCR patients (20 study and 20 fellow eyes) were included in the study. Outer nasal region CT was seen to be significantly lower than central CT (p = 0.042) and inner nasal CT (p = 0.007); outer ring CT was significantly less than central (p = 0.04) and inner ring (p = 0.01) CT in CSCR eyes. On potting all the CVI values against the corresponding CT values, a positive correlation was seen in CSCR eyes (r = 0.54, p < 0.01), which was slightly weaker in fellow eyes (r = 0.3, p < 0.01) and a negative correlation was seen in healthy eyes (r = −0.262, p < 0.01). Conclusions: Correlation between CVI and CT was altered in CSCR eyes as compared to fellow and normal eyes with increasing CVI towards the center of the macula and superiorly in CSCR eyes.
Collapse
Affiliation(s)
- Niroj Kumar Sahoo
- Department of Retina and Vitreous, L V Prasad Eye Institute, Vijayawada 521134, India;
| | - Sumit Randhir Singh
- Jacobs Retina Center, Shiley Eye Institute, University of California San Diego, San Diego, CA 92697, USA;
| | - Oliver Beale
- UPMC Eye Centre, University of Pittsburgh, Pittsburgh, PA 15213, USA; (O.B.); (G.N.); (K.K.V.)
| | - Gideon Nkrumah
- UPMC Eye Centre, University of Pittsburgh, Pittsburgh, PA 15213, USA; (O.B.); (G.N.); (K.K.V.)
| | - Mohammed Abdul Rasheed
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (M.A.R.); (A.J.)
| | - Asiya Jabeen
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON N2L 3G1, Canada; (M.A.R.); (A.J.)
| | | | - Mohammed Nasar Ibrahim
- Department of Electrical Engineering, Indian Institute of Technology, Hyderabad 502285, India;
| | - Filippo Tatti
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, 9121 Cagliari, Italy; (F.T.); (E.P.)
| | - Khushboo Chandra
- Department of Vitreoretina, Disha Eye Hospitals Pvt Ltd., 88(63A) Ghosh Para Road, Barrackpore, Kolkata 700120, India;
| | - Michele Lanza
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 81100 Naples, Italy; (M.L.); (C.I.)
| | - Claudio Iovino
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, 81100 Naples, Italy; (M.L.); (C.I.)
| | - Enrico Peiretti
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, 9121 Cagliari, Italy; (F.T.); (E.P.)
| | - Jay Chhablani
- UPMC Eye Centre, University of Pittsburgh, Pittsburgh, PA 15213, USA; (O.B.); (G.N.); (K.K.V.)
- Correspondence: ; Tel.: +1-412-377-1943
| |
Collapse
|
18
|
Singh SR, Beale O, Nkrumah G, Rasheed MA, Sahoo NK, Vupparaboina KK, Tatti F, Chandra K, Iovino C, Peiretti E, Chhablani J. Correlation of sectoral choroidal vascularity with angiographic leakage in central serous chorioretinopathy. Eur J Ophthalmol 2021; 32:11206721211013653. [PMID: 33947248 DOI: 10.1177/11206721211013653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To correlate sectoral choroidal vascularity with angiographic leakage in eyes with central serous chorioretinopathy (CSCR). METHODS This was a retrospective, cross-sectional study including patients with active CSCR. Multimodal imaging including fundus fluorescein angiography (FFA) and optical coherence tomography (OCT) were performed to identify leakage site and obtain choroidal measurements, respectively. An automated algorithm was used to perform shadow compensation, choroidal boundary localization and binarization, three (3-D) dimensional mapping, and early treatment of diabetic retinopathy study (ETDRS) grid based choroidal quantification that is, choroidal thickness (CT) and choroidal vascularity index (CVI). Nested analysis of variance (ANOVA) was performed to compare CT and CVI in different sectors. RESULTS Thirty-two eyes with active CSCR were analyzed. CT values varied significantly among the sectors (range, 450.27-482.63 µm; p = 0.005) and rings (range, 459.71-480.45 µm; p < 0.001), however, CVI failed to show significant variation among various segments (sectors, rings, and quadrants; range, 0.53-0.54; all p values > 0.05). Among 25 leaking spots in 25 different sectors, 12 (48%) had an increased CT compared to the overall CT whereas only 24% had increased CVI compared to overall CVI. Mean CT and CVI of the sectors with leakage (427.1 ± 81.1 µm; 0.51 ± 0.05) and remaining sectors without leakage (411.3 ± 73.9 µm; 0.53 ± 0.04) were not statistically different (p = 0.48; p = 0.12, respectively). CONCLUSION Though CT varied in different segments and increased CT corresponded to leakage points on FFA in 48% of eyes, CVI changes were more diffusely spread and local changes in CVI were not predictive of leakage location in eyes with active CSCR.
Collapse
Affiliation(s)
- Sumit Randhir Singh
- Jacobs Retina Center, Shiley Eye Institute, University of California San Diego, San Diego, CA, USA
| | - Oliver Beale
- UPMC Eye Centre, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gideon Nkrumah
- UPMC Eye Centre, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Niroj Kumar Sahoo
- L. V. Prasad Eye Institute, Tadigadapa, Vijayawada, Andhra Pradesh, India
| | | | - Filippo Tatti
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Khushboo Chandra
- Dept. of Vitreoretina, Disha Eye Hospitals Pvt Ltd, Kolkata, India
| | - Claudio Iovino
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, Università degli Studi della Campania 'Luigi Vanvitelli', Naples, Italy
| | - Enrico Peiretti
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Jay Chhablani
- UPMC Eye Centre, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
19
|
Iovino C, Di Iorio V, Testa F, Bombace V, Melillo P, Vupparaboina KK, Chhablani J, Simonelli F. Choroidal Vascularity Features in Patients with Choroideremia and Cystoid Spaces. Diagnostics (Basel) 2021; 11:diagnostics11030382. [PMID: 33668232 PMCID: PMC7996232 DOI: 10.3390/diagnostics11030382] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 02/02/2021] [Revised: 02/20/2021] [Accepted: 02/21/2021] [Indexed: 11/16/2022] Open
Abstract
Cystoid spaces (CSs) are a common retinal finding in choroideremia (CHM) patients. The aim of this study was to analyze the vascular features of the choroid associated with the presence of CSs in patients with confirmed genetic diagnosis of CHM. A total of 33 patients (33 eyes) were enrolled in this retrospective cross-sectional study and divided into two groups based on the presence (17 eyes) or absence (16 eyes) of CSs. Choroidal features were evaluated on spectral-domain optical coherence tomography including subfoveal choroidal thickness (CT), total choroidal area (TCA), luminal choroidal area (LCA), and stromal choroidal area (SCA). The choroidal vascularity index (CVI) was then calculated in all study eyes. All structural choroidal parameters were calculated both on the entire length of the B-scan and in the central subfoveal 1500 μm. The average age was 37.3 ± 11.6 and 31.4 ± 16.7 years (p = 0.25) and mean logMAR best-corrected visual acuity was 0.11 ± 0.20 and 0.20 ± 0.57 (p = 0.54) in the CHM groups with and without CSs, respectively. There were no significant differences in subfoveal CT, and TCA, LCA, SCA, and CVI evaluated on either the entire scan or in the central 1500 μm (all p > 0.05). All choroidal vasculature parameters exhibited no significant differences between CHM eyes with and without CSs. Our results suggest that the choroid may not be involved in the development of CSs in patients with CHM.
Collapse
Affiliation(s)
- Claudio Iovino
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania ‘Luigi Vanvitelli’, Via Pansini 5, 80131 Naples, Italy; (C.I.); (V.D.I.); (F.T.); (V.B.); (P.M.)
| | - Valentina Di Iorio
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania ‘Luigi Vanvitelli’, Via Pansini 5, 80131 Naples, Italy; (C.I.); (V.D.I.); (F.T.); (V.B.); (P.M.)
| | - Francesco Testa
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania ‘Luigi Vanvitelli’, Via Pansini 5, 80131 Naples, Italy; (C.I.); (V.D.I.); (F.T.); (V.B.); (P.M.)
| | - Viviana Bombace
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania ‘Luigi Vanvitelli’, Via Pansini 5, 80131 Naples, Italy; (C.I.); (V.D.I.); (F.T.); (V.B.); (P.M.)
| | - Paolo Melillo
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania ‘Luigi Vanvitelli’, Via Pansini 5, 80131 Naples, Italy; (C.I.); (V.D.I.); (F.T.); (V.B.); (P.M.)
| | - Kiran Kumar Vupparaboina
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad 500034, India;
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA;
| | - Francesca Simonelli
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania ‘Luigi Vanvitelli’, Via Pansini 5, 80131 Naples, Italy; (C.I.); (V.D.I.); (F.T.); (V.B.); (P.M.)
- Correspondence: ; Tel.: +39-081-7704501
| |
Collapse
|
20
|
Reddy JC, Devta S, Vupparaboina KK, Ali MH, Vaddavalli PK. Early results of circularity and centration of capsulotomy prepared by three different methods. Int J Ophthalmol 2021; 14:76-82. [PMID: 33469487 DOI: 10.18240/ijo.2021.01.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/01/2020] [Accepted: 08/12/2020] [Indexed: 01/19/2023] Open
Abstract
AIM To compare the difference of capsulotomy produced by precision pulse capsulotomy (PPC), manual (M-CCC), and femtosecond laser assisted capsulotomy (FLAC) in relation to intraocular lens (IOL) centration, circularity and its effect on visual outcomes. METHODS Prospective, non-randomized comparative study conducted at LV Prasad Eye Institute, Hyderabad, India. Sixty eyes of 52 patients were grouped into 3 (FLAC, PPC and M-CCC) based on capsulotomy techniques used. Twenty consecutive eyes with uneventful phacoemulsification and with no comorbidities affecting the capsulotomy or visual outcome were included in each group. The main outcome measure was IOL centration in relation to capsulotomy and pupil. Secondary outcome measures were post-operative visual acuity, manifest refraction and aberration profile between groups. RESULTS At 5wk the visual, refractive outcomes and endothelial cell density were comparable between the 3 groups. The median circularity index of FLAC was statistically significantly different to M-CCC or PPC (1-10) groups (P<0.01) but PPC (11-20) was comparable to FLAC. Decentration of IOL center in relation to capsulotomy was seen only between the PPC (1-10) group and FLAC group (P=0.02). The IOL was well centered in relation to the pupil in all the groups (P=0.46). The quality of vision parameters like the higher order aberrations, spherical aberration, coma, trefoil, modular transfer function, and Strehl ratio were comparable between the groups. CONCLUSION Our study shows that despite differences in the morphology of capsulotomy produced by PPC, M-CCC, FLAC a well-centered IOL can be achieved. The measured capsular morphology parameters do not affect visual outcomes.
Collapse
Affiliation(s)
- Jagadesh C Reddy
- Cataract and Refractive Services, Cornea Institute, L V Prasad Eye Institute (LVPEI), Hyderabad 500034, India
| | - Soumya Devta
- Cataract and Refractive Services, Cornea Institute, L V Prasad Eye Institute (LVPEI), Hyderabad 500034, India
| | - Kiran Kumar Vupparaboina
- Senior Scientific Officer, Srujana Centre for Innovation, L V Prasad Eye Institute (LVPEI), Hyderabad 500034, India
| | - Mohammad Hasnat Ali
- Biostatistician, Clinical Epidemiology and Biostatistics, L V Prasad Eye Institute (LVPEI), Hyderabad 500034, India
| | - Pravin K Vaddavalli
- Cataract and Refractive Services, Cornea Institute, L V Prasad Eye Institute (LVPEI), Hyderabad 500034, India
| |
Collapse
|
21
|
Singh SR, Invernizzi A, Rasheed MA, Cagini C, Goud A, Gujar R, Vupparaboina KK, Ankireddy S, Cozzi M, Lupidi M, Chhablani J. Wide-field choroidal vascular analysis in central serous chorioretinopathy. Eur J Ophthalmol 2020; 31:2520-2527. [PMID: 33135489 DOI: 10.1177/1120672120963456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To report the wide-field choroidal vessel analysis in central serous chrorioretinopathy (CSCR) and their fellow eyes. METHODS Wide-field optical coherence tomography (WF-OCT) images (55°) were obtained using Spectralis HRA + OCT (Heidelberg Engineering, Germany) in extremes of gazes in all quadrants and manual montages were created to obtain wide field images up to equator. Choroidal thickness (CT), large choroidal vessel layer thickness (LCVT), and choroidal vascularity index (CVI) were calculated in macular segment (twice the disc to fovea distance) and all four quadrants. Regression analysis was performed to identify the factors influencing CVI. RESULTS Thirty-one patients of CSCR including 39 eyes of CSCR (32 chronic, 7 acute) and 23 fellow eyes were analyzed. CT and LCVT were significantly higher in submacular choroid than all extramacular segments in both CSCR and fellow eyes (all p values <0.01). CVI varied significantly in different segments in horizontal (p < 0.01 in both) and vertical meridian (p < 0.01 and p = 0.01 respectively) in CSCR and fellow eyes. Both CSCR and fellow eyes had highest CVI in nasal segment with minimum CVI in macular segment. Age (p = 0.85), gender (p = 0.39), chronicity of the disease (acute vs chronic, p = 0.57), axial length (p = 0.67), SBP (p = 0.81), and DBP (p = 0.94) were not significantly correlated to CVI. CONCLUSION CVI shows significant regional variation with macular segment showing the lowest CVI whereas nasal segments have highest CVI in both CSCR and their fellow eyes. On the contrary, submacular segment has highest CT and LCVT with taper towards periphery in both CSCR and fellow eyes.
Collapse
Affiliation(s)
- Sumit Randhir Singh
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India.,Retina and Uveitis Department, GMR Varalakshmi Campus, L V Prasad Eye Institute, Hanumanthawaka Junction, Visakhapatnam, Andhra Pradesh, India
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", University of Milan, Milano, Italy
| | - Mohammed Abdul Rasheed
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Carlo Cagini
- Department of Biochemical and Surgical Sciences, Section of Ophthalmology, University of Perugia, Perugia, Italy
| | - Abhilash Goud
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Ramkailash Gujar
- Department of Biochemical and Surgical Sciences, Section of Ophthalmology, University of Perugia, Perugia, Italy
| | - Kiran Kumar Vupparaboina
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Samatha Ankireddy
- Kansas City School of Medicine, University of Missouri, Kansas City, MO, USA
| | - Mariano Cozzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", University of Milan, Milano, Italy
| | - Marco Lupidi
- Department of Biochemical and Surgical Sciences, Section of Ophthalmology, University of Perugia, Perugia, Italy
| | - Jay Chhablani
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India.,UPMC Eye Center, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
22
|
Hanumunthadu D, Rasheed MA, Goud A, Gupta A, Vupparaboina KK, Chhablani J. Choroidal hyper-reflective foci and vascularity in retinal dystrophy. Indian J Ophthalmol 2020; 68:130-133. [PMID: 31856490 PMCID: PMC6951143 DOI: 10.4103/ijo.ijo_148_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Indexed: 11/25/2022] Open
Abstract
Purpose: To investigate choroidal hyper-reflective foci (HRF) in subjects with retinal dystrophy [Stargardt's disease (SGD) and retinitis pigmentosa (RP)] and their association with demographics, visual acuity, choroidal thickness (CT), and choroidal vascularity index (CVI). Methods: Single center retrospective study of subjects with previously diagnosed SGD or RP. Swept-source optical coherence tomography images were analyzed for the presence of choroidal HRFs and CVI using previously validated automated algorithm. A Spearman's rank correlation coefficient was used to evaluate the correlation between the number of HRF and various baseline parameters including age, visual acuity, intraocular pressure, and other optical coherence tomography (OCT) parameters (CT, choroidal area, and CVI) were evaluated in these subjects. Results: This study included 46 eyes (23 subjects) and 55 eyes (28 subjects) with previously diagnosed RP and SGD, respectively. In the RP group, the mean number of HRFs was 247.9 ± 57.1 and mean CVI was 0.56 ± 0.04. In SGD group, mean HRF was 192.5 ± 44.3 and mean CVI was 0.41 ± 0.04. Mean HRF was significantly greater in the RP group (0.02), however, the mean CVI was not statistically different. In RP, mean HRF were correlated only with CVI (r = 0.49; P = 0.001), however, in SGD, it correlated with only choroidal area (r = 0.27; P = 0.04). Conclusion: Choroidal HRF were present in both RP and SGD subjects with more HRFs in those with RP. These HRFs were associated with alteration in choroidal vascularity, which further adds into the pathogenesis of these diseases.
Collapse
Affiliation(s)
| | - Mohammed Abdul Rasheed
- Srimati Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Hyderabad Eye Research Foundation, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Abhilash Goud
- Srimati Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Hyderabad Eye Research Foundation, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Arushi Gupta
- Srimati Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Hyderabad Eye Research Foundation, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Kiran Kumar Vupparaboina
- Srimati Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Hyderabad Eye Research Foundation, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Jay Chhablani
- Srimati Kanuri Santhamma Centre for Vitreo-Retinal Diseases, Hyderabad Eye Research Foundation, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
| |
Collapse
|
23
|
Guduru A, Rasheed MA, Goud A, Vupparaboina KK, Agrawal R, Lupidi M. Peripapillary choroidal vascularity quantification and characterization in healthy individuals. Nepal J Ophthalmol 2020; 12:48-55. [PMID: 32799239 DOI: 10.3126/nepjoph.v12i1.25188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION To characterize the peripapillary choroidal vasculature in healthy individuals using the choroidal vascular index (CVI), a previously established more robust tool of measurement of choroidal vascularity than choroidal thickness. METHODS The peripapillary choroid in healthy individuals was analyzed using optical coherence tomography. OCT B-scan were analyzed using automated binarization, a previously established technique. This separates the choroidal layer into the stromal and vascular areas. Choroidal vascular index (CVI), the vascular area/total area, was computed for each image over the macula and the peripapillary area of the optic disc. Regression analysis and generalized estimating equation (GEE) were used to analyze various demographics, and CVI in the macula and each quadrant of the optic disc. RESULTS Fifty eight eyes of 29 healthy individuals were included. Mean age was 42±17 years. Average CVI at the macula was 0.583. Average peripapillary CVI was 0.643 (nasal), 0.598 (temporal), 0.621 (superior) and 0.623 (inferior). Regression analysis of variables demonstrated there was no significant relationship between the demographic variables and macular CVI. However, the analysis demonstrated age and CVI of the peripapillary area were significantly correlated. Further stratification revealed significantly higher CVI in the optic disc in subjects over 45. CONCLUSION Peripapillary CVI in all quadrants is higher than macular CVI in all age groups. CVI significantly increases after the age of 45 in the peripapillary area but not macular area. This suggests that stromal area decline is greater than the decline of the luminal area in the choroid at the peripapillary area as age increases.
Collapse
Affiliation(s)
- Abhilash Guduru
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | | | | | | | | |
Collapse
|
24
|
Singh SR, Invernizzi A, Rasheed MA, Cagini C, Goud A, Gujar R, Pandey P, Vupparaboina KK, Cozzi M, Lupidi M, Chhablani J. Wide-field individual retinal layer thickness in healthy eyes. Eur J Ophthalmol 2020; 31:1970-1977. [PMID: 32476463 DOI: 10.1177/1120672120927664] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the individual retinal layer thickness in healthy subjects using wide-field optical coherence tomography. METHODS This was a prospective, cross-sectional study involving healthy subjects. A custom-designed semiautomated segmentation algorithm was used to split the retinal layers in seven bands, and individual retinal layer thicknesses were measured in horizontal (nasal, macular, and temporal segments) and vertical meridians (superior, macular, and inferior segments). The variation in retinal thickness was analyzed in different segments at an interval of 1 mm from reference points. Regression analysis was performed to identify the factors affecting retinal thickness. RESULTS Twenty eyes of 20 healthy subjects with mean age of 28.9 ± 6.3 years were analyzed. Overall, nasal and superior segments (mean ± standard deviation: 279.6 ± 17.0 and 234.4 ± 19.2 µm) had maximum and minimum retinal thicknesses, respectively. A total of seven bands were delineated in each optical coherence tomography b scan in each segment. Retinal nerve fiber layer was thickest immediately nasal to optic disk margin in horizontal scan (72.4 ± 32.4 µm) and near the vascular arcades in vertical meridian. Outer plexiform layer, external limiting membrane-ellipsoid zone and interdigitation zone-retinal pigment epithelium-Bruch's complex showed significant variation in both horizontal and vertical meridians (all p values <0.05). Macular segment in both meridians showed the highest coefficient of variation. Age was the only significant factor affecting retinal thickness in multiple regression analysis (p = 0.001). CONCLUSIONS Wide-field optical coherence tomography shows significant regional variation in overall and individual retinal layer thicknesses in macular and peripheral areas in healthy eyes with the highest variation in macular segment.
Collapse
Affiliation(s)
- Sumit Randhir Singh
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Alessandro Invernizzi
- Department of Biomedical and Clinical Science "Luigi Sacco," Eye Clinic, University of Milan, Milan, Italy
| | - Mohammed Abdul Rasheed
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Carlo Cagini
- Department of Biochemical and Surgical Sciences, Section of Ophthalmology, University of Perugia, Perugia, Italy
| | - Abhilash Goud
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Ramkailash Gujar
- Department of Biochemical and Surgical Sciences, Section of Ophthalmology, University of Perugia, Perugia, Italy
| | - Priti Pandey
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Kiran Kumar Vupparaboina
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Mariano Cozzi
- Department of Biomedical and Clinical Science "Luigi Sacco," Eye Clinic, University of Milan, Milan, Italy
| | - Marco Lupidi
- Department of Biochemical and Surgical Sciences, Section of Ophthalmology, University of Perugia, Perugia, Italy
| | - Jay Chhablani
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India.,UPMC Eye Center, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
25
|
Singh SR, Rasheed MA, Goud A, Sahoo NK, Vupparaboina KK, Chhablani J. Diurnal variation in subfoveal and peripapillary choroidal vascularity index in healthy eyes. Indian J Ophthalmol 2020; 67:1667-1672. [PMID: 31546505 PMCID: PMC6786150 DOI: 10.4103/ijo.ijo_2063_18] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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] [Indexed: 12/16/2022] Open
Abstract
Purpose To report the diurnal variation in choroidal vascularity index (CVI) in subfoveal (SF-CVI) and peripapillary area in healthy eyes. Methods The study was a cross-sectional study including 12 healthy subjects. Swept-source optical coherence tomography scans were taken at 9 am, 11 am, 1 pm, 3 pm, and 5 pm. Subfoveal choroidal thickness (SFCT) and CVI were calculated using automated segmentation techniques and previously validated algorithms. Systemic parameters including systolic blood pressure (SBP), diastolic blood pressure, mean arterial pressure, and mean ocular perfusion pressure were calculated and correlated with SFCT and CVI. Results A total of 12 eyes (right eye) of 12 patients (mean age: 26 ± 3.77 years) were analyzed. The mean (±standard deviation) amplitude of SFCT and SF-CVI variation was 35.91 ± 14.8 μm (range, 15-69 μm) and 0.05 ± 0.02 (range, 0.02-0.08). The mean CVI showed a significant diurnal variation in the temporal quadrant of the peripapillary region (P = 0.02). Conclusion SFCT and SF-CVI showed a significant diurnal variation in amplitude (peak-trough analysis) and SF-CVI correlated well with SBP suggestive of a direct influence of blood pressure on choroidal vascularity. The mean peripapillary CVI in the temporal quadrant also showed a significant diurnal variation with no significant change in other quadrants.
Collapse
Affiliation(s)
- Sumit Randhir Singh
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana; Retina and Uveitis Department, GMR Varalakshmi Campus, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Mohammed Abdul Rasheed
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Abhilash Goud
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Niroj Kumar Sahoo
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Kiran Kumar Vupparaboina
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Jay Chhablani
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| |
Collapse
|
26
|
van Rijssen TJ, Singh SR, van Dijk EHC, Rasheed MA, Vupparaboina KK, Boon CJF, Chhablani J. Prospective evaluation of changes in choroidal vascularity index after half-dose photodynamic therapy versus micropulse laser treatment in chronic central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2020; 258:1191-1197. [PMID: 32170365 PMCID: PMC7237528 DOI: 10.1007/s00417-020-04619-6] [Citation(s) in RCA: 4] [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: 10/11/2019] [Revised: 01/20/2020] [Accepted: 02/02/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose To assess whether treatment of chronic central serous chorioretinopathy (cCSC) with photodynamic therapy (PDT) and high-density subthreshold micropulse laser (HSML) results in choroidal vascularity index (CVI) changes that may account for the treatment effect. Methods Patients with cCSC were prospectively included and analyzed. Patients received either half-dose PDT or HSML treatment. CVI of the affected and unaffected eye was obtained before treatment, 6 to 8 weeks after treatment, and 7 to 8 months after treatment. Results At baseline, 29 eyes (29 patients) were included both in the PDT and in the HSML group. The mean (± standard deviation) CVI change in the HSML group between before PDT and 6 to 8 weeks after PDT was − 0.009 ± 0.032 (p = 0.127), whereas this was 0.0025 ± 0.037 (p = 0.723) between the visit before PDT and final visit. The patients in the PDT group had a CVI change of − 0.0025 ± 0.037 (p = 0.723) between the visit before PDT and first visit after PDT, and a mean CVI change of − 0.013 ± 0.038 (p = 0.080) between the visit before PDT and final visit. There was no significant correlation between CVI and BCVA at the measured time points, in both the HSML group (p = 0.885), and in the PDT group (p = 0.904). Moreover, no significant changes in CVI occurred in the unaffected eye at any time point. Conclusions PDT and HSML do not significantly affect CVI, and therefore a CVI change may not be primarily responsible for the treatment effect. The positive treatment effect of both interventions may rely on other mechanisms, such as an effect on choriocapillaris and/or retinal pigment epithelium function.
Collapse
Affiliation(s)
- Thomas J van Rijssen
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mohammed A Rasheed
- Department of Ophthalmology, L.V. Prasad Eye Institute, Hyderabad, India
| | | | - Camiel J F Boon
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands. .,Department of Ophthalmology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh, UPMC Eye Center, Pittsburgh, PA, USA
| |
Collapse
|
27
|
Wong RLM, Singh SR, Rasheed MA, Goud A, Chhablani G, Samantaray S, AnkiReddy S, Vupparaboina KK, Chhablani J. En-face choroidal vascularity in central serous chorioretinopathy. Eur J Ophthalmol 2020; 31:536-542. [PMID: 32103680 DOI: 10.1177/1120672120908719] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To evaluate the choroidal vascularity index of eyes for acute and chronic central serous chorioretinopathy patients using swept-source optical coherence tomography generated en-face scans. METHODS This was a retrospective study, in which slabs of en-face optical coherence tomography scans, at 5 μm intervals, spanning from the retina to choroid, were binarized using a validated algorithm to calculate choroidal vascularity index. The choroidal vascularity index was defined as the ratio between the choroidal vascular luminal area and the total choroidal area. Choroidal vascularity index was calculated for all the slabs of every subject in both the groups. RESULTS A total of 30 eyes for each acute and chronic central serous chorioretinopathy groups were recruited. The mean choroidal vascularity index of the acute group was 45.21% ± 2.25% at the choriocapillaris, which increased to the maximal value of 48.35% ± 2.06% at 75% depth of the choroidal thickness and 45.31% ± 3.27% at the choroidoscleral interface; whereas for the chronic group, the mean choroidal vascularity index was 44.76% ± 2.60% at the choriocapillaris, which maximized at 50% choroidal depth (48.70% ± 1.32%) and then returned to 45.41% ± 6.02% at the choroidoscleral interface. CONCLUSION For both groups, the choroidal vascularity index increased from choriocapillaris to maximum values at mid-choroid and returned to almost the choriocapillaris value at the choroidoscleral interface.
Collapse
Affiliation(s)
- Raymond Lai-Man Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shenzhen, China
| | - Sumit Randhir Singh
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Mohammed Abdul Rasheed
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, India.,School of Optometry & Vision Science, University of Waterloo, Waterloo, ON, Canada
| | - Abhilash Goud
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Gunjan Chhablani
- Department of Computer Science, BITS Pilani, K.K. Birla Goa Campus, Goa, India
| | | | - Samantha AnkiReddy
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | | | - Jay Chhablani
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, India.,University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| |
Collapse
|
28
|
Paterson EN, Ravindran ML, Griffiths K, Le Velly CA, Cardwell CC, McCarter RV, Nicol P, Chhablani JK, Rasheed MA, Vupparaboina KK, MacGillivray TJ, Harbinson M, Maxwell AP, Hogg RE, McKay GJ. Association of reduced inner retinal thicknesses with chronic kidney disease. BMC Nephrol 2020; 21:37. [PMID: 32005180 PMCID: PMC6995224 DOI: 10.1186/s12882-019-1679-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 09/03/2019] [Accepted: 12/30/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Tissue derived biomarkers may offer utility as indicators of accumulated damage. Reduced thickness of retinal neuronal tissue and the vascular choroid have previously been associated with vascular damage and diabetes. We evaluated associations between retinal thickness, retinal microvascular and choroidal measures, and renal function in a population with a high burden of comorbidity. METHODS Participants were recruited from nuclear cardiology or renal medicine clinics. Retinal and choroidal thickness were measured from spectral-domain optical coherence tomograms. Retinal microvascular parameters were assessed from digital fundus photographs using a semi-automated software package. MAIN OUTCOME MEASURE Chronic kidney disease (CKD) categorised as: CKD stages 1-2, eGFR ≥60 ml/min/1.73m2; CKD stage 3, eGFR 30-59 ml/min/1.73m2, and CKD stages 4-5, eGFR ≤29 ml/min/1.73m2. RESULTS Participants (n = 241) had a mean age of 65 years and a mean eGFR of 66.9 ml/min/1.73m2. Thirty-nine % of the cohort had diabetes and 27% were using diuretics. Thinning of the inner retina and changes to its microvascular blood supply were associated with lower eGFR and CKD stages 4 and 5, while no associations were found between the outer retinal layers or their choroidal blood supply and CKD of any stage. These associations remained following adjustment for age, mean arterial blood pressure, diabetes status, low-density lipoprotein, body mass index, and sex. CONCLUSIONS Inner retinal thinning and retinal microvascular variation is associated with advanced CKD (stages 4 & 5) independent of important confounding factors, but not with earlier stage CKD (stage 3) and, therefore, its utility as a biomarker for early CKD is not supported in this study.
Collapse
Affiliation(s)
- Euan N Paterson
- Centre for Public Health, Queen's University Belfast, Block B, Royal Hospital, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA
| | - Meera L Ravindran
- Centre for Public Health, Queen's University Belfast, Block B, Royal Hospital, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA
| | - Kayleigh Griffiths
- Centre for Public Health, Queen's University Belfast, Block B, Royal Hospital, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA
| | - Claire A Le Velly
- Centre for Public Health, Queen's University Belfast, Block B, Royal Hospital, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA
| | - Chris C Cardwell
- Centre for Public Health, Queen's University Belfast, Block B, Royal Hospital, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA
| | - Rachel V McCarter
- Centre for Public Health, Queen's University Belfast, Block B, Royal Hospital, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA
| | - Patrick Nicol
- Centre for Public Health, Queen's University Belfast, Block B, Royal Hospital, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA
| | - Jay K Chhablani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, USA
| | | | | | | | - Mark Harbinson
- Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland
| | - Alexander P Maxwell
- Centre for Public Health, Queen's University Belfast, Block B, Royal Hospital, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA
| | - Ruth E Hogg
- Centre for Public Health, Queen's University Belfast, Block B, Royal Hospital, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA
| | - Gareth J McKay
- Centre for Public Health, Queen's University Belfast, Block B, Royal Hospital, Grosvenor Road, Belfast, Northern Ireland, BT12 6BA.
| |
Collapse
|
29
|
Dev C, M S S, Reddy Manne S, Goud A, Bashar SB, Richhariya A, Chhablani J, Vupparaboina KK, Jana S. Diagnostic Quality Assessment of Ocular Fundus Photographs: Efficacy of Structure-Preserving ScatNet Features. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:2091-2094. [PMID: 31946313 DOI: 10.1109/embc.2019.8857046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Various ophthalmic procedures critically depend on high-quality images. For instance, efficiency of teleophthalmology, a framework to bring advanced eye care to remote regions, is determined by the capability of assessing diagnostic quality of ocular fundus photographs (FPs), and rejecting poor-quality ones at the source. In this context, we study algorithmic methods of classifying high- and low-quality FPs. Crucially, diagnostic quality (DQ) - determined by clinically, but not necessarily perceptually, significant structures - is not synonymous with perceptual appeal. Yet, traditional methods handpick features individually (or in small subsets) to meet certain ad hoc perceptual requirements. In contrast, we investigate the efficacy of a comprehensive set of structure-preserving features, systematically generated by a deep scattering network (ScatNet). Specifically, we consider three advanced machine learning classifiers, train each using ScatNet as well as traditional features separately, and demonstrate that the former ensure significantly superior performance for each classifier under multiple criteria including classification accuracy.
Collapse
|
30
|
Nasar M, Vupparaboina KK, Goud A, Bashar SB, Kumar Chhablani J, Jana S. Accurate Cross-Section Estimation of Blood Vessels in Choroidal Haller's Layer: An Iterative Method based on 3D Tensor Voting. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:2041-2044. [PMID: 31946302 DOI: 10.1109/embc.2019.8857183] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Various eye diseases, including polypoidal choroidal vasculopathy (PCV) and age-related macular degeneration (AMD), affect choroidal vasculature early, but possibly minutely. However, due to the complex networked structure of the vasculature, it becomes hard to visualize, analyze and detect such changes in 2D OCT B-scan images. In contrast, algorithmic evaluation of cross-section facilitates clinicians in tracing minute variations in the vessel network, and quantifying those correlated with pathologies, potentially leading to early diagnosis. In this context, we proposed a novel method of estimating vessel cross-sections in choroidal Haller's layer. Accuracy of our method was evaluated on synthetic as well as clinical data by trained optometrists, and earned a confidence score of 90%, marking about 60% improvement over estimates based on a well-known tree-based method.
Collapse
|
31
|
Teja RV, Reddy Manne S, Goud A, Rasheed MA, Dansingani KK, Chhablani J, Vupparaboina KK, Jana S. Classification and Quantification of Retinal Cysts in OCT B-Scans: Efficacy of Machine Learning Methods. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:48-51. [PMID: 31945842 DOI: 10.1109/embc.2019.8857075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The automatic segmentation of fluid spaces in optical coherence tomography (OCT) imaging facilitates clinically relevant quantification and monitoring of eye disorders over time. Eyes with florid disease are particularly challenging to segment, as the anatomy is often highly distorted from normal. In this context, we propose an end-to-end machine learning method consisting of near perfect detection of retinal fluid using random forest classifier and an efficient DeepLab algorithm for quantification and labeling of the target fluid compartments. In particular, we achieve an average Dice score of 86.23% with reference to manual delineations made by a trained expert.
Collapse
|
32
|
Goud A, Singh SR, Sahoo NK, Rasheed MA, Vupparaboina KK, Ankireddy S, Lupidi M, Chhablani J. New Insights on Choroidal Vascularity: A Comprehensive Topographic Approach. Invest Ophthalmol Vis Sci 2019; 60:3563-3569. [PMID: 31419299 DOI: 10.1167/iovs.18-26381] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To obtain a choroidal vascularity index (CVI) map of macular area on an Early Treatment Diabetic Retinopathy Study (ETDRS) grid. Methods The study was a cross-sectional study involving 30 eyes of 30 healthy individuals. In brief, a shadow-compensated automated algorithm was used to segment and binarize the individual optical coherence tomography (OCT) B-scans. This was followed by three-dimensional reconstruction of these processed B-scans to obtain the overall thickness and vascularity maps. ETDRS grid was overlaid on both the extrapolated thickness and vascularity maps to obtain the corresponding sector-wise CVI. The main outcome measure was to evaluate the topographical variation of CVI in the macular area. Results The mean age of the study participants was 44.33 ± 16.29 years (range, 18-70 years). CVI showed no significant difference in different rings, subfields, or quadrants of the ETDRS map. CVI had a negative correlation with age (r = -0.384, P = 0.03). There were no statistically significant differences between CVI of both eyes in either rings or the full ETDRS grid (P = 0.30) among normal subjects. Conclusions The variation in CVI does not follow similar patterns as seen in choroidal thickness (CT) in various locations. The novel choroidal vascularity mapping in the macular area may expand understanding on regional differences of choroidal vasculature in healthy eyes.
Collapse
Affiliation(s)
| | - Sumit Randhir Singh
- LV Prasad Eye Institute, Hyderabad, India.,Retina and Uveitis Department, GMR Varalakshmi Campus, LV Prasad Eye Institute, Visakhapatnam, India
| | | | | | | | - Samatha Ankireddy
- University of Missouri, Kansas City School of Medicine, Kansas City, Missouri, United States
| | - Marco Lupidi
- Fondazione per la Macula Onlus, Di.N.O.G.Mi, University Eye Clinic, Università di Genova, Genova, Italy.,Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy.,Centre de l'Odéon, Paris, France
| | | |
Collapse
|
33
|
Singh SR, Rasheed MA, Parveen N, Goud A, Ankireddy S, Sahoo NK, Vupparaboina KK, Jana S, Chhablani J. En-face choroidal vascularity map of the macula in healthy eyes. Eur J Ophthalmol 2019; 31:218-225. [PMID: 31760783 DOI: 10.1177/1120672119883593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report the en-face choroidal vascularity index in healthy eyes. METHODS Thirty eyes of 30 healthy individuals were studied. Multiple high-density cross-sectional swept source optical coherence tomography scans were obtained to create a volume scan. The choroid was segmented for the whole volume scan and choroidal inner boundaries were flattened. Subsequently, multiple en-face scans separated by 25 µm were obtained and binarized. Choroidal vascularity index was calculated at level of choriocapillaris, medium, and large choroidal vessels. RESULTS The mean age of the study cohort was 35.6 ± 8.8 years. The overall mean en-face choroidal vascularity index was 54.25 ± 0.55%. There was a statistically significant difference of choroidal vascularity index in choriocapillaris (53.16 ± 0.43%), medium choroidal vessel (51.38 ± 0.27%), and large choroidal vessel (55.69 ± 0.87%) (p < 0.01). Choroidal vascularity index analysis in three subgroups based on subfoveal choroidal thickness (low: <300 µm, medium: 300-400 µm, high: >400 µm) showed a statistically significant difference (p = 0.001). Choroidal vascularity index showed a significant correlation with subfoveal choroidal thickness (r = 0.441; p = 0.015), whereas there was no significant correlation of age (p = 0.21), refraction (p = 0.20), and gender (p = 0.67) with en-face choroidal vascularity index. CONCLUSION En-face choroidal vascularity index shows a significant variation at the level of choriocapillaris, medium choroidal vessel, and large choroidal vessel in normal eyes. Choroidal vascularity index reaches a nadir at the level of medium choroidal vessel and reaches the maximum value at large choroidal vessel near choroidoscleral interface. En-face choroidal vascularity index shows a significant physiological variation and appears to increase with increase in subfoveal choroidal thickness.
Collapse
Affiliation(s)
- Sumit Randhir Singh
- Smt. Kanuri Santhamma Centre for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India.,Retina and Uveitis Department, L V Prasad Eye Institute, Visakhapatnam, India
| | - Mohammed Abdul Rasheed
- Smt. Kanuri Santhamma Centre for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Nishad Parveen
- Department of Electrical Engineering, Indian Institute of Technology Hyderabad, Hyderabad, India
| | - Abhilash Goud
- Smt. Kanuri Santhamma Centre for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Samatha Ankireddy
- School of Medicine, University of Missouri-Kansas City, Kansas City, MI, USA
| | - Niroj Kumar Sahoo
- Smt. Kanuri Santhamma Centre for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | | | - Soumya Jana
- Department of Electrical Engineering, Indian Institute of Technology Hyderabad, Hyderabad, India
| | - Jay Chhablani
- Smt. Kanuri Santhamma Centre for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| |
Collapse
|
34
|
Singh SR, Chakurkar R, Goud A, Rasheed MA, Vupparaboina KK, Chhablani J. Pachydrusen in polypoidal choroidal vasculopathy in an Indian cohort. Indian J Ophthalmol 2019; 67:1121-1126. [PMID: 31238425 PMCID: PMC6611320 DOI: 10.4103/ijo.ijo_1757_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Indexed: 01/14/2023] Open
Abstract
Purpose To report the prevalence of pachydrusen and their relationship with subfoveal choroidal thickness (SFCT) and large choroidal vessel layer thickness (SF-LCVT) in eyes with polypoidal choroidal vasculopathy (PCV) and their fellow eyes. Methods The case records of 50 patients (99 eyes; 59 PCV and 40 fellow eyes) were retrospectively analyzed for the presence of pachydrusen and other drusen types such as soft drusen. The diagnosis was established using colour fundus photography and optical coherence tomography (OCT). SFCT and SF-LCVT were measured and correlated with the different types of drusen. Results The mean age of the study cohort was 62.26 ± 10.67 years and included 27 males and 23 females. Pachydrusen and soft drusen were seen in 14 (PCV: 8 and fellow eyes: 6) and 8 eyes (PCV: 2 and fellow eyes: 6) respectively. The mean SFCT and SF-LCVT in the eyes with and without pachydrusen was not significanty different (280.29 ± 103.11 μ vs. 292.63 ± 87.17 μ; P = 0.63 and 180.57 ± 59.20 vs. 173.73 ± 54.86 μ; P = 0.67, respectively). The pachydrusen were most commonly located near the vascular arcades and showed scattered distribution pattern. Though SFCT and SF-LCVT was lower in the eyes with soft drusen compared to eyes with pachydrusen, it failed to reach statistical significance (SFCT, P = 0.1 and SF-LCVT, P = 0.06). Conclusion The prevalence of pachydrusen in PCV and their fellow eyes is lower in Indian population suggestive of ethnic variations. SFCT and SF-LCVT was not noted to vary signifcantly in eyes with and without pachydrusen in this study cohort.
Collapse
Affiliation(s)
- Sumit Randhir Singh
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India; Retina and Uveitis Department, GMR Varalakshmi Campus, L V Prasad Eye Institute, Hanumanthawaka Junction, Visakhapatnam, Andhra Pradesh, India
| | - Renuka Chakurkar
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Abhilash Goud
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Mohammed Abdul Rasheed
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Kiran Kumar Vupparaboina
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Jay Chhablani
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| |
Collapse
|
35
|
Invernizzi A, Benatti E, Cozzi M, Erba S, Vaishnavi S, Vupparaboina KK, Staurenghi G, Chhablani J, Gillies M, Viola F. Choroidal Structural Changes Correlate With Neovascular Activity in Neovascular Age Related Macular Degeneration. Invest Ophthalmol Vis Sci 2019; 59:3836-3841. [PMID: 30073357 DOI: 10.1167/iovs.18-23960] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To correlate changes in choroidal thickness and vascularity index with disease activity in patients with neovascular age-related macular degeneration (nAMD). Methods Eyes diagnosed with AMD that had two sequential visits within 12 months and that had no choroidal neovascularization (CNV) or had inactive CNV at the first visit were included. Those that had active CNV at follow-up were enrolled as cases. Eyes that did not developed a CNV or that were still inactive at the second visit were enrolled as controls. Disease activity was based on optical coherence tomography (OCT) and fluorescein angiography findings. Subfoveal choroidal thickness (SCT), mean choroidal thickness (MCT), and choroidal vascularity index (CVI) were assessed on enhanced depth imaging OCT and compared between the baseline and follow-up visit. Subgroup analysis accounting for lesion type and previous treatment, if any, were performed. Results Sixty-five eyes from 60 patients (35 females) and 50 age- and sex-matched controls were included. At the active visit, cases had an increase from 164 ± 67 μm to 175 ± 70 μm in mean ± SD SCT and from 144 ± 45 μm to 152 ± 45 μm in MCT (both P < 0.0001). The mean CVI also increased at from 54.5% ± 3.3% to 55.4% ± 3.8% (P = 0.04). Controls did not show significant changes in choroidal measurements between the two visits. Mean SCT, MCT, and CVI values were similar for previously treated and treatment-naive eyes. Conclusions Choroidal thickness and CVI significantly increased with active disease in nAMD eyes. Changes in choroidal thickness may predict CNV development or recurrence before they are otherwise evident clinically.
Collapse
Affiliation(s)
- Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy.,Save Sight Institute, Sydney Eye Hospital, University of Sydney, Sydney, Australia
| | - Eleonora Benatti
- Department of Clinical Sciences and Community Health, University of Milan, Ophthalmological Unit, IRCCS-Cà Granda Foundation - Ospedale Maggiore Policlinico, Milan, Italy
| | - Mariano Cozzi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Stefano Erba
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | | | | | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | | | - Mark Gillies
- Save Sight Institute, Sydney Eye Hospital, University of Sydney, Sydney, Australia
| | - Francesco Viola
- Department of Clinical Sciences and Community Health, University of Milan, Ophthalmological Unit, IRCCS-Cà Granda Foundation - Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
36
|
Agrawal R, Seen S, Vaishnavi S, Vupparaboina KK, Goud A, Rasheed MA, Chhablani J. Choroidal Vascularity Index Using Swept-Source and Spectral-Domain Optical Coherence Tomography: A Comparative Study. Ophthalmic Surg Lasers Imaging Retina 2019; 50:e26-e32. [DOI: 10.3928/23258160-20190129-15] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 05/09/2018] [Indexed: 11/20/2022]
|
37
|
Dhommati VG, Vupparaboina KK, Challa K, Jana S, Richhariya A, Reddy JC. Automated 2D-3D quantitative analysis of corneal graft detachment post DSAEK based on AS-OCT images. Comput Methods Programs Biomed 2018; 167:1-12. [PMID: 30501855 DOI: 10.1016/j.cmpb.2018.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 09/18/2018] [Accepted: 10/01/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVE In current ophthalmological practices, assessment of graft condition post Descemet's stripping automated endothelial keratoplasty (DSAEK) is performed qualitatively using few (four) anterior-segment optical coherence tomography (AS-OCT) radial B-scans. From those scans, clinicians need to mentally synthesize the graft in 3D, and estimate its overall condition. In contrast, quantitative representation of 360° thickness profile would facilitate better visualization of graft condition, and hence medical decision making. Consequently, clinicians seek to quantify potential detachments in 3D from the aforementioned sparse B-scans. Against this backdrop, aiming to assist doctors in making an accurate postoperative assessment, we attempted at 3D visualization and quantification of donor lenticule separation (DLS) using only four AS-OCT radial B-scans. METHODS We developed an automated methodology to model and quantify DLS in 3D using only four AS-OCT B-scans. Firstly, we demonstrated that detachment can be viewed as a tubular vessel-like structure and hence can be detected using Hessian matrix analysis. Secondly, a two-stage interpolation was employed for determining the 3D profile of the detachment. Finally, various clinically significant parameters including type of separation (communicative and non-communicative), volume and 360° thickness profile of the detachment, thickness (central and peripheral) of the recipient cornea and donor graft were also obtained. Accuracy of the proposed algorithm was substantiated via thorough statistical analysis, specifically, vis-á-vis intra- and inter-observer repeatability using Dice coefficient (DC). RESULTS On twenty seven eyes of 27 patients (male and female), four radial OCT B-scans with 45° angular separation taken per eye, proposed algorithm found that donor graft detached completely in 3 eyes and detached one side (communicative) in remaining 24 eyes which is in agreement with expert's opinion. Quantitatively, proposed algorithm achieves a mean DC of 81.35% with manual reference which is close to the corresponding inter-observer repeatability value of 86.77%. Volume estimation of the detachment indicates that 11 eyes had 0-25%, 9 had 25-50%, 5 had 50-75% and 2 had 75-100% detachment. CONCLUSIONS Accuracy of the proposed methodology was corroborated vis-à-vis observer delineation. This model of image analysis may aid in prognostication of graft outcome in patients with graft detachment after DSAEK.
Collapse
Affiliation(s)
- Vikram Goud Dhommati
- Department of Electrical Engineering, Indian Institute of Technology Hyderabad, Telangana 502285, India
| | - Kiran Kumar Vupparaboina
- Department of Electrical Engineering, Indian Institute of Technology Hyderabad, Telangana 502285, India; Srujana Innovation Center, L. V. Prasad Eye Institute, Hyderabad, Telangana 500034, India.
| | - Kiran Challa
- Tej Kohli Cornea Institute, L. V. Prasad Eye Institute, Hyderabad, Telangana 500034, India; Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, Telangana 500034, India
| | - Soumya Jana
- Department of Electrical Engineering, Indian Institute of Technology Hyderabad, Telangana 502285, India
| | - Ashutosh Richhariya
- Srujana Innovation Center, L. V. Prasad Eye Institute, Hyderabad, Telangana 500034, India
| | - Jagadesh C Reddy
- Tej Kohli Cornea Institute, L. V. Prasad Eye Institute, Hyderabad, Telangana 500034, India
| |
Collapse
|
38
|
Singh SR, Vupparaboina KK, Goud A, Dansingani KK, Chhablani J. Choroidal imaging biomarkers. Surv Ophthalmol 2018; 64:312-333. [PMID: 30496750 DOI: 10.1016/j.survophthal.2018.11.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [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: 05/18/2018] [Revised: 11/18/2018] [Accepted: 11/19/2018] [Indexed: 12/22/2022]
Abstract
The choroid is the vascular coat of the eye, and its role has been studied in multiple chorioretinal disorders. Recent advancements in choroidal imaging techniques, including enhanced depth imaging optical coherence tomography, swept source optical coherence tomography, en face optical coherence tomography, and optical coherence tomography angiography have facilitated an in-depth analysis of the choroid. The gradual shift from manual to automated segmentation and binarization methods have led to precise and reproducible measurements of choroidal parameters. These qualitative and quantitative parameters, called choroidal imaging biomarkers, have evolved over the past decade from a simple linear subfoveal choroidal thickness to more complex 3D choroidal reconstruction, thus widening the spectrum encompassing multiple parameters. These biomarkers have provided a better understanding of the pathogenesis, are helpful in diagnostic dilemmas, and, in the future may also help to devise treatment options. The lack of normative data, absence of standardized parameters, and limitations of the imaging techniques, however, have led to ambiguity and difficulty in the interpretation of these variables. We attempt to address these lacunae in the literature and provide a basic understanding of the choroid in both health and disease using these choroidal biomarkers.
Collapse
Affiliation(s)
- Sumit Randhir Singh
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, India; Retina and Uveitis Department, GMR Varalakshmi Campus, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Kiran Kumar Vupparaboina
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Abhilash Goud
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jay Chhablani
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, LV Prasad Eye Institute, Hyderabad, India.
| |
Collapse
|
39
|
Dansingani KK, Vupparaboina KK, Devarkonda ST, Jana S, Chhablani J, Freund KB. Amplitude-scan classification using artificial neural networks. Sci Rep 2018; 8:12451. [PMID: 30127536 PMCID: PMC6102218 DOI: 10.1038/s41598-018-31021-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 01/04/2018] [Accepted: 08/09/2018] [Indexed: 12/03/2022] Open
Abstract
Optical coherence tomography (OCT) images semi-transparent tissues noninvasively. Relying on backscatter and interferometry to calculate spatial relationships, OCT shares similarities with other pulse-echo modalities. There is considerable interest in using machine learning techniques for automated image classification, particularly among ophthalmologists who rely heavily on diagnostic OCT. Artificial neural networks (ANN) consist of interconnected nodes and can be employed as classifiers after training on large datasets. Conventionally, OCT scans are rendered as 2D or 3D human-readable images of which the smallest depth-resolved unit is the amplitude-scan reflectivity-function profile which is difficult for humans to interpret. We set out to determine whether amplitude-scan reflectivity-function profiles representing disease signatures could be distinguished and classified by a feed-forward ANN. Our classifier achieved high accuracies after training on only 24 eyes, with evidence of good generalization on unseen data. The repertoire of our classifier can now be expanded to include rare and unseen diseases and can be extended to other disciplines and industries.
Collapse
Affiliation(s)
- Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Kiran Kumar Vupparaboina
- L.V. Prasad Eye Institute, Hyderabad, Telangana, India
- Department of Electrical Engineering, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
| | - Surya Teja Devarkonda
- Department of Electrical Engineering, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
| | - Soumya Jana
- Department of Electrical Engineering, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
| | - Jay Chhablani
- L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA
| |
Collapse
|
40
|
Chhablani J, Jhingan M, Goud A, Vupparaboina KK, Das T. Macular edema resolution assessment with implantable dexamethasone in diabetic retinopathy (MERIT): a pilot study. Clin Ophthalmol 2018; 12:1205-1211. [PMID: 30013313 PMCID: PMC6038870 DOI: 10.2147/opth.s163681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to evaluate the effect of dexamethasone implantation on the hard exudates (HEX) in patients with diabetic macular edema (DME). Study design This was a nonrandomized open-label single-center prospective trial. Methods This study included 15 eyes of 11 subjects with DME. Key inclusion criteria were naïve eyes with DME with HEX within 3 mm of fovea with center-involving DME; central macular thickness (CMT) >250 μm at baseline; best-corrected visual acuity (BCVA) between 20/400 and 20/40. Key exclusion criteria were previous intraocular surgery and history of panretinal photocoagulation (PRP) in past 4 months. The primary outcome measure was change in total HEX area at the macula (in mm2) measured by semiautomated algorithm. Secondary outcome measures were change in visual acuity, low-contrast visual acuity (LCVA), retinal sensitivity (RS) on macular microperimetry, and CMT. Results The total HEX area reduced from 1.5 mm2 (±1.46 mm2) at baseline to 0.89 mm2 (±1.062 mm2) at the final visit (p=0.185). The CMT improved significantly (p=0.03) from 488.67 μm (±240.66 μm) to 326.93 μm (±135.84 μm) at the final visit. Mean BCVA remained stable (p=0.95) (50.93±16.65 at baseline and 50.6±18.95 at final visit). The mean LCVA and RS showed insignificant improvement (p=0.31 and p=0.28, respectively). Conclusion Our pilot study demonstrated an improving trend in reduction of total HEX area and other anatomical outcomes, with limited functional outcomes. Larger randomized studies with a larger sample size with a control group are warranted to establish management protocols for DME with significant subfoveal HEX.
Collapse
Affiliation(s)
- Jay Chhablani
- Smt Kanuri Santhamma Retina Vitreous Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India,
| | - Mahima Jhingan
- Smt Kanuri Santhamma Retina Vitreous Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India,
| | - Abhilash Goud
- Smt Kanuri Santhamma Retina Vitreous Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India,
| | - Kiran Kumar Vupparaboina
- Smt Kanuri Santhamma Retina Vitreous Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India,
| | - Taraprasad Das
- Smt Kanuri Santhamma Retina Vitreous Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India,
| |
Collapse
|
41
|
Abstract
Purpose This study aims to compare the effect of laser photocoagulation or observation on choroidal vascularity in acute central serous chorioretinopathy (CSCR). Methods A retrospective analysis of 30 patients with acute CSCR treated either with laser photocoagulation (16 eyes) or sham laser (14 eyes) was performed. Demographic details, visual acuity (VA) assessment, and other relevant clinical data were considered from baseline to the 3rd and 6th month follow-up visits. Participants with chronic CSCR and missing follow-up or inadequate data were excluded. Choroidal analysis including choroidal thickness and choroidal vascularity index (CVI) assessment was done for each visit using Spectral Domain (SD) Optical Coherence Tomography (OCT) images. Results In laser arm group, there was a statistically significant change in VA, contrast sensitivity and central macular thickness (CMT) and neurosensory detachment (NSD) (P < 0.05) at the 3rd and 6th month visits. However, there was no statistically significant difference in subfoveal choroidal thickens (SFCT) and CVI (P > 0.05) at both the visits. In sham laser group, similarly, there was a significant improvement in VA, contrast sensitivity, CMT, and CVI (P < 0.05) at the 3rd and 6th month visits. There was significant reduction in NSD at the 3rd month; however, it was not statistically significant at the 6th month visit. SFCT did not change significantly at both the visits. There was no significant difference for the changes in parameters between the groups at the 6th month. Regression analysis showed no significant correlation with final VA with any of the baseline parameters. Conclusion Early laser photocoagulation does lead to change in choroidal morphology, though insignificant, in comparison to observation. The present data, yet again, support no additional benefit of early laser photocoagulation in acute CSCR.
Collapse
Affiliation(s)
- Mohammed Abdul Rasheed
- Srimati Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Abhilash Goud
- Srimati Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Ashik Mohamed
- Srimati Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Kiran Kumar Vupparaboina
- Srimati Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Jay Chhablani
- Srimati Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| |
Collapse
|
42
|
Vupparaboina KK, Dansingani KK, Goud A, Rasheed MA, Jawed F, Jana S, Richhariya A, Freund KB, Chhablani J. Quantitative shadow compensated optical coherence tomography of choroidal vasculature. Sci Rep 2018; 8:6461. [PMID: 29691426 PMCID: PMC5915389 DOI: 10.1038/s41598-018-24577-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 01/09/2018] [Accepted: 04/05/2018] [Indexed: 11/09/2022] Open
Abstract
Conventionally rendered optical coherence tomography (OCT) images of the posterior segment contain shadows which influence the visualization of deep structures such as the choroid. The purpose of this study was to determine whether OCT shadow compensation (SC) alters the appearance of the choroid and the apparent choroidal vascularity index (CVI), an OCT-derived estimated ratio of luminal to total choroidal volume. All scans were shadow compensated using a previously published algorithm, binarized using a novel validated algorithm and extracted binarized choroid to estimate CVI. On 27 raw swept-source OCT volume-scans of healthy subjects, the effect of SC on CVI was established both qualitatively and quantitatively. In shadow compensated scans, the choroid was visualized with greater brightness than the neurosensory retina and the masking of deep tissues by retinal blood vessels was greatly reduced. Among study subjects, significant mean difference in CVI of -0.13 was observed between raw and shadow compensated scans. Conventionally acquired OCT underestimates both choroidal reflectivity and calculated CVI. Quantitative analysis based on subjective grading demonstrated that SC increased the contrast between stromal and luminal regions and are in agreement with true tissue regions. This study is warranted to determine the effects of SC on CVI in diseased eyes.
Collapse
Affiliation(s)
- Kiran Kumar Vupparaboina
- Surjana Center for Innovation, LV Prasad Eye Institute Hyderabad, Hyderabad, Telangana, India.,Department of Electrical Engineering, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Abhilash Goud
- Clinical Research, LV Prasad Eye Institute Hyderabad, Hyderabad, Telangana, India
| | | | - Fayez Jawed
- Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, United States
| | - Soumya Jana
- Department of Electrical Engineering, Indian Institute of Technology Hyderabad, Hyderabad, Telangana, India
| | - Ashutosh Richhariya
- Surjana Center for Innovation, LV Prasad Eye Institute Hyderabad, Hyderabad, Telangana, India
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, USA.,LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, USA
| | - Jay Chhablani
- Vitreo-retinal Service, LV Prasad Eye Institute Hyderabad, Hyderabad, Telangana, India.
| |
Collapse
|
43
|
Ambiya V, Goud A, Rasheed MA, Gangakhedkar S, Vupparaboina KK, Chhablani J. Retinal and choroidal changes in steroid-associated central serous chorioretinopathy. Int J Retina Vitreous 2018; 4:11. [PMID: 29619248 PMCID: PMC5880079 DOI: 10.1186/s40942-018-0115-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 12/27/2017] [Accepted: 03/09/2018] [Indexed: 11/19/2022] Open
Abstract
Background To evaluate the retinal and choroidal alterations in steroid-associated central serous chorioretinopathy (CSC) in comparison to idiopathic CSC. Methods In this retrospective cohort study, swept source optical coherence tomography scans of eyes with steroid-associated CSC (group A) were compared with the same in idiopathic CSC (group B). The key features included central subfield retinal thickness, subfoveal choroidal thickness, subfoveal large choroidal vessel diameter, subretinal deposits, retinal pigment epithelial irregularities, double layer sign, hyperreflective dots, intraretinal fluid, and choroidal vascularity index (ratio of choroidal luminal area and total choroidal area, measured on a high definition horizontal 9 mm OCT B-scan. Results There were 20 eyes in group A and 30 in group B. Group A had a higher female proportion (60 vs. 16.67%; P < 0.01) and higher bilaterality (30 vs. 6.67%; P = 0.03). The height of neurosensory detachment was lower in group A (153.1 ± 175.70 µm vs. 312.9 ± 223.06 µm; P < 0.01). There was no significant difference in the prevalence of subretinal deposits, retinal pigment epithelial irregularities, pigment epithelial detachments, double layer sign, outer retinal layer disruption, and intraretinal fluid. Hyperreflective dots (HRDs) were less common in group A (15 vs. 46.67%; P = 0.03). The subfoveal choroidal thickness (P = 0.65) and subfoveal large choroidal vessel diameter (P = 0.78) were comparable. There was a trend towards a higher choroidal vascularity index (CVI) in group A (A: mean, 82%, 95% CI, 66–99%; B: mean, 58%, 95% CI, 57–59%; P = 0.10). Conclusion Steroid-associated CSC has a marginally higher CVI and less common association with HRDs as compared to idiopathic CSC.
Collapse
Affiliation(s)
- Vikas Ambiya
- Base Hospital, Delhi Cantonment, New Delhi, 110010 India
| | - Abhilash Goud
- 2Srimati Kannuri Santhamma Centre for Vitreo Retinal Diseases, L V Prasad Eye Institute, Kallam Anji Reddy Campus, L V Prasad Marg, Banjara Hills, Hyderabad, 500034 India
| | - Mohammed Abdul Rasheed
- 2Srimati Kannuri Santhamma Centre for Vitreo Retinal Diseases, L V Prasad Eye Institute, Kallam Anji Reddy Campus, L V Prasad Marg, Banjara Hills, Hyderabad, 500034 India
| | - Sankeert Gangakhedkar
- 2Srimati Kannuri Santhamma Centre for Vitreo Retinal Diseases, L V Prasad Eye Institute, Kallam Anji Reddy Campus, L V Prasad Marg, Banjara Hills, Hyderabad, 500034 India
| | - Kiran Kumar Vupparaboina
- 2Srimati Kannuri Santhamma Centre for Vitreo Retinal Diseases, L V Prasad Eye Institute, Kallam Anji Reddy Campus, L V Prasad Marg, Banjara Hills, Hyderabad, 500034 India
| | - Jay Chhablani
- 2Srimati Kannuri Santhamma Centre for Vitreo Retinal Diseases, L V Prasad Eye Institute, Kallam Anji Reddy Campus, L V Prasad Marg, Banjara Hills, Hyderabad, 500034 India
| |
Collapse
|
44
|
Agrawal R, Wei X, Goud A, Vupparaboina KK, Jana S, Chhablani J. Influence of scanning area on choroidal vascularity index measurement using optical coherence tomography. Acta Ophthalmol 2017; 95:e770-e775. [PMID: 28470942 DOI: 10.1111/aos.13442] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [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: 07/08/2016] [Accepted: 02/21/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Recently, choroidal vascularity index (CVI) is proposed as a novel tool to evaluate the choroidal vasculature. In this study, we investigate the impact of scanning area on CVI measurement using spectral-domain optical coherence tomography (SD-OCT). METHODS Spectral-domain optical coherence tomography (SD-OCT) using enhanced depth imaging mode was performed in 30 eyes from 15 normal subjects. Three scanning areas were compared: dingle foveal scan; central macular scans [scan passing through central 1000 microns circle on Early Treatment Diabetic Retinopathy Study (ETDRS) grid, inner circle]; and total macular cube scans. Binarization of OCT B-scans and segmentation of the binarized choroid layer were achieved using a previously reported validated automated software. Choroidal vascularity index (CVI) percentage was calculated. Degree of agreement among foveal, central macular and total macular CVI was assessed using intraclass correlation coefficient (ICC) and was plotted using Bland-Altman plot. RESULTS The mean CVI in subfoveal, central macular and total macular scans was 49.95 ± 4.84%, 50.00 ± 4.68% and 51.10 ± 4.63%, respectively. Intraclass correlation coefficient (ICC) was more than 0.8 for all three comparisons [subfoveal versus central macular CVI, ICC = 0.92 (95% CI: 0.84-0.96); central macular versus total macular CVI, ICC = 0.90 (95% CI: 0.82-0.96); subfoveal versus total macular CVI, ICC = 0.92 (95% CI: 0.85-0.95)]. No significant differences in variance (all p > 0.05) were noted among CVI measured from the three scanning areas. CONCLUSION Choroidal vascularity index (CVI) measurements were highly reproducible using subfoveal, central and total macular scans in healthy individuals. Single foveal scan choroidal vascularity represents total macular choroidal vascularity in healthy population.
Collapse
Affiliation(s)
- Rupesh Agrawal
- National Healthcare Group Eye Institute; Tan Tock Seng Hospital; Singapore Singapore
| | - Xin Wei
- National Healthcare Group Eye Institute; Tan Tock Seng Hospital; Singapore Singapore
| | - Abhilash Goud
- L.V. Prasad Eye Institute; Hyderabad Telangana India
| | | | - Soumya Jana
- Department of Electrical Engineering; Indian Institute of Technology Hyderabad; Telangana India
| | - Jay Chhablani
- L.V. Prasad Eye Institute; Hyderabad Telangana India
| |
Collapse
|
45
|
Marupally AG, Vupparaboina KK, Peguda HK, Richhariya A, Jana S, Chhablani J. Semi-automated quantification of hard exudates in colour fundus photographs diagnosed with diabetic retinopathy. BMC Ophthalmol 2017; 17:172. [PMID: 28931389 PMCID: PMC5607622 DOI: 10.1186/s12886-017-0563-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 05/09/2017] [Accepted: 09/05/2017] [Indexed: 01/18/2023] Open
Abstract
Background Hard exudates (HEs) are the classical sign of diabetic retinopathy (DR) which is one of the leading causes of blindness, especially in developing countries. Accordingly, disease screening involves examining HEs qualitatively using fundus camera. However, for monitoring the treatment response, quantification of HEs becomes crucial and hence clinicians now seek to measure the area of HEs in the digital colour fundus (CF) photographs. Against this backdrop, we proposed an algorithm to quantify HEs using CF images and compare with previously reported technique using ImageJ. Methods CF photographs of 30 eyes (20 patients) with diabetic macular edema were obtained. A robust semi-automated algorithm was developed to quantify area covered by HEs. In particular, the proposed algorithm, a two pronged methodology, involved performing top-hat filtering, second order statistical filtering, and thresholding of the colour fundus images. Subsequently, two masked observers performed HEs measurements using previously reported ImageJ-based protocol and compared with those obtained through proposed method. Intra and inter-observer grading was performed for determining percentage area of HEs identified by the individual algorithm. Results Of the 30 subjects, 21 were males and 9 were females with a mean age of the 50.25 ± 7.80 years (range 33–66 years). The correlation between the two measurements of semi-automated and ImageJ were 0.99 and 0.99 respectively. Previously reported method detected only 0–30% of the HEs area in 9 images, 30–60% in 12 images and 60–90% in remaining images, and more than 90% in none. In contrast, proposed method, detected 60–90% of the HEs area in 13 images and 90–100% in remaining 17 images. Conclusion Proposed method semi-automated algorithm achieved acceptable accuracy, qualitatively and quantitatively, on a heterogeneous dataset. Further, quantitative analysis performed based on intra- and inter-observer grading showed that proposed methodology detects HEs more accurately than previously reported ImageJ-based technique. In particular, we proposed algorithm detect faint HEs also as opposed to the earlier method.
Collapse
Affiliation(s)
- Abhilash Goud Marupally
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V.Prasad Eye Institute, Hyderabad, 500034, India
| | - Kiran Kumar Vupparaboina
- Engineering Group, Srujana Center for Innovation, L.V.Prasad Eye Institute, Hyderabad, 500034, India.,Deptartment of Electrical Engineering, Indian Institute of Technology Hyderabad, Hyderabad, 502285, India
| | - Hari Kumar Peguda
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V.Prasad Eye Institute, Hyderabad, 500034, India
| | - Ashutosh Richhariya
- Engineering Group, Srujana Center for Innovation, L.V.Prasad Eye Institute, Hyderabad, 500034, India
| | - Soumya Jana
- Deptartment of Electrical Engineering, Indian Institute of Technology Hyderabad, Hyderabad, 502285, India
| | - Jay Chhablani
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V.Prasad Eye Institute, Hyderabad, 500034, India.
| |
Collapse
|
46
|
Alshareef RA, Khuthaila MK, Goud A, Vupparaboina KK, Jana S, Chhablani J. Subfoveal Choroidal Vascularity in Myopia: Evidence From Spectral-Domain Optical Coherence Tomography. Ophthalmic Surg Lasers Imaging Retina 2017; 48:202-207. [DOI: 10.3928/23258160-20170301-02] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 12/12/2016] [Indexed: 01/01/2023]
|
47
|
Gattani VS, Vupparaboina KK, Patil A, Chhablani J, Richhariya A, Jana S. Semi-automated quantification of retinal IS/OS damage in en-face OCT image. Comput Biol Med 2016; 69:52-60. [PMID: 26720266 DOI: 10.1016/j.compbiomed.2015.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 08/22/2015] [Revised: 11/10/2015] [Accepted: 11/28/2015] [Indexed: 11/18/2022]
Abstract
A variety of vision ailments are indicated by structural changes in the retinal substructures of the posterior segment of the eye. In particular, integrity of the inner-segment/outer-segment (IS/OS) junction directly relates to the visual acuity. In the en-face optical coherence tomography (OCT) image, IS/OS damage manifests as a dark spot in the foveal region, and its quantification, usually performed by experts, assumes diagnostic significance. In this context, in view of the general scarcity of experts, it becomes imperative to develop algorithmic methods to reduce expert time and effort. Accordingly, we propose a semi-automated method based on level sets. As the energy function, we adopt mutual information which exploits the difference in statistical properties of the lesion and its surroundings. On a dataset of 27 en-face OCT images, segmentation obtained by the proposed algorithm exhibits close visual agreement with that obtained manually. Importantly, our results also match manual results in various statistical criteria. In particular, we achieve a mean Dice coefficient of 85.69%, desirably close to the corresponding observer repeatability index of 89.45%. Finally, we quantify algorithmic accuracy in terms of two quotient measures, defined relative to observer repeatability, which could be used as bases for comparison with future algorithms, even if the latter are tested on disparate datasets.
Collapse
Affiliation(s)
- Vineet Sunil Gattani
- Department of Electrical Engineering, Indian Institute of Technology Hyderabad, Telangana 502205, India
| | - Kiran Kumar Vupparaboina
- Department of Electrical Engineering, Indian Institute of Technology Hyderabad, Telangana 502205, India.
| | - Ameya Patil
- Department of Electrical Engineering, Indian Institute of Technology Hyderabad, Telangana 502205, India
| | - Jay Chhablani
- L.V. Prasad Eye Institute, Hyderabad, Telangana 500034, India
| | | | - Soumya Jana
- Department of Electrical Engineering, Indian Institute of Technology Hyderabad, Telangana 502205, India
| |
Collapse
|
48
|
Vupparaboina KK, Nizampatnam S, Chhablani J, Richhariya A, Jana S. Automated estimation of choroidal thickness distribution and volume based on OCT images of posterior visual section. Comput Med Imaging Graph 2015; 46 Pt 3:315-27. [PMID: 26526231 DOI: 10.1016/j.compmedimag.2015.09.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [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: 04/19/2015] [Revised: 07/24/2015] [Accepted: 09/29/2015] [Indexed: 12/17/2022]
Abstract
A variety of vision ailments are indicated by anomalies in the choroid layer of the posterior visual section. Consequently, choroidal thickness and volume measurements, usually performed by experts based on optical coherence tomography (OCT) images, have assumed diagnostic significance. Now, to save precious expert time, it has become imperative to develop automated methods. To this end, one requires choroid outer boundary (COB) detection as a crucial step, where difficulty arises as the COB divides the choroidal granularity and the scleral uniformity only notionally, without marked brightness variation. In this backdrop, we measure the structural dissimilarity between choroid and sclera by structural similarity (SSIM) index, and hence estimate the COB by thresholding. Subsequently, smooth COB estimates, mimicking manual delineation, are obtained using tensor voting. On five datasets, each consisting of 97 adult OCT B-scans, automated and manual segmentation results agree visually. We also demonstrate close statistical match (greater than 99.6% correlation) between choroidal thickness distributions obtained algorithmically and manually. Further, quantitative superiority of our method is established over existing results by respective factors of 27.67% and 76.04% in two quotient measures defined relative to observer repeatability. Finally, automated choroidal volume estimation, being attempted for the first time, also yields results in close agreement with that of manual methods.
Collapse
Affiliation(s)
- Kiran Kumar Vupparaboina
- Department of Electrical Engineering, Indian Institute of Technology Hyderabad, Telangana 502205, India.
| | - Srinath Nizampatnam
- Department of Electrical Engineering, Indian Institute of Technology Hyderabad, Telangana 502205, India
| | - Jay Chhablani
- L. V. Prasad Eye Institute, Hyderabad, Telangana 500034, India
| | | | - Soumya Jana
- Department of Electrical Engineering, Indian Institute of Technology Hyderabad, Telangana 502205, India
| |
Collapse
|