Economic impact of managing invasive mold disease with isavuconazole compared with liposomal amphotericin B followed by posaconazole in Spain

BACKGROUND

Invasive fungal infections (IFI) are associated with significant morbidity and mortality. The objective of this work was to compare the costs per adult patient, associated with intravenous isavuconazole (ISAV) followed by oral ISAV versus the regimen of liposomal amphotericin B followed by posaconazole (L-AMB→POSA) in the treatment of IFI. The comparison was conducted from the perspective of the Spanish National Health System (SNS).

METHODS

As indirect comparisons have demonstrated similar efficacy between the comparators, a cost-minimization approach was taken. Drug acquisition, administration, hospitalization, laboratory tests and adverse events costs were evaluated from SNS perspective. Deterministic and probabilistic sensitivity analyzes were performed.

RESULTS

Total costs per-patient were €24,715.54 with ISAV versus €29,753.53 with L-AMB→POSA, resulting in cost-savings per patient treated with ISAV of €5,037.99 (-16.9%). Treatment costs of IFI remained lower for ISAV than for L-AMB→POSA across all sensitivity analyses (-7,968.89€ to -326.59€), being treatment duration the most influential parameter.

CONCLUSION

According to the present model, the treatment of IFIs with ISAV would generate savings for the SNS compared to L-AMB→POSA. These savings are attributed to the shorter duration of IV treatment, reduced use of healthcare resources and lower costs associated with managing adverse effects when ISAV was employed.

Correction: Compensation for Blur Requires Increase in Field of View and Viewing Time

[This corrects the article DOI: 10.1371/journal.pone.0162711.].

Detection of novel drug-adverse drug reaction signals in rheumatoid arthritis and ankylosing spondylitis: analysis of Korean real-world biologics registry data

This study aimed to detect signals of adverse drug reactions (ADRs) associated with biological disease-modifying antirheumatic drugs (DMARDs) and targeted therapies in rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients. Utilizing the KOrean College of Rheumatology BIOlogics & Targeted Therapy Registry (KOBIO) data, we calculated relative risks, excluded previously reported drug-ADR pairs, and externally validated remaining pairs using US Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) and single centre's electronic health records (EHR) data. Analyzing data from 2279 RA and 1940 AS patients, we identified 35 significant drug-ADR pairs in RA and 26 in AS, previously unreported in drug labels. Among the novel drug-ADR pairs from KOBIO, 15 were also significant in the FAERS data. Additionally, 2 significant drug-laboratory abnormality pairs were found in RA using CDM MetaLAB analysis. Our findings contribute to the identification of 14 novel drug-ADR signals, expanding our understanding of potential adverse effects related to biological DMARDs and targeted therapies in RA and AS. These results emphasize the importance of ongoing pharmacovigilance for patient safety and optimal therapeutic interventions.

MNREAD Reading Vision in Adults With Glaucoma Under Mesopic and Photopic Conditions

Purpose

Despite good photopic visual acuity, glaucoma patients report difficulty performing daily activities under dim light such as reading. Here we investigated the impact of mesopic lighting conditions on reading vision of glaucoma patients.

Methods

The study design included 39 patients with glaucoma and 40 healthy controls. Reading vision was assessed with MNREAD charts under mesopic (2 cd/m2) and photopic (220 cd/m2) conditions. Four reading indexes: maximum reading speed (MRS), critical print size (CPS), reading acuity (RA), and reading accessibility index (ACC) were obtained from the MNREAD test yielding a plot of reading speed versus print size.

Results

Compared to photopic conditions, reading vision of both healthy controls and glaucoma patients significantly decreased under mesopic conditions (P < 0.05). For glaucoma patients (85% with mild or moderate glaucoma), MRS and ACC decreased by six words per minute and 0.1, respectively under mesopic conditions; CPS and RA increased by 0.25 and 0.18 logMAR, respectively. Moreover, under both photopic and mesopic conditions, reading vision of glaucoma patients was significantly worse than that of healthy controls, but the difference was greater under mesopic conditions (P < 0.05) even after controlling for age and visual acuity.

Conclusions

Mesopic conditions make reading more challenging for both healthy controls and glaucoma patients. However, reading in dim light appears to be more burdensome for glaucoma patients. Mesopic reading tests mediated by both cone and rod photoreceptor systems likely provide a more sensitive and comprehensive assessment of a patient's reading impairment than testing under photopic conditions.

Altered Eye Movements During Reading With Simulated Central and Peripheral Visual Field Defects

Purpose

Although foveal vision provides fine spatial information, parafoveal and peripheral vision are also known to be important for efficient reading behaviors. Here we systematically investigate how different types and sizes of visual field defects affect the way visual information is acquired via eye movements during reading.

Methods

Using gaze-contingent displays, simulated scotomas were induced in 24 adults with normal or corrected-to-normal vision during a reading task. The study design included peripheral and central scotomas of varying sizes (aperture or scotoma size of 2°, 4°, 6°, 8°, and 10°) and no-scotoma conditions. Eye movements (e.g., forward/backward saccades, fixations, microsaccades) were plotted as a function of either the aperture or scotoma size, and their relationships were characterized by the best fitting model.

Results

When the aperture size of the peripheral scotoma decreased below 6° (11 visible letters), there were significant decreases in saccade amplitude and velocity, as well as substantial increases in fixation duration and the number of fixations. Its dependency on the aperture size is best characterized by an exponential decay or growth function in log-linear coordinates. However, saccade amplitude and velocity, fixation duration, and forward/regressive saccades increased more or less linearly with increasing central scotoma size in log-linear coordinates.

Conclusions

Our results showed differential impacts of central and peripheral vision loss on reading behaviors while lending further support for the importance of foveal and parafoveal vision in reading. These apparently deviated oculomotor behaviors may in part reflect optimal reading strategies to compensate for the loss of visual information.

Reading Vision in Adults With Early and Intermediate Age-Related Macular Degeneration Under Mesopic and Photopic Conditions

Purpose

Reading is involved in various daily activities that operate under a wide range of luminance levels. Rod- and cone-mediated mesopic visual function is known to be impaired even in early/intermediate age-related macular degeneration (AMD). It remains unclear whether and to what extent mesopic reading is impaired in early/intermediate AMD. Here, we assessed differences in reading vision between photopic and mesopic conditions in early/intermediate AMD and compared their performance to those in older adults with normal macular health.

Methods

The study included 30 patients with early/intermediate AMD and 30 healthy controls. Reading performance was tested on the MNREAD iPad app under mesopic (2 cd/m2 with a neural-density filter) and photopic (220 cd/m2) conditions. Four reading indices-maximum reading speed (MRS), critical print size (CPS), reading acuity (RA), and reading accessibility index (ACC)-were obtained from the MNREAD test, yielding a function representing reading speed versus print size.

Results

Compared to photopic conditions, patients with AMD and healthy controls both exhibited noticeable decreases in reading vision under mesopic conditions (P < 0.001) despite normal photopic visual acuity. This decrease was more pronounced in AMD even after adjusting for age (P < 0.001): Under mesopic conditions, MRS and ACC decreased by 8 words per minute and 0.1, respectively; CPS and RA were enlarged by 0.27 and 0.24 logMAR, respectively.

Conclusions

Reading vision deteriorates under mesopic conditions compared to photopic conditions in early/intermediate AMD and is accentuated compared to this difference in healthy controls.

Translational Relevance

A mesopic reading test may provide a more sensitive and comprehensive assessment of a patient's reading impairment.

Despite Impaired Binocular Function, Binocular Disparity Integration Across the Visual Field Is Spared in Normal Aging and Glaucoma

Purpose

To examine how binocularly asymmetric glaucomatous visual field damage affects binocular disparity processing across the visual field.

Methods

We recruited 18 patients with primary open-angle glaucoma, 16 age-matched controls, and 13 young controls. Participants underwent standard clinical assessments of binocular visual acuity, binocular contrast sensitivity, stereoacuity, and perimetry. We employed a previously validated psychophysical procedure to measure how sensitivity to binocular disparity varied across spatial frequencies and visual field sectors (i.e., with full-field stimuli spanning the central 21° of the visual field and with stimuli restricted to annular regions spanning 0°-3°, 3°-9°, or 9°-21°). We employed measurements with annular stimuli to model different possible scenarios regarding how disparity information is combined across visual field sectors. We adjudicated between potential mechanisms by comparing model predictions to the patterns observed with full-field stimuli.

Results

Perimetry confirmed that patients with glaucoma exhibited binocularly asymmetric visual field damage (P < 0.001). Across participant groups, foveal regions preferentially processed disparities at finer spatial scales, whereas periphery regions were tuned for coarser scales (P < 0.001). Disparity sensitivity also decreased from fovea to periphery (P < 0.001) and across participant groups (Ps < 0.01). Finally, similar to controls, patients with glaucoma exhibited near-optimal disparity integration, specifically at low spatial frequencies (P < 0.001).

Conclusions

Contrary to the conventional view that glaucoma spares central vision, we find that glaucomatous damage causes a widespread loss of disparity sensitivity across both foveal and peripheral regions. Despite these losses, cortical integration mechanisms appear to be well preserved, suggesting that patients with glaucoma make the best possible use of their remaining binocular function.

Recommendations on the use of azole antifungals in hematology-oncology patients

The administration of antifungals for therapeutic and, especially, prophylactic purposes is virtually a constant in patients requiring hematology-oncology treatment. Any attempt to prevent or treat Aspergillus or Mucor infections requires the administration of some drugs in the azole group, which include voriconazole, posaconazole and isavuconazole, noted for their activity against these pathogens. One very relevant aspect is the potential risk of interaction when associated with one of the antineoplastic drugs used to treat hematologic tumors, with serious complications. In this regard, acalabrutinib, bortezomib, bosutinib, carfilzomib, cyclophosphamide, cyclosporine A, dasatinib, duvelisib, gilteritinib, glasdegib, ibrutinib, imatinib, nilotinib, ponatinib, prednisone, ruxolitinib, tacrolimus, all-transretinoic acid, arsenic trioxide, venetoclax, or any of the vinca alkaloids, are very clear examples of risk, in some cases because their clearance is reduced and in others because of increased risk of QTc prolongation, which is particularly evident when the drug of choice is voriconazole or posaconazole.

EZH2 mutations at diagnosis in follicular lymphoma: a promising biomarker to guide frontline treatment

EZH2 is mutated in nearly 25% of follicular lymphoma (FL) cases. Little is known about how EZH2 affects patients’ response to therapy. In this context, the aim of this study was to retrospectively analyze the frequency of mutations in EZH2 at diagnosis in tissue and ctDNA in patients with FL and to assess the patients’ outcomes after receiving immunochemotherapy, depending on the EZH2 mutation status. Among the 154 patients included in the study, 27% had mutated EZH2 (46% with high-grade and 26% with low-grade FL). Of the mutated tissue samples, the mutation in ctDNA was identified in 44% of cases. EZH2 mutation in ctDNA was not identified in any patient unmutated in the tissue.

Unmutated patients who received R-CHOP had significantly more relapses than patients who received R-Bendamustine (16/49 vs. 2/23, p = 0.040). Furthermore, our results show that patients with mutated EZH2 treated with R-CHOP vs. those treated with R-Bendamustine present a lower incidence of relapse (10% vs. 42% p = 0.09 at 4 years), a higher PFS (92% vs. 40% p = 0.039 at 4 years), and higher OS (100% vs. 78% p = 0.039 at 4 years). Based on these data, RCHOP could be a more suitable regimen for mutated patients, and R-bendamustine for unmutated patients. These findings could mean the first-time identification of a useful biomarker to guide upfront therapy in FL.

Altered eye movements during reading under degraded viewing conditions: Background luminance, text blur, and text contrast

Degraded viewing conditions caused by either natural environments or visual disorders lead to slow reading. Here, we systematically investigated how eye movement patterns during reading are affected by degraded viewing conditions in terms of spatial resolution, contrast, and background luminance. Using a high-speed eye tracker, binocular eye movements were obtained from 14 young normally sighted adults. Images of text passages were manipulated with varying degrees of background luminance (1.3-265 cd/m2), text blur (severe blur to no blur), or text contrast (2.6%-100%). We analyzed changes in key eye movement features, such as saccades, microsaccades, regressive saccades, fixations, and return-sweeps across different viewing conditions. No significant changes were observed for the range of tested background luminance values. However, with increasing text blur and decreasing text contrast, we observed a significant decrease in saccade amplitude and velocity, as well as a significant increase in fixation duration, number of fixations, proportion of regressive saccades, microsaccade rate, and duration of return-sweeps. Among all, saccade amplitude, fixation duration, and proportion of regressive saccades turned out to be the most significant contributors to reading speed, together accounting for 90% of variance in reading speed. Our results together showed that, when presented with degraded viewing conditions, the patterns of eye movements during reading were altered accordingly. These findings may suggest that the seemingly deviated eye movements observed in individuals with visual impairments may be in part resulting from active and optimal information acquisition strategies operated when visual sensory input becomes substantially deprived.

Foveal crowding appears to be robust to normal aging and glaucoma unlike parafoveal and peripheral crowding

Visual crowding is the inability to recognize a target object in clutter. Previous studies have shown an increase in crowding in both parafoveal and peripheral vision in normal aging and glaucoma. Here, we ask whether there is any increase in foveal crowding in both normal aging and glaucomatous vision. Twenty-four patients with glaucoma and 24 age-matched normally sighted controls (mean age = 65 ± 7 vs. 60 ± 8 years old) participated in this study. For each subject, we measured the extent of foveal crowding using Pelli's foveal crowding paradigm (2016). We found that the average crowding zone was 0.061 degrees for glaucoma and 0.056 degrees for age-matched normal vision, respectively. These values fall into the range of foveal crowding zones (0.0125 degrees to 0.1 degrees) observed in young normal vision. We, however, did not find any evidence supporting increased foveal crowding in glaucoma (p = 0.375), at least in the early to moderate stages of glaucoma. In the light of previous studies on foveal crowding in normal young vision, we did not find any evidence supporting age-related changes in foveal crowding. Even if there is any, the effect appears to be rather inconsequential. Taken together, our findings suggest unlike parafoveal or peripheral crowding (2 degrees, 4 degrees, 8 degrees, and 10 degrees eccentricities), foveal crowding (<0.25 degrees eccentricity) appears to be less vulnerable to normal aging or moderate glaucomatous damage.

Identifying the Retinal Layers Linked to Human Contrast Sensitivity Via Deep Learning

Purpose

Luminance contrast is the fundamental building block of human spatial vision. Therefore contrast sensitivity, the reciprocal of contrast threshold required for target detection, has been a barometer of human visual function. Although retinal ganglion cells (RGCs) are known to be involved in contrast coding, it still remains unknown whether the retinal layers containing RGCs are linked to a person's contrast sensitivity (e.g., Pelli-Robson contrast sensitivity) and, if so, to what extent the retinal layers are related to behavioral contrast sensitivity. Thus the current study aims to identify the retinal layers and features critical for predicting a person's contrast sensitivity via deep learning.

Methods

Data were collected from 225 subjects including individuals with either glaucoma, age-related macular degeneration, or normal vision. A deep convolutional neural network trained to predict a person's Pelli-Robson contrast sensitivity from structural retinal images measured with optical coherence tomography was used. Then, activation maps that represent the critical features learned by the network for the output prediction were computed.

Results

The thickness of both ganglion cell and inner plexiform layers, reflecting RGC counts, were found to be significantly correlated with contrast sensitivity (r = 0.26 ∼ 0.58,Ps < 0.001 for different eccentricities). Importantly, the results showed that retinal layers containing RGCs were the critical features the network uses to predict a person's contrast sensitivity (an average R² = 0.36 ± 0.10).

Conclusions

The findings confirmed the structure and function relationship for contrast sensitivity while highlighting the role of RGC density for human contrast sensitivity.

Binocularly Asymmetric Crowding in Glaucoma and a Lack of Binocular Summation in Crowding

Purpose

Glaucoma is associated with progressive loss of retinal ganglion cells. Here we investigated the impact of glaucomatous damage on monocular and binocular crowding in parafoveal vision. We also examined the binocular summation of crowding to see if crowding is alleviated under binocular viewing.

Methods

The study design included 40 individuals with glaucoma and 24 age-similar normal cohorts. For each subject, the magnitude of crowding was determined by the extent of crowding zone. Crowding zone measurements were made binocularly in parafoveal vision (i.e., at 2° and 4° retinal eccentricities) visual field. For a subgroup of glaucoma subjects (n = 17), crowding zone was also measured monocularly for each eye.

Results

Our results showed that, compared with normal cohorts, individuals with glaucoma exhibited significantly larger crowding—enlargement of crowding zone (an increase by 21%; P < 0.01). Moreover, we also observed a lack of binocular summation (i.e., a binocular ratio of 1): binocular crowding was determined by the better eye. Hence, our results did not provide evidence supporting binocular summation of crowding in glaucomatous vision.

Conclusions

Our findings show that crowding is exacerbated in parafoveal vision in glaucoma and binocularly asymmetric glaucoma seems to induce binocularly asymmetric crowding. Furthermore, the lack of binocular summation for crowding observed in glaucomatous vision combined with the lack of binocular summation reported in a previous study on normal healthy vision support the view that crowding may start in the early stages of visual processing, at least before the process of binocular integration takes place.

Functional Field of View Determined by Crowding, Aging, or Glaucoma Under Divided Attention

Purpose

Parafoveal or peripheral vision is important for various everyday activities. This is particularly relevant to those who suffer from visual field defects. Here we quantified the effect of visual crowding, normal aging, and glaucoma on the spatial extent of the functional field of view (FFV) under divided attention.

Methods

Unlike visual acuity measured by single-letter recognition or visual perimetry measured by light spot detection, we measured the FFV using a target letter presented either alone or in letter triplets appearing across the visual field. A subject's task was to report whether the target letter was the same as the letter displayed concurrently at the central fixation region (i.e., divided attention task). Over the trials, a plot of the proportion correct for letter recognition versus target location was constructed, resulting in a visual field map.

Results

The results obtained from three subject groups—normal young adults, normal older adults, and patients with glaucoma—showed that on average the central 20° visual field was relatively robust to uncrowded target recognition under divided attention. However, the FFV shrunk down to the central 10° visual field when the target appeared in clutter, suggesting a strong crowding effect on FFV. An additional shrinkage of the FFV occurred in the presence of aging and glaucoma.

Conclusions

Using a quantitative method, we demonstrate that crowding, aging, and glaucoma independently decrease the spatial extent of FFV under divided attention and that crowding seems to be the major contributor limiting FFV.

Translational Relevance

Our FFV test may complement standard clinical measurements by providing functionally relevant visual field information.

Phase II study of ceralasertib (AZD6738) in combination with durvalumab in patients with advanced/metastatic melanoma who have failed prior anti-PD-1 therapy

BACKGROUND

Modulating the DNA damage response and repair (DDR) pathways is a promising strategy for boosting cancer immunotherapy. Ceralasertib (AZD6738) is an oral inhibitor of the serine/threonine protein kinase ataxia telangiectasia and Rad3-related protein, which is crucial for DDR.

PATIENTS AND METHODS

This phase II trial evaluated ceralasertib plus durvalumab for the treatment of patients with metastatic melanoma who had failed anti-programmed cell death protein 1 therapy.

RESULTS

Among the 30 patients, we observed an overall response rate of 31.0% and a disease control rate of 63.3%. Responses were evident across patients with acral, mucosal, and cutaneous melanoma. The median duration of response was 8.8 months (range, 3.8-11.7 months). The median progression-free survival was 7.1 months (95% confidence interval, 3.6-10.6 months), and the median overall survival was 14.2 months (95% confidence interval, 9.3-19.1 months). Common adverse events were largely hematologic and manageable with dose interruptions and reductions. Exploratory biomarker analysis suggested that tumors with an immune-enriched microenvironment or alterations in the DDR pathway were more likely to respond to the study treatment.

CONCLUSION

We conclude that ceralasertib in combination with durvalumab has promising antitumor activity among patients with metastatic melanoma who have failed anti-programmed cell death protein 1 therapy, and constitute a population with unmet needs.

A Unified Rule for Binocular Contrast Summation Applies to Normal Vision and Common Eye Diseases

Purpose

Binocular summation refers to better visual performance with two eyes than with one eye. Little is known about the mechanism underlying binocular contrast summation in patients with common eye diseases who often exhibit binocularly asymmetric vision loss and structural changes along the visual pathway. Here we asked whether the mechanism of binocular contrast summation remains preserved in eye disease.

Methods

This study included 1035 subjects with normal ocular health, cataract, age-related macular degeneration, glaucoma, and retinitis pigmentosa. Monocular and binocular contrast sensitivity were measured by the Pelli-Robson contrast sensitivity chart. Interocular ratio (IOR) was quantified as the ratio between the poorer and better eye contrast sensitivity. Binocular summation ratio (BSR) was quantified as the ratio between binocular and better eye contrast sensitivity.

Results

All groups showed statistically significant binocular summation, with the BSR ranging from 1.25 [1.20, 1.30] in the glaucoma group to 1.31 [1.27, 1.36] in the normal vision group. There was no significant group difference in the BSR, after accounting for IOR. By fitting a binocular summation model Binocular = (Leftm + Rightm)1/m to the contrast sensitivity data, we found that the same binocular summation rule, reflected by the parameter m, applies across the five groups.

Conclusions

Cortical binocular contrast summation appears to be preserved in spite of eye diseases that can affect the two eyes differently. This finding supports the importance of assessing both monocular and binocular functions, rather than relying on a monocular assessment in the better eye as a potentially inaccurate surrogate measure.

Repeatability and Validity of MNREAD Test in Children With Vision Impairment

Purpose

To evaluate the test-retest reliability and validity of the MNREAD test for use in children with vision impairment (VI) and to compare their performance on the test to that of normally sighted children.

Methods

Children with VI (n = 62) and without VI (n = 40) were administered the MNREAD test and the Basic Reading Inventory (BRI) on two study visits, 1 to 3 weeks apart. The maximum reading rate, critical print size, and reading acuity were determined for the MNREAD test, and test-retest reliability was evaluated. The reading rate for the MNREAD test was compared to the BRI results.

Results

Strong correlations between visits were found for all MNREAD parameters (0.68-0.99). Older, but not younger, children with VI read significantly more slowly on both the MNREAD and the BRI than children with normal vision (P < 0.05). Reading rates between the two tests were strongly correlated (r = 0.88). For the MNREAD test, the reading rate increased 4.4 words per minute (wpm) per year for VI and 10.6 wpm/y for those with normal vision. For the BRI, the reading rate increased by 5.9 wpm/y for VI and 9.7 wpm/y for those with normal vision. Poorer visual acuity was associated with slower reading rates on the MNREAD test but not on the BRI, as the MNREAD relies largely on visual factors but the BRI also relies on linguistic and grammar skills.

Conclusions

The MNREAD test are reliable and valid for use in children with vision impairment.

Translational Relevance

The MNREAD test can be utilized by clinicians, as they are a quick, easy-to-administer method for evaluating reading vision in children with VI.

Molecular profiling of Asian patients with advanced melanoma receiving check-point inhibitor treatment

Objective

Melanoma is major medical challenge and being able to monitor treatment response is critical. This study aimed to use molecular profiling of Asian patients with advanced melanoma who were receiving treatment with check-point inhibitors (CPIs) to identify novel biomarkers of tumor response.

Methods

Next-generation sequencing (NGS) was performed using tumor specimens collected from 178 Asian patients with metastatic melanoma receiving CPIs. The NGS data and clinical-pathological factors were analyzed for potential genetic biomarkers of tumor response to CPI treatment.

Results

The most common melanoma subtype was acral melanoma (40%), followed by cutaneous melanoma (32%), mucosal melanoma (26%), and others (2%). For calculation of treatment efficacy, 164 of the patients could be evaluated. The overall response rate was 45.7%, of which 41 cases exhibited complete responses (25.0%) and 34 showed partial responses (20.7%). There were no significant differences in tumor responses based on melanoma subtype (P = 0.295). Genetically, NRAS mutations, TP53 mutations, and NF2 deletions were significantly associated with resistance to CPIs (P < 0.05). In contrast, MYC and RPS6KB1 amplifications were associated with responsiveness to CPIs (P < 0.05). Median progression-free survival (PFS) for patients treated with CPIs was 5.9 months (95% CI, 3.8-8.05 months). Univariate analysis identified TP53 and BRAF mutations, NF2 deletions, and BIRC2 amplifications as poor prognostic factors for PFS (P < 0.05).

Conclusions

This study determined the integrated genomic profiles of Asian patients with metastatic melanoma receiving CPIs and identified candidate biomarkers that reflected treatment outcomes.

•

The molecular characterization of Asian melanoma patients receiving check-point inhibitors (CPIs) using NGS has not been reported.

•

NRAS and TP53 mutations and NF2 deletions were significantly associated with resistance to CPIs.

•

MYC and RPS6KB1 amplifications were associated with responsiveness to CPIs.

•

TP53 and BRAF mutations, NF2 deletions, and BIRC2 amplifications were poor prognostic factors for progression-free survival.

•

This is the largest integrated genomic study to date that identifying novel biomarkers of CPIs in Asian melanoma patients.

Exploring a Structural Basis for Delayed Rod-Mediated Dark Adaptation in Age-Related Macular Degeneration Via Deep Learning

Purpose

Delayed rod-mediated dark adaptation (RMDA) is a functional biomarker for incipient age-related macular degeneration (AMD). We used anatomically restricted spectral domain optical coherence tomography (SD-OCT) imaging data to localize de novo imaging features associated with and to test hypotheses about delayed RMDA.

Methods

Rod intercept time (RIT) was measured in participants with and without AMD at 5 degrees from the fovea, and macular SD-OCT images were obtained. A deep learning model was trained with anatomically restricted information using a single representative B-scan through the fovea of each eye. Mean-occlusion masking was utilized to isolate the relevant imaging features.

Results

The model identified hyporeflective outer retinal bands on macular SD-OCT associated with delayed RMDA. The validation mean standard error (MSE) registered to the foveal B-scan localized the lowest error to 0.5 mm temporal to the fovea center, within an overall low-error region across the rod-free zone and adjoining parafovea. Mean absolute error (MAE) on the test set was 4.71 minutes (8.8% of the dynamic range).

Conclusions

We report a novel framework for imaging biomarker discovery using deep learning and demonstrate its ability to identify and localize a previously undescribed biomarker in retinal imaging. The hyporeflective outer retinal bands in central macula on SD-OCT demonstrate a structural basis for dysfunctional rod vision that correlates to published histopathologic findings.

Translational Relevance

This agnostic approach to anatomic biomarker discovery strengthens the rationale for RMDA as an outcome measure in early AMD clinical trials, and also expands the utility of deep learning beyond automated diagnosis to fundamental discovery.

Increased Equivalent Input Noise in Glaucomatous Central Vision: Is it Due to Undersampling of Retinal Ganglion Cells?

Purpose

Recent evidence shows that macular damage is common even in early stages of glaucoma. Here we investigated whether contrast sensitivity loss in the central vision of glaucoma patients is due to an increase in equivalent input noise (Neq), a decrease in calculation efficiency, or both. We also examined how retinal undersampling resulting from loss of retinal ganglion cells (RGCs) may affect Neq and calculation efficiency.

Methods

This study included 21 glaucoma patients and 23 age-matched normally sighted individuals. Threshold contrast for orientation discrimination was measured with a sinewave grating embedded in varying levels of external noise. Data were fitted to the linear amplifier model (LAM) to factor contrast sensitivity into Neq and calculation efficiency. We also correlated macular RGC counts estimated from structural (spectral-domain optical coherence tomography) and functional (standard automated perimetry Swedish interactive thresholding algorithm 10-2) data with either Neq or efficiency. Furthermore, using analytical and computer simulation approach, the relative effect of retinal undersampling on Neq and efficiency was evaluated by adding the RGC sampling module into the LAM.

Results

Compared with normal controls, glaucoma patients exhibited a significantly larger Neq without significant difference in efficiency. Neq was significantly correlated with Pelli-Robson contrast sensitivity and macular RGC counts. The results from analytical derivation and model simulation further demonstrated that Neq can be expressed as a function of internal noise and retinal sampling.

Conclusions

Our results showed that equivalent input noise is significantly elevated in glaucomatous vision, thereby impairing foveal contrast sensitivity. Our findings further elucidated how undersampling at the retinal level may increase equivalent input noise.

Relationship Between Acuity and Contrast Sensitivity: Differences Due to Eye Disease

Purpose

Visual acuity (VA) and contrast sensitivity (CS) characterize different aspects of visual function. Whereas VA is a standard test in routine eye exams and clinical trials, CS is often not included. We investigated the pathology-specific dissociation between VA and CS by quantifying and comparing the relationship between these two measures in common ocular pathologies.

Methods

VA and CS data were assembled from 1113 subjects, including groups with cataract (n = 450), age-related macular degeneration (AMD; n = 232), glaucoma (n = 100), retinitis pigmentosa (RP; n = 87), and normal ocular health (n = 244). VA and CS were measured by the Early Treatment Diabetic Retinopathy Study chart and Pelli-Robson chart, respectively.

Results

Even when VA was relatively normal (<0.3 logMAR), the four ocular pathology groups showed quantitatively different mean CS deficits relative to normal controls, ranging from -0.01 log units for cataract to 0.23 log units for RP. When the entire range of VA was considered, the corresponding deficits in CS were noticeably different across these four groups, being least for cataract and progressively more severe for glaucoma, AMD, and RP. For every 1.0 logMAR loss of VA, the corresponding deficit in CS ranged from 0.22 logCS for cataract to 0.97 logCS for RP.

Conclusions

The quantitative relationship between VA and CS depends on the ocular pathology. CS appears to provide valuable complementary information to VA in the early detection of eye disease and when evaluating visual impairment.

0268 Development of an Integrated Model of Sleep Deprivation in Adolescence

Introduction

Sleep deprivation is a consistently and widely concerning problem among adolescents. Although a few models have been proposed to explain the relationships and pathways through which factors influence sleep in adolescents, there are lack of theoretical models that apply both biological and behavioral factors that contribute to sleep deprivation across the trajectory of adolescent development. The current study proposes an integrated model that draws upon constructs from several influential theories with an aim to re-conceptualize factors associated with sleep deprivation as a chronic and cyclic problem that emerges from biological and behavioral changes in youth.

Methods

The Two Process Model of Sleep Regulation, Spielman’s 3p model, the theory of planned behavior, dual systems model, and sleep health framework are used to develop an integrated model of factors that lead to sleep deprivation in adolescents.

Results

The resulting integrated model highlights the importance of adolescent’s inherent nature of delayed sleep phase at pubertal onset (two process model); increased reward-seeking that precedes the structural maturation of their cognitive control and emotions (dual systems model); and their attitudes/perceptions towards sleep (theory of planned behavior), which is often geared toward not prioritizing sleep. Sleep health framework adequately frames the pattern of sleep-wakefulness in adolescents using a multidimensional approach of sleep. Moreover, the new model presents contextual factors (Spielman’s 3p model) and the way that these constructs interact in order to maintain a vicious cycle of insufficient sleep which leads to chronic sleep deprivation.

Conclusion

The current model portrays a wide-ranging view of mechanisms underlying sleep deprivation among adolescence by integrating both biological and behavioral aspects. The model is proposed to encourage researchers to explore these conceptual elements of biological and neurobiological changes, and behavioral problems in order to operationalize relevant measures to relate the concepts to sleep deprivation and subsequent health outcomes in adolescents.

Support

None

1051 Level Of Agreement Between Objective And Subjective Sleep Measures In Lung Cancer Survivors With Insomnia

Introduction

Lung cancer survivors (LCS) have the second-highest incidence of impaired sleep among cancer population. Clinical studies use self-reported and objective measures to assess insomnia in LCS. However, negative beliefs of sleep patterns may impair sleep perception, impact psychological state, and influence insomnia treatment and survivorship outcomes. This study aims to assess the level of agreement between subjective and objective sleep measures in LCS.

Methods

Forty-four non-small cell lung cancer survivors, stage I-III, at least 6 weeks after treatment completion, with Insomnia Severity Index &gt;7, were recruited from two sites from 2014-2016. Individuals with sleep apnea, menopause, rotating shift work, uncontrolled substance abuse, or unstable medical/psychiatric illnesses were excluded from the study. Agreement between total sleep time (TST), sleep latency (SL) and sleep efficiency (SE) from Sleep Diary and wrist-actigraphy (i.e. CamNtech) were assessed with Intraclass Correlation (ICC) and Bland-Altman plots. Analysis of ICC, mean difference, standard deviation (SD) and 95% confidence interval (CI) were conducted using SPSS 24.

Results

LCS were male (63.6%), 60-69 years old (52.3%), married or living with a partner (50%). Self-reported measurements underestimated TST (-68.2 minutes, ICC 0.45, CI 95%, SD 108.1) and SL (-25.9 minutes, ICC 95%, ICC -0.54, DS 17.5). Objective and self-reported measurements largely overlapped for SE, with a small actigraphy-based overestimation (9.2, ICC 0.2, CI95%, SD 7.3). Bland-Altman plots revealed that the agreement increased with lower SE values.

Conclusion

LCS tended to underestimate TST and SL. An apparent agreement between objective and self-reported measures for SE may indicate sleep state misperception. Differences in various sleep parameters and potential covariates should be investigated for contribution to the unexplained considerable individual variability in behavioral treatment response among cancer survivors in larger sample sizes.

Support

1R01NR018215-01 (GED); T32GM099607(CW).

Characterization of Central Visual Field Loss in End-stage Glaucoma by Unsupervised Artificial Intelligence

Importance

Although the central visual field (VF) in end-stage glaucoma may substantially vary among patients, structure-function studies and quality-of-life assessments are impeded by the lack of appropriate characterization of end-stage VF loss.

Objective

To provide a quantitative characterization and classification of central VF loss in end-stage glaucoma.

Design, Setting, and Participants

This retrospective cohort study collected data from 5 US glaucoma services from June 1, 1999, through October 1, 2014. A total of 2912 reliable 10-2 VFs of 1103 eyes from 1010 patients measured after end-stage 24-2 VFs with a mean deviation (MD) of -22 dB or less were included in the analysis. Data were analyzed from March 28, 2018, through May 23, 2019.

Main Outcomes and Measures

Central VF patterns were determined by an artificial intelligence algorithm termed archetypal analysis. Longitudinal analyses were performed to investigate whether the development of central VF defect mostly affects specific vulnerability zones.

Results

Among the 1103 patients with the most recent VFs, mean (SD) age was 70.4 (14.3) years; mean (SD) 10-2 MD, -21.5 (5.6) dB. Fourteen central VF patterns were determined, including the most common temporal sparing patterns (304 [27.5%]), followed by mostly nasal loss (280 [25.4%]), hemifield loss (169 [15.3%]), central island (120 [10.9%]), total loss (91 [8.3%]), nearly intact field (56 [5.1%]), inferonasal quadrant sparing (42 [3.8%]), and nearly total loss (41 [3.7%]). Location-specific median total deviation analyses partitioned the central VF into a more vulnerable superonasal zone and a less vulnerable inferotemporal zone. At 1-year and 2-year follow-up, new defects mostly occurred in the more vulnerable zone. Initial encroachments on an intact central VF at follow-up were more likely to be from nasal loss (11 [18.4%]; P < .001). One of the nasal loss patterns had a substantial chance at 2-year follow-up (8 [11.0%]; P = .004) to shift to total loss, whereas others did not.

Conclusions and Relevance

In this study, central VF loss in end-stage glaucoma was found to exhibit characteristic patterns that might be associated with different subtypes. Initial central VF loss is likely to be nasal loss, and 1 specific type of nasal loss is likely to develop into total loss.

Rydberg-Mediated Entanglement in a Two-Dimensional Neutral Atom Qubit Array

We demonstrate high fidelity two-qubit Rydberg blockade and entanglement on a pair of sites in a large two-dimensional qubit array. The qubit array is defined by a grid of blue detuned lines of light with 121 sites for trapping atomic qubits. Improved experimental methods have increased the observed Bell state fidelity to F_{Bell}=0.86(2). Accounting for errors in state preparation and measurement we infer a fidelity of F_{Bell}^{-SPAM}=0.88. Accounting for errors in single qubit operations we infer that a Bell state created with the Rydberg mediated C_{Z} gate has a fidelity of F_{Bell}^{C_{Z}}=0.89. Comparison with a detailed error model based on quantum process matrices indicates that finite atom temperature and laser noise are the dominant error sources contributing to the observed gate infidelity.

Diagnostic Accuracy and Scope of Intraoperative Transoral Ultrasound and Transoral Ultrasound-Guided Fine-Needle Aspiration of Retropharyngeal Masses

The use of transoral sonography-guided fine-needle aspiration for intraoperative localization of retropharyngeal masses has been described by Fornage et al. The purpose of this study was to assess the accuracy of this technique. We reviewed the images and medical records of 26 patients with a retropharyngeal lesion suspicious for a metastatic lymph node of Rouviere identified on CT and/or PET/CT. There were 14 patients with a history of thyroid cancer, 7 with mucosal squamous cell carcinoma, 1 with renal cell carcinoma, 1 with parotid acinic cell cancer, 1 with metastatic colon adenocarcinoma, and 2 with no history of cancer. Intraoperative transoral sonography was performed using a commercially available endovaginal transducer. A transoral sonography-guided fine-needle aspiration was performed with a 25-cm-long 20-ga Chiba needle through a needle guide attached to the transducer shaft. Cytopathologic results were categorized as malignant, benign, or nondiagnostic. Transoral sonography and transoral sonography-guided fine-needle aspiration were performed in all patients. A diagnostic specimen was obtained in 25 of 26 (96%) patients with a 100% overall accuracy. Twelve patients underwent subsequent transoral resection of the retropharyngeal mass. In each patient, surgical pathology confirmed the fine-needle aspiration biopsy result. In 4 patients, transoral sonography-guided injection of methylene blue was used to facilitate intraoperative localization of the metastatic retropharyngeal mass. Transoral sonography and transoral sonography-guided fine-needle aspiration of suspicious masses in the retropharyngeal space are highly accurate procedures for identification and cytologic evaluation of benign and metastatic lymph nodes of Rouviere and for presurgical localization.

Binocular Summation and Suppression of Contrast Sensitivity in Strabismus, Fusion and Amblyopia

Purpose: Amblyopia and strabismus affect 2%–5% of the population and cause a broad range of visual deficits. The response to treatment is generally assessed using visual acuity, which is an insensitive measure of visual function and may, therefore, underestimate binocular vision gains in these patients. On the other hand, the contrast sensitivity function (CSF) generally takes longer to assess than visual acuity, but it is better correlated with improvement in a range of visual tasks and, notably, with improvements in binocular vision. The present study aims to assess monocular and binocular CSFs in amblyopia and strabismus patients.

Methods: Both monocular CSFs and the binocular CSF were assessed for subjects with amblyopia (n = 11), strabismus without amblyopia (n = 20), and normally sighted controls (n = 24) using a tablet-based implementation of the quick CSF, which can assess a full CSF in <3 min. Binocular summation was evaluated against a baseline model of simple probability summation.

Results: The CSF of amblyopic eyes was impaired at mid-to-high spatial frequencies compared to fellow eyes, strabismic eyes without amblyopia, and control eyes. Binocular contrast summation exceeded probability summation in controls, but not in subjects with amblyopia (with or without strabismus) or strabismus without amblyopia who were able to fuse at the test distance. Binocular summation was less than probability summation in strabismic subjects who were unable to fuse.

Conclusions: We conclude that monocular and binocular contrast sensitivity deficits define important characteristics of amblyopia and strabismus that are not captured by visual acuity alone and can be measured efficiently using the quick CSF.

Common constraints limit Korean and English character recognition in peripheral vision

The visual span refers to the number of adjacent characters that can be recognized in a single glance. It is viewed as a sensory bottleneck in reading for both normal and clinical populations. In peripheral vision, the visual span for English characters can be enlarged after training with a letter-recognition task. Here, we examined the transfer of training from Korean to English characters for a group of bilingual Korean native speakers. In the pre- and posttests, we measured visual spans for Korean characters and English letters. Training (1.5 hours × 4 days) consisted of repetitive visual-span measurements for Korean trigrams (strings of three characters). Our training enlarged the visual spans for Korean single characters and trigrams, and the benefit transferred to untrained English symbols. The improvement was largely due to a reduction of within-character and between-character crowding in Korean recognition, as well as between-letter crowding in English recognition. We also found a negative correlation between the size of the visual span and the average pattern complexity of the symbol set. Together, our results showed that the visual span is limited by common sensory (crowding) and physical (pattern complexity) factors regardless of the language script, providing evidence that the visual span reflects a universal bottleneck for text recognition.