1
|
Sohn YB, Wang R, Ashworth J, Broqua P, Tallandier M, Abitbol JL, Jozwiak E, Pollard L, Wood TC, Aslam T, Harmatz PR. Biomarkers of Glycosaminoglycans (GAG) accumulation in patients with mucopolysaccharidosis type VI-LeukoGAG, Corneal Opacification (COM) and Carotid Intima Media Thickening (CIMT). Mol Genet Metab Rep 2024; 38:101041. [PMID: 38234862 PMCID: PMC10792263 DOI: 10.1016/j.ymgmr.2023.101041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 01/19/2024] Open
Abstract
Mucopolysaccharidosis type VI (MPS VI) is an autosomal recessive lysosomal storage disorder characterized by deficient activity of arylsulfatase B enzyme (ASB) resulting in cellular accumulation of dermatan sulfate (DS) and chondroitin sulfate (CS) that leads to cell injury. Urinary glycosaminoglycans (GAG) are often used as a biomarker in MPS diseases for diagnosis and to monitor treatment efficacy. This study evaluated leukocyte GAGs (leukoGAG) and skin GAGs as alternate biomarkers representing intracellular GAG changes in patients with MPS VI and treated with enzyme replacement therapy (ERT). In addition, we evaluated corneal opacification measurements (COM) and carotid intima media thickness (CIMT) as indicators of GAG accumulation and tissue injury. The study was performed in a serial two-step design in a single center. A quantitative method to measure leukoGAG levels in leukocytes was developed in Study 1 to compare the GAG levels between MPS VI patients and a control group and to assess correlations between leukoGAG and urineGAG. Study 2 validated the leukoGAG measurement, assessed the effect of ERT infusion on leukoGAG and ASB activity in leukocytes, identified correlations between leukoGAG and other biomarkers, and assessed differences in GAG accumulation between MPS VI patients and control subjects. In Study 1, leukoCS and leukoDS levels were significantly higher in the MPS VI group than the control group (leukoCS: 37.9 ± 10.2 and 2.9 ± 1.5 μg/μg protein, respectively, p = 0.005; leukoDS: 0.26 ± 0.2 and 0.0 ± 0.0 μg/μg protein, respectively, p = 0.028) with positive correlations between leukoCS and urine CS and leukoDS and urineDS. In Study 2, leukoCS (32.0 ± 11.8 vs 6.9 ± 3.1 μg/mg protein, p = 0.005) and leukoDS (0.4 ± 0.1 and 0.2 ± 0.1 μg/mg protein, p = 0.020) were significantly higher compared with control subjects. Thus, these results highlight the potential of leukoGAG as a new biomarker representing intracellular GAG accumulation in MPS VI patients and may be valuable for patient management.
Collapse
Affiliation(s)
- Young Bae Sohn
- Department of Medical Genetics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Raymond Wang
- Children's Hospital of Orange County, Orange, CA, USA
| | | | | | | | | | - Erin Jozwiak
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | | | - Timothy C. Wood
- Section of Genetics and Metabolism, University of Colorado/Children's Hospital of Colorado, Aurora, CO, USA
| | | | | |
Collapse
|
2
|
Drira I, Noor M, Stone A, D'Souza Y, John B, McGrath O, Patel PJ, Aslam T. Comparison of Widefield OCT Angiography Features Between Severe Non-Proliferative and Proliferative Diabetic Retinopathy. Ophthalmol Ther 2024; 13:831-849. [PMID: 38273048 PMCID: PMC10853160 DOI: 10.1007/s40123-024-00886-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/10/2024] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION There is a high and ever-increasing global prevalence of diabetic retinopathy (DR) and invasive imaging techniques are often required to confirm the presence of proliferative disease. The aim of this study was to explore the images of a rapid and non-invasive technique, widefield optical coherence tomography angiography (OCT-A), to study differences between patients with severe non-proliferative and proliferative DR (PDR). METHODS We conducted an observational longitudinal study from November 2022 to March 2023. We recruited 75 patients who were classified into a proliferative group (28 patients) and severe non-proliferative group (47 patients). Classification was done by specialist clinicians who had full access to any multimodal imaging they required to be confident of their diagnosis, including fluorescein angiography. For all patients, we performed single-shot 4 × 4 and 10 × 10 mm (widefield) OCT-A imaging and when possible, the multiple images required for mosaic 17.5 × 17.5 mm (ultra widefield) OCT-A imaging. We assessed the frequency with which proliferative disease was identifiable solely from these OCT-A images and used custom-built MATLAB software to analyze the images and determine computerized metrics such as density and intensity of vessels, foveal avascular zone, and ischemic areas. RESULTS On clinically assessing the OCT-A 10 × 10 fields, we were only able to detect new vessels in 25% of known proliferative images. Using ultra-widefield mosaic images, however, we were able to detect new vessels in 100% of PDR patients. The image analysis metrics of 4 × 4 and 10 × 10 mm images did not show any significant differences between the two clinical groups. For mosaics, however, there were significant differences in the capillary density in patients with PDR compared to severe non-PDR (9.1% ± 1.9 in the PDR group versus 11.0% ± 1.9 for severe group). We also found with mosaics a significant difference in the metrics of ischemic areas; average area of ischemic zones (253,930.1 ± 108,636 for the proliferative group versus 149,104.2 ± 55,101.8 for the severe group. CONCLUSIONS Our study showed a high sensitivity for detecting PDR using only ultra-widefield mosaic OCT-A imaging, compared to multimodal including fluorescein angiography imaging. It also suggests that image analysis of aspects such as ischemia levels may be useful in identifying higher risk groups as a warning sign for future conversion to neovascularization.
Collapse
Affiliation(s)
- Ines Drira
- Manchester University, Manchester Royal Eye Hospital, Oxford Rd, Manchester, M13 9WL, UK
- Hospital of Toulouse, Pl. du Dr Joseph Baylac, 31300, Toulouse, France
| | - Maha Noor
- Manchester University, Manchester Royal Eye Hospital, Oxford Rd, Manchester, M13 9WL, UK
| | - Amy Stone
- Manchester University, Manchester Royal Eye Hospital, Oxford Rd, Manchester, M13 9WL, UK
| | - Yvonne D'Souza
- Manchester University, Manchester Royal Eye Hospital, Oxford Rd, Manchester, M13 9WL, UK
| | - Binu John
- Manchester University, Manchester Royal Eye Hospital, Oxford Rd, Manchester, M13 9WL, UK
| | - Orlaith McGrath
- Manchester University, Manchester Royal Eye Hospital, Oxford Rd, Manchester, M13 9WL, UK
| | - Praveen J Patel
- National Institute for Health and Care Research Biomedical Research Centre, Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, UK
| | - Tariq Aslam
- Manchester University, Manchester Royal Eye Hospital, Oxford Rd, Manchester, M13 9WL, UK.
| |
Collapse
|
3
|
Noor M, McGrath O, Drira I, Aslam T. Retinal Microvasculature Image Analysis Using Optical Coherence Tomography Angiography in Patients with Post-COVID-19 Syndrome. J Imaging 2023; 9:234. [PMID: 37998081 PMCID: PMC10672226 DOI: 10.3390/jimaging9110234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/14/2023] [Accepted: 10/17/2023] [Indexed: 11/25/2023] Open
Abstract
Several optical coherence tomography angiography (OCT-A) studies have demonstrated retinal microvascular changes in patients post-SARS-CoV-2 infection, reflecting retinal-systemic microvasculature homology. Post-COVID-19 syndrome (PCS) entails persistent symptoms following SARS-CoV-2 infection. In this study, we investigated the retinal microvasculature in PCS patients using OCT-angiography and analysed the macular retinal nerve fibre layer (RNFL) and ganglion cell layer (GCL) thickness via spectral domain-OCT (SD-OCT). Conducted at the Manchester Royal Eye Hospital, UK, this cross-sectional study compared 40 PCS participants with 40 healthy controls, who underwent ophthalmic assessments, SD-OCT, and OCT-A imaging. OCT-A images from the superficial capillary plexus (SCP) were analysed using an in-house specialised software, OCT-A vascular image analysis (OCTAVIA), measuring the mean large vessel and capillary intensity, vessel density, ischaemia areas, and foveal avascular zone (FAZ) area and circularity. RNFL and GCL thickness was measured using the OCT machine's software. Retinal evaluations occurred at an average of 15.2 ± 6.9 months post SARS-CoV-2 infection in PCS participants. Our findings revealed no significant differences between the PCS and control groups in the OCT-A parameters or RNFL and GCL thicknesses, indicating that no long-term damage ensued in the vascular bed or retinal layers within our cohort, providing a degree of reassurance for PCS patients.
Collapse
Affiliation(s)
- Maha Noor
- Department of Eye Research, Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
| | - Orlaith McGrath
- Department of Eye Research, Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
| | - Ines Drira
- Department of Eye Research, Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
- Ophtalmologie Département, Centre Hospitalier Universitaire de Toulouse, 31300 Toulouse, France
| | - Tariq Aslam
- Department of Eye Research, Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| |
Collapse
|
4
|
Oo HH, Mohan M, Song W, Rojas-Carabali W, Tsui E, de-la-Torre A, Cifuentes-González C, Rousselot A, Srinivas SP, Aslam T, Gupta V, Agrawal R. Anterior chamber inflammation grading methods: A critical review. Surv Ophthalmol 2023:S0039-6257(23)00135-2. [PMID: 37804869 DOI: 10.1016/j.survophthal.2023.10.005] [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: 05/27/2023] [Revised: 09/26/2023] [Accepted: 10/03/2023] [Indexed: 10/09/2023]
Abstract
Assessing anterior chamber inflammation is highly subjective and challenging. Although various grading systems attempt to offer objectivity and standardization, the clinical assessment has high interobserver variability. Traditional techniques, such as laser flare meter and fluorophotometry, are not widely used since they are time-consuming. With the development of optical coherence tomography with high sensitivity, direct imaging offers an excellent alternative to assess objectively inflammation with the potential for automated analysis. We describe various anterior chamber inflammation grading methods and discuss their utility, advantages, and disadvantages.
Collapse
Affiliation(s)
- Hnin Hnin Oo
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Madhuvanthi Mohan
- Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Wenjun Song
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - William Rojas-Carabali
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Edmund Tsui
- Ocular Inflammatory Disease Center, UCLA Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Alejandra de-la-Torre
- Neuroscience (NEUROS) Research Group, Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Carlos Cifuentes-González
- Neuroscience (NEUROS) Research Group, Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Andres Rousselot
- Consultorios Oftalmológicos Benisek Ascarza, Capital Federal, Argentina
| | | | - Tariq Aslam
- School of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Vishali Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Agrawal
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore; Singapore Eye Research Institute, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Duke NUS Medical School, Singapore, Singapore.
| |
Collapse
|
5
|
Noor M, McGrath O, Parry N, Aslam T, Ashworth J. 15 Retinopathy in patients with mucopolysaccharidosis. BMJ Open Ophthalmol 2023; 8:A5-A6. [PMID: 37798001 DOI: 10.1136/bmjophth-2023-biposa.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
The mucopolysaccharidoses are a group of inherited metabolic disorders resulting in abnormal degradation of glycosaminoglycans within lysosomes. Ophthalmic manifestations resulting in visual loss include corneal clouding, optic neuropathy and raised intraocular pressure, and retinopathy which occurs in MPS type I, II, III, IV. While corneal clouding may be stabilised with early treatment with HSCT or surgically treated with a corneal transplant, there is currently no known effective treatment for retinopathy.We conducted a prospective observational study of patients with MPS who underwent fundus examination, OPTOS imaging, OCT, and electroretinography.76 patients with MPS were studied, comprised of 45 MPSI, 9 MPSII, 13 MPSIV and 9 MPSVI patients. The age range was 3- 58 years of age. OPTOS imaging was performed in 65 individuals, OCT in 61, and electrodiagnostic assessments in 37 patients. Ten patients (7 MPSI, 3 MPS II) had fundoscopic signs of retinopathy, of which 5 had abnormal ERGs. Twenty one patients (17 MPSI, 2 MPSII, 2 MPSVI) had abnormalities on ERG, of which 5 had concurrent fundoscopic evidence of retinopathy. The onset of retinopathy in MPS patients was observed over a broad age range, with initial detection occurring between 2 and 53 years of age.Retinopathy can be diagnosed on examination, imaging, or ERG in MPS patients as young as 2 years of age. The development of novel medicines, such as gene therapy, have potential to stabilise or improve retinopathy in the future. Therefore, phenotypic and natural history information pertaining to retinopathy in MPS is extremely valuable.
Collapse
Affiliation(s)
- M Noor
- Manchester Royal Eye Hospital, Manchester, UK
| | - O McGrath
- Manchester Royal Eye Hospital, Manchester, UK
| | - N Parry
- Manchester Royal Eye Hospital, Manchester, UK
| | - T Aslam
- Manchester Royal Eye Hospital, Manchester, UK
| | - J Ashworth
- Manchester Royal Eye Hospital, Manchester, UK
| |
Collapse
|
6
|
Makhotkina NY, Nijkamp MD, Berendschot TTJM, van den Borne B, Aelen-van Kruchten M, van Vught L, Beenakker JWM, Krijgh E, Aslam T, Pesudovs K, Nuijts RMMA. Measuring quality of vision including negative dysphotopsia. Acta Ophthalmol 2023. [PMID: 37698026 DOI: 10.1111/aos.15762] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/15/2023] [Accepted: 08/29/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE To adapt the Quality of Vision Questionnaire (QoV) for measuring negative dysphotopsia and to validate the original and modified versions in the Dutch population. METHODS The QoV was translated into Dutch according to standardized methodology. Negative dysphotopsia items were constructed based on focus group interviews, literature review and clinical data. The questionnaire was completed by 404 subjects, including contact lens wearers, patients with cataract and after cataract surgery (95.5% with a monofocal, 4.5% with a multifocal intraocular lens). Rasch analysis was applied for evaluation of reliability and validity of the original QoV and modified version, Negative Dysphotopsia QoV (ND-QoV). RESULTS The frequency, severity and bothersome scales of the QoV and ND-QoV demonstrated good measurement precision, good fit statistics for all but one item, but significant mistargeting of more than one logit. Item estimations were stable across the study groups and scales were unidimensional with more than 50% of variance explained by the measurements. There was a positive correlation between questionnaire scores and best corrected visual acuity (r = 0.3, p < 0.01). The quality of vision measured by all three scales was significantly poorer (p < 0.01) in patients with negative dysphotopsia compared to asymptomatic pseudophakic patients. CONCLUSION The Dutch version of the QoV questionnaire has shown good psychometric properties comparable to the native version as well as good reliability and validity. The addition of negative dysphotopsia items is a valuable modification for the reliable assessment of quality of vision in pseudophakic patients.
Collapse
Affiliation(s)
- Natalia Y Makhotkina
- University Eye Clinic Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marjan D Nijkamp
- School of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
| | - Tos T J M Berendschot
- University Eye Clinic Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Bart van den Borne
- Department of Health Promotion, University of Maastricht, Maastricht, The Netherlands
| | | | - Luc van Vught
- Department of Ophthalmology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Edwin Krijgh
- Visser Contact Lenses Practice, Nijmegen, The Netherlands
| | | | - Konrad Pesudovs
- University of New South Wales, Sydney, Australia
- Anglia Ruskin University, Cambridge, UK
| | - Rudy M M A Nuijts
- University Eye Clinic Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| |
Collapse
|
7
|
Danese C, Kale AU, Aslam T, Lanzetta P, Barratt J, Chou YB, Eldem B, Eter N, Gale R, Korobelnik JF, Kozak I, Li X, Li X, Loewenstein A, Ruamviboonsuk P, Sakamoto T, Ting DS, van Wijngaarden P, Waldstein SM, Wong D, Wu L, Zapata MA, Zarranz-Ventura J. The impact of artificial intelligence on retinal disease management: Vision Academy retinal expert consensus. Curr Opin Ophthalmol 2023; 34:396-402. [PMID: 37326216 PMCID: PMC10399953 DOI: 10.1097/icu.0000000000000980] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE OF REVIEW The aim of this review is to define the "state-of-the-art" in artificial intelligence (AI)-enabled devices that support the management of retinal conditions and to provide Vision Academy recommendations on the topic. RECENT FINDINGS Most of the AI models described in the literature have not been approved for disease management purposes by regulatory authorities. These new technologies are promising as they may be able to provide personalized treatments as well as a personalized risk score for various retinal diseases. However, several issues still need to be addressed, such as the lack of a common regulatory pathway and a lack of clarity regarding the applicability of AI-enabled medical devices in different populations. SUMMARY It is likely that current clinical practice will need to change following the application of AI-enabled medical devices. These devices are likely to have an impact on the management of retinal disease. However, a consensus needs to be reached to ensure they are safe and effective for the overall population.
Collapse
Affiliation(s)
- Carla Danese
- Department of Medicine – Ophthalmology, University of Udine, Udine, Italy
- Department of Ophthalmology, AP-HP Hôpital Lariboisière, Université Paris Cité, Paris, France
| | - Aditya U. Kale
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham
| | - Tariq Aslam
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester School of Health Sciences, Manchester, UK
| | - Paolo Lanzetta
- Department of Medicine – Ophthalmology, University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare, Udine, Italy
| | - Jane Barratt
- International Federation on Ageing, Toronto, Canada
| | - Yu-Bai Chou
- Department of Ophthalmology, Taipei Veterans General Hospital
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Bora Eldem
- Department of Ophthalmology, Hacettepe University, Ankara, Turkey
| | - Nicole Eter
- Department of Ophthalmology, University of Münster Medical Center, Münster, Germany
| | - Richard Gale
- Department of Ophthalmology, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Jean-François Korobelnik
- Service d’ophtalmologie, CHU Bordeaux
- University of Bordeaux, INSERM, BPH, UMR1219, F-33000 Bordeaux, France
| | - Igor Kozak
- Moorfields Eye Hospital Centre, Abu Dhabi, UAE
| | - Xiaorong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin
| | - Xiaoxin Li
- Xiamen Eye Center, Xiamen University, Xiamen, China
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Paisan Ruamviboonsuk
- Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University, Kagoshima, Japan
| | - Daniel S.W. Ting
- Singapore National Eye Center, Duke-NUS Medical School, Singapore
| | - Peter van Wijngaarden
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | | | - David Wong
- Unity Health Toronto – St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Lihteh Wu
- Macula, Vitreous and Retina Associates of Costa Rica, San José, Costa Rica
| | | | | |
Collapse
|
8
|
Chou YB, Kale AU, Lanzetta P, Aslam T, Barratt J, Danese C, Eldem B, Eter N, Gale R, Korobelnik JF, Kozak I, Li X, Li X, Loewenstein A, Ruamviboonsuk P, Sakamoto T, Ting DS, van Wijngaarden P, Waldstein SM, Wong D, Wu L, Zapata MA, Zarranz-Ventura J. Current status and practical considerations of artificial intelligence use in screening and diagnosing retinal diseases: Vision Academy retinal expert consensus. Curr Opin Ophthalmol 2023; 34:403-413. [PMID: 37326222 PMCID: PMC10399944 DOI: 10.1097/icu.0000000000000979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE OF REVIEW The application of artificial intelligence (AI) technologies in screening and diagnosing retinal diseases may play an important role in telemedicine and has potential to shape modern healthcare ecosystems, including within ophthalmology. RECENT FINDINGS In this article, we examine the latest publications relevant to AI in retinal disease and discuss the currently available algorithms. We summarize four key requirements underlining the successful application of AI algorithms in real-world practice: processing massive data; practicability of an AI model in ophthalmology; policy compliance and the regulatory environment; and balancing profit and cost when developing and maintaining AI models. SUMMARY The Vision Academy recognizes the advantages and disadvantages of AI-based technologies and gives insightful recommendations for future directions.
Collapse
Affiliation(s)
- Yu-Bai Chou
- Department of Ophthalmology, Taipei Veterans General Hospital
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Aditya U. Kale
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Paolo Lanzetta
- Department of Medicine – Ophthalmology, University of Udine
- Istituto Europeo di Microchirurgia Oculare, Udine, Italy
| | - Tariq Aslam
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester School of Health Sciences, Manchester, UK
| | - Jane Barratt
- International Federation on Ageing, Toronto, Canada
| | - Carla Danese
- Department of Medicine – Ophthalmology, University of Udine
- Department of Ophthalmology, AP-HP Hôpital Lariboisière, Université Paris Cité, Paris, France
| | - Bora Eldem
- Department of Ophthalmology, Hacettepe University, Ankara, Turkey
| | - Nicole Eter
- Department of Ophthalmology, University of Münster Medical Center, Münster, Germany
| | - Richard Gale
- Department of Ophthalmology, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Jean-François Korobelnik
- Service d’ophtalmologie, CHU Bordeaux
- University of Bordeaux, INSERM, BPH, UMR1219, F-33000 Bordeaux, France
| | - Igor Kozak
- Moorfields Eye Hospital Centre, Abu Dhabi, UAE
| | - Xiaorong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin
| | - Xiaoxin Li
- Xiamen Eye Center, Xiamen University, Xiamen, China
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Paisan Ruamviboonsuk
- Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University, Kagoshima, Japan
| | - Daniel S.W. Ting
- Singapore National Eye Center, Duke-NUS Medical School, Singapore
| | - Peter van Wijngaarden
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | | | - David Wong
- Unity Health Toronto – St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Lihteh Wu
- Macula, Vitreous and Retina Associates of Costa Rica, San José, Costa Rica
| | | | | |
Collapse
|
9
|
McGrath O, Sornalingam K, Aslam T, Ashworth J. Changes in Corneal Clouding Over Time in Patients With Mucopolysaccharidosis. Cornea 2023; 42:992-999. [PMID: 36857777 DOI: 10.1097/ico.0000000000003214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 10/24/2022] [Indexed: 03/03/2023]
Abstract
PURPOSE Mucopolysaccharidoses (MPSs) are a rare group of lysosomal storage disorders characterized by the accumulation of incompletely degraded glycosaminoglycans (GAGs) in multiple organ systems, including the eye. Visual loss occurs in MPS predominantly due to corneal clouding. Despite the success of enzyme replacement therapy (ERT) and hematopoietic stem cell transplantation (HSCT) in improving many systemic manifestations of MPS, less is known about their effect on corneal clouding. This study prospectively analyses the effect of both ERT and HSCT on corneal clouding using objective measures over time. METHODS This is a prospective longitudinal observational study. Corneal clouding was assessed in each participant using slitlamp, digital slit-lamp photographs, and an iris camera (Corneal Opacification Measure [COM] and the Pentacam system). RESULTS Data were collected for 65 participants: 39 MPS I (Hurler), 5 MPS II (Hunter), 12 MPS IV (Morquio), and 9 MPS VI (Maroteaux-Lamy). Follow-up data are available for 45 participants (29 MPS I, 3 MPS II, 6 MPS IV, and 7 MPS VI). CONCLUSIONS This study found corneal clouding to be stable in most participants with MPS I, II, IV, and VI over a follow-up period of 5 to 75 months (median of 30 months) when measured with clinical corneal grading systems, graded digital slit-lamp images, and iris camera COMs. For those with Pentacam densitometry measures, there was a progression of corneal clouding, on average, in those with MPS I and MPS VI. There was no apparent difference in progression of corneal clouding between patients who were on ERT, HSCT, or no treatment.
Collapse
Affiliation(s)
- Orlaith McGrath
- Manchester Royal Eye Hospital, Manchester, United Kingdom; and
- University of Manchester, Manchester, United Kingdom
| | - Krishanthy Sornalingam
- Manchester Royal Eye Hospital, Manchester, United Kingdom; and
- University of Manchester, Manchester, United Kingdom
| | - Tariq Aslam
- Manchester Royal Eye Hospital, Manchester, United Kingdom; and
- University of Manchester, Manchester, United Kingdom
| | - Jane Ashworth
- Manchester Royal Eye Hospital, Manchester, United Kingdom; and
- University of Manchester, Manchester, United Kingdom
| |
Collapse
|
10
|
Hanumunthadu D, Saleh A, Florea D, Balaskas K, Keane PA, Aslam T, Patel PJ. Biomarkers of macular neovascularisation activity using optical coherence tomography angiography in treated stable neovascular age related macular degeneration. BMC Ophthalmol 2023; 23:68. [PMID: 36782163 PMCID: PMC9926859 DOI: 10.1186/s12886-022-02749-5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/19/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND The aim of this study was to describe features of disease activity in patients with treated stable macular neovascularisation (MNV) in neovascular age related macular degeneration (nAMD) using optical coherence tomography angiography (OCTA). METHODS Thirty-two eyes of 32 patients with nAMD were included in this prospective, observational study. These patients were undergoing treatment with aflibercept on a treat-and-extend regimen attending an extension to a 12-week treatment interval. RESULTS All subjects had no macular haemorrhage and no structural OCT markers of active MNV activity at the index 12-week treatment extension visit. 31/32 OCTA images were gradeable without significant imaging artefact. The mean MNV size was 3.6mm2 ± 4.6mm2 and 27 (87.1%) had detectable MNV blood flow. 29/31 (93.5%) subjects had MNV with mature phenotypes including 10 non-specific, 10 tangle and 3 deadtree phenotypes. MNV halo and MNV central feeder vessel were noted in 18 (58.1%) and 19 (61.3%) of subjects respectively; only 1 (3.2%) subject was noted to have a MNV capillary fringe. CONCLUSIONS MNV blood flow is still detectable using OCTA in the majority of subjects in this study with treated stable MNV. OCTA features associated included MNV mature phenotype, MNV feeder vessel, MNV halo and absence of capillary fringe.
Collapse
Affiliation(s)
- Daren Hanumunthadu
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - Azahir Saleh
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Daniela Florea
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Konstantinos Balaskas
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Pearse A Keane
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Tariq Aslam
- Manchester Royal Eye Hospital, NHS Central Manchester University Hospitals and University of Manchester, Manchester, UK
| | - Praveen J Patel
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
| |
Collapse
|
11
|
Gale RP, Finger RP, Eldem B, Aslam T, Barratt J, Daien V, Kodjikian L, Loewenstein A, Okada M, Wong TY, Sylvanowicz M, Rodríguez FJ. The management of neovascular age-related macular degeneration: A systematic literature review of patient-reported outcomes, patient mental health and caregiver burden. Acta Ophthalmol 2023; 101:e26-e42. [PMID: 35790079 PMCID: PMC10084380 DOI: 10.1111/aos.15201] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE The aim of this systematic literature review was to describe patient-reported outcomes, mental health and caregiver burden in patients with neovascular age-related macular degeneration (nAMD) treated with anti-vascular endothelial growth factor (VEGF) agents in routine clinical practice. METHODS Electronic searches were conducted in Embase and MEDLINE according to pre-defined criteria. RESULTS Of 856 records identified, 63 met inclusion criteria. Depression or depressive symptoms were reported in up to 42% of patients with nAMD. Of 25/63 (40%) studies evaluating quality of life (QoL) and using various tools, eight studies reported composite National Eye Institute Visual Functioning Questionnaire scores following anti-VEGF treatment. Of these, seven reported a statistically significant improvement at the earliest time point measured (Month 3-12) and approximately 50% reported sustained QoL benefits at 12 months. In studies comparing the attributed or different regimens, the most important factor from the patient's perspective was the likelihood that a particular regimen would maintain vision. There was a preference towards treat and extend, which was associated with a perceived reduction in patient and caregiver burden, compared to fixed dosing. CONCLUSIONS A coordinated holistic approach to patient care is key to optimizing patient well-being as well as visual outcomes. Further research regarding the patient-reported impact of nAMD management outside the trial setting (particularly international longitudinal studies) is warranted. Standardization of QoL studies would assist in establishing whether sustained QoL improvement, rather than prevention of QoL decline, should be a realistic expectation of treatment of nAMD in the longer term.
Collapse
Affiliation(s)
- Richard P Gale
- York and Scarborough Teaching Hospital NHS Foundation Trust, York, UK
| | - Robert P Finger
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Tariq Aslam
- Manchester Royal Eye Hospital, Manchester, UK.,University of Manchester, Manchester, UK
| | - Jane Barratt
- International Federation on Ageing, Toronto, ON, Canada
| | - Vincent Daien
- Department of Ophthalmology, University Hospital of Montpellier, Montpellier, France
| | - Laurent Kodjikian
- University of Lyon, Lyon, France.,Croix-Rousse University Hospital, Lyon, France
| | - Anat Loewenstein
- Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mali Okada
- Royal Victorian Eye and Ear Hospital, Melbourne, Vic., Australia
| | - Tien Yin Wong
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | | | - Francisco J Rodríguez
- Department of Ophthalmology, Fundación Oftalmológica Nacional and Universidad del Rosario School of Medicine, Bogotá, Colombia
| |
Collapse
|
12
|
Julian TH, Cooper-Knock J, MacGregor S, Guo H, Aslam T, Sanderson E, Black GCM, Sergouniotis PI. Phenome-wide Mendelian randomisation analysis identifies causal factors for age-related macular degeneration. eLife 2023; 12:82546. [PMID: 36705323 PMCID: PMC9883012 DOI: 10.7554/elife.82546] [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: 08/08/2022] [Accepted: 12/18/2022] [Indexed: 01/28/2023] Open
Abstract
Background Age-related macular degeneration (AMD) is a leading cause of blindness in the industrialised world and is projected to affect >280 million people worldwide by 2040. Aiming to identify causal factors and potential therapeutic targets for this common condition, we designed and undertook a phenome-wide Mendelian randomisation (MR) study. Methods We evaluated the effect of 4591 exposure traits on early AMD using univariable MR. Statistically significant results were explored further using: validation in an advanced AMD cohort; MR Bayesian model averaging (MR-BMA); and multivariable MR. Results Overall, 44 traits were found to be putatively causal for early AMD in univariable analysis. Serum proteins that were found to have significant relationships with AMD included S100-A5 (odds ratio [OR] = 1.07, p-value = 6.80E-06), cathepsin F (OR = 1.10, p-value = 7.16E-05), and serine palmitoyltransferase 2 (OR = 0.86, p-value = 1.00E-03). Univariable MR analysis also supported roles for complement and immune cell traits. Although numerous lipid traits were found to be significantly related to AMD, MR-BMA suggested a driving causal role for serum sphingomyelin (marginal inclusion probability [MIP] = 0.76; model-averaged causal estimate [MACE] = 0.29). Conclusions The results of this MR study support several putative causal factors for AMD and highlight avenues for future translational research. Funding This project was funded by the Wellcome Trust (224643/Z/21/Z; 200990/Z/16/Z); the University of Manchester's Wellcome Institutional Strategic Support Fund (Wellcome ISSF) grant (204796/Z/16/Z); the UK National Institute for Health Research (NIHR) Academic Clinical Fellow and Clinical Lecturer Programmes; Retina UK and Fight for Sight (GR586); the Australian National Health and Medical Research Council (NHMRC) (1150144).
Collapse
Affiliation(s)
- Thomas H Julian
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of ManchesterManchesterUnited Kingdom
- Manchester Royal Eye Hospital, Manchester University NHS Foundation TrustManchesterUnited Kingdom
| | - Johnathan Cooper-Knock
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of SheffieldSheffieldUnited Kingdom
| | - Stuart MacGregor
- Statistical Genetics, QIMR Berghofer Medical Research InstituteBrisbaneAustralia
| | - Hui Guo
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of ManchesterManchesterUnited Kingdom
| | - Tariq Aslam
- Manchester Royal Eye Hospital, Manchester University NHS Foundation TrustManchesterUnited Kingdom
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, School of Health Sciences, University of ManchesterManchesterUnited Kingdom
| | - Eleanor Sanderson
- MRC Integrative Epidemiology Unit, University of BristolBristolUnited Kingdom
| | - Graeme CM Black
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of ManchesterManchesterUnited Kingdom
- Manchester Centre for Genomic Medicine, Saint Mary’s Hospital, Manchester University NHS Foundation TrustManchesterUnited Kingdom
| | - Panagiotis I Sergouniotis
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of ManchesterManchesterUnited Kingdom
- Manchester Royal Eye Hospital, Manchester University NHS Foundation TrustManchesterUnited Kingdom
- Manchester Centre for Genomic Medicine, Saint Mary’s Hospital, Manchester University NHS Foundation TrustManchesterUnited Kingdom
- European Molecular Biology Laboratory, European Bioinformatics Institute (EMBL-EBI), Wellcome Genome CampusCambridgeUnited Kingdom
| |
Collapse
|
13
|
Talks SJ, Daien V, Mitchell P, Aslam T, Barratt J, Biberger A, Lamoureux EL, Hirst C, Sylvanowicz M, Finger RP. The Patient Voice in Neovascular Age-Related Macular Degeneration: Findings from a Qualitative Study. Ophthalmol Ther 2022; 12:561-575. [PMID: 36525220 PMCID: PMC9756919 DOI: 10.1007/s40123-022-00631-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Visual impairment resulting from diseases such as neovascular age-related macular degeneration (nAMD) may cause behavioural, environmental, psychological, and logistical challenges that could act as barriers to effective uptake and sustainability of treatment with anti-vascular endothelial growth factor agents (anti-VEGFs). Understanding emotions and experiences of patients with nAMD may help inform the determinants of adherence, and could contribute to improvements in ophthalmic outcomes and quality of life. METHODS Seventeen patients with nAMD receiving anti-VEGF injections were enrolled from three clinics: one each in France (n = 5), Germany (n = 6), and the UK (n = 6). Patients' health information and treatment characteristics were collected. Individual phone interviews were conducted by experienced health care interviewers. Transcripts were analysed thematically. RESULTS Patients (53% female) had a mean age of 77 years. Bilateral anti-VEGF injections were received by 24% (n = 4); and most (76%, n = 13) were adherent to their treatment. Patient emotions at diagnosis ranged from happiness at learning about the treatment for nAMD to being terrified of receiving an injection in the eye. Most patients mentioned feeling anxious and fearful before their first injection despite receiving reassurance. After the first injection, these feelings and apprehension abated for many, but not all. With the goal of maintaining the best possible vision, few (24%, n = 4) patients reported more than one missed appointment, and most had never considered stopping treatment. No patient reported additional assistance beyond family support; however, many had difficulties with recreational and domestic activities and had developed coping strategies. CONCLUSION This study provides insights on patients' emotions related to their experience of nAMD and its management, highlighting the varying experiences between individuals. It shows the importance of the patient's voice when considering patient care and management, and how the nature and timing of interventions can improve the experience of living with and managing nAMD.
Collapse
Affiliation(s)
- S. James Talks
- grid.420004.20000 0004 0444 2244Newcastle Eye Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Vincent Daien
- grid.157868.50000 0000 9961 060XDepartment of Ophthalmology, University Hospital of Montpellier, Montpellier, France
| | - Paul Mitchell
- grid.1013.30000 0004 1936 834XUniversity of Sydney (Westmead Institute for Medical Research), Sydney, NSW Australia
| | - Tariq Aslam
- grid.416375.20000 0004 0641 2866Manchester Royal Eye Hospital, Manchester, UK ,grid.5379.80000000121662407University of Manchester, Manchester, UK
| | - Jane Barratt
- grid.511577.00000 0001 0942 4326International Federation on Ageing, Toronto, ON Canada
| | | | - Ecosse L. Lamoureux
- grid.272555.20000 0001 0706 4670Singapore Eye Research Institute, Singapore, Singapore ,grid.428397.30000 0004 0385 0924Duke-NUS Medical School, Singapore, Singapore
| | - Ceri Hirst
- grid.483721.b0000 0004 0519 4932Bayer Consumer Care AG, Basel, Switzerland
| | | | - Robert P. Finger
- grid.10388.320000 0001 2240 3300Department of Ophthalmology, University of Bonn, Bonn, Germany
| |
Collapse
|
14
|
Lv R, Wang C, Wang R, Wang X, Zhao J, Wang B, Aslam T, Han F, Liu B. Chromosomal instability and phenotypic variation in a specific lineage derived from a synthetic allotetraploid wheat. Front Plant Sci 2022; 13:981234. [PMID: 36072314 PMCID: PMC9441941 DOI: 10.3389/fpls.2022.981234] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/04/2022] [Indexed: 06/15/2023]
Abstract
Newly formed plant allopolyploids usually have meiosis defect, resulting in chromosomal instability manifested as variation in chromosome number and/or structure. However, not all nascent allopolyploids are equally unstable. The wheat group (Aegilops/Triticum) contains 13 diploid species with distinct genome types. Many of these species can be artificially hybridized to produce viable but sterile inter-specific/intergeneric F1 hybrids, which can generate fertile synthetic allotetraploid wheats after whole genome doubling. Compared with synthetic allotetraploid wheats that contain genome combinations of AADD and S*S*DD (S* refers to related S genomes of a different species), those containing an S*S*AA genome are significantly more stable. However, robustness of the relative stability of S*S*AA genomes is unknown, nor are the phenotypic and fitness consequences during occurrences of secondary chromosomal instability. Here, we report a specific lineage originated from a single individual plant of a relatively stable synthetic allotetraploid wheat with genomes S l S l AA (S l and A subgenomes were from Ae. longissima and T. urartu, respectively) that showed a high degree of transgenerational chromosomal instability. Both numerical chromosome variation (NCV) and structural chromosome variation (SCV) occurred widely. While substantial differences in frequencies of both NCV and SCV were detected across the different chromosomes, only NCV frequencies were significantly different between the two subgenomes. We found that NCVs and SCVs occurred primarily due to perturbed meiosis, allowing formation of multivalents and univalents as well as homoeologous exchanges. Thus, the combination of NCVs and SCVs affected multiple phenotypic traits, particularly those related to reproductive fitness.
Collapse
Affiliation(s)
- Ruili Lv
- School of Life Sciences, Linyi University, Linyi, China
- Key Laboratory of Molecular Epigenetics of the Ministry of Education (MOE), Northeast Normal University, Changchun, China
| | - Changyi Wang
- Key Laboratory of Molecular Epigenetics of the Ministry of Education (MOE), Northeast Normal University, Changchun, China
| | - Ruisi Wang
- Key Laboratory of Molecular Epigenetics of the Ministry of Education (MOE), Northeast Normal University, Changchun, China
| | - Xiaofei Wang
- Key Laboratory of Molecular Epigenetics of the Ministry of Education (MOE), Northeast Normal University, Changchun, China
| | - Jing Zhao
- Key Laboratory of Molecular Epigenetics of the Ministry of Education (MOE), Northeast Normal University, Changchun, China
| | - Bin Wang
- Key Laboratory of Molecular Epigenetics of the Ministry of Education (MOE), Northeast Normal University, Changchun, China
| | - Tariq Aslam
- Key Laboratory of Molecular Epigenetics of the Ministry of Education (MOE), Northeast Normal University, Changchun, China
| | - Fangpu Han
- School of Life Sciences, Linyi University, Linyi, China
- Institute of Genetics and Developmental Biology, Chinese Academy of Sciences (CAS), Beijing, China
| | - Bao Liu
- Key Laboratory of Molecular Epigenetics of the Ministry of Education (MOE), Northeast Normal University, Changchun, China
| |
Collapse
|
15
|
Clancy N, Aslam T, Cackett P. Depression secondary to vision loss in old age and an effective rapid screening tool for undiagnosed cases. Ann Gen Psychiatry 2022; 21:15. [PMID: 35655227 PMCID: PMC9160179 DOI: 10.1186/s12991-022-00396-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Zenebe et al. recently stated that despite depression being a common mental health problem in the elderly population, it is underdiagnosed in over half of the cases (Zenebe et al. in Ann Gen Psychiatry, 2021). They described an extensive list of risk factors associated with geriatric depression. However, we noted that they did not include ophthalmic conditions in this list which have previously been identified as an important risk factor for depression in the elderly. MAIN BODY To determine the extent of undiagnosed anxiety and depression in our elderly population with vision loss, we screened a cohort of our patients, over 60 years with vision loss secondary to macular disease for both conditions. Our cohort included 104 patients with mean best corrected visual acuity 0.58 LogMAR (Snellen equivalent 6/24). In this group, we identified 29.8% (31/104) and 28.8% (30/104) of patients with at least one depression or anxiety-related symptom, respectively, in the past 2 weeks. We identified 7.7% (8/104) and 3.8% (4/104) who had significant symptoms of depression and anxiety, respectively, that warranted further follow-up. Only two of these patients had previously been diagnosed with anxiety or depression with the majority having no previous history of either condition. Patients from our cohort who screened for depression or anxiety often cited frustration completing tasks and loss of independence secondary to declining vision. They also complained that the vision loss resulted in a lack of confidence which in turn resulted in social isolation and loneliness. Most of the patients welcomed referral to their GP for follow-up for input regarding their mental health and they also stated an interest in attending hospital optometry low vision services and counselling support. CONCLUSIONS With increasing time pressures on healthcare services and the rising use of virtual clinics especially during the COVID-19 pandemic, it is still essential to screen efficiently for depression in those elderly patients who are at significant risk. There is a considerable burden of major depressive disease in the geriatric population, and we would recommend that physicians (Geriatricians, GPs, Ophthalmologists etc.) screen elderly patients with vision loss for depression using the rapid screening tool which we suggest.
Collapse
Affiliation(s)
- Noah Clancy
- University of Edinburgh Medical School, Edinburgh, UK
| | - Tariq Aslam
- Manchester Royal Eye Hospital, Manchester University, Manchester, UK
| | - Peter Cackett
- Princess Alexandra Eye Pavilion, Chalmers Street, Edinburgh, EH3 9HA, UK.
| |
Collapse
|
16
|
Han JED, Liu X, Bunce C, Douiri A, Vale L, Blandford A, Lawrenson J, Hussain R, Grimaldi G, Learoyd AE, Kernohan A, Dinah C, Minos E, Sim D, Aslam T, Patel PJ, Denniston AK, Keane PA, Balaskas K. Teleophthalmology-enabled and artificial intelligence-ready referral pathway for community optometry referrals of retinal disease (HERMES): a Cluster Randomised Superiority Trial with a linked Diagnostic Accuracy Study-HERMES study report 1-study protocol. BMJ Open 2022; 12:e055845. [PMID: 35105593 PMCID: PMC8808461 DOI: 10.1136/bmjopen-2021-055845] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Recent years have witnessed an upsurge of demand in eye care services in the UK. With a large proportion of patients referred to Hospital Eye Services (HES) for diagnostics and disease management, the referral process results in unnecessary referrals from erroneous diagnoses and delays in access to appropriate treatment. A potential solution is a teleophthalmology digital referral pathway linking community optometry and HES. METHODS AND ANALYSIS The HERMES study (Teleophthalmology-enabled and artificial intelligence-ready referral pathway for community optometry referrals of retinal disease: a cluster randomised superiority trial with a linked diagnostic accuracy study) is a cluster randomised clinical trial for evaluating the effectiveness of a teleophthalmology referral pathway between community optometry and HES for retinal diseases. Nested within HERMES is a diagnostic accuracy study, which assesses the accuracy of an artificial intelligence (AI) decision support system (DSS) for automated diagnosis and referral recommendation. A postimplementation, observational substudy, a within-trial economic evaluation and discrete choice experiment will assess the feasibility of implementation of both digital technologies within a real-life setting. Patients with a suspicion of retinal disease, undergoing eye examination and optical coherence tomography (OCT) scans, will be recruited across 24 optometry practices in the UK. Optometry practices will be randomised to standard care or teleophthalmology. The primary outcome is the proportion of false-positive referrals (unnecessary HES visits) in the current referral pathway compared with the teleophthalmology referral pathway. OCT scans will be interpreted by the AI DSS, which provides a diagnosis and referral decision and the primary outcome for the AI diagnostic study is diagnostic accuracy of the referral decision made by the Moorfields-DeepMind AI system. Secondary outcomes relate to inappropriate referral rate, cost-effectiveness analyses and human-computer interaction (HCI) analyses. ETHICS AND DISSEMINATION Ethical approval was obtained from the London-Bromley Research Ethics Committee (REC 20/LO/1299). Findings will be reported through academic journals in ophthalmology, health services research and HCI. TRIAL REGISTRATION NUMBER ISRCTN18106677 (protocol V.1.1).
Collapse
Affiliation(s)
- Ji Eun Diana Han
- University of Birmingham Institute of Inflammation and Ageing, Birmingham, UK
| | - Xiaoxuan Liu
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Catey Bunce
- RM CTU, Royal Marsden Hospital NHS Trust, London, UK
| | - Abdel Douiri
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Luke Vale
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | | | - John Lawrenson
- Dvision of Optometry and Visual Science, City University of London, London, UK
| | - Rima Hussain
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
- Moorfields Ophthalmic Reading Centre and Artificial Intelligence Lab, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Gabriela Grimaldi
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
- Moorfields Ophthalmic Reading Centre and Artificial Intelligence Lab, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Annastazia E Learoyd
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Christiana Dinah
- Ophthalmology, London North West Healthcare NHS Trust, Harrow, UK
| | - Evangelos Minos
- North West Anglia NHS Foundation Trust, Peterborough, Cambridgeshire, UK
| | - Dawn Sim
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
- Moorfields Ophthalmic Reading Centre and Artificial Intelligence Lab, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | | | - Praveen J Patel
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
- Moorfields Ophthalmic Reading Centre and Artificial Intelligence Lab, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Pearse A Keane
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
- Moorfields Ophthalmic Reading Centre and Artificial Intelligence Lab, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Konstantinos Balaskas
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
- Moorfields Ophthalmic Reading Centre and Artificial Intelligence Lab, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Medical Retina Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| |
Collapse
|
17
|
Okada M, Wong TY, Mitchell P, Eldem B, Talks SJ, Aslam T, Daien V, Rodriguez FJ, Gale R, Barratt J, Finger RP, Loewenstein A. Defining Nonadherence and Nonpersistence to Anti-Vascular Endothelial Growth Factor Therapies in Neovascular Age-Related Macular Degeneration. JAMA Ophthalmol 2021; 139:769-776. [PMID: 34081099 DOI: 10.1001/jamaophthalmol.2021.1660] [Citation(s) in RCA: 18] [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: 02/01/2023]
Abstract
Importance Poor adherence or persistence to treatment can be a barrier to optimizing clinical practice (real-world) outcomes to intravitreal injection therapy in patients with neovascular age-related macular degeneration (nAMD). Currently, there is a lack of consensus on the definition and classification of adherence specific to this context. Objective To describe the development and validation of terminology on patient nonadherence and nonpersistence to anti-vascular endothelial growth factor therapy. Design, Setting, and Participants Following a systematic review of currently used terminology in the literature, a subcommittee panel of retinal experts developed a set of definitions and classification for validation. Definitions were restricted to use in patients with nAMD requiring intravitreal anti-vascular endothelial growth factor therapy. Validation by the full nAMD Barometer Leadership Coalition was established using a modified Delphi approach, with predetermined mean scores of 7.5 or more signifying consensus. Subsequent endorsement of the definitions was provided from a second set of retinal experts, with more than 50% members agreeing or strongly agreeing with all definitions. Main Outcomes and Measures Development of consensus definitions for the terms adherence and persistence and a classification system for the factors associated with treatment nonadherence or nonpersistence in patients with nAMD. Results Nonadherence was defined as missing 2 or more treatment or monitoring visits over a period of 12 months, with a visit considered missed if it exceeded more than 2 weeks from the recommended date. Nonpersistence was defined by nonattendance or an appointment not scheduled within the last 6 months. The additional terms planned discontinuation and transfer of care were also established. Reasons for treatment nonadherence and nonpersistence were classified into 6 dimensions: (1) patient associated, (2) condition associated, (3) therapy associated, (4) health system and health care team associated, (5) social/economic, and (6) other, with subcategories specific to treatment for nAMD. Conclusions and Relevance This classification system provides a framework for assessing treatment nonadherence and nonpersistence over time and across different health settings in the treatment of nAMD with current intravitreal anti-vascular endothelial growth factor treatments. This may have additional importance, given the potential association of the coronavirus pandemic on adherence to treatment in patients with nAMD.
Collapse
Affiliation(s)
- Mali Okada
- Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Paul Mitchell
- Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Bora Eldem
- Department of Ophthalmology, Hacettepe University, Ankara, Turkey
| | - S James Talks
- The Newcastle upon Tyne Hospitals NHS Foundation, Newcastle upon Tyne, United Kingdom
| | - Tariq Aslam
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, The University of Manchester School of Health Sciences, Manchester, United Kingdom
| | - Vincent Daien
- Montpellier University Hospital, Montpellier, France
| | - Francisco J Rodriguez
- Fundación Oftalmologica Nacional, Universidad del Rosario School of Medicine, Bogotá, Colombia
| | - Richard Gale
- Department of Ophthalmology, York Teaching Hospital NHS Foundation Trust, York, United Kingdom
| | - Jane Barratt
- International Federation on Ageing, Toronto, Ontario, Canada
| | - Robert P Finger
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
18
|
Lois N, Cook J, Wang A, Aldington S, Mistry H, Maredza M, McAuley D, Aslam T, Bailey C, Chong V, Ghanchi F, Scanlon P, Sivaprasad S, Steel D, Styles C, Azuara-Blanco A, Prior L, Waugh N. Multimodal imaging interpreted by graders to detect re-activation of diabetic eye disease in previously treated patients: the EMERALD diagnostic accuracy study. Health Technol Assess 2021; 25:1-104. [PMID: 34060440 DOI: 10.3310/hta25320] [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: 11/22/2022] Open
Abstract
BACKGROUND Owing to the increasing prevalence of diabetes, the workload related to diabetic macular oedema and proliferative diabetic retinopathy is rising, making it difficult for hospital eye services to meet demands. OBJECTIVE The objective was to evaluate the diagnostic performance, cost-effectiveness and acceptability of a new pathway using multimodal imaging interpreted by ophthalmic graders to detect reactivation of diabetic macular oedema/proliferative diabetic retinopathy in previously treated patients. DESIGN This was a prospective, case-referent, cross-sectional diagnostic study. SETTING The setting was ophthalmic clinics in 13 NHS hospitals. PARTICIPANTS Adults with type 1 or type 2 diabetes with previously successfully treated diabetic macular oedema/proliferative diabetic retinopathy in one/both eyes in whom, at the time of enrolment, diabetic macular oedema/proliferative diabetic retinopathy could be active or inactive. METHODS For the ophthalmic grader pathway, review of the spectral domain optical coherence tomography scans to detect diabetic macular oedema, and seven-field Early Treatment Diabetic Retinopathy Study/ultra-wide field fundus images to detect proliferative diabetic retinopathy, by trained ophthalmic graders. For the current standard care pathway (reference standard), ophthalmologists examined patients face to face by slit-lamp biomicroscopy for proliferative diabetic retinopathy and, in addition, spectral domain optical coherence tomography imaging for diabetic macular oedema. OUTCOME MEASURES The primary outcome measure was sensitivity of the ophthalmic grader pathway to detect active diabetic macular oedema/proliferative diabetic retinopathy. The secondary outcomes were specificity, agreement between pathways, cost-consequences, acceptability and the proportion of patients requiring subsequent ophthalmologist assessment, unable to undergo imaging and with inadequate quality images/indeterminate findings. It was assumed for the main analysis that all patients in whom graders diagnosed active disease or were 'unsure' or images were 'ungradable' required examination by an ophthalmologist. RESULTS Eligible participants with active and inactive diabetic macular oedema (152 and 120 participants, respectively) and active and inactive proliferative diabetic retinopathy (111 and 170 participants, respectively) were recruited. Under the main analysis, graders had a sensitivity of 97% (142/147) (95% confidence interval 92% to 99%) and specificity of 31% (35/113) (95% confidence interval 23% to 40%) to detect diabetic macular oedema. For proliferative diabetic retinopathy, graders had a similar sensitivity and specificity using seven-field Early Treatment Diabetic Retinopathy Study [sensitivity 85% (87/102), 95% confidence interval 77% to 91%; specificity 48% (77/160), 95% confidence interval 41% to 56%] or ultra-wide field imaging [sensitivity 83% (87/105), 95% confidence interval 75% to 89%; specificity 54% (86/160), 95% confidence interval 46% to 61%]. Participants attending focus groups expressed preference for face-to-face evaluations by ophthalmologists. In the ophthalmologists' absence, patients voiced the need for immediate feedback following grader's assessments, maintaining periodic evaluations by ophthalmologists. Graders and ophthalmologists were supportive of the new pathway. When compared with the reference standard (current standard pathway), the new grader pathway could save £1390 per 100 patients in the review of people with diabetic macular oedema and, depending on the imaging modality used, between £461 and £1189 per 100 patients in the review of people with proliferative diabetic retinopathy. CONCLUSIONS For people with diabetic macular oedema, the ophthalmic grader pathway appears safe and cost saving. The sensitivity of the new pathway to detect active proliferative diabetic retinopathy was lower, but may still be considered acceptable for patients with proliferative diabetic retinopathy previously treated with laser. Suggestions from focus group discussions should be taken into consideration if the new pathway is introduced to ensure its acceptability to users. LIMITATIONS Lack of fundus fluorescein angiography to confirm diagnosis of active proliferative diabetic retinopathy. FUTURE WORK Could refinement of the new pathway increase its sensitivity to detect proliferative diabetic retinopathy? Could artificial intelligence be used for automated reading of images in this previously treated population? TRIAL REGISTRATION Current Controlled Trials ISRCTN10856638 and ClinicalTrials.gov NCT03490318. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology AssessmentVol. 25, No. 32. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Noemi Lois
- The Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Jonathan Cook
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Ariel Wang
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | | | - Hema Mistry
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Mandy Maredza
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Danny McAuley
- The Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK.,The Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, UK
| | - Tariq Aslam
- The Manchester Academic Health Science Centre, Manchester Royal Eye Hospital and Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | | - Victor Chong
- Royal Free Hospital NHS Foundation Trust, London, UK
| | - Faruque Ghanchi
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford Royal Infirmary, Bradford, UK
| | - Peter Scanlon
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Sobha Sivaprasad
- National Institute for Health Research Moorfields Biomedical Research Centre, London, UK
| | - David Steel
- Sunderland Eye Infirmary, Sunderland, UK.,Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Lindsay Prior
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Norman Waugh
- Warwick Medical School, University of Warwick, Coventry, UK
| |
Collapse
|
19
|
Aslam T, Mahmood F, Sabanathan A, Waxman R, Helliwell PS. A clinical and radiographic comparison of patients with psoriatic arthritis from different ethnic backgrounds. Rheumatology (Oxford) 2021; 60:340-345. [PMID: 32778892 DOI: 10.1093/rheumatology/keaa298] [Citation(s) in RCA: 3] [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] [Received: 01/22/2020] [Revised: 05/02/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES There are few papers concerning ethnic differences in disease expression in PsA, which may be influenced by a number of genetic, lifestyle and cultural factors. This article aims to compare clinical and radiographic phenotypes in people of South Asian (SA) and North European (NE) origin with a diagnosis of PsA. METHODS This was a cross-sectional observational study recruiting patients of SA and NE origin from two hospitals in a well-defined area in the North of England. RESULTS A total of 58 SA and 48 NE patients were recruited. SA patients had a more severe clinical phenotype with more tender (median 5 vs 2) and swollen (median 1 vs 0) joints, more severe enthesitis (median 3 vs 1.5), more patients with dactylitis (24% vs 8%), more severe skin disease (median PASI 2.2 vs 1) and worse disease activity as measured by the composite Psoriatic Arthritis Disease Activity Score (mean 4.5 vs 3.6). With regards to patient-completed measures, SA patients had worse impact with poorer quality of life and function (mean HAQ 0.9 vs 0.6; mean PsAQoL 10.8 vs 6.2; mean 36-item short form physical component score 33.5 vs 38.9). No significant differences in current MTX and biologics use were found. CONCLUSIONS SA patients had a worse clinical phenotype and worse impact of disease than NE patients. Further studies are needed to confirm and explore the reasons behind these differences.
Collapse
Affiliation(s)
- Tariq Aslam
- Department of Rheumatology, St. Luke's Hospital, Bradford Teaching NHS Foundation Trust, Bradford, UK
| | - Farrouq Mahmood
- Department of Rheumatology, St. Luke's Hospital, Bradford Teaching NHS Foundation Trust, Bradford, UK
| | - Anetha Sabanathan
- Department of Rheumatology, St. Luke's Hospital, Bradford Teaching NHS Foundation Trust, Bradford, UK
| | - Robin Waxman
- Leeds Institute of Rheumatology and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Philip S Helliwell
- Department of Rheumatology, St. Luke's Hospital, Bradford Teaching NHS Foundation Trust, Bradford, UK.,Leeds Institute of Rheumatology and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| |
Collapse
|
20
|
Mc Grath O, Sarfraz MW, Gupta A, Yang Y, Aslam T. Clinical Utility of Artificial Intelligence Algorithms to Enhance Wide-Field Optical Coherence Tomography Angiography Images. J Imaging 2021; 7:jimaging7020032. [PMID: 34460631 PMCID: PMC8321271 DOI: 10.3390/jimaging7020032] [Citation(s) in RCA: 5] [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: 01/14/2021] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 12/27/2022] Open
Abstract
The aim of this paper is to investigate the clinical utility of the application of deep learning denoise algorithms on standard wide-field Optical Coherence Tomography Angiography (OCT-A) images. This was a retrospective case-series assessing forty-nine 10 × 10 mm OCT-A1 macula scans of 49 consecutive patients attending a medical retina clinic over a 6-month period. Thirty-seven patients had pathology; 13 had none. Retinal vascular layers were categorised into superficial or deep capillary plexus. For each category, the retinal experts compared the original standard image with the same image that had intelligent denoise applied. When analysing the Superficial Capillary Plexus (SCP), the denoised image was selected as "best for clinical assessment" in 98% of comparisons. No difference was established in the remaining 2%. On evaluating the Deep Capillary Plexus (DCP), the denoised image was preferred in 35% of comparisons. No difference was found in 65%. There was no evidence of new artefactual features nor loss of anatomical detail in denoised compared to the standard images. The wide-field denoise feature of the Canon Xephilio OCT-A1 produced scans that were clinically preferable over their original OCT-A images, especially for SCP assessment, without evidence for causing a new artefactual error.
Collapse
|
21
|
Rodrigo-Diaz E, Tahir HJ, Kelly JM, Parry NRA, Aslam T, Murray IJ. The Light and the Dark of Early and Intermediate AMD: Cone- and Rod-Mediated Changes Are Linked to Fundus Photograph and FAF Abnormalities. Invest Ophthalmol Vis Sci 2020; 60:5070-5079. [PMID: 31801157 DOI: 10.1167/iovs.19-27971] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this paper is to describe the extent to which scotopic and photopic measures of visual function predict color fundus photograph (CFP) and fundus autofluorescence (FAF) changes in early and intermediate nonexudative AMD. Methods Sixty-nine observers were recruited: 56 AMD patients (mean age, 73 ± 12.98 years) and 13 controls (mean age, 67.77 ± 9.72 years). A nonmydriatic retinal camera was used to obtain stereo fundus photographs and FAF images were recorded with a cSLO Heidelberg Spectralis HRA+OCT. Visual acuity (VA) was measured using an Early Treatment of Diabetic Retinopathy Study chart. Contrast sensitivity (CS) was assessed with a Pelli-Robson chart. Dark adaptation (DA) curves were recorded at 3° eccentricity using a PC-based technique. Analysis of these curves yielded five parameters: cone threshold (CT), cone time constant (CC), cone-rod break (α), slope of the second rod component (S2), and rod-rod break (β). Results Both cone and rod sensitivity recovery were grossly abnormal in the patients. The rod recovery slope (S2) most accurately predicted the fundus photograph-based grade and the FAF classification (ρ = 0.61 and ρ = 0.60, respectively; both P < 0.0001). CS showed a strong association with FAF (ρ = 0.50, P < 0.0001) and with fundus photograph-based grade (ρ = 0.38, P < 0.002). There was no correlation between VA and either imaging method. Conclusions Dynamic, rod-based measures most accurately reflect the severity of early AMD. Although less specific to AMD than DA changes, static photopic abnormalities such as CS also correspond with morphologic changes. Assessment of function in early AMD should include dynamic rod- and cone-mediated measurements of sensitivity recovery.
Collapse
Affiliation(s)
- Elena Rodrigo-Diaz
- Vision Science Lab, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Humza J Tahir
- Vision Science Lab, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Jeremiah M Kelly
- Vision Science Lab, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Neil R A Parry
- Vision Science Lab, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Vision Science Centre, Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Tariq Aslam
- Vision Science Lab, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.,Vision Science Centre, Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Ian J Murray
- Vision Science Lab, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| |
Collapse
|
22
|
Leal I, Tan SZ, Aslam T, Steeples LR, Jones NP, Chhabra R. Intra and inter-rater agreement of inflammatory choroidal neovascular membrane measurements using optical coherence tomography angiography. Graefes Arch Clin Exp Ophthalmol 2019; 258:647-651. [PMID: 31858223 DOI: 10.1007/s00417-019-04538-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 05/08/2019] [Revised: 10/27/2019] [Accepted: 11/03/2019] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Automated measurement algorithm software is not routinely available in optical coherence tomography angiography (OCTA) devices and manual measurement of choroidal neovascular membrane (CNVM) size is necessary. Our aim was to determine intra- and inter-rater agreement of inflammatory CNVM manual measurements obtained with OCTA. METHODS OCTA (Triton® Topcon Corporation) images in patients with inflammatory CNVM were imported into ImageJ software v1.50 (NIH image). Two experienced observers performed manual area and perimeter measurements independently, and one of the observers performed the same measurements twice. Agreement was evaluated with intraclass correlation coefficients (ICC) and concordance correlation coefficients (CCC). Bland-Altman plots were plotted to graphically assess concordance. Statistical analysis was performed using STATA v13.0. RESULTS Sixteen eyes of 16 subjects, with a mean age of 39.0 ± 16.6 years (range 13-71), were included. Mean CNVM area and perimeter was 124.83 ± 117.80 and 4.20 ± 2.00 mm, respectively. Intra-rater ICC for both area and perimeter measured was 0.99 (95% confidence interval (CI) 0.99-0.99). Inter-rater ICC for area and perimeter measured was 0.95 (95%CI 0.87-0.98) and 0.81 (95%CI 0.17-0.94), respectively. Intra-rater CCC for both area and perimeter measured was 0.99 (95%CI 0.99-0.99). Inter-rater CCC for both area and perimeter measured was 0.91 (95%CI 0.81-0.99) and 0.66 (95%CI 0.44-0.88), respectively. CONCLUSIONS Inflammatory CNVM manual measurement showed high intra-rater agreement and moderate inter-rater agreement. Repeatability and reproducibility studies are essential in manual analysis to establish thresholds that can distinguish measurements variation from true clinical change. An automatic algorithm may be helpful to accurately grade lesions and monitor disease activity and response to treatment.
Collapse
Affiliation(s)
- Inês Leal
- Manchester Royal Eye Hospital, Central Manchester Foundation Trust, Manchester, UK. .,Centro de Estudos das Ciências da Visão, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
| | - Shi Zhuan Tan
- Ophthalmology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tariq Aslam
- Manchester Royal Eye Hospital, Central Manchester Foundation Trust, Manchester, UK.,Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Laura R Steeples
- Manchester Royal Eye Hospital, Central Manchester Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Nicholas P Jones
- Manchester Royal Eye Hospital, Central Manchester Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Ramandeep Chhabra
- Manchester Royal Eye Hospital, Central Manchester Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| |
Collapse
|
23
|
Yeung WK, Dawes P, Pye A, Charalambous AP, Neil M, Aslam T, Dickinson C, Leroi I. Erratum: Author Correction: eHealth tools for the self-testing of visual acuity: a scoping review. NPJ Digit Med 2019; 2:117. [PMID: 31799424 PMCID: PMC6879736 DOI: 10.1038/s41746-019-0195-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
[This corrects the article DOI: 10.1038/s41746-019-0154-5.].
Collapse
Affiliation(s)
- Wai Kent Yeung
- 1Division of Neuroscience and Experimental Psychology, University of Manchester and the Manchester Academic Health Sciences Centre, Manchester, UK
| | - Piers Dawes
- 2Manchester Centre for Audiology and Deafness, University of Manchester and the Manchester Academic Health Sciences, Manchester, UK
| | - Annie Pye
- 1Division of Neuroscience and Experimental Psychology, University of Manchester and the Manchester Academic Health Sciences Centre, Manchester, UK
| | | | | | - Tariq Aslam
- 5Manchester University NHS Foundation Trust, Manchester, UK.,6Division of Pharmacy & Optometry, University of Manchester and the Manchester Academic Health Sciences Centre, Manchester, UK
| | - Christine Dickinson
- 6Division of Pharmacy & Optometry, University of Manchester and the Manchester Academic Health Sciences Centre, Manchester, UK
| | - Iracema Leroi
- 1Division of Neuroscience and Experimental Psychology, University of Manchester and the Manchester Academic Health Sciences Centre, Manchester, UK.,7Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
24
|
Kopsidas K, Javidi H, Kelly SP, Aslam T, Black G, Mahmood S. Unique Case of Bilateral Exudative Retinal Detachment following Creatine Supplementation in a Patient with Autosomal Dominant Bestrophinopathy. Case Rep Ophthalmol 2019; 10:374-378. [PMID: 31762771 PMCID: PMC6873073 DOI: 10.1159/000503853] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 10/02/2019] [Indexed: 11/19/2022] Open
Abstract
We report a case of bilateral serous retinal detachment in a patient with rod-cone dystrophy caused by mutation of BEST1. This followed creatine monohydrate use as a dietary supplement. A 39-year-old male with rod-cone dystrophy and low hyperopia developed extensive bilateral exudative retinal detachment following creatine monohydrate diet supplementation. Five days after stopping creatine use, the bilateral retinal detachments resolved completely. This may indicate a causative relation of creatine supplementation to development of serous retinal detachment in a susceptible patient with pre-existing retinal dystrophy.
Collapse
Affiliation(s)
- Konstantinos Kopsidas
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Hedayat Javidi
- Faculty of Biology Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Simon P. Kelly
- Department of Ophthalmology, Bolton NHS Foundation Trust, Bolton, United Kingdom
| | - Tariq Aslam
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Faculty of Biology Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Graeme Black
- Manchester Centre for Genomic Medicine, University of Manchester, Manchester, United Kingdom
| | - Sajjad Mahmood
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Faculty of Biology Medicine and Health, University of Manchester, Manchester, United Kingdom
- *Sajjad Mahmood, Royal Eye Hospital, Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL (UK), E-Mail
| |
Collapse
|
25
|
Senra H, Macedo AF, Nunes N, Balaskas K, Aslam T, Costa E. Psychological and Psychosocial Interventions for Depression and Anxiety in Patients With Age-Related Macular Degeneration: A Systematic Review. Am J Geriatr Psychiatry 2019; 27:755-773. [PMID: 31005495 DOI: 10.1016/j.jagp.2019.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 03/01/2019] [Accepted: 03/01/2019] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To review the current literature on psychosocial and psychological interventions to prevent and treat depression and anxiety in patients with age-related macular degeneration (AMD). METHODS The authors conducted a systematic review of literature evaluating psychosocial and psychological interventions for depression and anxiety in patients with AMD. Primary searches of PubMed, Cochrane library, EMBASE, Global Health, Web of Science, EBSCO, and Science Direct were conducted to include all articles published up to April 21, 2018. RESULTS Of a total of 398 citations retrieved, the authors selected 12 eligible studies published between 2002 and 2016. The authors found nine randomized controlled trials (RCT), and three non-randomized intervention (NRI) studies. RCT studies suggested that interventions using group self-management techniques and individual behavioral activation plus low vision rehabilitation can be effective to treat and prevent depression in patients with AMD, and one study suggested that a stepped-care intervention using cognitive-behavioral techniques can be effective to manage anxiety and depression over time. NRI studies highlighted a positive effect of self-help and emotion-focused interventions to reduce depression. CONCLUSION Clinical practice with patients with AMD can rely on some tailored cognitive-behavioral therapeutic protocols to improve patients' mental health, but further clinical trials will generate the necessary evidence-based knowledge to improve those therapeutic techniques and offer additional tailored interventions for patients with AMD.
Collapse
Affiliation(s)
- Hugo Senra
- Institute of Psychiatry, Psychology and Neuroscience (HS), King's College London, London
| | - António Filipe Macedo
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden; Low Vision and Visual Rehabilitation Lab, Department and Center of Physics - Optometry and Vision Science, University of Minho, Braga, Portugal
| | - Nuno Nunes
- Centre of Psychology, Faculty of Psychology and Educational Sciences (NN, EC), University of Porto, Porto, Portugal
| | - Konstantinos Balaskas
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Tariq Aslam
- Division of Pharmacy and Optometry (TA), School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Royal Eye Hospital (TA), Central Manchester Foundation Trust, Manchester, UK
| | - Emilia Costa
- Centre of Psychology, Faculty of Psychology and Educational Sciences (NN, EC), University of Porto, Porto, Portugal
| |
Collapse
|
26
|
Lois N, Cook J, Aldington S, Waugh N, Mistry H, Sones W, McAuley D, Aslam T, Bailey C, Chong V, Ghanchi F, Scanlon P, Sivaprasad S, Steel D, Styles C, McNally C, Rice R, Prior L, Azuara-Blanco A. Effectiveness of Multimodal imaging for the Evaluation of Retinal oedema And new vesseLs in Diabetic retinopathy (EMERALD). BMJ Open 2019; 9:e027795. [PMID: 31256030 PMCID: PMC6609061 DOI: 10.1136/bmjopen-2018-027795] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Diabetic macular oedema (DMO) and proliferative diabetic retinopathy (PDR) are the major causes of sight loss in people with diabetes. Due to the increased prevalence of diabetes, the workload related to these complications is increasing making it difficult for Hospital Eye Services (HSE) to meet demands. METHODS AND ANALYSIS Effectiveness of Multimodal imaging for the Evaluation of Retinal oedema And new vesseLs in Diabetic retinopathy (EMERALD) is a prospective, case-referent, cross-sectional diagnostic study. It aims at determining the diagnostic performance, cost-effectiveness and acceptability of a new form of surveillance for people with stable DMO and/or PDR, which entails multimodal imaging and image review by an ophthalmic grader, using the current standard of care (evaluation of patients in clinic by an ophthalmologist) as the reference standard. If safe, cost-effective and acceptable, this pathway could help HES by freeing ophthalmologist time. The primary outcome of EMERALD is sensitivity of the new surveillance pathway in detecting active DMO/PDR. Secondary outcomes include specificity, agreement between new and the standard care pathway, positive and negative likelihood ratios, cost-effectiveness, acceptability, proportion of patients requiring subsequent full clinical assessment, unable to undergo imaging, with inadequate quality images or indeterminate findings. ETHICS AND DISSEMINATION Ethical approval was obtained for this study from the Office for Research Ethics Committees Northern Ireland (reference 17/NI/0124). Study results will be published as a Health Technology Assessment monograph, in peer-reviewed national and international journals and presented at national/international conferences and to patient groups. TRIAL REGISTRATION NUMBER NCT03490318 and ISRCTN:10856638.
Collapse
Affiliation(s)
- Noemi Lois
- Ophthalmology, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | | | | | - Norman Waugh
- The Division of Health Sciences, University of Warwick, Warwick, UK
| | - Hema Mistry
- The Division of Health Sciences, University of Warwick, Warwick, UK
| | | | - Danny McAuley
- Wellcome-Wolfson Institute for Experimental Medicine, Queens University, Belfast, UK
| | - Tariq Aslam
- The Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Claire Bailey
- Ophthalmology Department, Bristol Eye Hospital, Bristol, UK
| | - Victor Chong
- Ophthalmology, Royal Free Hospital NHS Foundation Trust, London, UK
| | - Faruque Ghanchi
- Ophthalmology, Bradford Royal Infirmary, Bradford, West Yorkshire, UK
| | - Peter Scanlon
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, London
| | - David Steel
- Sunderland Eye Infirmary, Sunderland, UK
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Rachael Rice
- Northern Ireland Clinical Trials Unit, Belfast, UK
| | | | | |
Collapse
|
27
|
Aslam T. Ophthalmology and Therapy: Looking Back at 2018 and Forward to 2019. Ophthalmol Ther 2019; 8:1-4. [PMID: 30684244 PMCID: PMC6393259 DOI: 10.1007/s40123-019-0162-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Tariq Aslam
- Manchester Royal Eye Hospital, Manchester, UK.
| |
Collapse
|
28
|
Sornalingam K, Javed A, Aslam T, Sergouniotis P, Jones S, Ghosh A, Ashworth J. Variability in the ocular phenotype in mucopolysaccharidosis. Br J Ophthalmol 2018; 103:504-510. [PMID: 30120129 DOI: 10.1136/bjophthalmol-2017-311749] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 12/14/2017] [Revised: 04/24/2018] [Accepted: 05/12/2018] [Indexed: 11/03/2022]
Abstract
PURPOSE Mucopolysaccharidoses (MPSs) are a heterogeneous group of lysosomal storage disorders. Ocular complications (such as corneal clouding, retinopathy and optic neuropathy) are common. Notably, there is a paucity of data on the effect of genotype and systemic treatments (enzyme replacement therapy or haematopoietic stem cell transplantation) on the ocular phenotype in MPS. We prospectively studied the ocular features of patients with MPSI (Hurler/Hurler-Scheie/Scheie), MPSIV (Morquio) and MPSVI (Maroteaux-Lamy), to evaluate the effect of different therapeutic interventions and to correlate the findings with genetic and biomarker data. METHODS Prospective observational cohort study. Study participants underwent detailed ocular examination including visual acuity; assessment of corneal clouding (Iris camera Corneal Opacification Measure score and Pentacam densitometry) and retinal and optic nerve imaging (optical coherence tomography and wide-field fundus imaging). Data on genotype, biomarkers and delivered therapies (type and length of treatment) were also collected for each patient where available. RESULTS Overall, 21 patients with MPSI, 4 patients with MPSIV and 3 patients with MPSVI were recruited. Corneal clouding scores were higher in MPSI compared with MPSIV and MPSVI. Retinopathy was evident in patients with MPSI only. Association was observed between corneal clouding and biomarkers in MPSI, MPSIV and MPSVI. However, no clear association was seen between genotype or treatment type and ocular phenotype. CONCLUSIONS The ocular phenotype in MPS is variable, with corneal clouding occurring in MPSI, MPSIV and MPSVI, and retinopathy in MPSI only. There was an association between corneal clouding and efficacy of systemic treatment as measured by biomarkers.
Collapse
Affiliation(s)
- Krishanthy Sornalingam
- Manchester Academic Health Science Centre, Manchester Royal Eye Hospital, Manchester, UK.,Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Ahmed Javed
- Manchester Academic Health Science Centre, Manchester Royal Eye Hospital, Manchester, UK
| | - Tariq Aslam
- Manchester Academic Health Science Centre, Manchester Royal Eye Hospital, Manchester, UK.,Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Panagiotis Sergouniotis
- Manchester Academic Health Science Centre, Manchester Royal Eye Hospital, Manchester, UK.,Division of Evolution and Genetics, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Simon Jones
- Willink Unit, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester, UK
| | - Arunabha Ghosh
- Willink Unit, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester, UK
| | - Jane Ashworth
- Manchester Academic Health Science Centre, Manchester Royal Eye Hospital, Manchester, UK .,Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| |
Collapse
|
29
|
Affiliation(s)
- Haoyu Wang
- Centre for Ophthalmology and Vision Sciences, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - Shi Zhuan Tan
- Centre for Ophthalmology and Vision Sciences, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Tariq Aslam
- Centre for Ophthalmology and Vision Sciences, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Nicholas P. Jones
- Centre for Ophthalmology and Vision Sciences, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Laura R. Steeples
- Centre for Ophthalmology and Vision Sciences, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| |
Collapse
|
30
|
Javed A, Aslam T, Jones SA, Mercer J, Tyler K, Church H, Ghosh A, Wynn R, Sornalingam K, Ashworth J. The effect of haemopoietic stem cell transplantation on the ocular phenotype in mucopolysaccharidosis type I (Hurler). Acta Ophthalmol 2018; 96:494-498. [PMID: 29240299 DOI: 10.1111/aos.13627] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 10/17/2017] [Indexed: 01/13/2023]
Abstract
PURPOSE To determine whether the ocular phenotype in patients with mucopolysaccharidosis type I (MPSI) Hurler is affected by the efficacy of previous haemopoietic stem cell transplantation (HSCT). DESIGN A retrospective cohort study of patients with MPSI who had undergone treatment with HSCT. METHODS Ocular phenotype was documented for each patient and compared to levels of biomarkers representing efficacy of previous transplantation. MAIN OUTCOME MEASURES Assessment of visual acuity (VA), severity of corneal clouding and the presence of optic neuropathy or retinopathy. Biomarker assessment included dermatan sulphate/chondroitin sulphate (DS/CS) ratio and iduronidase enzyme level. RESULTS Severe corneal clouding was significantly greater in patients with lower iduronidase levels (p = 0.023) and raised DS/CS ratio (R2 = 0.28 p = 0.043). Better VA was related to a higher iduronidase levels (R2 = 0.15, p = 0.004) and lower DS/CS ratio (R2 = 0.38, p = 0.001). CONCLUSION Improved ocular phenotypes in MPSI are associated with markers signifying efficacy of prior transplant. Early and effective HSCT may result in a better visual prognosis and reduction in ocular complications for patients with MPSI.
Collapse
Affiliation(s)
- Ahmed Javed
- Manchester Royal Eye Hospital; Manchester Academic Health Science Centre; Manchester UK
| | - Tariq Aslam
- Manchester Royal Eye Hospital; Manchester Academic Health Science Centre; Manchester UK
- Faculty of Medical and Human Sciences; Centre for Ophthalmology and Vision Sciences; Institute of Human Development; University of Manchester; Manchester UK
| | - Simon A. Jones
- Willink Unit; Manchester Centre for Genomic Medicine; St Mary's Hospital; CMFT; Manchester UK
| | - Jean Mercer
- Willink Unit; Manchester Centre for Genomic Medicine; St Mary's Hospital; CMFT; Manchester UK
| | - Karen Tyler
- Willink Unit; Manchester Centre for Genomic Medicine; St Mary's Hospital; CMFT; Manchester UK
| | - Heather Church
- Willink Unit; Manchester Centre for Genomic Medicine; St Mary's Hospital; CMFT; Manchester UK
| | - Arunabha Ghosh
- Willink Unit; Manchester Centre for Genomic Medicine; St Mary's Hospital; CMFT; Manchester UK
| | - Robert Wynn
- Department of Paediatric Blood and Marrow Transplant; Royal Manchester Children's Hospital; Manchester UK
| | | | - Jane Ashworth
- Manchester Royal Eye Hospital; Manchester Academic Health Science Centre; Manchester UK
- Faculty of Medical and Human Sciences; Centre for Ophthalmology and Vision Sciences; Institute of Human Development; University of Manchester; Manchester UK
| |
Collapse
|
31
|
Aslam T. Antimicrobial evaluation of various leaves extracted samples of nettle desert (Forsskaolea tenacissima L.). PAB 2018. [DOI: 10.19045/bspab.2018.70018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
32
|
Montesano G, Way CM, Ometto G, Ibrahim H, Jones PR, Carmichael R, Liu X, Aslam T, Keane PA, Crabb DP, Denniston AK. Optimizing OCT acquisition parameters for assessments of vitreous haze for application in uveitis. Sci Rep 2018; 8:1648. [PMID: 29374239 PMCID: PMC5785990 DOI: 10.1038/s41598-018-20092-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 10/20/2017] [Accepted: 01/12/2018] [Indexed: 12/19/2022] Open
Abstract
Detection and evaluation of inflammatory activity in uveitis is essential to the management of the condition, and yet continues to be largely dependent on subjective clinical measures. Optical coherence tomography (OCT) measurement of vitreous activity is an alternative to clinical vitreous haze scoring and has passed a number of early validation studies. In this study we aimed to evaluate the impact of ‘operator factors’ on the variability of the technique as part of the validation process, and to help evaluate its suitability for ‘real world’ use. Vitreous haze index was calculated as a ratio between the reflectivity of the vitreous and of the outer retina in each scan. Different scanning conditions were tested and their effect on the measurement is reported. Our results show that the ‘quantitative imaging’ technique of OCT-measured vitreous activity had good reliability in normal subjects under a range of ‘real world’ conditions, such as when the operator changes the averaging value. The technique was however vulnerable to highly inaccurate focussing or abnormal downward displacement of the image. OCT-based quantification of vitreous activity is a promising alternative to current subjective clinical estimates, with sufficient ‘tolerance’ to be used in routine clinical practice as well as clinical trials.
Collapse
Affiliation(s)
- G Montesano
- City, University of London, Optometry and Visual Sciences, London, United Kingdom
| | - C M Way
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.,Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - G Ometto
- City, University of London, Optometry and Visual Sciences, London, United Kingdom
| | - H Ibrahim
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.,Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - P R Jones
- City, University of London, Optometry and Visual Sciences, London, United Kingdom.,NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - R Carmichael
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - X Liu
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.,Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - T Aslam
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Faculty of Medical and Human Sciences, University of Manchester, Manchester, United Kingdom.,School of Built Environment, Heriot-Watt University, Edinburgh, United Kingdom
| | - P A Keane
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - D P Crabb
- City, University of London, Optometry and Visual Sciences, London, United Kingdom
| | - A K Denniston
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom. .,Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom. .,NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom.
| |
Collapse
|
33
|
Layana AG, Minnella AM, Garhöfer G, Aslam T, Holz FG, Leys A, Silva R, Delcourt C, Souied E, Seddon JM. Vitamin D and Age-Related Macular Degeneration. Nutrients 2017; 9:nu9101120. [PMID: 29027953 PMCID: PMC5691736 DOI: 10.3390/nu9101120] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/03/2017] [Accepted: 10/06/2017] [Indexed: 12/12/2022] Open
Abstract
In recent years, the relationship between vitamin D and health has received growing attention from the scientific and medical communities. Vitamin D deficiencies have been repeatedly associated with various acute and chronic diseases, including age-related macular degeneration (AMD). Its active metabolite, 1α,25-dihydoxy vitamin D, acts as a modulator of cell proliferation, differentiation and apoptosis, and cumulative data from experimental and observational studies suggest that relatively a lower vitamin D status could be a potential risk factor for the development of early and/or late AMD. Herein, we made a narrative review of the mechanisms linking a potential role of vitamin D with the current concepts of AMD pathophysiology.
Collapse
Affiliation(s)
| | - Angelo Maria Minnella
- Dipartimento di Scienze Otorinolaringoiatriche e Oftalmologiche, Universita' Cattolica del Sacro Cuore, Lgo F. Vito 1, 00168 Roma, Italy.
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, University of Vienna, 1090 Vienna, Austria.
| | - Tariq Aslam
- School of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK.
- Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, M13 9WL Manchester, and Heriot Watt University, Edinburgh EH14 4AS, UK.
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, D-53107 Bonn, Germany.
| | - Anita Leys
- Department of Ophthalmology, University Hospitals Leuven, 3000 Leuven, Belgium.
| | - Rufino Silva
- Faculty of Medicine, Institute for Biomedical Imaging and Life Sciences (IBILI), University of Coimbra, 3000-548 Coimbra, Portugal.
- Centro Hospitalar e Universitário de Coimbra (CHUC), Department of Ophthalmology, 3000-548 Coimbra, Portugal.
- Centro Hospitalar e Universitário de Coimbra (CHUC), Faculty of Medicine, Institute for Biomedical Imaging and Life Sciences (IBILI-FMUC), University of Coimbra, 3000-548 Coimbra, Portugal.
- Centro Hospitalar e Universitário de Coimbra (CHUC), Association for Innovation and Biomedical Research on Light and Image (AIBILI), 3000-548 Coimbra, Portugal.
| | - Cécile Delcourt
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, Team LEHA, UMR 1219, F-33000 Bordeaux, France.
| | - Eric Souied
- Hôpital Intercommunal de Créteil, University Paris Est, 94010 Créteil, France.
| | - Johanna M Seddon
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA 02111, USA.
- Ophthalmic Epidemiology and Genetics Service, Tufts Medical Center, Boston, MA 02111, USA.
| |
Collapse
|
34
|
Javed A, Aslam T, Jones SA, Ashworth J. Objective Quantification of Changes in Corneal Clouding Over Time in Patients With Mucopolysaccharidosis. Invest Ophthalmol Vis Sci 2017; 58:954-958. [PMID: 28170539 DOI: 10.1167/iovs.16-20647] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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 We determine objective changes in corneal opacification levels over time in patients with mucopolysaccharidoses (MPS) treated with enzyme replacement therapy or hematopoietic stem cell transplant. A prospective cohort study was done of 9 patients with MPS I (Hurler) or VI (Maroteaux-Lamy). Methods Quantification of corneal clouding using the Iris camera and full ophthalmic examination, including subjective assessment of corneal clouding, was done in 2011 and repeated in 2015/2016. Patients also had assessment of biomarkers, including dermatan sulfate/chondroitin sulfate (DS/CS) ratio. Change in corneal opacification were measured by Iris camera corneal opacification measure (COM) score during a mean of 60 months follow-up. Results A total of 5/17 (29%) eyes had a deterioration in COM score, indicating increased corneal clouding. There was no significant change in COM score in 10/17 (59%) patient eyes. One patient (2/17 eyes) demonstrated significant improvement in corneal clarity and this was associated with improved biomarker levels. Conclusions Assessment of COM scores using the Iris camera are an objective means of monitoring corneal opacification over time in patients with MPS. Corneal opacification may potentially be reversed with intensive treatment demonstrated by impact on biomarkers.
Collapse
Affiliation(s)
- Ahmed Javed
- Manchester Royal Eye Hospital, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Tariq Aslam
- Manchester Royal Eye Hospital, Manchester Academic Health Science Centre, Manchester, United Kingdom 2Faculty of Medical and Human Sciences, Centre for Ophthalmology and Vision Sciences, Institute of Human Development, University of Manchester, Manchester, United Kingdom
| | - Simon A Jones
- Willink Unit, Manchester Centre for Genomic Medicine, St. Mary's Hospital, CMFT, Manchester, United Kingdom
| | - Jane Ashworth
- Manchester Royal Eye Hospital, Manchester Academic Health Science Centre, Manchester, United Kingdom 2Faculty of Medical and Human Sciences, Centre for Ophthalmology and Vision Sciences, Institute of Human Development, University of Manchester, Manchester, United Kingdom
| |
Collapse
|
35
|
Affiliation(s)
- Kirti Madhukar Jasani
- Department of Vitreoretina, Manchester Royal Eye Hospital, Manchester, Lancashire, UK
| | - Nazar Sharaf
- Neurology, Salford Royal NHS Foundation Trust, Manchester, Lancashire, UK
| | - David Rog
- Neurology, Salford Royal NHS Foundation Trust, Manchester, Lancashire, UK.,Neurology, Salford Royal NHS Foundation Trust, Manchester, Lancashire, UK
| | - Tariq Aslam
- Medical Retina, Manchester Royal Eye Hospital, Manchester, Lancashire, UK
| |
Collapse
|
36
|
Senra H, Balaskas K, Mahmoodi N, Aslam T. Experience of Anti-VEGF Treatment and Clinical Levels of Depression and Anxiety in Patients With Wet Age-Related Macular Degeneration. Am J Ophthalmol 2017; 177:213-224. [PMID: 28302534 DOI: 10.1016/j.ajo.2017.03.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/06/2017] [Accepted: 03/06/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate detailed patient experiences specific to receiving vascular endothelial growth factor inhibitors (anti-VEGF) for wet age-related macular degeneration (wAMD), and to acquire a snapshot of the frequency of clinically significant levels of depression, anxiety, and posttraumatic stress among patients and levels of burden in patients' carers. DESIGN Observational cross-sectional mixed-methods study. METHODS Three hundred patients with wAMD receiving anti-VEGF treatment and 100 patient carers were recruited. Qualitative data on patients' experience of treatment were collected using a structured survey. Standardized validated questionnaires were used to quantify clinically significant levels of anxiety, depression, and posttraumatic stress, as well as cognitive function and carers' burden. RESULTS Qualitative data showed that 56% of patients (n = 132) reported anxiety related to anti-VEGF treatment. The main sources of anxiety were fear of going blind owing to intravitreal injections and concerns about treatment effectiveness, rather than around pain. From validated questionnaires, 17% of patients (n = 52) showed clinical levels of anxiety and 12% (n = 36) showed clinical levels of depression. Depression levels, but not anxiety, were significantly higher in patients who received up to 3 injections compared with patients who received from 4 to 12 injections (analysis of variance [ANOVA] P = .027) and compared with patients who received more than 12 injections (ANOVA P = .001). CONCLUSIONS Anti-VEGF treatment is often experienced with some anxiety related to treatment, regardless of the number of injections received. Clinical levels of depression seem to be more frequent in patients at early stages of anti-VEGF treatment. Strategies to improve patient experience of treatment and minimize morbidity are suggested.
Collapse
|
37
|
Miranda MA, Henson DB, Fenerty C, Biswas S, Aslam T. Development of a Pediatric Visual Field Test. Transl Vis Sci Technol 2016; 5:13. [PMID: 27980876 PMCID: PMC5156444 DOI: 10.1167/tvst.5.6.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 05/24/2016] [Accepted: 10/01/2016] [Indexed: 12/02/2022] Open
Abstract
Purpose We describe a pediatric visual field (VF) test based on a computer game where software and hardware combine to provide an enjoyable test experience. Methods The test software consists of a platform-based computer game presented to the central VF. A storyline was created around the game as was a structure surrounding the computer monitor to enhance patients' experience. The patient is asked to help the central character collect magic coins (stimuli). To collect these coins a series of obstacles need to be overcome. The test was presented on a Sony PVM-2541A monitor calibrated from a central midpoint with a Minolta CS-100 photometer placed at 50 cm. Measurements were performed at 15 locations on the screen and the contrast calculated. Retinal sensitivity was determined by modulating stimulus in size. To test the feasibility of the novel approach 20 patients (4–16 years old) with no history of VF defects were recruited. Results For the 14 subjects completing the study, 31 ± 15 data points were collected on 1 eye of each patient. Mean background luminance and stimulus contrast were 9.9 ± 0.3 cd/m2 and 27.9 ± 0.1 dB, respectively. Sensitivity values obtained were similar to an adult population but variability was considerably higher – 8.3 ± 9.0 dB. Conclusions Preliminary data show the feasibility of a game-based VF test for pediatric use. Although the test was well accepted by the target population, test variability remained very high. Translational Relevance Traditional VF tests are not well tolerated by children. This study describes a child-friendly approach to test visual fields in the targeted population.
Collapse
Affiliation(s)
- Marco A Miranda
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom ; Faculty of Brain Sciences, Visual Neurosciences, Institute of Ophthalmology, University College London, London, United Kingdom ; NIHR Biomedical Research Centre, Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, United Kingdom
| | - David B Henson
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom ; Royal Eye Hospital, NHS Central Manchester University Hospitals, Manchester, United Kingdom
| | - Cecilia Fenerty
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom ; Royal Eye Hospital, NHS Central Manchester University Hospitals, Manchester, United Kingdom
| | - Susmito Biswas
- Royal Eye Hospital, NHS Central Manchester University Hospitals, Manchester, United Kingdom
| | - Tariq Aslam
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom ; Royal Eye Hospital, NHS Central Manchester University Hospitals, Manchester, United Kingdom ; Heriot-Watt University, Edinburgh, United Kingdom
| |
Collapse
|
38
|
Javed A, Aslam T, Ashworth J. Use of new imaging in detecting and monitoring ocular manifestations of the mucopolysaccharidoses. Acta Ophthalmol 2016; 94:e676-e682. [PMID: 27273899 DOI: 10.1111/aos.13098] [Citation(s) in RCA: 10] [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] [Received: 02/01/2016] [Accepted: 03/24/2016] [Indexed: 12/13/2022]
Abstract
The aim of this review is to summate the eye involvement in patients with mucopolysaccharidoses (MPS) using current ocular imaging techniques, their advantages and disadvantages and how they may aid diagnosis, management and monitoring. We critically reviewed the current literature surrounding MPS and recent imaging technology as well as histology. Primary searches of PubMed and Web of Science were performed. We reviewed all papers on the topic published and summarized the findings of each medical device as well as the advantages and disadvantages of using these for the MPS patient. We discussed the potential of each of these devices to monitor potential ocular pathology in the MPS cohorts in the order of MPS subtype. We reviewed imaging techniques involving use of the Iris Camera, Pentacam, Optical Coherence Tomography (OCT) as well as ultrasound and Heidelberg OCT. The need for reliable objective quantification of eye findings in MPS has led to utilization of new imaging technologies described here, and future use will enhance our understanding of the unique eye features in MPS. In particular, we note that the Pentacam and iris camera are able to provide objective measurements of corneal haze and monitor ocular response to treatment.
Collapse
Affiliation(s)
- Ahmed Javed
- Manchester Royal Eye Hospital; Manchester Academic Health Science Centre; Manchester UK
| | - Tariq Aslam
- Manchester Royal Eye Hospital; Manchester Academic Health Science Centre; Manchester UK
- Faculty of Medical and Human Sciences; Centre for Ophthalmology and Vision Sciences; Institute of Human Development; University of Manchester; Manchester UK
| | - Jane Ashworth
- Manchester Royal Eye Hospital; Manchester Academic Health Science Centre; Manchester UK
- Faculty of Medical and Human Sciences; Centre for Ophthalmology and Vision Sciences; Institute of Human Development; University of Manchester; Manchester UK
| |
Collapse
|
39
|
Wang Y, Ali Z, Subramani S, Biswas S, Fenerty C, Henson DB, Aslam T. Normal Threshold Size of Stimuli in Children Using a Game-Based Visual Field Test. Ophthalmol Ther 2016; 6:115-122. [PMID: 27885592 PMCID: PMC5449290 DOI: 10.1007/s40123-016-0071-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION The aim of this study was to demonstrate and explore the ability of novel game-based perimetry to establish normal visual field thresholds in children. METHODS One hundred and eighteen children (aged 8.0 ± 2.8 years old) with no history of visual field loss or significant medical history were recruited. Each child had one eye tested using a game-based visual field test 'Caspar's Castle' at four retinal locations 12.7° (N = 118) from fixation. Thresholds were established repeatedly using up/down staircase algorithms with stimuli of varying diameter (luminance 20 cd/m2, duration 200 ms, background luminance 10 cd/m2). Relationships between threshold and age were determined along with measures of intra- and intersubject variability. RESULTS The Game-based visual field test was able to establish threshold estimates in the full range of children tested. Threshold size reduced with increasing age in children. Intrasubject variability and intersubject variability were inversely related to age in children. CONCLUSIONS Normal visual field thresholds were established for specific locations in children using a novel game-based visual field test. These could be used as a foundation for developing a game-based perimetry screening test for children.
Collapse
Affiliation(s)
- Yanfang Wang
- Manchester Royal Eye Hospital, CMFT, Manchester Academic Health Sciences Centre, Oxford Road, Manchester, UK.,Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Zaria Ali
- Manchester Royal Eye Hospital, CMFT, Manchester Academic Health Sciences Centre, Oxford Road, Manchester, UK
| | - Siddharth Subramani
- Manchester Royal Eye Hospital, CMFT, Manchester Academic Health Sciences Centre, Oxford Road, Manchester, UK
| | - Susmito Biswas
- Manchester Royal Eye Hospital, CMFT, Manchester Academic Health Sciences Centre, Oxford Road, Manchester, UK.,Division of Evolution and Genomic Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Cecilia Fenerty
- Manchester Royal Eye Hospital, CMFT, Manchester Academic Health Sciences Centre, Oxford Road, Manchester, UK.,Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - David B Henson
- Manchester Royal Eye Hospital, CMFT, Manchester Academic Health Sciences Centre, Oxford Road, Manchester, UK.,Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Tariq Aslam
- Manchester Royal Eye Hospital, CMFT, Manchester Academic Health Sciences Centre, Oxford Road, Manchester, UK. .,Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK. .,Heriot Watt University, Edinburgh, UK.
| |
Collapse
|
40
|
Balaskas K, Tiew S, Czanner G, Tan AL, Ashworth J, Biswas S, Aslam T. The Novel Evidenced Assessment of Tortuosity system: interobserver reliability and agreement with clinical assessment. Acta Ophthalmol 2016; 94:e421-6. [PMID: 26686744 DOI: 10.1111/aos.12907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 09/23/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE Computer-assisted assessment of vessel tortuosity is clinically useful in retinopathy of prematurity (ROP). However, poor image quality is often prohibitive for accurate segmentation by fully automated systems and semi-automated systems are prone to unreliability. In the present work, we describe a method of retinal vessel tortuosity measurement by means of purpose-built image analysis software that does not require high image quality yet is also reliable. METHODS Images were obtained from neonates at risk of ROP with Retcam Shuttle(®) . Individual vessels were assessed with the semi-automated Novel Evidenced Assessment of Tortuosity (NEAT) system by two masked experimenters. Scores were compared to assess reliability. They were also compared against clinical scoring of individual vessels by two ROP screeners to assess relationship with clinical assessment. In a second image cohort, the mean of the most tortuous vessel in each of four quadrants in each eye (NEAT-O) was compared against the documented gold standard clinical grading of plus disease. RESULTS Reliability of the NEAT system for 50 individual vessels using Bland-Altman plots was excellent. NEAT tortuosity scores for 50 individual vessels compared to clinical scoring showed strong correlation (0.706). Correlation between the NEAT-O score for average tortuosity and gold standard for 167 eyes was modest (0.578). CONCLUSIONS The NEAT system is intuitive, user-friendly and robust enough to be clinically useful in poor-quality images. It allows for a rapid, valid and reliable assessment of tortuosity of individual vessels and produces a tortuosity score that correlates well with severity of plus disease.
Collapse
Affiliation(s)
- Konstantinos Balaskas
- Manchester Royal Eye Hospital; Central Manchester University Hospitals; NHS Foundation Trust; Manchester UK
- Centre for Hearing and Vision Research; Medical School; University of Manchester; Manchester UK
- Moorfields Eye Hospital; NHS Foundation Trust; London UK
| | - Stephanie Tiew
- Aintree University Hospitals; NHS Foundation Trust; Aintree UK
| | - Gabriela Czanner
- Departments of Eye and Vision Science and Biostatistics; Faculty of Health and Life Sciences; University of Liverpool; Liverpool UK
| | - Ai Ling Tan
- Centre for Hearing and Vision Research; Medical School; University of Manchester; Manchester UK
| | - Jane Ashworth
- Manchester Royal Eye Hospital; Central Manchester University Hospitals; NHS Foundation Trust; Manchester UK
- Centre for Hearing and Vision Research; Medical School; University of Manchester; Manchester UK
| | - Susmito Biswas
- Manchester Royal Eye Hospital; Central Manchester University Hospitals; NHS Foundation Trust; Manchester UK
- Centre for Hearing and Vision Research; Medical School; University of Manchester; Manchester UK
| | - Tariq Aslam
- Manchester Royal Eye Hospital; Central Manchester University Hospitals; NHS Foundation Trust; Manchester UK
- Centre for Hearing and Vision Research; Medical School; University of Manchester; Manchester UK
- Heriot-Watt University; Edinburgh; United Kingdom
| |
Collapse
|
41
|
Souied EH, Aslam T, Garcia-Layana A, Holz FG, Leys A, Silva R, Delcourt C. Omega-3 Fatty Acids and Age-Related Macular Degeneration. Ophthalmic Res 2016; 55:62-9. [PMID: 26610051 DOI: 10.1159/000441359] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 09/23/2015] [Indexed: 11/19/2022]
Abstract
Against a background of considerable epidemiological and other evidence implicating omega-3 fatty acids in the prevention of age-related macular degeneration (AMD), the negative results of the Age-Related Disease Study 2 (AREDS2) were unexpected. The possibility that the design, setting, intake or subjects of AREDS2 may not have permitted the prophylactic potential of omega-3 to be adequately demonstrated is considered. Epidemiological studies had indicated potential preventative effects of omega-3, and an earlier randomised prospective study (NAT2) showed that patients who achieved high red blood cell membrane EPA/DHA (eicosapentaenoic acid/docosahexaenoic acid) levels were significantly protected against AMD compared with those with permanently low EPA/DHA levels. Various methodological differences between these studies are considered. NAT2 included a true placebo group, whereas control subjects in AREDS2 received a nutritional formula already found to be effective in AREDS1, but no placebo for DHA/EPA supplementation. Differences in the handling of non-compliant subjects and the formulation of the test formulations are considered. Given these considerations, and other lines of evidence from laboratory and clinical studies, closing the chapter on omega-3 in AMD prevention may be premature.
Collapse
Affiliation(s)
- Eric H Souied
- Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | | | | | | | | | | | | |
Collapse
|
42
|
Senra H, Ali Z, Balaskas K, Aslam T. Psychological impact of anti-VEGF treatments for wet macular degeneration-a review. Graefes Arch Clin Exp Ophthalmol 2016; 254:1873-1880. [PMID: 27262729 PMCID: PMC5045477 DOI: 10.1007/s00417-016-3384-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [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: 10/21/2015] [Revised: 04/05/2016] [Accepted: 05/10/2016] [Indexed: 01/14/2023] Open
Abstract
Purpose To review the current literature on the psychological impact of anti-VEGF treatments for wet age-related macular degeneration (wAMD), in terms of patients’ experiences of receiving these treatments, and the impact of these treatments for patients’ mental health and quality of life. Methods We critically analyzed current literature evaluating psychological impact of anti-VEGF treatments for wAMD. Primary searches of PubMed, Science Direct, and Web of Science were conducted in July and August of 2015. We reviewed all papers on the topic published until August 5, 2015. Results Our literature search found 14 papers addressing the psychological impact of anti-VEGF treatments for wAMD. Results highlighted potential anxieties and experiences of pain caused by receiving regular intravitreal injections. A positive visual outcome of anti-VEGF therapy is associated with positive vision-related QOL outcomes, although such association seems to be dependent on improvements on visual acuity. In the literature reviewed, patients receiving anti-VEGF treatments showed a prevalence rate of depression between 20 and 26 %. Conclusions Although anti-VEGF treatments can cause some anxiety and being experienced as a stressful event, especially in the beginning of the treatment, preliminary findings suggest a potential benefit for long-term vision-related quality of life. Further longitudinal and qualitative research should bring more evidence on the positive and negative effects of these treatments on patients’ long-term mental health.
Collapse
Affiliation(s)
- Hugo Senra
- Institute of Human Development, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Zaria Ali
- Manchester Royal Eye Hospital, Manchester, UK
| | | | - Tariq Aslam
- Institute of Human Development, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.,Manchester Royal Eye Hospital, Manchester, UK.,Heriot Watt University, Edinburgh, UK
| |
Collapse
|
43
|
Sim DA, Mitry D, Alexander P, Mapani A, Goverdhan S, Aslam T, Tufail A, Egan CA, Keane PA. The Evolution of Teleophthalmology Programs in the United Kingdom: Beyond Diabetic Retinopathy Screening. J Diabetes Sci Technol 2016; 10:308-17. [PMID: 26830492 PMCID: PMC4773982 DOI: 10.1177/1932296816629983] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Modern ophthalmic practice in the United Kingdom is faced by the challenges of an aging population, increasing prevalence of systemic pathologies with ophthalmic manifestations, and emergent treatments that are revolutionary but dependent on timely monitoring and diagnosis. This represents a huge strain not only on diagnostic services but also outpatient management and surveillance capacity. There is an urgent need for newer means of managing this surge in demand and the socioeconomic burden it places on the health care system. Concurrently, there have been exponential increases in computing power, expansions in the strength and ubiquity of communications technologies, and developments in imaging capabilities. Advances in imaging have been not only in terms of resolution, but also in terms of anatomical coverage, allowing new inferences to be made. In spite of this, image analysis techniques are still currently superseded by expert ophthalmologist interpretation. Teleophthalmology is therefore currently perfectly placed to face this urgent and immediate challenge of provision of optimal and expert care to remote and multiple patients over widespread geographical areas. This article reviews teleophthalmology programs currently deployed in the United Kingdom, focusing on diabetic eye care but also discussing glaucoma, emergency eye care, and other retinal diseases. We examined current programs and levels of evidence for their utility, and explored the relationships between screening, teleophthalmology, disease detection, and monitoring before discussing aspects of health economics pertinent to diabetic eye care. The use of teleophthalmology presents an immense opportunity to manage the steadily increasing demand for eye care, but challenges remain in the delivery of practical, viable, and clinically proven solutions.
Collapse
Affiliation(s)
- Dawn A Sim
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK Moorfields South, Croydon University Hospital, London, UK Moorfields South, St George's Hospital, London, UK University College London, Institute of Ophthalmology, London, UK
| | - Danny Mitry
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Philip Alexander
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Adam Mapani
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Srini Goverdhan
- University of Southampton, Southampton Eye Unit, Southampton, UK
| | - Tariq Aslam
- Manchester University, Manchester Royal Eye Hospital, Manchester, UK
| | - Adnan Tufail
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK University College London, Institute of Ophthalmology, London, UK
| | - Catherine A Egan
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK Moorfields South, St George's Hospital, London, UK University College London, Institute of Ophthalmology, London, UK
| | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK University College London, Institute of Ophthalmology, London, UK
| |
Collapse
|
44
|
Zarranz-Ventura J, Keane PA, Sim DA, Llorens V, Tufail A, Sadda SR, Dick AD, Lee RW, Pavesio C, Denniston AK, Adan A, Adán A, Aslam T, Denniston AK, Dick AD, Karampelas M, Keane PA, Lee RW, Murray PI, Nussenblatt RB, Pavesio CE, Sadda SR, Sen HN, Sim DA, Tufail A, Zarranz-Ventura J. Evaluation of Objective Vitritis Grading Method Using Optical Coherence Tomography: Influence of Phakic Status and Previous Vitrectomy. Am J Ophthalmol 2016; 161:172-80.e1-4. [PMID: 26476212 DOI: 10.1016/j.ajo.2015.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 10/06/2015] [Accepted: 10/07/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate a proposed method for objective measurement of vitreous inflammation using a spectral-domain optical coherence tomography (SD OCT) device in a large cohort of uveitis eyes, including pseudophakic eyes and vitrectomized eyes. DESIGN Retrospective, observational cohort study. METHODS One hundred five uveitis eyes (105 patients) with different vitreous haze score grades according to standardized protocols and corresponding SD OCT images (Cirrus HD-OCT; Carl Zeiss Meditec, Dublin, California, USA) were included. Clinical data recorded included phakic status, previous vitreoretinal surgery, and anterior chamber (AC) cells and flare. SD OCT images were analyzed using custom software that provided absolute measurements of vitreous (VIT) and retinal pigment epithelium (RPE) signal intensities, which were compared to generate a relative optical density ratio with arbitrary units (VIT/RPE-relative intensity) and compared to VHS. RESULTS VIT/RPE-relative intensity showed a significant positive correlation with vitreous haze score (r = 0.535, P < .001) that remained significant after adjusting for factors governing media clarity, such as AC cells, AC flare, and phakic status (R(2)-adjusted = 0.424, P < .001). Significant differences were also observed between the different vitreous haze score groups (P < .001). Preliminary observation did not observe differences in VIT/RPE-relative intensity values between phakic and pseudophakic eyes (0.3522 vs 0.3577, P = .48) and between nonvitrectomized and vitrectomized eyes (0.3540 vs 0.3580, P = .52), overall and respectively for each vitreous haze score subgroup. CONCLUSIONS VIT/RPE-relative intensity values provide objective measurements of vitreous inflammation employing an SD OCT device. Phakic status and previous vitrectomy surgery do not appear to influence these values, although these preliminary findings need validation in future studies.
Collapse
|
45
|
Akram AR, Avlonitis N, Vendrell M, Chankeshwara S, McDonald N, Aslam T, Scholefield E, Walsh T, Haslett C, Bradley M, Dhaliwal K. T4 Optically detectable antimicrobial peptides enable the immediate detection of bacteria and fungi in the lung. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
46
|
Ghazali N, Aslam T, Henson DB. New superior-inferior visual field asymmetry indices for detecting POAG and their agreement with the glaucoma hemifield test. Eye (Lond) 2015; 29:1375-82. [PMID: 26315707 DOI: 10.1038/eye.2015.165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/28/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To describe and measure the discriminatory performance of three new superior-inferior asymmetry indices for detecting primary open angle glaucoma (POAG) and to compare these with the glaucoma hemifield test (GHT). METHODS In all, 412 control and 247 POAG eyes were selected from a visual field database of patients attending the Manchester Royal Eye Hospital. Age-adjusted defect asymmetries were calculated for each of the 22 vertically mirrored test point pairs used in the GHT. The three new indices, hemifield mean difference (HMD) and hemifield standard deviation (HSD) of the asymmetry values along with the number of test pairs (NP) falling outside the 85% probability limits of the control population, were calculated. ROC curves of the indices and GHT were constructed. Agreement between the indices was explored with a proportional Venn diagram and 3 × 3 contingency tables. Cases of disagreement between the indices were reviewed. RESULTS The area under the ROC curves were HMD=0.745 (95% confidence interval (CI) 0.705-0.786), HSD=0.864 (95% CI 0.833-0.894), NP=0.863 (95% CI 0.832-0.893) and GHT=0.792 (95% CI 0.754-0.829). The Venn diagram and contingency tables highlighted the good agreement between HSD, NP and GHT. Agreement was 78% (HSD vs. GHT) and 82% (NP vs. GHT) in the control sample and 70% (HSD vs. GHT) and 71% (NP vs. GHT) in the POAG sample. Five cases are presented where disagreement existed between the indices. CONCLUSIONS The new HSD and NP asymmetry indices perform better than GHT in differentiating between normal and POAG eyes in this data set. GHT can fail to detect significant asymmetry, detected by HSD and NP, when an early defect crosses sector boundaries.
Collapse
Affiliation(s)
- N Ghazali
- Institute of Human Development, Faculty of Medical and Human Development, University of Manchester, Manchester, UK
| | - T Aslam
- Institute of Human Development, Faculty of Medical and Human Development, University of Manchester, Manchester, UK.,Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - D B Henson
- Institute of Human Development, Faculty of Medical and Human Development, University of Manchester, Manchester, UK.,Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| |
Collapse
|
47
|
Keane PA, Balaskas K, Sim DA, Aman K, Denniston AK, Aslam T, And For The Equator Study Group. Automated Analysis of Vitreous Inflammation Using Spectral-Domain Optical Coherence Tomography. Transl Vis Sci Technol 2015; 4:4. [PMID: 26396930 DOI: 10.1167/tvst.4.5.4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 04/27/2015] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To develop an automated method for quantifying vitreous signal intensity on optical coherence tomography (OCT), with particular application for use in the assessment of vitreous inflammation. METHODS This retrospective, observational case-control series comprised 30 patients (30 eyes), with vitreous haze secondary to intermediate, posterior, or panuveitis; 12 patients (12 eyes) with uveitis without evidence of vitreous haze; and 18 patients (18 eyes) without intraocular inflammation or vitreoretinal disease. The presence and severity of vitreous haze was classified according to the National Eye Institute system; other inflammatory indices and clinical parameters were also documented. Spectral-domain OCT images were analyzed using custom VITreous ANalysis software (termed 'VITAN'), which is fully automated and avoids the need for manual segmentation. RESULTS VITAN performed accurate segmentation in all scans. Automated measurements of the vitreous:retinal pigment epithelium (RPE) signal ratio showed a moderate correlation with clinical vitreous haze scores (r = 0.585, P < 0.001), comparable to that reported using manual segmentation in our previous study (r = 0.566, P = 0.0001). The novel parameter of vitreous:RPE textural ratio showed a marginally stronger correlation (r = 0.604, P < 0.001) with clinical vitreous haze scores than the Vitreous:RPE signal ratio. CONCLUSIONS The custom OCT image analysis software (VITAN) allows rapid and automated measurement of vitreous parameters, that is comparable to our previously reported vitreous:RPE index, and correlates with clinically measured disease activity. Such OCT-based indices may provide the much needed objective markers of vitreous activity, which may be used in both clinical assessment, and as outcome measures in clinical trials for intermediate, posterior, and panuveitis. TRANSLATIONAL RELEVANCE We describe a rapid automated method for quantifying vitreous signal intensity on optical coherence tomography (OCT) and show that this correlates with clinical assessment of vitreous inflammation. Such OCT-based indices may provide the much needed objective markers of vitreous activity, which may be used both in routine clinical assessment, and as outcome measures in clinical trials for intermediate, posterior, and panuveitis.
Collapse
Affiliation(s)
- Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Konstantinos Balaskas
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Dawn A Sim
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Kiran Aman
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Alastair K Denniston
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK ; Centre for Translational Inflammation Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK ; Birmingham & Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Tariq Aslam
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK ; Faculty of Medical and Human Sciences, University of Manchester, UK ; School of Built Environment, Herriot-Watt University, UK
| | - And For The Equator Study Group
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| |
Collapse
|
48
|
Moshtael H, Aslam T, Underwood I, Dhillon B. High Tech Aids Low Vision: A Review of Image Processing for the Visually Impaired. Transl Vis Sci Technol 2015; 4:6. [PMID: 26290777 DOI: 10.1167/tvst.4.4.6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 06/10/2015] [Indexed: 11/24/2022] Open
Abstract
Recent advances in digital image processing provide promising methods for maximizing the residual vision of the visually impaired. This paper seeks to introduce this field to the readership and describe its current state as found in the literature. A systematic search revealed 37 studies that measure the value of image processing techniques for subjects with low vision. The techniques used are categorized according to their effect and the principal findings are summarized. The majority of participants preferred enhanced images over the original for a wide range of enhancement types. Adapting the contrast and spatial frequency content often improved performance at object recognition and reading speed, as did techniques that attenuate the image background and a technique that induced jitter. A lack of consistency in preference and performance measures was found, as well as a lack of independent studies. Nevertheless, the promising results should encourage further research in order to allow their widespread use in low-vision aids.
Collapse
Affiliation(s)
- Howard Moshtael
- EPSRC Centre for Doctoral Training in Applied Photonics, Heriot-Watt University, UK
| | - Tariq Aslam
- Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, UK ; Honorary Professor of Vision Science and Interface Technologies, Heriot-Watt University, UK ; Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | | |
Collapse
|
49
|
Murray C, Shakir S, Aslam T. P96 A New Interactive Game Device May Improve Compliance With Spacer Devices In Very Young Children. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
50
|
Aslam T, Tan SZ, D'Souza Y, Balaskas K, Mahmood S. Comparison of mathematical morphological descriptors of hyporeflective cavities in optical coherence tomography of patients with macular telangiectasia compared to patients with diabetic maculopathy. Acta Ophthalmol 2014; 92:e580-1. [PMID: 24667012 DOI: 10.1111/aos.12390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Tariq Aslam
- Centre for Hearing and Vision Research; Institute of Human Development; Faculty of Medicine; University of Manchester; Manchester UK
- Manchester Royal Eye Hospital; Central Manchester University Hospitals NHS Foundation Trust; Manchester Academic Health Science Centre; Manchester UK
| | - Shi Zhuan Tan
- Manchester Royal Eye Hospital; Central Manchester University Hospitals NHS Foundation Trust; Manchester Academic Health Science Centre; Manchester UK
| | - Yvonne D'Souza
- Manchester Royal Eye Hospital; Central Manchester University Hospitals NHS Foundation Trust; Manchester Academic Health Science Centre; Manchester UK
| | - Konstantinos Balaskas
- Manchester Royal Eye Hospital; Central Manchester University Hospitals NHS Foundation Trust; Manchester Academic Health Science Centre; Manchester UK
- Moorfields Eye Hospital NHS Foundation Trust; London UK
| | - Sajjad Mahmood
- Manchester Royal Eye Hospital; Central Manchester University Hospitals NHS Foundation Trust; Manchester Academic Health Science Centre; Manchester UK
| |
Collapse
|