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Daftarian N, Lima A, Marozoff S, Ojo D, Levasseur SD, Maberley DAL, Hoens A, Esdaile J, Dawes M, Aviña-Zubieta JA, Adante B, Bhui RD, Bhui SB, Butler M, Chui L, Erasmus M, Etminan M, Godinho D, Hay E, Hollands H, Hoonjan M, Joe A, Lukaris A, Mammo Z, Navajas E, Pakzad-Vaezi K, Sanmugasunderam S, Shojania K. RetINal Toxicity And HydroxyChloroquine Therapy (INTACT): protocol for a prospective population-based cohort study. BMJ Open 2022; 12:e053852. [PMID: 35177450 PMCID: PMC8860004 DOI: 10.1136/bmjopen-2021-053852] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Hydroxychloroquine (HCQ) is an important medication for patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and other rheumatic diseases. Although it is well-tolerated and cost-effective, the risk of HCQ retinal toxicity is of increasing concern. The aim of this study is to re-examine the HCQ retinal toxicity incidence rate, risk factors and clinical course after discontinuation. METHODS We designed a prospective population-based cohort study in adult patients with SLE or RA, currently receiving HCQ for five or more years, who are residents of British Columbia (BC), Canada. Based on administrative data, we identified 5508 eligible participants (1346 SLE and 4162 RA). They will participate in annual or biannual retinal screening over 5 years in alignment with the recently revised American Academy of Ophthalmology guidelines. To standardise procedures for retinal screening, imaging, diagnostic criteria, severity staging and data transfer, a consensus meeting was convened in December 2019 with participation of BC retinal specialists and the research team. Agreement was attained on: use of spectral domain-optical coherence tomography as the primary objective screening modality; classification of images into categories of normal, equivocal or abnormal; and transferring the equivocal and abnormal images plus corresponding subjective test results via cloud-based server from each clinic to a reading centre. Confirmation of HCQ retinal toxicity diagnoses and severity staging will be performed by three independent and masked reviewers. The incidence of HCQ retinal toxicity will be calculated, accounting for the competing risk of death. Hazard ratios for each risk factor will be calculated for the risk of HCQ retinopathy, after adjusting for confounders. We will also estimate the risk of HCQ retinal toxicity progression over 5 years. ETHICS AND DISSEMINATION This study has received approval from the University of British Columbia Clinical Research Ethics Board (H20-00736) and the Vancouver Coastal Health Research Institute.
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Affiliation(s)
- Narsis Daftarian
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Experimental Medicine, Department of Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Adriana Lima
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Shelby Marozoff
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Dami Ojo
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Steve D Levasseur
- Department of Ophthalmology and Visual Sciences, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - David A L Maberley
- Department of Ophthalmology and Visual Sciences, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Alison Hoens
- Department of Physical Therapy, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Centre for Clinical Epidemiology & Evaluation, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - John Esdaile
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Division of Rheumatology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Martin Dawes
- Department of Family Practice, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - J Antonio Aviña-Zubieta
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Division of Rheumatology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Beatrice Adante
- Department of Ophthalmology and Visual Sciences, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Ravinder Dennis Bhui
- Department of Ophthalmology and Visual Sciences, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Suruchi B Bhui
- Department of Ophthalmology and Visual Sciences, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Michael Butler
- Department of Ophthalmology and Visual Sciences, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Lica Chui
- Department of Ophthalmology and Visual Sciences, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Murray Erasmus
- Department of Ophthalmology and Visual Sciences, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of Victoria Island Medical Program, Victoria, British Columbia, Canada
| | - Mahyar Etminan
- Departments of Ophthalmology and Visual Sciences, Pharmacology and Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Derek Godinho
- Department of Ophthalmology and Visual Sciences, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Elizabeth Hay
- Department of Ophthalmology and Visual Sciences, Nanaimo Regional General Hospital, Nanaimo, British Columbia, Canada
| | - Hussein Hollands
- Department of Ophthalmology and Visual Sciences, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Malvinder Hoonjan
- Department of Ophthalmology and Visual Sciences, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Aaron Joe
- Kelowna General Hospital, Kelowna, British Columbia, Canada
| | - Andrew Lukaris
- Department of Ophthalmology and Visual Sciences, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Zaid Mammo
- Department of Ophthalmology and Visual Sciences, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Eduardo Navajas
- Department of Ophthalmology and Visual Sciences, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Kaivon Pakzad-Vaezi
- Department of Ophthalmology and Visual Sciences, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Suren Sanmugasunderam
- Department of Ophthalmology and Visual Sciences, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Kam Shojania
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Division of Rheumatology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
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Pole C, Au A, Navajas E, Freund KB, Sadda S, Sarraf D. En Face Optical Coherence Tomography Imaging of Foveal Dots in Eyes With Posterior Vitreous Detachment or Internal Limiting Membrane Peeling. Invest Ophthalmol Vis Sci 2021; 62:5. [PMID: 34351357 PMCID: PMC8354030 DOI: 10.1167/iovs.62.10.5] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To analyze the morphology of foveal hyperreflective dots (HRD) identified with en face optical coherence tomography (OCT) and evaluate the effects of internal limiting membrane (ILM) peeling and posterior vitreous detachment (PVD) on the number of these lesions. Methods Retrospective cross-sectional study of patients with OCT angiography and en face OCT. Using en face OCT, superficial HRD lying on the foveal floor were measured and quantitated in eyes with ILM peel and in the fellow nonsurgical eyes. Eyes with foveal PVD were also compared to fellow eyes without foveal PVD. High-magnification en face OCT was also performed to better understand the morphology of HRD in the fovea. Results Eyes that underwent ILM peel (n = 10) displayed fewer HRD (P = 0.012) compared to control fellow nonoperated eyes. In eyes with foveal PVD, the mean number of HRD was numerically greater, but without statistical significance, compared to the contralateral eye without foveal PVD. High-magnification en face OCT illustrated HRD with irregular shapes and fine cilia-like or dendriform extensions. Average length of HRD was between 15 to 21 µm in all four groups. Conclusions HRD decreased in eyes with ILM peeling by en face OCT compared with fellow nonoperated eyes and exhibited a glial cell-like morphology and size closely resembling the white dot fovea described previously using scanning electron microscopy. HRD may represent processes of activated retinal glia, possibly Muller cells, that traverse defects in the ILM.
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Affiliation(s)
- Cameron Pole
- Retinal Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California at Los Angeles, Los Angeles, California, United States
| | - Adrian Au
- Retinal Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California at Los Angeles, Los Angeles, California, United States
| | - Eduardo Navajas
- Department of Ophthalmology and Visual Sciences, Eye Care Center, University of British Columbia, British Columbia, Vancouver, Canada
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York, United States.,Department of Ophthalmology, New York University Grossman School of Medicine, New York, New York, United States
| | - Srinivas Sadda
- Doheny Eye Institute, Los Angeles, California, United States.,University of California at Los Angeles, Los Angeles, California, United States
| | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics, Stein Eye Institute, University of California at Los Angeles, Los Angeles, California, United States.,Greater Los Angeles VA Healthcare Center, Los Angeles, California, United States
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Lu D, Heisler M, Lee S, Ding GW, Navajas E, Sarunic MV, Beg MF. Deep-learning based multiclass retinal fluid segmentation and detection in optical coherence tomography images using a fully convolutional neural network. Med Image Anal 2019; 54:100-110. [DOI: 10.1016/j.media.2019.02.011] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/15/2019] [Accepted: 02/15/2019] [Indexed: 11/28/2022]
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Akil H, Karst S, Heisler M, Etminan M, Navajas E, Maberley D. Application of optical coherence tomography angiography in diabetic retinopathy: a comprehensive review. Can J Ophthalmol 2019; 54:519-528. [PMID: 31564340 DOI: 10.1016/j.jcjo.2019.02.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/22/2019] [Accepted: 02/25/2019] [Indexed: 12/12/2022]
Abstract
Optical coherence tomography angiography (OCTA) is a noninvasive method that enables visualization of blood flow within retinal vessels down to the size of capillaries by detecting motion contrast from moving blood cells. OCTA provides a fast and safe procedure to assess retinal microvasculature with higher contrast and resolution than conventional fluorescence angiography. The different capillary plexuses are displayed separately and their perfusion density can be quantified. Imaging capabilities such as these have led to an emerging field of clinical application for OCTA in vascular diseases such as diabetic retinopathy (DR). Evaluation of parameters such as parafoveal capillary perfusion density could be a biomarker for disease diagnosis and progression. Typical microvascular changes in DR such as capillary nonperfusion, microaneurysms, intraretinal microvascular abnormalities, and neovascularization can be reliably detected in optical coherence tomography angiograms, characterized in detail and attributed to the different capillary plexuses. Monitoring of these lesions in vivo gives potential novel insight into the pathophysiology in DR. The aim of this article is to summarize the potential applications/utility of OCTA in DR reported in the literature.
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Affiliation(s)
- Handan Akil
- Department of Ophthalmology, Faculty of Medicine, University of British Columbia, Vancouver, B.C
| | - Sonja Karst
- Department of Ophthalmology, Faculty of Medicine, University of British Columbia, Vancouver, B.C.; Department of Ophthalmology and Optometry, Medical University Vienna, Vienna, Austria
| | - Morgan Heisler
- Faculty of Applied Sciences, Simon Fraser University, Burnaby, B.C
| | - Mahyar Etminan
- Department of Ophthalmology, Faculty of Medicine, University of British Columbia, Vancouver, B.C
| | - Eduardo Navajas
- Department of Ophthalmology, Faculty of Medicine, University of British Columbia, Vancouver, B.C
| | - David Maberley
- Department of Ophthalmology, Faculty of Medicine, University of British Columbia, Vancouver, B.C..
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Heisler M, Lee S, Mammo Z, Jian Y, Ju M, Merkur A, Navajas E, Balaratnasingam C, Beg MF, Sarunic MV. Strip-based registration of serially acquired optical coherence tomography angiography. J Biomed Opt 2017; 22:36007. [PMID: 28265647 DOI: 10.1117/1.jbo.22.3.036007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/20/2017] [Indexed: 05/18/2023]
Abstract
The visibility of retinal microvasculature in optical coherence tomography angiography (OCT-A) images is negatively affected by the small dimension of the capillaries, pulsatile blood flow, and motion artifacts. Serial acquisition and time-averaging of multiple OCT-A images can enhance the definition of the capillaries and result in repeatable and consistent visualization. We demonstrate an automated method for registration and averaging of serially acquired OCT-A images. Ten OCT-A volumes from six normal control subjects were acquired using our prototype 1060-nm swept source OCT system. The volumes were divided into microsaccade-free en face angiogram strips, which were affine registered using scale-invariant feature transform keypoints, followed by nonrigid registration by pixel-wise local neighborhood matching. The resulting averaged images were presented of all the retinal layers combined, as well as in the superficial and deep plexus layers separately. The contrast-to-noise ratio and signal-to-noise ratio of the angiograms with all retinal layers (reported as average ± standard deviation ) increased from 0.52 ± 0.22 and 19.58 ± 4.04 ?? dB for a single image to 0.77 ± 0.25 and 25.05 ± 4.73 ?? dB , respectively, for the serially acquired images after registration and averaging. The improved visualization of the capillaries can enable robust quantification and study of minute changes in retinal microvasculature.
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Affiliation(s)
- Morgan Heisler
- Simon Fraser University, School of Engineering Science, Faculty of Applied Sciences, Burnaby, British Columbia, Canada
| | - Sieun Lee
- Simon Fraser University, School of Engineering Science, Faculty of Applied Sciences, Burnaby, British Columbia, Canada
| | - Zaid Mammo
- University of British Columbia, Department of Ophthalmology and Visual Sciences, Vancouver, British Columbia, Canada
| | - Yifan Jian
- Simon Fraser University, School of Engineering Science, Faculty of Applied Sciences, Burnaby, British Columbia, Canada
| | - MyeongJin Ju
- Simon Fraser University, School of Engineering Science, Faculty of Applied Sciences, Burnaby, British Columbia, Canada
| | - Andrew Merkur
- University of British Columbia, Department of Ophthalmology and Visual Sciences, Vancouver, British Columbia, Canada
| | - Eduardo Navajas
- University of British Columbia, Department of Ophthalmology and Visual Sciences, Vancouver, British Columbia, Canada
| | - Chandrakumar Balaratnasingam
- University of British Columbia, Department of Ophthalmology and Visual Sciences, Vancouver, British Columbia, CanadacUniversity of Western Australia, Lions Eye Institute, Centre for Ophthalmology and Visual Science, Department of Physiology and Pharmacology, Nedlands, AustraliadVitreous Retina Macula Consultants of New York, New York, United StateseManhattan Eye, Ear and Throat Hospital, LuEsther T. Mertz Retinal Research Center, New York, New York, United States
| | - Mirza Faisal Beg
- Simon Fraser University, School of Engineering Science, Faculty of Applied Sciences, Burnaby, British Columbia, Canada
| | - Marinko V Sarunic
- Simon Fraser University, School of Engineering Science, Faculty of Applied Sciences, Burnaby, British Columbia, Canada
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Mammo Z, Heisler M, Balaratnasingam C, Lee S, Yu DY, Mackenzie P, Schendel S, Merkur A, Kirker A, Albiani D, Navajas E, Beg MF, Morgan W, Sarunic MV. Quantitative Optical Coherence Tomography Angiography of Radial Peripapillary Capillaries in Glaucoma, Glaucoma Suspect, and Normal Eyes. Am J Ophthalmol 2016; 170:41-49. [PMID: 27470061 DOI: 10.1016/j.ajo.2016.07.015] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [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: 04/17/2016] [Revised: 07/18/2016] [Accepted: 07/18/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the quantitative characteristics of the radial peripapillary capillary (RPC) network in glaucoma, glaucoma suspect, and normal eyes using speckle variance optical coherence tomography angiography (OCT-A). To determine correlations between RPC density, nerve fiber layer (NFL) thickness, and visual field indices. DESIGN Cross-sectional study. METHODS OCT-A images of RPCs were acquired at a single institution using a custom-built 1060 nm system from 3 groups: unilateral glaucoma (10 eyes from 5 subjects), glaucoma suspects (6 eyes from 3 subjects), and normal control eyes (16 eyes from 9 normal subjects). Peripapillary NFL thickness measurements were determined using spectral-domain optical coherence tomography. Glaucoma and glaucoma suspects also underwent automated 30-2 Humphrey visual field analysis. Manual tracing techniques were used to quantify RPC density in the OCT-A images. Data were analyzed using a linear mixed model with 1 fixed-effect covariate. Correlations between main outcome measures (RPC density, NFL thickness, and visual field index) were determined. RESULTS Mean age was not significantly different between the 3 groups (P = .25). The density of RPCs was significantly lower in glaucomatous eyes compared with matched-peripapillary regions in the fellow eye, glaucoma suspect group, and normal group (all P < .001). RPC density was strongly correlated with NFL thickness (P < .001) and visual field index (P < .001). CONCLUSIONS Significant reductions in RPC density were correlated with sites of NFL decrease and visual field loss in glaucoma. Speckle variance OCT-A allows visualization and quantification of RPCs and may therefore be a useful tool for indirectly quantifying and monitoring retinal ganglion cell axonal injury in glaucoma.
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Affiliation(s)
- Zaid Mammo
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Morgan Heisler
- School of Engineering Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Chandrakumar Balaratnasingam
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Vitreous Retina Macula Consultants of New York, New York, New York; LuEsther T. Mertz Retinal Research Center, Eye, Ear and Throat Hospital, New York, New York; Department of Physiology and Pharmacology, Centre for Ophthalmology and Visual Science, Lions Eye Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Sieun Lee
- School of Engineering Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Dao-Yi Yu
- Department of Physiology and Pharmacology, Centre for Ophthalmology and Visual Science, Lions Eye Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Paul Mackenzie
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada; School of Engineering Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Steven Schendel
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Merkur
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Kirker
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Albiani
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eduardo Navajas
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mirza Faisal Beg
- School of Engineering Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - William Morgan
- Department of Physiology and Pharmacology, Centre for Ophthalmology and Visual Science, Lions Eye Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Marinko V Sarunic
- School of Engineering Science, Simon Fraser University, Burnaby, British Columbia, Canada.
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Prentašic P, Heisler M, Mammo Z, Lee S, Merkur A, Navajas E, Beg MF, Šarunic M, Loncaric S. Segmentation of the foveal microvasculature using deep learning networks. J Biomed Opt 2016; 21:75008. [PMID: 27401936 DOI: 10.1117/1.jbo.21.7.075008] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/16/2016] [Indexed: 05/22/2023]
Abstract
Accurate segmentation of the retinal microvasculature is a critical step in the quantitative analysis of the retinal circulation, which can be an important marker in evaluating the severity of retinal diseases. As manual segmentation remains the gold standard for segmentation of optical coherence tomography angiography (OCT-A) images, we present a method for automating the segmentation of OCT-A images using deep neural networks (DNNs). Eighty OCT-A images of the foveal region in 12 eyes from 6 healthy volunteers were acquired using a prototype OCT-A system and subsequently manually segmented. The automated segmentation of the blood vessels in the OCT-A images was then performed by classifying each pixel into vessel or nonvessel class using deep convolutional neural networks. When the automated results were compared against the manual segmentation results, a maximum mean accuracy of 0.83 was obtained. When the automated results were compared with inter and intrarater accuracies, the automated results were shown to be comparable to the human raters suggesting that segmentation using DNNs is comparable to a second manual rater. As manually segmenting the retinal microvasculature is a tedious task, having a reliable automated output such as automated segmentation by DNNs, is an important step in creating an automated output.
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Affiliation(s)
- Pavle Prentašic
- University of Zagreb, Faculty of Electrical Engineering and Computing, Unska ul. 3, Zagreb 10000, Croatia
| | - Morgan Heisler
- Simon Fraser University, Department of Engineering Science, 8888 University Drive, Burnaby, British Columbia V5A1S6, Canada
| | - Zaid Mammo
- University of British Columbia, Department of Ophthalmology and Visual Science, Eye Care Center, 2550 Willow Street, Vancouver, British Columbia V5Z 3N9, Canada
| | - Sieun Lee
- Simon Fraser University, Department of Engineering Science, 8888 University Drive, Burnaby, British Columbia V5A1S6, Canada
| | - Andrew Merkur
- University of British Columbia, Department of Ophthalmology and Visual Science, Eye Care Center, 2550 Willow Street, Vancouver, British Columbia V5Z 3N9, Canada
| | - Eduardo Navajas
- University of British Columbia, Department of Ophthalmology and Visual Science, Eye Care Center, 2550 Willow Street, Vancouver, British Columbia V5Z 3N9, Canada
| | - Mirza Faisal Beg
- Simon Fraser University, Department of Engineering Science, 8888 University Drive, Burnaby, British Columbia V5A1S6, Canada
| | - Marinko Šarunic
- Simon Fraser University, Department of Engineering Science, 8888 University Drive, Burnaby, British Columbia V5A1S6, Canada
| | - Sven Loncaric
- University of Zagreb, Faculty of Electrical Engineering and Computing, Unska ul. 3, Zagreb 10000, Croatia
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Abstract
BACKGROUND To describe autofluorescence patterns of choroidal melanocytic lesions using the Heidelberg Retinal Angiograph 2 system (HRA2). METHODS 20 patients with choroidal melanocytic lesions in the ocular fundus underwent ophthalmologic examination, fundus photography, autofluorescence and optical coherence tomography (OCT). Pathologic examination was performed on one enucleated eye with a large choroidal melanoma. RESULTS 15 patients had choroidal nevi and 5 had malignant choroidal melanoma (1 small, 1 medium and 3 large tumours). Choroidal nevi did not show any characteristic autofluorescence pattern, although secondary retinal pigment epithelium (RPE) changes, such as drusen and pigment epithelium detachment, appeared faintly hyperautofluorescent in 2 patients. Only the small malignant choroidal melanomas had prominent orange pigmentation, although all melanomas had an intense confluent hyperautofluorescent signal over the lesions. Pathology of one large malignant melanoma revealed lipofuscin underlying RPE. CONCLUSION Most nevi did not have characteristic hyperautofluorescent features, but choroidal melanomas seemed to have a pattern of confluent hyperautofluorescence. Therefore, autofluorescence may be a useful non-invasive tool to assess lipofuscin in pigmented choroidal lesions, which may contribute to the diagnosis of malignancy. This hypothesis, however, remains to be confirmed in large prospective studies.
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Affiliation(s)
- Daniel Lavinsky
- Vision Institute, Escola Paulista de Medicina, Universidade Federal de São Paulo, SP 04023-062, Brazil.
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