Ophthalmology science最新文献

{"title":"Impact of Tumor Pigmentation in 6934 Patients with Uveal Melanoma at a Single Center","authors":"","doi":"10.1016/j.xops.2024.100585","DOIUrl":"10.1016/j.xops.2024.100585","url":null,"abstract":"<div><h3>Purpose</h3><p>To evaluate clinical features and outcomes associated with degree of tumor pigmentation in patients with uveal melanoma (UM) of the choroid and ciliary body.</p></div><div><h3>Design</h3><p>Retrospective observational study.</p></div><div><h3>Subjects</h3><p>Six thousand nine hundred thirty-four consecutive patients with choroidal or ciliary body melanoma between 1971 and 2007 from a single ocular oncology center.</p></div><div><h3>Methods</h3><p>Data on patient demographics, tumor characteristics, treatment approach, and clinical outcomes were collected. Comparisons between pigmented (>80% pigmentation by surface area), partially pigmented (20%–80%), and nonpigmented tumors (<20%) were performed using relevant hypothesis testing. Survival analyses for metastasis and melanoma-related death were conducted using the Kaplan–Meier method with log-rank tests for univariate comparisons. A multivariate Cox regression analysis was performed to assess the independent effects of multiple covariates on time-to-metastasis.</p></div><div><h3>Main Outcome Measures</h3><p>Extraocular extension, ocular melanocytosis, time to tumor recurrence, tumor location, and melanoma-related metastasis and death.</p></div><div><h3>Results</h3><p>There were 6934 eyes with UM and the degree of tumor pigmentation was classified as pigmented (n = 3762; 54%), partially pigmented (n = 2115; 31%), or nonpigmented (n = 1057; 15%). Pigmented UM was associated with extraocular extension (<em>P</em> < 0.001), ocular melanocytosis (<em>P</em> = 0.003), earlier tumor recurrence (<em>P</em> < 0.001), and more anterior tumor epicenter location (ciliary body, and equator to ora serrata) (<em>P</em> < 0.001). Pigmented UMs also exhibited the highest 10-year metastasis rate at 26%, compared with 19% for partially pigmented UMs and 16% for nonpigmented UMs (<em>P</em> < 0.001). Kaplan–Meier survival curves demonstrated differences among the tumor pigmentation groups for melanoma-related metastasis (<em>P</em> < 0.001) and melanoma-related death (<em>P</em> < 0.001). Multivariate Cox regression analysis for melanoma-related metastasis showed that pigmented UMs had a 29% higher relative risk of developing metastasis compared with partially pigmented UMs (<em>P</em> = 0.002) and a 54% higher relative risk of developing metastasis compared with nonpigmented UMs (<em>P</em> < 0.001).</p></div><div><h3>Conclusions</h3><p>Pigmented choroidal and ciliary body melanoma is more often associated with ocular melanocytosis, extraocular extension, anterior tumor epicenter, and earlier tumor recurrence. We also revealed that patients with pigmented UMs demonstrate a higher 10-year rate of metastatic disease and have decreased metastatic survival relative to partially pigmented and nonpigmented UMs.</p></div><div><h3>Financial Disclosures</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p><","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666914524001210/pdfft?md5=4d655f3e430b8f3aa54879df299e9a92&pid=1-s2.0-S2666914524001210-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lens Thickness in Infants and Children with Cataracts","authors":"","doi":"10.1016/j.xops.2024.100588","DOIUrl":"10.1016/j.xops.2024.100588","url":null,"abstract":"<div><h3>Purpose</h3><p>The purpose of this study was to determine the association between lens thickness and cataract in participants aged 0 to 5 years.</p></div><div><h3>Design</h3><p>This was a prospective, multicenter, case–control study.</p></div><div><h3>Participants</h3><p>We enrolled 118 participants (171 eyes) aged 0 to 5 years, mean age 14.6 ± 17.0 months, range 0 to 60 months.</p></div><div><h3>Methods</h3><p>Lens thickness was measured on 342 ultrasound biomicroscopy (UBM) images.</p></div><div><h3>Main Outcome Measures</h3><p>Lens thickness; feasibility of lens thickness measurement from UBM images.</p></div><div><h3>Results</h3><p>The mean lens thickness among noncataracts was 3.60 ± 0.17 mm, compared with 3.16 ± 0.61 mm among cataracts (<em>P</em> &lt; 0.0001). Lens thickness &lt;3.5 mm was significantly associated with increased odds of cataract; adjusted odds ratio = 5.99 (95% confidence interval, 2.41–14.88; <em>P</em> &lt; 0.0003) among participants age 0 to 7 months. Lens thickness was significantly associated with cataract laterality among participants age 0 to 7 months (<em>P</em> &lt; 0.0001).</p></div><div><h3>Conclusions</h3><p>Quantitative UBM can be used to evaluate lens thickness in infants and children with congenital cataracts. The lens in congenital cataract eyes was thinner than that of controls among infants. Abnormal lens thickness was significantly associated with cataract. Future longitudinal studies will examine the association between lens thickness and postcataract surgery outcomes.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666914524001246/pdfft?md5=d926594c5f4edb7fbd5f74572e84042f&pid=1-s2.0-S2666914524001246-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141847244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retinal Microstructural Changes Reflecting Treatment-Associated Cognitive Dysfunction in Patients with Lower-Grade Gliomas","authors":"","doi":"10.1016/j.xops.2024.100577","DOIUrl":"10.1016/j.xops.2024.100577","url":null,"abstract":"<div><h3>Purpose</h3><p>To determine whether microstructural retinal changes, tumor features, and <em>apolipoprotein E (APOE) ε4</em> polymorphism are correlated with clinically detectable treatment-associated cognitive dysfunction (TACD) in patients with lower-grade gliomas.</p></div><div><h3>Design</h3><p>Cohort study.</p></div><div><h3>Participants and Controls</h3><p>Sixteen patients with lower-grade glioma at a United States academic ophthalmology department between January 2021 and November 2023. Normal controls were recruited from convenient sampling.</p></div><div><h3>Methods</h3><p>Montreal Cognitive Assessment (MoCA) scores and retinal changes were assessed in 6-month intervals. <em>Apolipoprotein E</em> genotyping was performed, and tumor details were recorded. Partial least-squares discriminant (PLSD) model was established to evaluate the association between TACD with <em>APOE</em> genotype, ophthalmic, and tumor features.</p></div><div><h3>Main Outcome Measures</h3><p>The main outcome measure was cognitive status as measured by the MoCA score and analyzed in relation to ophthalmic measurements, tumor features, and <em>APOE</em> genotype.</p></div><div><h3>Results</h3><p>Median time to first eye examination was 34 months (2–266) from tumor diagnosis and 23 months (0–246) from radiation. Nine patients (56%) had abnormal cognition (MoCA &lt;26/30). Montreal Cognitive Assessment scores were significantly worse in patients with temporal (22 ± 7.2) than frontal lobe tumors (26 ± 3.1, <em>P</em> = 0.02) and those with oligodendrogliomas (22 ± 4.1) than astrocytomas (26 ± 3.6, = 0.02). Patients with TACD had significant radial peripapillary capillary density loss (45% ± 4.6) compared with those with normal cognition (49% ± 2.6, <em>P</em> = 0.02). A PLSD model correlated MoCA scores with retinal nerve fiber thickness, intraocular pressure, foveal avascular zone, best-corrected visual acuity, months since first diagnosis, and tumor pathology (oligodendroglioma or not). Using these features, the model identified patients with TACD with 77% accuracy. <em>Apolipoprotein E</em> genotyping showed: 2 <em>ε2/ε3</em> (13%), 10 <em>ε3/ε3</em> (63%)<em>,</em> and 1 <em>ε3/ε4</em> (6%).</p></div><div><h3>Conclusions</h3><p>Retinal microstructural changes may serve as biomarkers for TACD in patients with lower-grade gliomas. Temporal lobe tumors and oligodendrogliomas may increase susceptibility to TACD. Utilization of retinal markers may enhance TACD diagnosis, progression monitoring, and inform management of lower-grade patients with glioma. A larger study with serial eye examinations is warranted to evaluate the role of <em>APOE ε</em>4 and develop a predictive model.</p></div><div><h3>Financial Disclosures</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666914524001131/pdfft?md5=25ad236fa7ec07fef6003a7e446c9ab3&pid=1-s2.0-S2666914524001131-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Tolerability of Suprachoroidal Axitinib Injectable Suspension, for Neovascular Age-related Macular Degeneration; Phase I/IIa Open-Label, Dose-Escalation Trial","authors":"","doi":"10.1016/j.xops.2024.100586","DOIUrl":"10.1016/j.xops.2024.100586","url":null,"abstract":"<div><h3>Purpose</h3><p>To evaluate the safety and tolerability of a single dose of axitinib injectable suspension (CLS-AX), a pan-anti-VEGF tyrosine kinase inhibitor (TKI), administered via suprachoroidal injection in patients with neovascular age-related macular degeneration (nAMD).</p></div><div><h3>Design</h3><p>Phase I/IIa, open-label, sequential dose escalation.</p></div><div><h3>Participants</h3><p>Anti-VEGF treatment-experienced patients with active subfoveal choroidal neovascularization secondary to nAMD.</p></div><div><h3>Methods</h3><p>The study included 4 cohorts (0.03, 0.10, 0.50, and 1.0 mg) of approximately 5 patients each enrolled in a dose-escalating fashion. Enrolled patients received intravitreal aflibercept (2 mg) followed by a single unilateral dose of CLS-AX 1 month later. All patients were followed monthly for 3 months with the option of an additional 3 months of extended follow-up for cohorts 2 to 4. End points included systemic and ocular safety and tolerability, visual acuity, retinal thickness, and need for aflibercept therapy.</p></div><div><h3>Main Outcome Measures</h3><p>The number of patients reporting treatment-emergent adverse events (TEAEs) and serious adverse events (SAEs), changes in ophthalmic examinations, and the number of patients qualifying for additional therapy for nAMD based on protocol-defined criteria.</p></div><div><h3>Results</h3><p>OASIS enrolled 27 patients with nAMD with mean age of 81 years, mean duration of nAMD diagnosis of 54 months, and between 5 and 90 prior anti-VEGF treatments. Twenty-six patients completed through 3 months, with 14 entering and completing the 3-month extension. No SAEs, drug-related TEAEs, or TEAEs leading to discontinuation were observed after CLS-AX administration; there were no adverse events related to ocular inflammation, vasculitis, intraocular pressure, or dispersion of drug into the vitreous or anterior chamber. Through 6 months, stable mean best-corrected visual acuity and stable mean central subfield thickness (CST) were observed, suggestive of TKI biologic effect. No aflibercept therapy was administered up to 3 months in 58% (15/26) of patients who completed 3 months of follow-up in OASIS. In the Extension, 57% (8/14) of patients went up to 6 months without receiving aflibercept therapy.</p></div><div><h3>Conclusions</h3><p>Up to 1.0 mg CLS-AX, a highly potent TKI targeted to the suprachoroidal space (SCS) via the SCS Microinjector, was well tolerated, with stable mean visual acuity and mean CST. A majority of patients followed for 6 months did not require aflibercept therapy.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666914524001222/pdfft?md5=7f4193eb9e1e0cf90b1d2460ea4427ec&pid=1-s2.0-S2666914524001222-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141846467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating Uncertainty of Geographic Atrophy Segmentations with Bayesian Deep Learning","authors":"","doi":"10.1016/j.xops.2024.100587","DOIUrl":"10.1016/j.xops.2024.100587","url":null,"abstract":"<div><h3>Purpose</h3><p>To apply methods for quantifying uncertainty of deep learning segmentation of geographic atrophy (GA).</p></div><div><h3>Design</h3><p>Retrospective analysis of OCT images and model comparison.</p></div><div><h3>Participants</h3><p>One hundred twenty-six eyes from 87 participants with GA in the SWAGGER cohort of the Nonexudative Age-Related Macular Degeneration Imaged with Swept-Source OCT (SS-OCT) study.</p></div><div><h3>Methods</h3><p>The manual segmentations of GA lesions were conducted on structural subretinal pigment epithelium en face images from the SS-OCT images. Models were developed for 2 approximate Bayesian deep learning techniques, Monte Carlo dropout and ensemble, to assess the uncertainty of GA semantic segmentation and compared to a traditional deep learning model.</p></div><div><h3>Main Outcome Measures</h3><p>Model performance (Dice score) was compared. Uncertainty was calculated using the formula for Shannon Entropy.</p></div><div><h3>Results</h3><p>The output of both Bayesian technique models showed a greater number of pixels with high entropy than the standard model. Dice scores for the Monte Carlo dropout method (0.90, 95% confidence interval 0.87–0.93) and the ensemble method (0.88, 95% confidence interval 0.85–0.91) were significantly higher (<em>P</em> &lt; 0.001) than for the traditional model (0.82, 95% confidence interval 0.78–0.86).</p></div><div><h3>Conclusions</h3><p>Quantifying the uncertainty in a prediction of GA may improve trustworthiness of the models and aid clinicians in decision-making. The Bayesian deep learning techniques generated pixel-wise estimates of model uncertainty for segmentation, while also improving model performance compared with traditionally trained deep learning models.</p></div><div><h3>Financial Disclosures</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666914524001234/pdfft?md5=678a9a10974ce3ddf09356f4abea5102&pid=1-s2.0-S2666914524001234-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141846967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Microperimetry and Static Perimetry for Evaluating Macular Function and Progression in Retinitis Pigmentosa","authors":"","doi":"10.1016/j.xops.2024.100582","DOIUrl":"10.1016/j.xops.2024.100582","url":null,"abstract":"<div><h3>Purpose</h3><p>To compare the usefulness of microperimetry and static automated perimetry in patients with retinitis pigmentosa (RP), using macular anatomical metrics as a reference.</p></div><div><h3>Design</h3><p>Prospective observational study.</p></div><div><h3>Participants</h3><p>Forty-eight eyes of 48 patients with RP in Kyushu University Hospital who underwent microperimetry-3 (MP-3) and Humphrey Field Analyzer (HFA) 10-2 testing ≥3 times during ≥2 years were included.</p></div><div><h3>Methods</h3><p>Macular anatomy (ellipsoid zone [EZ] length) was assessed by OCT, and macular function was assessed by MP-3 (mean retinal sensitivity at radii 2°, 4°, and 8°) and HFA10-2 program (mean retinal sensitivity at radii 2°, 4°, and 8°). Correlations between functional and anatomical parameters were analyzed cross sectionally at baseline and longitudinally by comparing the rate of progression.</p></div><div><h3>Main Outcome Measures</h3><p>Correlation coefficients between anatomical and functional metrics.</p></div><div><h3>Results</h3><p>The mean age at baseline was 50.1 ± 12.3 years, and the mean follow-up period was 2.8 ± 0.7 years. At baseline, EZ length was significantly correlated with MP-3 mean retinal sensitivity at radii 2°, 4°, and 8° (Spearman’s ρ = 0.65, 0.84, 0.89; all <em>P</em> &lt; 0.005) and HFA10-2 mean retinal sensitivity at radii 2°, 4°, and 8° (Spearman’s ρ = 0.61, 0.73, 0.78; all <em>P</em> &lt; 0.005). Longitudinal analysis showed that the slope of EZ length (−88.92 μm/year) was significantly correlated with the slope of MP-3 retinal sensitivity at 8° radius (−0.62 decibels [dB]/year; Spearman’s ρ = 0.31, <em>P</em>=0.03) and the slope of HFA retinal sensitivity at 8° radius (−0.60 dB/year; Spearman’s ρ = 0.43, <em>P</em> &lt; 0.005).</p></div><div><h3>Conclusions</h3><p>Both MP-3 and HFA values were cross sectionally well-correlated with EZ length in patients with patients; however, these associations became weaker in the longitudinal analysis. This highlights the need for researchers to explore additional or more sensitive parameters to better monitor RP progression.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666914524001180/pdfft?md5=c461abfc8bfc9d216d0c70256a7d2651&pid=1-s2.0-S2666914524001180-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Choroidal Nevus Transformation to Melanoma Using Machine Learning","authors":"","doi":"10.1016/j.xops.2024.100584","DOIUrl":"10.1016/j.xops.2024.100584","url":null,"abstract":"<div><h3>Purpose</h3><p>To develop and validate machine learning (ML) models to predict choroidal nevus transformation to melanoma based on multimodal imaging at initial presentation.</p></div><div><h3>Design</h3><p>Retrospective multicenter study.</p></div><div><h3>Participants</h3><p>Patients diagnosed with choroidal nevus on the Ocular Oncology Service at Wills Eye Hospital (2007–2017) or Mayo Clinic Rochester (2015–2023).</p></div><div><h3>Methods</h3><p>Multimodal imaging was obtained, including fundus photography, fundus autofluorescence, spectral domain OCT, and B-scan ultrasonography. Machine learning models were created (XGBoost, LGBM, Random Forest, Extra Tree) and optimized for area under receiver operating characteristic curve (AUROC). The Wills Eye Hospital cohort was used for training and testing (80% training–20% testing) with fivefold cross validation. The Mayo Clinic cohort provided external validation. Model performance was characterized by AUROC and area under precision–recall curve (AUPRC). Models were interrogated using SHapley Additive exPlanations (SHAP) to identify the features most predictive of conversion from nevus to melanoma. Differences in AUROC and AUPRC between models were tested using 10 000 bootstrap samples with replacement and results.</p></div><div><h3>Main Outcome Measures</h3><p>Area under receiver operating curve and AUPRC for each ML model.</p></div><div><h3>Results</h3><p>There were 2870 nevi included in the study, with conversion to melanoma confirmed in 128 cases. Simple AI Nevus Transformation System (SAINTS; XGBoost) was the top-performing model in the test cohort [pooled AUROC 0.864 (95% confidence interval (CI): 0.864–0.865), pooled AUPRC 0.244 (95% CI: 0.243–0.246)] and in the external validation cohort [pooled AUROC 0.931 (95% CI: 0.930–0.931), pooled AUPRC 0.533 (95% CI: 0.531–0.535)]. Other models also had good discriminative performance: LGBM (test set pooled AUROC 0.831, validation set pooled AUROC 0.815), Random Forest (test set pooled AUROC 0.812, validation set pooled AUROC 0.866), and Extra Tree (test set pooled AUROC 0.826, validation set pooled AUROC 0.915). A model including only nevi with at least 5 years of follow-up demonstrated the best performance in AUPRC (test: pooled 0.592 (95% CI: 0.590–0.594); validation: pooled 0.656 [95% CI: 0.655–0.657]). The top 5 features in SAINTS by SHAP values were: tumor thickness, largest tumor basal diameter, tumor shape, distance to optic nerve, and subretinal fluid extent.</p></div><div><h3>Conclusions</h3><p>We demonstrate accuracy and generalizability of a ML model for predicting choroidal nevus transformation to melanoma based on multimodal imaging.</p></div><div><h3>Financial Disclosures</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666914524001209/pdfft?md5=611e184a6e4ec4c46ad3dd1688c15182&pid=1-s2.0-S2666914524001209-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141844736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reference Database for a Novel Binocular Visual Function Perimeter: A Randomized Clinical Trial","authors":"","doi":"10.1016/j.xops.2024.100583","DOIUrl":"10.1016/j.xops.2024.100583","url":null,"abstract":"<div><h3>Purpose</h3><p>To construct a comprehensive reference database (RDB) for a novel binocular automated perimeter.</p></div><div><h3>Design</h3><p>A four-site prospective randomized clinical trial.</p></div><div><h3>Subjects and Controls</h3><p>Three hundred fifty-six healthy subjects without ocular conditions that might affect visual function were categorized into 7 age groups.</p></div><div><h3>Methods</h3><p>Subjects underwent comprehensive ocular examination of both eyes before enrollment. Using the TEMPO/IMOvifa automated perimeter (Topcon Healthcare/CREWT Medical Systems), each subject completed 4 binocular threshold visual field (VF) tests during a single visit: First, practice 24-2 and 10-2 tests were obtained from both eyes. Next, study 24-2 and 10-2 tests were obtained from both eyes. Test order of each sequence was randomized, and the tests were conducted under standard automated perimetry testing conditions: Goldmann stimulus size III, 3183 cd/m² maximum stimulus intensity, and background intensity of 10 cd/m², using AIZE-Rapid test strategy. Standard VF reliability indices were assessed. For each subject, 24-2 and 10-2 test results from 1 randomly selected eye were analyzed.</p></div><div><h3>Main Outcome Measures</h3><p>Perimetric threshold sensitivity and reference limits for each test analysis parameter.</p></div><div><h3>Results</h3><p>The ages of the study cohort were widely distributed, with a mean age (standard deviation [SD]) of 52.3 (18.5) years. Sex assignment was 44.0% male and 56.0% female. The majority of subjects self-identified as White (67.4%), followed by Black or African American (13.5%) and Asian (8.7%), with 14.6% self-identified as Hispanic or Latino ethnicity. Mean sensitivity (SD) was 29.1 (1.3) decibels (dB) for the 24-2 and 32.4 (1.0) dB for the 10-2 test. For the 24-2 and 10-2, mean sensitivity (SD) age-related changes averaged −0.06 (0.01) dB and −0.05 (0.01) dB per year, respectively. The normal range of pointwise threshold sensitivity increased with eccentricity and showed asymmetry around the mean, particularly notable in the 24-2 test. Mean (SD) binocular test duration was 3.18 (0.38) minutes (1 minute 35 seconds per eye) for the 24-2 test and 3.58 (0.43) minutes (1 minute 47 seconds per eye) for the 10-2 test.</p></div><div><h3>Conclusions</h3><p>An RDB for the TEMPO/IMOvifa perimeter was established, highlighting the significance of considering both age and stimulus eccentricity in interpreting threshold VF test results.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666914524001192/pdfft?md5=ec0b7377fc17660ad95c7721e62a1e84&pid=1-s2.0-S2666914524001192-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141838949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Censoring the Floor Effect in Long-Term Stargardt Disease Microperimetry Data Produces a Faster Rate of Decline","authors":"","doi":"10.1016/j.xops.2024.100581","DOIUrl":"10.1016/j.xops.2024.100581","url":null,"abstract":"<div><h3>Purpose</h3><p>To evaluate progression rate estimation in long-term Stargardt disease microperimetry data by accounting for floor effect.</p></div><div><h3>Design</h3><p>Cohort study.</p></div><div><h3>Subjects</h3><p>Thirty-seven subjects (23 females, 14 males) with biallelic ABCA4 pathogenic or likely pathogenic variants and more than &gt;2 years of longitudinal microperimetry data.</p></div><div><h3>Methods</h3><p>Cross-sectional and longitudinal microperimetry data (Grid A: 18° diameter, Grid B: 6° diameter; Macular Integrity Assessment microperimeter, dynamic range 0–36 decibels [dB]) was extracted from patients with biallelic mutation in the adenosine triphosphate-binding cassette subfamily A member 4 (<em>ABCA4</em>) gene. For each eye, mean sensitivity (MS) and responding point sensitivity (RPS) rates were extracted. Floor censored sensitivity (FCS) progression rate, which accounts for the floor effect at each locus by terminating calculation when scotoma was observed in 2 consecutive visits, was also calculated. In a subset of eyes with ≥1 scotomatous locus at baseline (Grid A), sensitivity progression of loci around the scotoma (edge of scotoma sensitivity [ESS]) was examined against other progression parameters. Paired <em>t</em> test compared progression rate parameters across the same eyes.</p></div><div><h3>Main Outcome Measures</h3><p>Microperimetry grid parameters at baseline and progression rates.</p></div><div><h3>Results</h3><p>A total of 37 subjects with biallelic <em>ABCA4</em> mutations and &gt;2 years of longitudinal microperimetry data were included in the study. In Grid A, at baseline, the average MS and RPS were 16.5 ± 7.9 and 19.1 ± 5.7 dB, respectively. Similar MS (18.4 ± 7.6 dB) and RPS (20.0 ± 5.5 dB) values were found at baseline for Grid B. In Grid A, overall, MS, RPS, and FCS progression rates were −0.57 ± 1.05, −0.74 ± 1.24, and −1.26 ± 1.65 (all dB/year), respectively. Floor censored sensitivity progression rate was significantly greater than the MS or RPS progression rates. Similar findings were observed in Grid B (MS −1.22 ± 1.42, RPS −1.44 ± 1.44, FCS −2.16 ± 2.24, all dB/year), with paired <em>t</em> test again demonstrated that FCS had a significantly faster rate of decline than MS or RPS. In patients with progression data in both grids, MS, RPS, and FCS progression rates were significantly faster in the smaller Grid B. In 24 eyes with scotoma at baseline, fastest rate of decline was ESS combined with FCS compared with other progression parameters.</p></div><div><h3>Conclusions</h3><p>Incorporation of FCS can reduce confound of floor effect in perimetry analysis and can in turn detect a faster rate of decline.</p></div><div><h3>Financial Disclosure(s)</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666914524001179/pdfft?md5=5a10ead90090ebe64a026d61cb8212f2&pid=1-s2.0-S2666914524001179-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141840548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative Volumetric Analysis of Retinal Ischemia with an Oxygen Diffusion Model and OCT Angiography","authors":"","doi":"10.1016/j.xops.2024.100579","DOIUrl":"10.1016/j.xops.2024.100579","url":null,"abstract":"<div><h3>Purpose</h3><p>Retinal ischemia is a major feature of diabetic retinopathy (DR). Traditional nonperfused areas measured by OCT angiography (OCTA) measure blood supply but not ischemia. We propose a novel 3-dimensional (3D) quantitative method to derive ischemia measurements from OCTA data.</p></div><div><h3>Design</h3><p>Cross-sectional study.</p></div><div><h3>Participants</h3><p>We acquired 223 macular OCTA volumes from 33 healthy eyes, 33 diabetic eyes without retinopathy, 7 eyes with nonreferable DR, 17 eyes with referable but nonvision-threatening DR, and 133 eyes with vision-threatening DR.</p></div><div><h3>Methods</h3><p>Each eye was scanned using a spectral-domain OCTA system (Avanti RTVue-XR, Visionix/Optovue, Inc) with 1.6-mm scan depth in a 3 × 3-mm region (640 × 304 × 304 voxels) centered on the fovea. For each scanned OCTA volume, a custom algorithm removed flow projection artifacts. We then enhanced, binarized, and skeletonized the vasculature in each OCTA volume and generated a 3D oxygen tension map using a zero-order kinetics oxygen diffusion model. Each volume was scaled to the average retina thickness in healthy controls after foveal registration and flattening of the Bruch's membrane. Finally, we extracted 3D ischemia maps by comparison with a reference map established from scans of healthy eyes using the same processing. To assess the ability of the ischemia maps to grade DR severity, we constructed receiver operating characteristic curves for diagnosing diabetes, referable DR, and vision-threatening DR.</p></div><div><h3>Main Outcome Measures</h3><p>Spearman correlation coefficient and area under receiver operating characteristic curve (AUC) were used to quantify the ability of the ischemia maps to DR.</p></div><div><h3>Results</h3><p>The ischemia maps showed that the ischemic tissues were at or near pathologically nonperfused areas, but not the normally nonvascular tissue, such as the foveal avascular zone. We found multiple novel metrics, including inferred 3D-oxygen tension, ischemia index, and ischemic volume ratio, were strongly correlated with DR severity. The AUCs of ischemia index measured were 0.94 for diabetes, 0.89 for DR, 0.88 for referable DR, and 0.85 for vision-threatening DR.</p></div><div><h3>Conclusions</h3><p>A quantitative method to infer 3D oxygen tension and ischemia using OCTA in diabetic eyes can identify ischemic tissue that are more specific to pathologic changes in DR.</p></div><div><h3>Financial Disclosures</h3><p>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666914524001155/pdfft?md5=b7ecfcf304d2f9f069a370d571d1ba6c&pid=1-s2.0-S2666914524001155-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}