Ophthalmology science最新文献

{"title":"Repeatability of Fractal Analysis in OCT Angiography of the Macula and Optic Nerve Head","authors":"Gustavo Rosa Gameiro MD, PhD,&nbsp;Alessandro A. Jammal MD, PhD,&nbsp;Verônica Vilasboas-Campos MD,&nbsp;Jianhua Wang MD, PhD,&nbsp;Felipe A. Medeiros MD, PhD","doi":"10.1016/j.xops.2025.100784","DOIUrl":"10.1016/j.xops.2025.100784","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the repeatability of OCT angiography (OCTA) vessel density measurements using fractal analysis in the macula and optic nerve head (ONH) regions.</div></div><div><h3>Design</h3><div>A prospective longitudinal observational cohort study.</div></div><div><h3>Participants</h3><div>One hundred sixteen eyes from 71 primary open-angle glaucoma patients with valid macula OCTA scans and 91 eyes from 59 primary open-angle glaucoma patients with valid ONH OCTA scans, with 53 patients contributing scans for both regions.</div></div><div><h3>Methods</h3><div>Participants underwent 5 OCTA imaging sessions at weekly intervals using the Spectralis spectral-domain OCT (Heidelberg Engineering). OCT angiography images were processed for fractal analysis focusing on small vessels (&lt;25 μm in diameter) within <em>en face</em> slabs of the superficial vascular complex (SVC), deep vascular complex (DVC), full retina, and nerve fiber layer vascular plexus (NFLVP). Vessel density repeatability was assessed using the coefficient of variation (CoV) with bootstrapped 95% confidence intervals. Associations between fractal analysis parameters and peripapillary retinal nerve fiber layer (RNFL) thickness were analyzed.</div></div><div><h3>Main Outcome Measures</h3><div>Repeatability of OCTA vessel density quantified by fractal analysis and correlation with RNFL thickness.</div></div><div><h3>Results</h3><div>One thousand three hundred twenty-eight macula OCTA scans from 269 visits and 801 ONH scans from 164 visits were included. Fractal analysis demonstrated high repeatability for vessel density measurements, with CoVs ranging from 0.4% to 0.9% in the macula and 0.7% to 1.8% in the ONH region. Full retina slabs exhibited the best repeatability in both regions, while DVC measurements in the ONH showed the highest variability (CoV = 1.8%). Moderate correlations between fractal parameters and RNFL thickness were observed in the ONH (SVC: rho = 0.65; NFLVP: rho = 0.67; <em>P</em> &lt; 0.001) and macula (SVC: rho = 0.33, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>High repeatability of OCTA vessel density measurements using fractal analysis was observed in the macula and ONH regions, supporting its potential utility in monitoring vascular changes in glaucoma. Future studies should investigate its diagnostic accuracy and ability to detect disease progression.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"5 5","pages":"Article 100784"},"PeriodicalIF":3.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143907487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Imminent Conversion to Exudative Age-Related Macular Degeneration Using Multimodal Data and Ensemble Machine Learning","authors":"T.Y.Alvin Liu MD ,&nbsp;Yuxuan Liu MS ,&nbsp;Madeleine S. Gastonguay BS ,&nbsp;Dan Midgett PhD ,&nbsp;Nathanael Kuo PhD ,&nbsp;Yujie Zhao ,&nbsp;Kareef Ullah ,&nbsp;Gwyneth Alexander ,&nbsp;Todd Hartman ,&nbsp;Neslihan D. Koseoglu MD ,&nbsp;Craig Jones PhD","doi":"10.1016/j.xops.2025.100785","DOIUrl":"10.1016/j.xops.2025.100785","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;Exudative age-related macular degeneration (eAMD) is a major cause of central vision loss. Identifying patients at high risk of imminent eAMD could enable timely treatment and improve outcomes. Our goal was to develop and compare classical machine learning (ML) and deep learning (DL) models to predict imminent eAMD conversion within 6 months and integrate OCT with clinical data into a single predictive model.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Retrospective cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants&lt;/h3&gt;&lt;div&gt;Patients seen at the Wilmer Eye Institute between 2013 and 2021 with eAMD in ≥1 eye.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Spectral domain OCT volumes prior to conversion and the corresponding clinical data (age, best-corrected visual acuity, sex, and fellow-eye status) were collected and used for model training or testing. ResNet-50 and classical ML (Random Forest and XGBoost) models were trained to predict imminent conversion to eAMD within 6 months on an eye level. For the multilayer perceptron (MLP) framework, the trained ResNet-50 model was used as the feature encoder, and a downsampled feature vector concatenated with corresponding clinical tabular data was passed through the MLP (prediction head). Data were partitioned at the patient level (75% training, 15% validation, and 10% testing). Model performance was evaluated using the area under the operating characteristic curve (AUC) and 95% confidence interval (CI) for the model AUC was calculated using the percentile method after bootstrapping the test set 10 000 times. Model comparisons were made using modified paired &lt;em&gt;t&lt;/em&gt; test. &lt;em&gt;P&lt;/em&gt; &lt; 0.05 was considered statistically significant.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;Area under the operating characteristic curve.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Thirty-three thousand one hundred eighty-nine OCT volumes from 2084 patients (63% female; 89.1% White, 4.8% Black, and 2.3% Asian) were included. The mean age at the time of first-eye conversion was 78.9 (± 9.3) years. Our best-performing models, “MLP multimodal” (trained with both OCT and clinical data; AUC: 0.76, 95% CI: 0.71–0.80) and “CNN OCT” (trained with only OCT data; AUC: 0.75, 95% CI: 0.70–0.79), had a DL (ResNet-50) architecture; “MLP multimodal” outperformed “CNN OCT” in predicting both all-eye (&lt;em&gt;P&lt;/em&gt; &lt; 0.05) and first-eye conversion (&lt;em&gt;P&lt;/em&gt; &lt; 0.001).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;The 3-dimensional DL models, trained with OCT volumes, are capable of predicting both first-eye and fellow-eye imminent conversion to eAMD. The addition of clinical data further improved the model performance. These models, if validated prospectively, could serve as screening tools and allow retinal specialists to prioritize patients with more acute retinal issues.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Financial Disclosure(s)&lt;/h3&gt;&lt;div&gt;Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"5 5","pages":"Article 100785"},"PeriodicalIF":3.2,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144124774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Features and Natural Progression of Unilateral High Myopia in Adults: A Comparison Study","authors":"Dong Geun Kim MD ,&nbsp;Seok Hyun Bae MD ,&nbsp;Dong Ju Kim MD ,&nbsp;Jong Suk Lee MD ,&nbsp;Kwangsic Joo MD, PhD ,&nbsp;Sang Jun Park MD, PhD ,&nbsp;Se Joon Woo MD, PhD ,&nbsp;Kyu Hyung Park MD, PhD","doi":"10.1016/j.xops.2025.100780","DOIUrl":"10.1016/j.xops.2025.100780","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate and compare the clinical characteristics of patients with unilateral high myopia (UHM) and bilateral high myopia (BHM) based on axial length (AL).</div></div><div><h3>Design</h3><div>A retrospective cohort study.</div></div><div><h3>Participants</h3><div>Adult patients diagnosed with UHM or BHM between March 2011 and August 2021.</div></div><div><h3>Methods</h3><div>Unilateral high myopia was defined as ≥26 mm AL in 1 eye and &lt;26 mm in the other, with ≥2 mm difference. Bilateral high myopia was defined as ≥26 mm AL in both eyes, with ≤3 mm difference. In each patient, the eye with the longer AL was designated the “longer eye” and the other the “shorter eye.” We analyzed differences in clinical features, including ophthalmic history, best-corrected visual acuity, ocular biometry, and myopic maculopathy grade. Myopic maculopathy was graded based on atrophy, traction, and neovascularization using a known method. Long-term features included treatments for myopic neovascular maculopathy and myopic tractional maculopathy and AL change over time.</div></div><div><h3>Main Outcome Measures</h3><div>Comparison of clinical characteristics between UHM and BHM groups.</div></div><div><h3>Results</h3><div>We analyzed 369 patients (79 with UHM and 290 with BHM) with a median follow-up period of 4.5 years. The UHM group had a higher proportion of women than the BHM group (88.8% vs. 76.2%, <em>P</em> = 0.025). Compared with longer eyes in the BHM group, those in the UHM group had worse best-corrected visual acuity (0.8 ± 0.6 vs. 0.6 ± 0.6 in logarithm of the minimum angle of resolution, <em>P</em> &lt; 0.001) despite having shorter AL (29.1 ± 1.6 mm vs. 30.6 ± 1.9 mm, <em>P</em> &lt; 0.001). In the analysis of AL changes, shorter eyes in the UHM group showed no elongation over time (0.014 mm/year, <em>P</em> = 0.12), unlike the longer eyes in UHM and both eyes in BHM (0.049–0.071 mm/year, <em>P</em> &lt; 0.01).</div></div><div><h3>Conclusions</h3><div>Adult UHM patients mostly lacked associated environmental factors. The poorer visual acuity in the longer eyes of UHM patients, which cannot be explained by structural abnormalities, suggests that the interocular difference may have originated in early childhood. During the follow-up period, AL elongation and myopic complications occurred at similar rates in the longer eye of UHM and both eyes of BHM. Meanwhile, such changes were not observed in the shorter eye in UHM. Further investigation of the underlying mechanisms, such as the genetic factors contributing to this extreme asymmetry, is warranted.</div></div><div><h3>Financial Disclosure(s)</h3><div>The author(s) have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"5 5","pages":"Article 100780"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143907489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Analysis of Mesopic Microperimetry in a Phase II Trial Evaluating Minocycline for Geographic Atrophy","authors":"Thilaka Arunachalam BS ,&nbsp;Maria Abraham ScM ,&nbsp;Christine Orndahl PhD ,&nbsp;Supriya Menezes MS ,&nbsp;Souvick Mukherjee PhD ,&nbsp;Cameron Duic BS ,&nbsp;Minali Prasad BA ,&nbsp;Fares Siddig BS ,&nbsp;Sunil Bellur MD ,&nbsp;Alisa T. Thavikulwat MD ,&nbsp;Clare Bailey MD ,&nbsp;SriniVas R. Sadda MD ,&nbsp;Wai T. Wong MD, PhD ,&nbsp;Emily Y. Chew MD ,&nbsp;Brett G. Jeffrey PhD ,&nbsp;Tiarnán D.L. Keenan BM BCh, PhD","doi":"10.1016/j.xops.2025.100783","DOIUrl":"10.1016/j.xops.2025.100783","url":null,"abstract":"<div><h3>Purpose</h3><div>To analyze mesopic microperimetry data from a recent phase II trial of minocycline for geographic atrophy (GA) for possible efficacy on the change in visual function and, in the absence of efficacy, to perform longitudinal analyses as a natural history study.</div></div><div><h3>Design</h3><div>Phase II, prospective, single-arm, nonrandomized trial. After a 9-month run-in phase, participants began oral minocycline 100 mg twice daily for 3 years.</div></div><div><h3>Participants</h3><div>Individuals with GA in ≥1 eye.</div></div><div><h3>Methods</h3><div>Participants underwent mesopic microperimetry at baseline, month 3, and every 6 months thereafter, using a custom T-shaped test pattern. Rates of change in microperimetry parameters were compared between the 24-month treatment phase and 9-month run-in phase by linear spline regression.</div></div><div><h3>Main Outcome Measures</h3><div>The mean macular and responding sensitivity; the mean perilesional and extralesional sensitivity; number of absolute and relative scotomatous loci.</div></div><div><h3>Results</h3><div>Thirty study eyes from 30 participants (mean age 74.1 years) underwent microperimetry (mean follow-up 27.4 months). For 5 of the 6 microperimetry parameters, no significant difference in the rate of change between the treatment and run-in phases was observed. The difference between the 2 phases was −0.74 decibels (dB)/year (standard error [SE] 0.85; <em>P</em> = 0.39) for mean macular sensitivity, −0.30 dB/year (SE 0.85; <em>P</em> = 0.72) for mean responding sensitivity, 1.23 dB/year (SE 1.01; <em>P</em> = 0.22) for mean perilesional sensitivity, and −0.02 (SE 0.01; <em>P</em> = 0.31) for transformed mean extralesional sensitivity. The difference in incidence rate ratios between the 2 phases was 1.17 (SE 0.11; <em>P</em> = 0.14) for absolute scotomatous loci and 0.73 (SE 0.11; <em>P</em> = 0.004) for relative scotomatous loci.</div></div><div><h3>Conclusions</h3><div>The results do not appear consistent with a clinically meaningful effect of minocycline on the rate of visual function decline from GA progression. This is consistent with previous analyses of the corresponding structural data. The findings demonstrate the advantages and disadvantages of different microperimetry parameters. The optimal testing patterns and parameters represent a trade-off between greater sensitivity vs. greater risk of floor/ceiling effects, with regional averages providing a useful compromise. The results may provide insights to guide the development of microperimetry end points for clinical trials.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"5 5","pages":"Article 100783"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HORNBILL: A First-in-Human Phase I/IIa Study of the Safety, Tolerability, and Early Pharmacodynamics of BI 764524 for Diabetic Macular Ischemia","authors":"Quan Dong Nguyen MD, MSc ,&nbsp;Chirag Jhaveri MD ,&nbsp;Maged Habib MD ,&nbsp;Yasir J. Sepah MBBS ,&nbsp;Khaled Nassar MD, PhD ,&nbsp;Bartlomiej Krawczyk PhD ,&nbsp;Gudrun Simons PhD ,&nbsp;Andrea Giani MD ,&nbsp;Elizabeth Pearce PhD ,&nbsp;Martin Gliem MD ,&nbsp;Mohamed Ahmed MBBCh, MD ,&nbsp;Sobha Sivaprasad DM ,&nbsp;HORNBILL Study Group","doi":"10.1016/j.xops.2025.100781","DOIUrl":"10.1016/j.xops.2025.100781","url":null,"abstract":"<div><h3>Objective</h3><div>To report safety and early pharmacodynamic results from a first-in-human trial of intravitreal (IVT) anti-semaphorin 3A antibody in participants with diabetic macular ischemia (DMI).</div></div><div><h3>Design</h3><div>HORNBILL, a phase I/IIa study of BI 764524, comprised a nonrandomized, open-label, uncontrolled, single-rising-dose (SRD) and masked, randomized, sham-controlled, multiple-dose (MD) parts.</div></div><div><h3>Participants</h3><div>Adults with DMI and stable diabetic retinopathy (DR) treated with pan-retinal photocoagulation and without center-involving diabetic macular edema.</div></div><div><h3>Methods</h3><div>Twelve participants received single IVT doses of BI 764524 0.5 mg (n = 3), 1.0 mg (n = 3), or 2.5 mg (n = 6) in the SRD part. Thirty-one participants received 3 IVT doses of BI 764524 2.5 mg (n = 21) or sham procedures (n = 10) at 4-week intervals and were followed to week 22 in the MD part.</div></div><div><h3>Main Outcome Measures</h3><div>The primary SRD end point was the number of participants with dose-limiting events; secondary end points assessed drug-related and ocular adverse events (AEs). The primary MD end point was the number of participants with drug-related AEs; secondary end points included changes from baseline in foveal avascular zone (FAZ) area, best-corrected visual acuity (BCVA), and central subfield thickness (CST).</div></div><div><h3>Results</h3><div>No dose-limiting events or drug-related AEs were reported with SRD; the highest tested dose (2.5 mg) was selected for the MD part. In the MD part, 2 investigator-assessed drug-related AEs (vitreous floaters and increased gamma-glutamyl transferase) were reported. No intraocular inflammation or occlusive retinal vasculitis cases occurred. At week 12 (4 weeks after the final injection), the adjusted mean FAZ area change was −0.004 mm² in the BI 764524 group and +0.019 mm² with sham. At week 22 (14 weeks after the final injection), the adjusted mean FAZ area change was −0.001 mm² in the BI 764524 group and +0.010 mm² with sham. No relevant BCVA and CST changes occurred.</div></div><div><h3>Conclusions</h3><div>HORNBILL met the primary safety end points; all evaluated BI 764524 doses were well tolerated. These findings support further investigation of BI 764524 in participants with DR and retinal nonperfusion.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"5 5","pages":"Article 100781"},"PeriodicalIF":3.2,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Light Inhibits Lens-Induced Myopia through an Intensity-Dependent Dopaminergic Mechanism","authors":"Cindy Karouta PhD ,&nbsp;Kate Thomson PhD ,&nbsp;Ian Morgan PhD ,&nbsp;Regan Ashby PhD","doi":"10.1016/j.xops.2025.100779","DOIUrl":"10.1016/j.xops.2025.100779","url":null,"abstract":"<div><h3>Purpose</h3><div>Bright light exposure has been postulated to underlie the ability of time spent outdoors to prevent the development of myopia in humans. In support of this, bright light inhibits the development of form-deprivation myopia (FDM) in all species studied. While lens-induced myopia (LIM) is also inhibited by bright light in most species, it remains unclear whether this is brought about in an intensity-dependent manner and whether dopamine (DA) plays the same critical role in this paradigm as is seen in FDM.</div></div><div><h3>Design</h3><div>An experimental study.</div></div><div><h3>Subjects</h3><div>White Leghorn chickens (<em>Gallus gallus</em>).</div></div><div><h3>Methods</h3><div>To examine the effect of light on LIM, chicks fit with lenses of −10 diopters were exposed to 500, 20 000, or 40 000 lux for 14 days (n = 6 per group). To assess the role of DA, its levels were measured 30 minutes after light exposure in previously dark-adapted animals over 6 light intensities (between dark and 40 000 lux). In a separate experiment, a D1-like (SCH-23390) or D2-like (spiperone) receptor antagonist was administered (once daily) to chicks wearing negative lenses under 40 000 lux (n = 5 to 6 per group) for a period of 5 days.</div></div><div><h3>Main Outcome Measures</h3><div>Refraction (infrared photoretinoscopy), axial length (A-scan ultrasonography), and DA levels (liquid chromatography-tandem mass spectrometry).</div></div><div><h3>Results</h3><div>Bright light inhibited LIM in an intensity-dependent manner (<em>P</em> &lt; 0.05) but did not prevent full compensation. The protection afforded by bright light was significantly reduced by administration of spiperone (D2-like, <em>P</em> &lt; 0.05), but not SCH-23390 (D1-like, <em>P</em> = 0.77). Retinal DA levels showed an intensity-dependent increase (<em>P</em> &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>As previously observed for FDM, bright light can inhibit the development of LIM in an intensity-dependent manner. This protection occurs, at least in part, via a DA-dependent mechanism. However, bright light's inability to prevent compensation to negative lenses is indicative of mechanistic differences between the 2 experimental models of myopia. These differences are most likely linked to the presence of a defocus-driven end point for growth in LIM that is not present in FDM.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"5 5","pages":"Article 100779"},"PeriodicalIF":3.2,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143911923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computerized Analysis of the Eye Vasculature in a Mass Dataset of Digital Fundus Images: The Example of Age, Sex, and Primary Open-Angle Glaucoma","authors":"Jonathan Fhima MSc ,&nbsp;Jan Van Eijgen MD, PhD ,&nbsp;Anat Reiner-Benaim PhD ,&nbsp;Lennert Beeckmans MSc ,&nbsp;Or Abramovich MSc ,&nbsp;Ingeborg Stalmans MD, PhD ,&nbsp;Joachim A. Behar PhD","doi":"10.1016/j.xops.2025.100778","DOIUrl":"10.1016/j.xops.2025.100778","url":null,"abstract":"<div><h3>Objective</h3><div>To develop and validate an automated end-to-end methodology for analyzing retinal vasculature in large datasets of digital fundus images (DFIs), aiming to assess the influence of demographic and clinical factors on retinal microvasculature.</div></div><div><h3>Design</h3><div>This study employs a retrospective cohort design to achieve its objectives.</div></div><div><h3>Participants</h3><div>The research utilized a substantial dataset consisting of 32 768 DFIs obtained from individuals undergoing routine eye examinations. There was no inclusion of a separate control group in this study.</div></div><div><h3>Methods</h3><div>The proposed methodology integrates multiple stages: initial image quality assessment, detection of the optic disc (OD), definition of the region of interest surrounding the OD, automated segmentation of retinal arterioles and venules, and the engineering of digital biomarkers representing vasculature characteristics. To analyze the impact of demographic variables (age, sex) and clinical factors (disc size, primary open-angle glaucoma [POAG]), statistical analyses were performed using linear mixed-effects models.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcomes measured were changes in the retinal vascular geometry. Special attention was given to evaluating the independent effects of age, sex, disc size, and POAG on the newly engineered microvasculature biomarkers.</div></div><div><h3>Results</h3><div>The analysis revealed significant independent similarities in the retinal vascular geometry alterations associated with both advanced age and POAG. These findings suggest a potential mechanism of accelerated vascular aging in patients with POAG.</div></div><div><h3>Conclusions</h3><div>This novel methodology allows for the comprehensive and quantitative analysis of retinal vasculature, facilitating the investigation of its correlations with specific diseases. By enabling the reproducible analysis of extensive datasets, this approach provides valuable insights into the state of retinal vascular health and its broader implications for cardiovascular and ocular health. The software developed through this research will be made publicly available upon publication, offering a critical tool for ongoing and future studies in retinal vasculature.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"5 5","pages":"Article 100778"},"PeriodicalIF":3.2,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Onset of End-Stage Atrophic Age-Related Macular Degeneration as an End Point—A Delphi Study: Classification of Atrophy Meetings Report 7","authors":"Zhichao Wu BAppSc(Optom), PhD ,&nbsp;Srinivas R. Sadda MD ,&nbsp;Thomas Ach MD ,&nbsp;Barbara A. Blodi MD ,&nbsp;Ferdinando Bottoni MD ,&nbsp;Usha Chakravarthy MD, PhD ,&nbsp;Emily Y. Chew MD ,&nbsp;Christine A. Curcio PhD ,&nbsp;Frederick L. Ferris III MD ,&nbsp;Monika Fleckenstein MD ,&nbsp;K. Bailey Freund MD ,&nbsp;Juan E. Grunwald MD ,&nbsp;Frank G. Holz MD ,&nbsp;Glenn J. Jaffe MD ,&nbsp;Sandra Liakopoulos MD ,&nbsp;Tock Han Lim FRCSEd ,&nbsp;Jordi M. Monés MD, PhD ,&nbsp;Sergio Pagliarini MD, FRCOphth ,&nbsp;Daniel Pauleikhoff MD ,&nbsp;Maximilian Pfau MD ,&nbsp;Robyn H. Guymer MBBS, PhD","doi":"10.1016/j.xops.2025.100777","DOIUrl":"10.1016/j.xops.2025.100777","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate whether consensus can be reached on the acceptability of end-stage atrophy onset as a clinical end point in early intervention trials of age-related macular degeneration (AMD), and the criteria for defining such an end point.</div></div><div><h3>Design</h3><div>A modified Delphi study.</div></div><div><h3>Participants</h3><div>International panel of experts in AMD, retinal imaging, and histopathology that are part of the Classification of Atrophy Meetings group.</div></div><div><h3>Methods</h3><div>A modified Delphi study was undertaken to determine if there is consensus on the acceptability of the onset of end-stage atrophic AMD as a clinical end point to evaluate early interventions and the criteria for defining such an end point. Two initial rounds of online surveys were conducted. Aggregate results and anonymized comments were provided after each round, followed by a face-to-face meeting before a final survey round was completed.</div></div><div><h3>Main Outcome Measures</h3><div>Statements where consensus was reached, defined as ≥80% of responses within the 3-point bracket for agreement or disagreement based on a 9-point Likert rating scale, from a total of 33 statements included in the final round of the survey.</div></div><div><h3>Results</h3><div>Consensus was reached for the statement that the onset of end-stage atrophic AMD was an appropriate clinical end point to evaluate early interventions (82% responses in agreement). Consensus was also reached for the statement that such an end point should be defined based on anatomical changes that have been previously shown in clinical studies to be associated with marked, but not necessarily complete, functional loss (95% responses in agreement). Consensus was nearly reached for the specific criterion that ≥90% of such atrophic AMD lesions should have ≥1 test location that was ≤10 decibels on 2 microperimetry tests (77% responses in agreement).</div></div><div><h3>Conclusions</h3><div>There was expert group consensus that the onset of end-stage atrophy is an appropriate clinical end point to evaluate early interventions in AMD, and that such an end point should show evidence of marked functional loss in prior clinical studies. We believe these findings will help to define incident clinical end points that are acceptable to regulatory authorities.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"5 5","pages":"Article 100777"},"PeriodicalIF":3.2,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genotypic Distribution and Clinical Correlations in Familial Exudative Vitreoretinopathy: A Single-Center Study","authors":"Brian T. Soetikno MD PhD ,&nbsp;Emily Spoth MS ,&nbsp;M. Elizabeth Hartnett MD","doi":"10.1016/j.xops.2025.100782","DOIUrl":"10.1016/j.xops.2025.100782","url":null,"abstract":"<div><h3>Purpose</h3><div>To report the role of wide-angle imaging in detecting suspicious cases of familial exudative vitreoretinopathy (FEVR) in pediatric patients with unexplained vision loss and describe genotypic distribution and examples of phenotypes.</div></div><div><h3>Design</h3><div>A retrospective cohort study was conducted at a single tertiary referral center in the Intermountain West.</div></div><div><h3>Subjects and Participants</h3><div>Patients diagnosed with FEVR or atypical retinopathy of prematurity (ROP) between 2010 and 2021 at the University of Utah. Twenty-five families with FEVR were included, with 21 families undergoing genetic testing. Eight families with atypical ROP were included.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis of patients referred with unexplained vision loss and diagnosed with FEVR at the pediatric retina center at the University of Utah from 2010 to 2021. Clinical examination and wide-angle fluorescein angiography (FA) were performed. Patients identified with abnormal peripheral retinal or intravitreal vascularization were recommended for genetic testing. Next-generation sequencing was used to identify variants in known genes associated with FEVR. The positivity rate and the proportion of each positive genetic mutation were calculated. We also include a small cohort of premature infants with atypical ROP who underwent genetic testing prior to the examination under anesthesia.</div></div><div><h3>Main Outcome Measures</h3><div>Detection rate of FEVR-associated mutations.</div></div><div><h3>Results</h3><div>Genetic variants were identified in 85.7% of families who underwent testing, exceeding previously reported detection rates. LRP5 (33.3%) and FZD4 (19%) were the most common mutations. Indeterminate results were reported in 4.8% of cases, while 9.5% had negative results for FEVR-associated mutations. Among the 8 premature infants with atypical regression of ROP, none tested positive for FEVR-associated genotypes. We described 5 illustrative cases that demonstrate unique presentations in our cohort, including those showing phenotypic variability or masquerading as other disorders.</div></div><div><h3>Conclusions</h3><div>The findings highlight the genotypic and phenotypic heterogeneity of FEVR and underscore the value of wide-angle FA to trigger obtaining genetic testing for accurate diagnosis. A high clinical suspicion for FEVR is recommended in pediatric patients with unexplained vision loss and vitreoretinal abnormalities. Future studies are needed to investigate additional genetic modifiers and refine genotype–phenotype correlations.</div></div><div><h3>Financial Disclosure(s)</h3><div>The author(s) have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"5 5","pages":"Article 100782"},"PeriodicalIF":3.2,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Eye-Related Emergency Department Visits and Pediatric Eye Provider Location and Density","authors":"Julius T. Oatts MD ,&nbsp;Albert Xu BS ,&nbsp;Jonathan R. Morse BA ,&nbsp;John M. Nesemann MD ,&nbsp;Kara M. Cavuoto MD ,&nbsp;Jeremy D. Keenan MD","doi":"10.1016/j.xops.2025.100776","DOIUrl":"10.1016/j.xops.2025.100776","url":null,"abstract":"<div><h3>Objective</h3><div>There is a shortage of pediatric eye specialists. Inaccessible eye care may lead parents to bring their children to the emergency department (ED) to address eye problems that could have been handled at a clinic visit. This study aimed to determine the association between childhood eye-related ED visits and the location and density of pediatric eye specialists in California.</div></div><div><h3>Design</h3><div>A population-based cross-sectional study.</div></div><div><h3>Participants</h3><div>All California ED visits between January 2012 and December 2021 for patients ≤18 years of age were identified using the California Office of Health Care Access and Information Database.</div></div><div><h3>Methods</h3><div>International Classification of Diseases diagnosis codes were used to identify eye-related ED visits. Public databases were used to identify pediatric ophthalmologist and optometrist addresses. Census data were used to determine the number of visits per 10 000 children in each zip code. Poisson regressions evaluated associations at the zip code level of eye-related ED visits and provider density with geographic sociodemographic factors.</div></div><div><h3>Main Outcome Measures</h3><div>Incidence of pediatric eye-related ED visits.</div></div><div><h3>Results</h3><div>Of the 117 363 721 ED visits in California between 2012 and 2021, 27 346 729 (23.3%) were for children, of which 391 985 (1.4%) were eye-related. Median age was 5.0 years (interquartile range: 2.0, 10.0), and 51.7% were male. The most common diagnoses were conjunctivitis (250 028; 63.8%), chalazion/blepharitis (56 389; 14.4%), and other disorders of the eye/adnexa (13 070; 3.3%). The mean number of visits per year per 10 000 children was 43 ± 12 (median 46, interquartile range: 43, 51). The estimated number of pediatric eye providers in California in 2023 was 142 (1 per 61 413 children). Zip codes with more pediatric eye providers had fewer eye-related ED visits: each additional provider per 10 000 children was associated with 2.1 fewer eye-related ED visits per 10 000 children (95% confidence interval −0.04 to −4.25; <em>P</em> = 0.046).</div></div><div><h3>Conclusions</h3><div>Most eye-related ED visits were for nonemergent eye conditions. There was a low eye provider-to-child ratio and an association between provider density and eye-related ED visit incidence. Expanding pediatric eye care could improve access and decrease ED utilization for nonemergent eye concerns.</div></div><div><h3>Financial Disclosure(s)</h3><div>The author(s) have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"5 5","pages":"Article 100776"},"PeriodicalIF":3.2,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}