Detailed Morphological Changes of Foveoschisis in Patient with X-Linked Retinoschisis Detected by SD-OCT and Adaptive Optics Fundus Camera

Purpose. To report the morphological and functional changes associated with a regression of foveoschisis in a patient with X-linked retinoschisis (XLRS).Methods. A 42-year-old man with XLRS underwent genetic analysis and detailed ophthalmic examinations. Functional assessments included best-corrected visual acuity (BCVA), full-field electroretinograms (ERGs), and multifocal ERGs (mfERGs). Morphological assessments included fundus photography, spectral-domain optical coherence tomography (SD-OCT), and adaptive optics (AO) fundus imaging. After the baseline clinical data were obtained, topical dorzolamide was applied to the patient. The patient was followed for 24 months.Results. A reportedRS1gene mutation was found (P203L) in the patient. At the baseline, his decimal BCVA was 0.15 in the right and 0.3 in the left eye. Fundus photographs showed bilateral spoke wheel-appearing maculopathy. SD-OCT confirmed the foveoschisis in the left eye. The AO images of the left eye showed spoke wheel retinal folds, and the folds were thinner than those in fundus photographs. During the follow-up period, the foveal thickness in the SD-OCT images and the number of retinal folds in the AO images were reduced.Conclusions. We have presented the detailed morphological changes of foveoschisis in a patient with XLRS detected by SD-OCT and AO fundus camera. However, the findings do not indicate whether the changes were influenced by topical dorzolamide or the natural history.

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Diabetic maculopathy: multicolour and SD-OCT versus fundus photography

BMJ Open Ophthalmology ◽

10.1136/bmjophth-2020-000514 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000514

Author(s):

Obaid Kousha ◽

Martina Maria Delle Fave ◽

Mariano Cozzi ◽

Elisa Carini ◽

Sergio Pagliarini

Keyword(s):

Macular Oedema ◽

Cross Sectional Study ◽

Fundus Photography ◽

Diabetic Maculopathy ◽

Perfect Agreement ◽

Cross Sectional ◽

Clinically Significant ◽

Fundus Photographs ◽

Diabetic Eye Screening ◽

Sd Oct

ObjectiveThe English Diabetic Eye Screening (DES) programme recommends patients with M1 diabetic maculopathy to be referred to hospital eye services. DES uses flash fundus photography as the reference standard for maculopathy grading. We compared multicolour versus non-stereoscopic fundus photography at identifying M1 maculopathy, with spectral domain optical coherence tomography (SD-OCT) identifying macular thickening.Methods and analysisThis cross-sectional study included 345 patients with R1M1 referred from DES and reviewed in secondary care with fundus photographs, multicolour and SD-OCT. Maculopathy was graded based on DES exudate criteria on both multicolour and fundus photography in a blind fashion by two independent graders. Macular thickness was ascertained on SD-OCT.ResultsIntergrader agreement on grading maculopathy using fundus photography (Cohen’s κ=0.91) and multicolour (Cohen’s κ=0.82) was ‘almost perfect’. Agreement between fundus photography and multicolour on grading maculopathy (Cohen’s κ=0.76) was ‘substantial’. Compared with fundus photography, multicolour had sensitivity of 87% (95% CI 81% to 93%) and specificity of 90% (95% CI 87% to 94%) in detecting M1 maculopathy. SD-OCT identified 84 eyes with macular thickening, 47 of which were graded as M0 by fundus photography. 5 eyes with exudates and severe macular oedema requiring urgent intervention were also missed on fundus photography but not on multicolour. Multicolour, when complemented by SD-OCT, did not miss any clinically significant macular oedema.ConclusionMulticolour integrates synergistically in a single platform with SD-OCT providing effective monitoring of M1 diabetic maculopathy. The need for fundus photography is eliminated by multicolour/SD-OCT in dedicated R1M1 virtual clinics not requiring parallel diabetic retinopathy grading.

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Deep learning-assisted (automatic) diagnosis of glaucoma using a smartphone

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-318107 ◽

2021 ◽

pp. bjophthalmol-2020-318107

Author(s):

Kenichi Nakahara ◽

Ryo Asaoka ◽

Masaki Tanito ◽

Naoto Shibata ◽

Keita Mitsuhashi ◽

...

Keyword(s):

Deep Learning ◽

Learning Algorithm ◽

Fundus Photography ◽

Training Dataset ◽

Mean Deviation ◽

Fundus Camera ◽

Deep Learning Algorithm ◽

Testing Dataset ◽

Advanced Glaucoma ◽

Fundus Photographs

Background/aimsTo validate a deep learning algorithm to diagnose glaucoma from fundus photography obtained with a smartphone.MethodsA training dataset consisting of 1364 colour fundus photographs with glaucomatous indications and 1768 colour fundus photographs without glaucomatous features was obtained using an ordinary fundus camera. The testing dataset consisted of 73 eyes of 73 patients with glaucoma and 89 eyes of 89 normative subjects. In the testing dataset, fundus photographs were acquired using an ordinary fundus camera and a smartphone. A deep learning algorithm was developed to diagnose glaucoma using a training dataset. The trained neural network was evaluated by prediction result of the diagnostic of glaucoma or normal over the test datasets, using images from both an ordinary fundus camera and a smartphone. Diagnostic accuracy was assessed using the area under the receiver operating characteristic curve (AROC).ResultsThe AROC with a fundus camera was 98.9% and 84.2% with a smartphone. When validated only in eyes with advanced glaucoma (mean deviation value < −12 dB, N=26), the AROC with a fundus camera was 99.3% and 90.0% with a smartphone. There were significant differences between these AROC values using different cameras.ConclusionThe usefulness of a deep learning algorithm to automatically screen for glaucoma from smartphone-based fundus photographs was validated. The algorithm had a considerable high diagnostic ability, particularly in eyes with advanced glaucoma.

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Right-angled vessels in macular telangiectasia type 2

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-313364 ◽

2019 ◽

pp. bjophthalmol-2018-313364 ◽

Cited By ~ 7

Author(s):

Simone Tzaridis ◽

Tjebo Heeren ◽

Clarissa Mai ◽

Sarah Thiele ◽

Frank G Holz ◽

...

Keyword(s):

Disease Progression ◽

Morphological Changes ◽

Fundus Photography ◽

Outer Retina ◽

Macular Telangiectasia ◽

Age Related ◽

Macular Telangiectasia Type 2 ◽

Sd Oct

PurposeTo evaluate the role of right-angled vessels (RAVs) during disease progression in macular telangiectasia type 2 (MacTel).MethodsIn this study, 100 eyes of 52 patients and 52 eyes of 26 age-related controls were examined using fundus photography, spectral-domain optical coherence tomography (SD-OCT), OCT angiography (OCT-A) and fundus fluorescein angiography (FFA). Two masked readers graded fundus photographs of patients’ eyes into five disease stages according to Gass and Blodi, and evaluated all eyes for the presence of RAVs. If RAVs were present, their course and origin (arterial vs venous) was evaluated with OCT-A and FFA, respectively. Additionally, we looked for morphological correlates of these vessels on SD-OCT scans. Neovascular eyes were analysed for the presence of RAVs and for morphological changes on formation of neovascularisations (NVs).ResultsIn OCT-A, RAVs were already detectable in eyes with early stages (1 to 2), could be tracked from superficial to outer retinal layers and were shown to form anastomoses in the outer retina with disease progression. These vessels were of both arterial and venous origin as shown by early phase FFA. Dilated capillaries and RAVs in OCT-A corresponded to hyper-reflective alterations of the outer retina on SD-OCT scans. In 19/19 eyes, NVs were associated with the presence of RAVs, and RAVs were shown to directly connect to neovascular complexes and to undergo morphological changes upon NV formation.ConclusionsThe results emphasise the role of RAVs during disease progression from an early stage on and demonstrate their involvement in the development of secondary NVs in MacTel.

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Inter-Rater Reliability of Cyclotorsion Measurements Using Fundus Photography

Klinische Monatsblätter für Augenheilkunde ◽

10.1055/s-0044-101013 ◽

2018 ◽

Vol 235 (04) ◽

pp. 420-423

Author(s):

Muriel Dysli ◽

Madeleine Kanku ◽

Ghislaine Traber

Keyword(s):

Healthy Subjects ◽

Intraclass Correlation ◽

Fundus Photography ◽

Healthy Controls ◽

Trochlear Nerve ◽

Rater Reliability ◽

Fundus Camera ◽

The Mean ◽

Fundus Photographs ◽

Very High

Abstract Background The foveo-papillary angle (FPA) on fundus photographs is the accepted standard for the measurement of ocular cyclotorsion. We assessed the inter-rater reliability of this method in healthy subjects and in patients with trochlear nerve palsies. Patients and Methods In this methodological study, fundus photographs of healthy subjects and of patients with trochlear nerve palsies were made with a fundus camera (Zeiss Fundus Camera FF 450 plus, Jena, Germany). Three independent observers measured the FPA on the fundus photographs of all subjects in synedra View (synedra View 16, Version 16.0.0.11, Innsbruck, Austria). Results One hundred and four eyes of 52 subjects (26 healthy controls and 26 patients) were assessed. The mean FPA of the healthy controls was 5.80 degrees (°) [± 0.44 standard error of the mean (SEM)] compared to 11.55° (± 0.80 SEM) for patients with trochlear nerve palsies. The inter-rater reliability of all measured FPAs showed an intraclass correlation coefficient (ICC) of 0.98 (95% CI 0.97 – 0.98). Conclusions The inter-rater reliability of objective cyclotorsion measurements using fundus photographs was very high.

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Opinion and Special Articles: Amateur fundus photography with various new devices

Neurology ◽

10.1212/wnl.0000000000005480 ◽

2018 ◽

Vol 90 (19) ◽

pp. 897-901 ◽

Cited By ~ 4

Author(s):

Saman Zafar ◽

Ylec Mariana Cardenas ◽

Lakshmi Leishangthem ◽

Sridhara Yaddanapudi

Keyword(s):

Emergency Department ◽

Personal Experience ◽

Fundus Photography ◽

Fundus Examination ◽

Fundus Camera ◽

Diagnostic Skills ◽

Trial Outcomes ◽

Fundus Photographs ◽

American Academy Of Neurology ◽

The Way

Times are changing in the way we secure and share patient fundus photographs to enhance our diagnostic skills in neurology. At the recent American Academy of Neurology meeting, the use of a fundus camera and smartphones to secure good-quality fundus photographs of patients presenting with headache to the emergency department (ED) was presented. We were enthusiastic to replicate the success of the Fundus Photography vs Ophthalmoscopy Trial Outcomes in the Emergency Department (FOTO-ED) study in our neurology department, but encountered problems in terms of cost, setup, feasibility, and portability of the device. As neurology residents, we came up with 3 easier options. We present these 3 options as our personal experience, and hope to reignite enthusiasm among neurology trainees to find their own means of performing ophthalmoscopy routinely in the hospital, as it appears that the Internet market is now thriving with many other devices to make this examination easier and more rewarding. Of the options explored above, the Handheld Fundus Camera was a clear favorite among the residents, and we have placed one in our call room for routine use. It travels to the clinic, floor, intensive care unit, and ED when needed. It has enhanced the way we approach the fundus examination and been a fun skill to acquire. We look forward to further advances that will make it possible to carry such a device in a physician's pocket.

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Morphological Changes in the Rat Granulosa Cell Surface During Differentiation Induced by Estradiol and Gonadotropins

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100079851 ◽

1977 ◽

Vol 35 ◽

pp. 484-485

Author(s):

P. Bagavandoss ◽

JoAnne S. Richards ◽

A. Rees Midgley

Keyword(s):

Cell Surface ◽

Granulosa Cell ◽

Morphological Changes ◽

Follicular Development ◽

Female Rats ◽

Functional Changes ◽

Group 4 ◽

Group 3 ◽

Group 5 ◽

Group 2

During follicular development in the mammalian ovary, several functional changes occur in the granulosa cells in response to steroid hormones and gonadotropins (1,2). In particular, marked changes in the content of membrane-associated receptors for the gonadotropins have been observed (1).We report here scanning electron microscope observations of morphological changes that occur on the granulosa cell surface in response to the administration of estradiol, human follicle stimulating hormone (hFSH), and human chorionic gonadotropin (hCG).Immature female rats that were hypophysectcmized on day 24 of age were treated in the following manner. Group 1: control groups were injected once a day with 0.1 ml phosphate buffered saline (PBS) for 3 days; group 2: estradiol (1.5 mg/0.2 ml propylene glycol) once a day for 3 days; group 3: estradiol for 3 days followed by 2 days of hFSH (1 μg/0.1 ml) twice daily, group 4: same as in group 3; group 5: same as in group 3 with a final injection of hCG (5 IU/0.1 ml) on the fifth day.

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P009 Service evaluation to optimise ophthalmological services for hydroxychloroquine retinal screening

Rheumatology ◽

10.1093/rheumatology/keab247.008 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Chan Ning Lee ◽

Mrinalini Dey ◽

Mooikhin Hng ◽

Simon Peterson ◽

Imna Rahiman ◽

...

Keyword(s):

Patient Education ◽

Service Evaluation ◽

Continuous Treatment ◽

Fundus Photography ◽

Baseline Risk ◽

Service Development ◽

Cross Sectional ◽

Retinal Pathology ◽

Retinal Screening ◽

Sd Oct

Abstract Background/Aims Hydroxychloroquine (HCQ), a frequently-used therapy in rheumatology, can be associated with retinal toxicity. More stringent screening and monitoring guidelines for HCQ-related retinopathy were published by the Royal College of Ophthalmologists (RCOphth) in 2018. Recommendations include: 1) baseline retinal screening within six-twelve months of commencing HCQ; 2) subsequent annual monitoring for at-risk patients, specifically: concurrent tamoxifen-use, estimated glomerular filtration rate (eGFR) <60ml/min/1.73m2, HCQ dose >5mg/kg/day; 3) annual monitoring for all other patients after five years continuous treatment; 4) patient education on HCQ retinopathy. We quantified the rheumatology HCQ exposure and estimated burden on ophthalmology, to inform the development of HCQ retinal screening services. Methods Cross-sectional data were extracted for patients established on HCQ between 1995-2020 including: weight; eGFR; concomitant retino-toxic medication; concomitant retinal pathology; HCQ dose and duration; documentation of patient education on retinal side-effects. Documentation of relevant ophthalmic testing at baseline (i.e. at time of starting HCQ) were recorded, specifically colour fundus photography, spectral domain optical coherence tomography (SD-OCT) and 10-2 Humphrey visual field (HVF) testing as necessary. Subsequent monitoring with 10-2 HVFs, SD-OCT, autofluorescence (AF) and electrodiagnostic tests (EDTs) as appropriate annually from baseline and from 5 years was recorded. Results 150 patients were included, 84% female, with a mean baseline age of 50.7 years (SD 14.8) and mean weight of 76.4kg (SD 17.6). 63% were on HCQ >5 years (mean duration 7.0 years, SD 5.1). At time of auditing, 50% (75/150) patients had permanently ceased HCQ (62% due to treatment >5 years). 60% patients had documented evidence of education regarding HCQ retinopathy. Of the 150 patients, 39% had baseline risks for retinopathy. 6% had a baseline eGFR <60ml/min/1.73m2. 32% were commenced on HCQ dose greater than 5mg/kg/day. No patients were on concomitant tamoxifen; one patient was on a known retino-toxic drug (quinine). 4% of patients had pre-existing retinal pathology. Of the 75 patients still taking HCQ at time of auditing, 27 (36%) had baseline risk factors warranting yearly retinal screening and 44 (58%) had been on treatment >5years. Most ophthalmology reviews were put on hold until a screening service was established. Of the small number (5.3%) that had baseline ophthalmic screening, 12.5% had colour photography and 75% had SD-OCT. No patients required HVF testing or EDTs. Annual screening revealed 50% of patients had 10-2 HVFs; 75% had SD-OCT; 75% had AF. Only one patient developed maculopathy, not attributed to HCQ. Conclusion Our results demonstrate the need for service development to facilitate adherence to RCOphth guidance. Up to 40% of patients started on HCQ have baseline risks for retinopathy, most due to dosing >5mg/kg/day warranting yearly screening. Our findings will inform development of a rheumatology HCQ retinal screening pathway and services, to ensure safe long-term use of HCQ. Disclosure C. Lee*: None. M. Dey*: None. M. Hng: None. S. Peterson: None. I. Rahiman: None. M. Elshafei: None. C. Estrach: None. N.J. Goodson: None.

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Retinal vascular geometry detection as a biomarker in diabetes mellitus

European Journal of Ophthalmology ◽

10.1177/11206721211033488 ◽

2021 ◽

pp. 112067212110334

Author(s):

Meng Li ◽

Gengyuan Wang ◽

Honghui Xia ◽

Ziqing Feng ◽

Peng Xiao ◽

...

Keyword(s):

Diabetes Mellitus ◽

Regression Analysis ◽

Healthy Subjects ◽

Morphological Changes ◽

Vessel Diameter ◽

Parameter Analysis ◽

Generative Adversarial Network ◽

Vascular Geometry ◽

Fundus Photographs ◽

Retinal Vascular Geometry

Objective: To compare the vessel geometry characteristics of color fundus photographs in normal control and diabetes mellitus (DM) patients and to find potential biomarkers for early diabetic retinopathy (DR) based on a neural network vessel segmentation system and automated vascular geometry parameter analysis software. Methods: A total of 102 consecutive patients with type 2 DM (T2DM) and 132 healthy controls were recruited. All participants underwent general ophthalmic examinations, and retinal fundus photographs were taken with a digital fundus camera without mydriasis. Color fundus photographs were input into a dense-block generative adversarial network (D-GAN)-assisted retinal vascular segmentation system ( http://www.gdcerc.cn:8081/#/login ) to obtain binary images. These images were then analyzed by customized software (ocular microvascular analysis system V2.9.1) for automatic processing of vessel geometry parameters, including the monofractal dimension ( Dbox), multifractal dimension ( D0), vessel area ratio ( R), max vessel diameter ( dmax), average vessel diameter ( dave), arc–chord ratio (A/C), and tortuosity (τn). Geometric differences between the healthy subjects and DM patients were analyzed. Then, regression analysis and receiver operating characteristic (ROC) curve analysis were performed to evaluate the diagnostic efficiency of the vascular geometry parameters. Results: No significant differences were observed between the baseline characteristics of each group. DM patients had lower Dbox and D0 values (1.330 ± 0.041; 1.347 ± 0.038) than healthy subjects (1.343 ± 0.048, p < 0.05; 1.362 ± 0.042, p < 0.05) and showed increasing values of dmax, dave, A/C, and τn compared with normal controls, although only the differences in dave and τn between the groups were statistically significant. In the regression analysis, dave and τn showed a good correlation with diabetes ( dave, OR 1.765, 95% CI 1.319–2.362, p < 0.001; τn, OR 9.323, 95% CI 1.492–58.262, p < 0.05). Conclusions: We demonstrated the relationship between retinal vascular geometry and the process in DM patients, showing that Dbox, D0, dave, and τn may be indicators of morphological changes in retinal vessels in DM patients and can be early biomarkers of DR.

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Morphological Changes in Lamellar Macular Holes According to SD-OCT Examination over a Long Observation Period

Diagnostics ◽

10.3390/diagnostics11071145 ◽

2021 ◽

Vol 11 (7) ◽

pp. 1145

Author(s):

Magdalena Kal ◽

Izabela Chojnowska-Ćwiąkała ◽

Mateusz Winiarczyk ◽

Monika Jasielska ◽

Jerzy Mackiewicz

Keyword(s):

Retinal Thickness ◽

Morphological Changes ◽

Outer Diameter ◽

Corrected Visual Acuity ◽

Macular Holes ◽

Kolmogorov Smirnov ◽

Inner Diameter ◽

Observation Period ◽

Sd Oct

Background: The aim of this study was to evaluate the quantitative morphological changes in lamellar macular holes (LMHs) based on SD-OCT examinations and to assess the correlations among minimal retinal thickness (MRT), reading vision (RV), and best corrected visual acuity (BCVA) over a 36-month follow-up period. Methods: A group of 40 patients (44 eyes) with LMH was evaluated, with an average age of 69.87 (SD = 10.14). The quantitative parameters monitored in the follow-up period (at 0, 3, 6, 12, 18, 24, 30, and 36 months) were tested for normality of distribution by Shapiro–Wilk and Kolmogorov–Smirnov tests. Results: The RV and BCVA values were stable, and no significant changes were found at any of the check-ups during the 36-month follow-up period (BCVA p = 0.435 and RV p = 0.0999). The analysis of individual quantitative LMH parameters during the 36-month follow-up period did not demonstrate statistically significant differences: MRT (p = 0.461), Max RT temporal (p = 0.051), Max RT nasal (p = 0.364), inner diameter (ID) (p = 0.089), and outer diameter (OD) (p = 0.985). Conclusions: The observations at 0, 6, 12, 18, 24, 30, and 36 months revealed moderate and significant correlations between RV and MRT. No significant correlation between BCVA and MRT was observed.

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Structural evaluation in inherited retinal diseases

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2021-319228 ◽

2021 ◽

pp. bjophthalmol-2021-319228

Author(s):

Malena Daich Varela ◽

Burak Esener ◽

Shaima A Hashem ◽

Thales Antonio Cabral de Guimaraes ◽

Michalis Georgiou ◽

...

Keyword(s):

Adaptive Optics ◽

Fundus Autofluorescence ◽

Standard Of Care ◽

Laser Speckle ◽

Fundus Photography ◽

Laser Speckle Flowgraphy ◽

Retinal Diseases ◽

Autofluorescence Imaging ◽

Structural Evaluation ◽

Fundus Imaging

Ophthalmic genetics is a field that has been rapidly evolving over the last decade, mainly due to the flourishing of translational medicine for inherited retinal diseases (IRD). In this review, we will address the different methods by which retinal structure can be objectively and accurately assessed in IRD. We review standard-of-care imaging for these patients: colour fundus photography, fundus autofluorescence imaging and optical coherence tomography (OCT), as well as higher-resolution and/or newer technologies including OCT angiography, adaptive optics imaging, fundus imaging using a range of wavelengths, magnetic resonance imaging, laser speckle flowgraphy and retinal oximetry, illustrating their utility using paradigm genotypes with on-going therapeutic efforts/trials.

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