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Asymmetric Macular Structural Damage Is Associated With Relative Afferent Pupillary Defects in Patients With Glaucoma
摘要： PURPOSE. We examined the relationship between relative afferent pupillary defects (RAPDs) and macular structural damage measured by macular thickness and macular ganglion cell-inner plexiform layer (mGCIPL) thickness in patients with glaucoma. METHODS. A cross-sectional study was done of 106 glaucoma patients and 85 healthy individuals from the Diagnostic Innovations in Glaucoma Study. All subjects underwent standard automated perimetry (SAP) and optic nerve and macular imaging using Cirrus Spectral Domain Optical Coherence Tomography (SDOCT). Glaucoma was de?ned as repeatable abnormal SAP or progressive glaucomatous changes on stereo photographs. Pupil responses were assessed using an automated pupillometer, which records the magnitude of RAPD (RAPD score), with additional RAPD scores recorded for each of a series of colored stimuli (blue, red, green, and yellow). The relationship between RAPD score and intereye differences (right minus left eye) in circumpapillary retinal nerve ?ber layer (cpRNFL) thickness, mGCIPL, macular thickness, and SAP mean deviation (MD), was examined using linear regression. RESULTS. There was fair correlation between RAPD score and asymmetric macular structural damage measured by intereye difference in mGCIPL thickness (R2 ? 0.285, P < 0.001). The relationship between RAPD score and intereye difference in macular thickness was weaker (R2 ? 0.167, P < 0.001). Intereye difference in cpRNFL thickness (R2 ? 0.350, P < 0.001) and SAP MD (R2 ? 0.594, P < 0.001) had stronger association with RAPD scores compared to intereye difference in mGCIPL and macular thickness. CONCLUSIONS. Objective assessment of pupillary responses using a pupillometer was associated with asymmetric macular structural damage in patients with glaucoma.
关键词： glaucoma,pupillary re?ex,pupillary response,structural damage,macula
更新于2025-09-04 15:30:14
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Quantification of Focal Outflow Enhancement Using Differential Canalograms
摘要： PURPOSE. To quantify regional changes of conventional out?ow caused by ab interno trabeculectomy (AIT). METHODS. Gonioscopic, plasma-mediated AIT was established in enucleated pig eyes. We developed a program to automatically quantify out?ow changes (R, package eye-canalogram, github.com) using a ?uorescent tracer reperfusion technique. Trabecular meshwork (TM) ablation was demonstrated with ?uorescent spheres in six eyes before formal out?ow quanti?cation with two-dye reperfusion canalograms in six additional eyes. Eyes were perfused with a central, intracameral needle at 15 mm Hg. Canalograms and histology were correlated for each eye. RESULTS. The pig eye provided a model with high similarity to AIT in human patients. Histology indicated ablation of TM and unroo?ng of most Schlemm’s canal segments. Spheres highlighted additional circumferential and radial out?ow beyond the immediate area of ablation. Differential canalograms showed that AIT caused an increase of out?ow of 17 6 5-fold inferonasally, 14 6 3-fold superonasally, and also an increase in the opposite quadrants with a 2 6 1-fold increase superotemporally, and 3 6 3 inferotemporally. Perilimbal speci?c ?ow image analysis showed an accelerated nasal ?lling with an additional perilimbal ?ow direction into adjacent quadrants. CONCLUSIONS. A quantitative, differential canalography technique was developed that allows us to quantify supraphysiological out?ow enhancement by AIT.
关键词： canalogram,glaucoma,trabecular meshwork,segmental out?ow,porcine eyes
更新于2025-09-04 15:30:14
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[IEEE 2018 International Conference on Current Trends towards Converging Technologies (ICCTCT) - Coimbatore, India (2018.3.1-2018.3.3)] 2018 International Conference on Current Trends towards Converging Technologies (ICCTCT) - Processing Retinal Images to Discover Diseases
摘要： The retina of a human eye consists of billion of photosensitive cells (rods and cones) and alternative nerve cells that acquire and arrange visual information. The retina of a human eye is a thin tissue layer on the inside back wall of your eye. Three of the are Diabetic retinal diseases most Retinopathy, Glaucoma, and Cataract. The world is presently experiencing an epidemic of Diabetic Retinopathy (DR). Current predictions draw an estimation of doubling of the number affected from the current 170 million to an estimated 367 million by 2030. We propose a system wherein we extract blood vessels of the retina to detect eye diseases. Manually extracting the blood vessels of the human retina is a time-consuming task, and thus an automation of this process results in easy implementation of the work. This paper aims to design and consequently implement deep convolutional neural networks to identify the presence of an exudate, and thereby classify it into Diabetic Retinopathy, Glaucoma, and/or Cataract.
关键词： Computer vision,Glaucoma,Diabetic Retinopathy,Cataract,Convolutional Neural Networks,Retinal disease detection,CNN
更新于2025-09-04 15:30:14
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Influence of uveitis on Bruch’s membrane opening minimum rim width and retinal nerve fibre layer thickness measurements
摘要： background/aims To assess the impact of papillary leakage and active inflammation on optical coherence tomography (OCT)-based retinal nerve fibre layer thickness (RNFLT) and Bruch’s membrane opening minimum rim width (BMO-MRW) measurements in uveitic eyes with and without secondary glaucoma. Methods Prospective, single-centre analysis of patients with uveitis. All patients included received a fluorescein angiography examination and an OCT scan measuring the BMO-MRW and the RNFLT in three concentric peripapillary ring scans. results Overall, 95 eyes of 56 patients were enrolled. Papillary leakage and active inflammation were present in 39 (41%) and 57 (60%) eyes, respectively. Twenty-one eyes were classified as glaucomatous; 10 of those glaucomatous eyes showed papillary leakage. Both BMO-MRW and RNFLT measurements were significantly increased in eyes with papillary leakage (BMO-MRW: p=0.0001; RNFL: first to third ring (p<0.0001)). Active inflammation led to a significantly thickened RNFLT (first ring: p=0.0026; second ring: p=0.0009; third ring: p=0.0002) while only a trend towards increased values could be observed in the BMO-MRW measurements (p=0.3063). Glaucomatous eyes with papillary leakage demonstrated significantly higher values on both BMO-MRW and RNFLT measurements than glaucomatous eyes without leakage (BMO-MRW: p=0.0159; RNFL: first ring: p=0.0062; second ring: p=0.0037; third ring: p=0.0197). No significant difference could be observed between glaucomatous eyes with leakage and non-glaucomatous eyes without leakage (BMO-MRW: p=0.4132; RNFL: first ring: p=0.5412; second ring: p=0.3208; third ring: p=0.1164). Conclusions The OCT scanning parameters BMO-MRW and RNFLT were significantly influenced by papillary leakage in uveitic eyes with and without glaucoma. RNFLT values were also significantly increased while active inflammation was present. In patients with uveitis, these OCT-based imaging tools should be interpreted with caution, especially in those with papillary leakage or active inflammation.
关键词： uveitis,optical coherence tomography,retinal nerve fibre layer thickness,Bruch’s membrane opening minimum rim width,glaucoma
更新于2025-09-04 15:30:14
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Confocal Adaptive Optics Imaging of Peripapillary Nerve Fiber Bundles: Implications for Glaucomatous Damage Seen on Circumpapillary OCT Scans
摘要： To improve our understanding of glaucomatous damage as seen on circumpapillary disc scans obtained with frequency-domain optical coherence tomography (fdOCT), fdOCT scans were compared to images of the peripapillary retinal nerve fiber (RNF) bundles obtained with an adaptive optics-scanning light ophthalmoscope (AO-SLO). The AO-SLO images and fdOCT scans were obtained on 6 eyes of 6 patients with deep arcuate defects (5 points (cid:2)(cid:3)15 db) on 10-2 visual fields. The AO-SLO images were montaged and aligned with the fdOCT images to compare the RNF bundles seen with AO-SLO to the RNF layer thickness measured with fdOCT. All 6 eyes had an abnormally thin (1% confidence limit) RNF layer (RNFL) on regions of RNF bundles on AO-SLO in fdOCT and abnormal corresponding regions. However, regions of abnormal, but equal, RNFL thickness on fdOCT scans varied in appearance on AO-SLO images. These regions could be largely devoid of RNF bundles (5 eyes), have abnormal-appearing bundles of lower contrast (6 eyes), or have isolated areas with a few relatively normal-appearing bundles (2 eyes). There also were local variations in reflectivity of the fdOCT RNFL that corresponded to the variations in AO-SLO RNF bundle appearance. Relatively similar 10-2 defects with similar fdOCT RNFL thickness profiles can have very different degrees of RNF bundle damage as seen on fdOCT and AO-SLO. While the results point to limitations of fdOCT RNFL thickness as typically analyzed, they also illustrate the potential for improving fdOCT by attending to variations in local intensity.
关键词： optical coherence tomography,retinal nerve fiber layer,glaucoma,adaptive optics,optic disc
更新于2025-09-04 15:30:14
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Diagnostic Performance of Peripapillary Retinal Nerve Fiber Layer Thickness for Detection of Glaucoma in an Elderly Population: The ALIENOR Study
摘要： PURPOSE. To assess diagnostic accuracy of spectral-domain optical coherence tomography (SD-OCT) to discriminate glaucoma and control subjects in an elderly population. METHODS. The antioxidants, essential lipids, nutrition and ocular maladies study (ALIENOR: ‘‘Antioxydants, Lipides Essentiels, Nutrition et Maladies Oculaires’’) is a population-based study. From 2009 to 2010, a total of 624 subjects, aged 74 years or older underwent a complete eye examination, including optic disc color photography and SD-OCT examination of the macula and the optic nerve head. Glaucoma diagnosis was made using retinophotography of the optic nerve head and International Society for Epidemiologic and Geographical Ophthalmology criteria. Average and sectorial peripapillary retinal nerve ?ber layer thicknesses (RNFLT) were compared between glaucoma and control subjects using area under the receiver operating characteristic curves (AUC), positive and negative likelihood ratios (LRt/LR(cid:2)), and diagnostic odds ratios (DOR). RESULTS. A total of 532 subjects had complete data, 492 were classi?ed as controls and 40 were classi?ed as glaucoma. Mean age was 82.1 6 4.2 years and average RNFLT was signi?cantly different between both groups (controls: 88.7 6 12.2 lm, glaucoma: 65.4 6 14.4 lm, P < 0.001). Highest AUC values were observed for average (0.895), temporal-inferior (0.874), and temporal-superior (0.868) RNFLT. Temporal-superior RNFLT had the highest DOR (25.31; LRt, 4.65; LR(cid:2), 0.18), followed by average RNFLT (DOR: 24.80; LRt, 6.36; LR(cid:2), 0.26). When using the normative database provided by the machine, DOR increased to 31.03 (LRt, 1.75; LR(cid:2), 0.06) if at least one parameter was considered abnormal (at P < 0.05). CONCLUSIONS. Parameters of SD-OCT RNFL may provide valuable information in a screening strategy to improve glaucoma detection in a general population of elderly people.
关键词： spectral-domain OCT,OCT,optical coherence tomography,glaucoma screening,likelihood ratios,aging
更新于2025-09-04 15:30:14
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Detecting an Event of Progression Using Glaucoma Probability Score and the Stereometric Parameters of Heidelberg Retina Tomograph 3
摘要： Purpose: To evaluate the correlation of the change in glaucoma probability score (GPS) and the stereometric optic nerve head (ONH) parameters of the Heidelberg Retina Tomograph (HRT)3 to an event of glaucomatous progression observed with stereoscopic ONH photography. Methods: The subjects for this retrospective follow-up study were monitored with the HRT and stereoscopic ONH photographs. Stable, high-quality imaging and at least 18 months of follow-up was required. The topography examinations were acquired using HRT II and calculated with HRT3 software. The event of progression was determined by masked evaluation of stereoscopic ONH photographs. Results: A total of 476 eyes of 342 subjects met the inclusion criteria. All the examinations with HRT II were backwards compatible with either the GPS or the stereometric parameters of HRT3. The highest statistical significance for the correlation with progression was observed in the change in cup volume and cup:disc area ratio (p<0.0005). The vertical cup:disc ratio was the parameter with the largest area under the receiver operating characteristics curve (AUC = 0.696). The AUC calculated for the change in GPS was 0.541. The GPS showed no statistically significant correlation with progression (p = 0.213). Conclusions: Detecting an event of glaucomatous progression should not be based solely on the change in GPS or the stereometric parameters of the HRT. The good backwards compatibility between HRT II and HRT3 should allow the detection of a trend of glaucomatous progression even when changing from HRT II to HRT3 during the follow-up of glaucoma.
关键词： Heidelberg Retina Tomograph,Backwards compatibility,Glaucoma,Progression
更新于2025-09-04 15:30:14
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Comparison study of OCT, HRT and VF findings among normal controls and patients with pseudoexfoliation, with or without increased IOP
摘要： Purpose: To compare and evaluate optic nerve head (ONH) and retinal nerve fiber layer (RNFL) measurements obtained with the optical coherence tomography (OCT) and the Heidelberg retina tomography (HRT) to visual field (VF) parameters in normal and in patients with pseudoexfoliation with or without increased intraocular pressure (IOP). Methods: A total of 96 subjects were included in our study aged between 65 years and 78 years. The normal group consisted of 28 subjects (14 men and 14 women). Out of the total number of patients, 68 patients who showed pseudoexfoliation (21 men and 47 women) were divided into two groups. Of these, the first group had pseudoexfoliation with increased IOP and the second group showed deposits of pseudoexfoliative material without an increase in IOP. The normal controls were randomly chosen and restricted to those without any glaucomatous optic disc damages, VF defects, and an IOP 15 mmHg. All subjects were prospectively included for repeated measurements of IOP, OCT, HRT, and VFs during the same visit by the same examiner and all measurements were repeated every 3 months. Results: Mean RNFL thickness measured by OCT was larger in the normal controls than in the other two groups (98.04 μm (first group) vs 75.42 μm and 97.02 μm (second group), P0.05). Four-quadrant RNFL thickness measurements were significantly different between the normal and the group 1 (P0.05) but not with the group 2 (P0.05). Rim area had a mean difference of -0.44, whereas cup-to-disc ratio (C/D) showed a mean difference of 0.31, thus being significantly different between the normal and the two groups (all P0.05). The median of the mean deviation parameter of VFs was -0.28 for the normal vs -0.32 and -0.18 for the other two groups, whereas pattern standard deviation median difference was 0.89 for the normal and 1.32 and 1.20 for the other two groups, respectively (P0.05). Conclusion: Both OCT and HRT showed early ONH and RNFL changes in their parameters and did not correlate with the normal findings of the automated perimetry.
关键词： retinal nerve fiber layer (RNFL),visual fields (VFs),pseudoexfoliation glaucoma,pseudoexfoliation syndrome,Heidelberg retina tomograph (HRT),optical coherence tomography (OCT)
更新于2025-09-04 15:30:14
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Visualizing Deep Learning Models for the Detection of Referable Diabetic Retinopathy and Glaucoma
摘要： IMPORTANCE Convolutional neural networks have recently been applied to ophthalmic diseases; however, the rationale for the outputs generated by these systems is inscrutable to clinicians. A visualization tool is needed that would enable clinicians to understand important exposure variables in real time. OBJECTIVE To systematically visualize the convolutional neural networks of 2 validated deep learning models for the detection of referable diabetic retinopathy (DR) and glaucomatous optic neuropathy (GON). DESIGN, SETTING, AND PARTICIPANTS The GON and referable DR algorithms were previously developed and validated (holdout method) using 48 116 and 66 790 retinal photographs, respectively, derived from a third-party database (LabelMe) of deidentified photographs from various clinical settings in China. In the present cross-sectional study, a random sample of 100 true-positive photographs and all false-positive cases from each of the GON and DR validation data sets were selected. All data were collected from March to June 2017. The original color fundus images were processed using an adaptive kernel visualization technique. The images were preprocessed by applying a sliding window with a size of 28 × 28 pixels and a stride of 3 pixels to crop images into smaller subimages to produce a feature map. Threshold scales were adjusted to optimal levels for each model to generate heat maps highlighting localized landmarks on the input image. A single optometrist allocated each image to predefined categories based on the generated heat map. MAIN OUTCOMES AND MEASURES Visualization regions of the fundus. RESULTS In the GON data set, 90 of 100 true-positive cases (90%; 95% CI, 82%-95%) and 15 of 22 false-positive cases (68%; 95% CI, 45%-86%) displayed heat map visualization within regions of the optic nerve head only. Lesions typically seen in cases of referable DR (exudate, hemorrhage, or vessel abnormality) were identified as the most important prognostic regions in 96 of 100 true-positive DR cases (96%; 95% CI, 90%-99%). In 39 of 46 false-positive DR cases (85%; 95% CI, 71%-94%), the heat map displayed visualization of nontraditional fundus regions with or without retinal venules. CONCLUSIONS AND RELEVANCE These findings suggest that this visualization method can highlight traditional regions in disease diagnosis, substantiating the validity of the deep learning models investigated. This visualization technique may promote the clinical adoption of these models.
关键词： visualization,convolutional neural networks,deep learning,glaucoma,diabetic retinopathy
更新于2025-09-04 15:30:14
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Neurodegeneration in ocular and central nervous systems: optical coherence tomography study in normal-tension glaucoma and Alzheimer disease*
摘要： To evaluate, in vivo, the optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) in patients with normal-tension glaucoma (NTG) and those with Alzheimer disease (AD) in comparison with healthy subjects. This cross-sectional study included 18 patients with NTG, 20 with AD, and 20 control subjects. An ophthalmologic examination and OCT scans of both eyes were performed in all patients. There was a significant reduction in peripapillary RNFL thickness and macular GCC thickness and a significant increase in the global loss volume (GLV) rate in both the NTG and AD patients when compared to the control subjects (P = 0.004, P = 0.006, P < 0.001, respectively). The statistical evaluation showed no difference in any RNFL or GCC parameters between the AD and NTG groups (P > 0.05). There was a negative correlation between disease duration and average RNFL and GCC thicknesses (r = ?0.350, P = 0.027 and r = ?0.471, P = 0.002, respectively) and a positive correlation between duration and GLV (r = 0.427, P = 0.006) in the AD group. The average RNFL thickness, GCC thickness, and GLV rates may help in the diagnosis of AD as an additional examination and may provide some important clues about the duration of the disease.
关键词： ganglion cell complex,Alzheimer disease,retinal nerve fiber layer,Optical coherence tomography,normal-tension glaucoma
更新于2025-09-04 15:30:14