Pub Date : 2024-08-02DOI: 10.1101/2024.08.01.24311293
Lucas Neves de Oliveira, Matheus Gomes Reis Costa, Isadora Oliveira Santiago Pereira, Isabela Carolina Tokumoto, Joao Lucas de Magalhaes Leal Moreira, Matheus Carneiro Leal Freitas, Clarissa Silva Sampaio, Jose de Bessa Junior, Hermelino Lopes de Oliveira Neto
OBJECTIVE: To describe the prevalence of Low Visual Acuity (LVA) in public school students in Feira de Santana (FSA), Bahia (BA). METHODS: This was an observational, cross-sectional, exploratory study. The sample consisted of schoolchildren from the 2nd to the 4th grade of five public schools in FSA/BA. Data collection was carried out in the schools themselves, with a sociodemographic and clinical questionnaire applied and Visual Acuity (VA) measured using the Snellen E optotype chart. LVA was defined as uncorrected VA < 20/25 in at least one eye. RESULTS: The sample consisted of 358 children, with a median age of 9 [8-10] years, of which 189 (52.9%) were female. 248 (69.3%) individuals had never been to an ophthalmologist. LVA was found in 105 (29.3%) schoolchildren, and of these, 7.6% (8/105) current used glasses. Factors associated with LVA were female gender and white ethnicity. LVA was evidenced in 60 (31.7%) schoolchildren with excessive screen use and in 35 (25.5%) without excessive use (OR 1.35; 95% CI 0.83 - 2.19, p = 0.222), and excessive screen use was associated with visual signs/symptoms such as tearing and eye itching. CONCLUSION: LVA was observed in approximately 30% of children in public schools in the interior of Bahia, and less than 10% of these current used glasses. Our study reinforces the importance of visual screening of schoolchildren through active search in our region and the creation of strategies to facilitate access to ophthalmological consultations and glasses.
{"title":"Prevalence of Low Visual Acuity in children from public schools in Northeast of Brazil","authors":"Lucas Neves de Oliveira, Matheus Gomes Reis Costa, Isadora Oliveira Santiago Pereira, Isabela Carolina Tokumoto, Joao Lucas de Magalhaes Leal Moreira, Matheus Carneiro Leal Freitas, Clarissa Silva Sampaio, Jose de Bessa Junior, Hermelino Lopes de Oliveira Neto","doi":"10.1101/2024.08.01.24311293","DOIUrl":"https://doi.org/10.1101/2024.08.01.24311293","url":null,"abstract":"OBJECTIVE: To describe the prevalence of Low Visual Acuity (LVA) in public school students in Feira de Santana (FSA), Bahia (BA). METHODS: This was an observational, cross-sectional, exploratory study. The sample consisted of schoolchildren from the 2nd to the 4th grade of five public schools in FSA/BA. Data collection was carried out in the schools themselves, with a sociodemographic and clinical questionnaire applied and Visual Acuity (VA) measured using the Snellen E optotype chart. LVA was defined as uncorrected VA < 20/25 in at least one eye. RESULTS: The sample consisted of 358 children, with a median age of 9 [8-10] years, of which 189 (52.9%) were female. 248 (69.3%) individuals had never been to an ophthalmologist. LVA was found in 105 (29.3%) schoolchildren, and of these, 7.6% (8/105) current used glasses. Factors associated with LVA were female gender and white ethnicity. LVA was evidenced in 60 (31.7%) schoolchildren with excessive screen use and in 35 (25.5%) without excessive use (OR 1.35; 95% CI 0.83 - 2.19, p = 0.222), and excessive screen use was associated with visual signs/symptoms such as tearing and eye itching. CONCLUSION: LVA was observed in approximately 30% of children in public schools in the interior of Bahia, and less than 10% of these current used glasses. Our study reinforces the importance of visual screening of schoolchildren through active search in our region and the creation of strategies to facilitate access to ophthalmological consultations and glasses.","PeriodicalId":501390,"journal":{"name":"medRxiv - Ophthalmology","volume":"298 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141883217","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}
Pub Date : 2024-08-02DOI: 10.1101/2024.08.01.24311332
Cristina Cuscó, Pau Esteve-Bricullé, Ana Almazán-Moga, Jimena Fernández-Carneado, Berta Ponsati
Objective: To quantify microvascular lesions in a large Real-World Data (RWD) set, based on single central retinal fundus images from different origins, with the aim of validating its use as a precision tool for classifying Diabetic Retinopathy (DR) severity. Design: Retrospective meta-analysis across multiple fundus image datasets. Sample size: The study analyzed 2,340 retinal fundus images from diabetic patients across four diverse RWD international datasets, including populations from Spain, India, China and the US. Intervention: The quantification of specific microvascular lesions: microaneurysms (MAs), hemorrhages (Hmas) and hard exudates (HEs) using advanced automated image analysis techniques on central retinal images to validate reliable metrics for DR severity assessment. The images were pre-classified in the DR severity levels as defined by the International Clinical Diabetic Retinopathy (ICDR) scale. Main Outcome Measures: The primary variables measured were the number of MAs, Hmas, red lesions (RLs) and HEs. These counts were related with DR severity levels using statistical methods to validate the relationship between lesion counts and disease severity. Results: The analysis revealed a robust and statistically significant increase (p<0.001) in the number of microvascular lesions and the DR severity across all datasets. Tight data distributions were reported for MAs, Hmas and RLs, supporting the reliability of lesion quantification for accurately assessing DR severity. HEs also followed a similar pattern, but with a broader dispersion of data. Data used in this study are consistent with the definition of the DR severity levels established by the ICDR guidelines. Conclusions: The statistically significant increase in the number of microvascular lesions across DR severity validate the use of lesion quantification in a single central retinal field as a key biomarker for disease classification and assessment. This quantification method demonstrates an improvement over traditional assessment scales, providing a quantitative metric that enhances the precision of disease classification and patient monitoring. The inclusion of a numerical component allows for the detection of subtle variations within the same severity level, offering a deeper understanding of disease progression. The consistency of results across diverse datasets not only confirms the method's reliability but also its applicability in a global healthcare setting.
目的根据不同来源的单个中心视网膜眼底图像，量化大型真实世界数据集（RWD）中的微血管病变，以验证其作为糖尿病视网膜病变（DR）严重程度分级精确工具的有效性：设计：对多个眼底图像数据集进行回顾性荟萃分析：研究分析了来自四个不同 RWD 国际数据集的 2340 张糖尿病患者视网膜眼底图像，包括来自西班牙、印度、中国和美国的人群：干预措施：在中心视网膜图像上使用先进的自动图像分析技术量化特定微血管病变：微动脉瘤（MA）、出血（Hmas）和硬性渗出（HE），以验证用于 DR 严重程度评估的可靠指标。根据国际临床糖尿病视网膜病变（ICDR）量表的定义，这些图像被预先划分为 DR 严重程度等级：测量的主要变量是 MA、Hmas、红色病变 (RL) 和 HE 的数量。使用统计方法将这些计数与 DR 严重程度相关联，以验证病变计数与疾病严重程度之间的关系：结果：分析表明，在所有数据集中，微血管病变数量和 DR 严重程度都出现了稳健且具有统计学意义的增长（p<0.001）。据报告，MAs、Hmas 和 RL 的数据分布紧密，证明了病变量化在准确评估 DR 严重程度方面的可靠性。HEs也遵循类似的模式，但数据分布更广。本研究使用的数据与 ICDR 指南确定的 DR 严重程度定义一致：微血管病变的数量在不同的 DR 严重程度下都有统计学意义上的明显增加，这验证了将单个中心视网膜视野中的病变量化作为疾病分类和评估的关键生物标志物的有效性。与传统的评估量表相比，这种量化方法有所改进，提供了一种量化指标，提高了疾病分类和患者监测的精确度。数字成分的加入可以检测同一严重程度的细微变化，从而更深入地了解疾病的进展。不同数据集之间结果的一致性不仅证实了该方法的可靠性，还证实了它在全球医疗环境中的适用性。
{"title":"Microvascular Metrics on Diabetic Retinopathy: Insights from a Meta-Analysis of Diabetic Eye Images from Real-World Data","authors":"Cristina Cuscó, Pau Esteve-Bricullé, Ana Almazán-Moga, Jimena Fernández-Carneado, Berta Ponsati","doi":"10.1101/2024.08.01.24311332","DOIUrl":"https://doi.org/10.1101/2024.08.01.24311332","url":null,"abstract":"Objective: To quantify microvascular lesions in a large Real-World Data (RWD) set, based on single central retinal fundus images from different origins, with the aim of validating its use as a precision tool for classifying Diabetic Retinopathy (DR) severity.\u0000Design: Retrospective meta-analysis across multiple fundus image datasets.\u0000Sample size: The study analyzed 2,340 retinal fundus images from diabetic patients across four diverse RWD international datasets, including populations from Spain, India, China and the US.\u0000Intervention: The quantification of specific microvascular lesions: microaneurysms (MAs), hemorrhages (Hmas) and hard exudates (HEs) using advanced automated image analysis techniques on central retinal images to validate reliable metrics for DR severity assessment. The images were pre-classified in the DR severity levels as defined by the International Clinical Diabetic Retinopathy (ICDR) scale.\u0000Main Outcome Measures: The primary variables measured were the number of MAs, Hmas, red lesions (RLs) and HEs. These counts were related with DR severity levels using statistical methods to validate the relationship between lesion counts and disease severity.\u0000Results: The analysis revealed a robust and statistically significant increase (p<0.001) in the number of microvascular lesions and the DR severity across all datasets. Tight data distributions were reported for MAs, Hmas and RLs, supporting the reliability of lesion quantification for accurately assessing DR severity. HEs also followed a similar pattern, but with a broader dispersion of data. Data used in this study are consistent with the definition of the DR severity levels established by the ICDR guidelines.\u0000Conclusions: The statistically significant increase in the number of microvascular lesions across DR severity validate the use of lesion quantification in a single central retinal field as a key biomarker for disease classification and assessment. This quantification method demonstrates an improvement over traditional assessment scales, providing a quantitative metric that enhances the precision of disease classification and patient monitoring. The inclusion of a numerical component allows for the detection of subtle variations within the same severity level, offering a deeper understanding of disease progression. The consistency of results across diverse datasets not only confirms the method's reliability but also its applicability in a global healthcare setting.","PeriodicalId":501390,"journal":{"name":"medRxiv - Ophthalmology","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141883220","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}
Pub Date : 2024-07-24DOI: 10.1101/2024.07.24.24310925
Naimah E Khan, Martin Masinde Kisenge
ABSTRACT Background information: Refractive errors and presbyopia remain a burden to the entire population. An estimated 76% of the 191 million blind people have preventable or treatable causes. Uncorrected Refractive Error (URE), the number one cause (51%) of moderate and severe vision impairment is easily preventable. Aim: The study aimed to evaluate the accessibility, affordability, and acceptability of refractive services in Kakamega Municipality. Methodology: A population-based descriptive cross-sectional study was undertaken in Kakamega municipality using a cluster sampling method and descriptive data analysis. Results: Out of 358 participants, 199 (55.6%) were male and 159 (44.4%) were female. The analysis shows affordability (18.3%) as the main reason for not using spectacles, followed by lack of quality care (3.4%), access to eye care (3.4%), awareness (2.5%), unpleasant past experiences (2.2%), importance not given to eye care issues (1.6%), lack of communication (0.9%), and disapproval from family members (0.9%). The study found that the affordable price range for spectacles varies between Kshs.5000 and less than Kshs.2000. More participants (38.0%) reported above Kshs.5000, while 29% indicated less Kshs.2000. The study found that affordability (p = 0.000), availability (p=0.004), and accessibility (p=0.005) of refractive services significantly influenced the uptake of these services. Conclusion: The study reveals that refractive services in Kakamega municipality are not easily accessible due to the lack of adequate services in government hospitals. Additionally, patients in the municipality struggle to afford spectacles due to the direct cost of spectacles and the lack of services in easily accessible public facilities. Keywords: Barriers Accessibility Affordability Availability Uptake Refractive services
{"title":"ASSESSING THE ACCESSIBILITY, AFFORDABILITY, AND ACCEPTABILITY OF REFRACTIVE SERVICES AS BARRIERS TO UPTAKE OF THESE SERVICES IN KAKAMEGA MUNICIPALITY, KENYA","authors":"Naimah E Khan, Martin Masinde Kisenge","doi":"10.1101/2024.07.24.24310925","DOIUrl":"https://doi.org/10.1101/2024.07.24.24310925","url":null,"abstract":"ABSTRACT Background information: Refractive errors and presbyopia remain a burden to the entire population. An estimated 76% of the 191 million blind people have preventable or treatable causes. Uncorrected Refractive Error (URE), the number one cause (51%) of moderate and severe vision impairment is easily preventable. Aim: The study aimed to evaluate the accessibility, affordability, and acceptability of refractive services in Kakamega Municipality. Methodology: A population-based descriptive cross-sectional study was undertaken in Kakamega municipality using a cluster sampling method and descriptive data analysis. Results: Out of 358 participants, 199 (55.6%) were male and 159 (44.4%) were female. The analysis shows affordability (18.3%) as the main reason for not using spectacles, followed by lack of quality care (3.4%), access to eye care (3.4%), awareness (2.5%), unpleasant past experiences (2.2%), importance not given to eye care issues (1.6%), lack of communication (0.9%), and disapproval from family members (0.9%). The study found that the affordable price range for spectacles varies between Kshs.5000 and less than Kshs.2000. More participants (38.0%) reported above Kshs.5000, while 29% indicated less Kshs.2000. The study found that affordability (p = 0.000), availability (p=0.004), and accessibility (p=0.005) of refractive services significantly influenced the uptake of these services.\u0000Conclusion: The study reveals that refractive services in Kakamega municipality are not easily accessible due to the lack of adequate services in government hospitals. Additionally, patients in the municipality struggle to afford spectacles due to the direct cost of spectacles and the lack of services in easily accessible public facilities.\u0000Keywords: Barriers Accessibility Affordability Availability Uptake Refractive services","PeriodicalId":501390,"journal":{"name":"medRxiv - Ophthalmology","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141784845","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}
Pub Date : 2024-07-21DOI: 10.1101/2024.07.21.24310769
Ivan M. Tavares, Flavio E. Hirai, Diogo F. C. Landim, Paola Zucchi
Objective: To evaluate the economic impact on the Brazilian Public Health System (SUS) of the initial treatment of glaucoma in two scenarios: (1) the traditional continuous clinical treatment with hypotensive eye drops and (2) the single treatment with Selective Laser Trabeculoplasty. Methods: Economic impact analysis was conducted in three scenarios, from the least to the most conservative, for the two initial treatment methods for open-angle glaucoma in a hypothetical cohort of 5,000 individuals. Projections were then made based on a prevalence of 3% of the Brazilian population in 2021. Results: All three scenarios analyzed showed a significantly lower economic impact for Selective Laser Trabeculoplasty on the Brazilian Public Health System over one to five years, with a favorable difference of more than 8 billion US dollars over five years when considering 3% of the Brazilian population over 40 years old in 2021. Conclusion: The economic impact on the Brazilian Public Health System was lower for Selective Laser Trabeculoplasty compared to the use of latanoprost and timolol maleate eye drops as the initial treatment for primary open-angle glaucoma in all scenarios studied over one and five-year periods.
{"title":"Initial Treatment of Glaucoma with Selective Laser Trabeculoplasty: Economic Impact from the Perspective of the Brazilian Public Health System.","authors":"Ivan M. Tavares, Flavio E. Hirai, Diogo F. C. Landim, Paola Zucchi","doi":"10.1101/2024.07.21.24310769","DOIUrl":"https://doi.org/10.1101/2024.07.21.24310769","url":null,"abstract":"Objective: To evaluate the economic impact on the Brazilian Public Health System (SUS) of the initial treatment of glaucoma in two scenarios: (1) the traditional continuous clinical treatment with hypotensive eye drops and (2) the single treatment with Selective Laser Trabeculoplasty.\u0000Methods: Economic impact analysis was conducted in three scenarios, from the least to the most conservative, for the two initial treatment methods for open-angle glaucoma in a hypothetical cohort of 5,000 individuals. Projections were then made based on a prevalence of 3% of the Brazilian population in 2021. Results: All three scenarios analyzed showed a significantly lower economic impact for Selective Laser Trabeculoplasty on the Brazilian Public Health System over one to five years, with a favorable difference of more than 8 billion US dollars over five years when considering 3% of the Brazilian population over 40 years old in 2021.\u0000Conclusion: The economic impact on the Brazilian Public Health System was lower for Selective Laser Trabeculoplasty compared to the use of latanoprost and timolol maleate eye drops as the initial treatment for primary open-angle glaucoma in all scenarios studied over one and five-year periods.","PeriodicalId":501390,"journal":{"name":"medRxiv - Ophthalmology","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141746434","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}
Pub Date : 2024-07-21DOI: 10.1101/2024.07.21.24310763
Jonathan Fhima, Jan Van Eijgen, Anat Reiner-Benaim, Lennert Beeckmans, Or Abramovich, Ingeborg Stalmans, Joachim A. Behar
Objective: 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. Design: This study employs a retrospective cohort design to achieve its objectives. Participants: The research utilized a substantial dataset consisting of 115,237 digital fundus images obtained from individuals undergoing routine eye examinations. There was no inclusion of a separate control group in this study. Methods: The proposed methodology integrates multiple stages: initial image quality assessment, detection of the optic disc, definition of the region of interest surrounding the optic disc, 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. Main Outcome Measures: 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. Results: The analysis revealed significant independent similarities in 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. Conclusions: 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.
{"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, Jan Van Eijgen, Anat Reiner-Benaim, Lennert Beeckmans, Or Abramovich, Ingeborg Stalmans, Joachim A. Behar","doi":"10.1101/2024.07.21.24310763","DOIUrl":"https://doi.org/10.1101/2024.07.21.24310763","url":null,"abstract":"Objective: 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.\u0000Design: This study employs a retrospective cohort design to achieve its objectives.\u0000Participants: The research utilized a substantial dataset consisting of 115,237 digital fundus images obtained from individuals undergoing routine eye examinations. There was no inclusion of a separate control group in this study.\u0000Methods: The proposed methodology integrates multiple stages: initial image quality assessment, detection of the optic disc, definition of the region of interest surrounding the optic disc, 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.\u0000Main Outcome Measures: 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.\u0000Results: The analysis revealed significant independent similarities in 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.\u0000Conclusions: 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.","PeriodicalId":501390,"journal":{"name":"medRxiv - Ophthalmology","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141744546","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}
Purpose: To quantitatively measure eye movement behaviors in indoor, outdoor, and reading scenarios to understand their potential link to myopia. Methods: Forty-one healthy adult subjects freely viewed indoor and outdoor scenes and performed reading activities using virtual reality (VR). Eye movement data were recorded with the built-in eye tracker of the VR headset (HTC Vive Pro Eye). Gaze and fixation data were calculated and reported for eight regions of the visual field. Results: Indoor scenes exhibited a more pronounced downward gaze than outdoor environments. Significant differences (p < 0.05) in gaze and fixation behaviors were observed between reading and other scenarios. In region 8 (peripheral inferior visual field), the median (1st quartile, 3rd quartile) number of gaze points were 816 (463, 1175), 1123 (743, 1497), and 1705 (966, 2382) for outdoor, indoor and reading scenarios, respectively. Similarly, fixation behavior counts were 4 (1, 9), 7 (1, 11), and 39 (22, 54), respectively. Conclusions: Downward gaze and fixation behaviors are more prevalent in reading and indoor environments. Given that downwards eye movements can induce instantaneous axial elongation, our results suggested a potential biomechanical pathway for myopia progression through optic nerve traction and ocular tissue remodeling. This study underscores the need for further research to explore the specific role of eye movement behaviors in the progression of myopia, especially in real-life settings.
{"title":"Eye Movement Variations in Indoor, Outdoor, and Reading Scenarios and their Implications for Myopia","authors":"Qi Li, Chao Zhou, Tingting Liu, Yingxiang Han, Dajiang Wang, Xiaofei Wang","doi":"10.1101/2024.07.20.24310744","DOIUrl":"https://doi.org/10.1101/2024.07.20.24310744","url":null,"abstract":"Purpose: To quantitatively measure eye movement behaviors in indoor, outdoor, and reading scenarios to understand their potential link to myopia. Methods: Forty-one healthy adult subjects freely viewed indoor and outdoor scenes and performed reading activities using virtual reality (VR). Eye movement data were recorded with the built-in eye tracker of the VR headset (HTC Vive Pro Eye). Gaze and fixation data were calculated and reported for eight regions of the visual field.\u0000Results: Indoor scenes exhibited a more pronounced downward gaze than outdoor environments. Significant differences (p < 0.05) in gaze and fixation behaviors were observed between reading and other scenarios. In region 8 (peripheral inferior visual field), the median (1st quartile, 3rd quartile) number of gaze points were 816 (463, 1175), 1123 (743, 1497), and 1705 (966, 2382) for outdoor, indoor and reading scenarios, respectively. Similarly, fixation behavior counts were 4 (1, 9), 7 (1, 11), and 39 (22, 54), respectively. Conclusions: Downward gaze and fixation behaviors are more prevalent in reading and indoor environments. Given that downwards eye movements can induce instantaneous axial elongation, our results suggested a potential biomechanical pathway for myopia progression through optic nerve traction and ocular tissue remodeling. This study underscores the need for further research to explore the specific role of eye movement behaviors in the progression of myopia, especially in real-life settings.","PeriodicalId":501390,"journal":{"name":"medRxiv - Ophthalmology","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141744505","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}
Pub Date : 2024-07-15DOI: 10.1101/2024.07.15.24306102
Simone Tzaridis, Edith Aguilar, Michael I Dorrell, Martin Friedlander, Kevin T Eade
Retinal pigment epithelial (RPE)-cells possess numerous functions and may respond to stress and damage of the neuroretina. In different neurodegenerative diseases, including age-related macular degeneration (AMD), retinitis pigmentosa, and macular telangiectasia type 2 (MacTel), RPE-cells have been shown to proliferate and migrate into the neuroretina, forming intraretinal pigment plaques. Though pigmentary changes are associated with disease progression, it is not known if their presence is protective or detrimental. In this study, we evaluated the impact of pigment plaques on vascular changes and disease progression in patients with macular telangiectasia type 2 (MacTel), an example of a progressive neurodegenerative retinal disease. We then studied underlying pathomechanisms using a mouse model mirroring these changes, the very-low-density lipoprotein receptor mutant (Vldlr-/-) mouse. In a retrospective, longitudinal study, we analyzed multimodal retinal images of patients with MacTel and showed that pigment plaques were associated with a decrease in vascular leakage and stabilized neovascular growth. Using genetic approaches, we analyzed changes in expression levels of relevant genes in the RPE and retinas of Vldlr-/- mice during RPE-proliferation and migration. Our data indicated that RPE-cells transitioned from an epithelial to a mesenchymal state ('epithelial-mesenchymal transition', EMT), proliferated and accumulated along neovessels. Using dextran angiography and immunofluorescence, we demonstrated that the perivascular accumulation of RPE-cells reduced vascular leakage. Pharmacologic inhibition of EMT led to a decrease in pigment coverage and exacerbation of neovascular growth and exudation. Our findings indicate that the proliferation, migration and perivascular accumulation of RPE-cells may stabilize vascular proliferation and exudation, thereby exerting a protective effect on the diseased retina. We conclude that interfering with this 'natural repair mechanism' may have detrimental effects on the course of the disease and should thus be avoided.
{"title":"Retinal pigment epithelial cells reduce vascular leak and proliferation in retinal neovessels","authors":"Simone Tzaridis, Edith Aguilar, Michael I Dorrell, Martin Friedlander, Kevin T Eade","doi":"10.1101/2024.07.15.24306102","DOIUrl":"https://doi.org/10.1101/2024.07.15.24306102","url":null,"abstract":"Retinal pigment epithelial (RPE)-cells possess numerous functions and may respond to stress and damage of the neuroretina. In different neurodegenerative diseases, including age-related macular degeneration (AMD), retinitis pigmentosa, and macular telangiectasia type 2 (MacTel), RPE-cells have been shown to proliferate and migrate into the neuroretina, forming intraretinal pigment plaques. Though pigmentary changes are associated with disease progression, it is not known if their presence is protective or detrimental. In this study, we evaluated the impact of pigment plaques on vascular changes and disease progression in patients with macular telangiectasia type 2 (MacTel), an example of a progressive neurodegenerative retinal disease. We then studied underlying pathomechanisms using a mouse model mirroring these changes, the very-low-density lipoprotein receptor mutant (Vldlr-/-) mouse. In a retrospective, longitudinal study, we analyzed multimodal retinal images of patients with MacTel and showed that pigment plaques were associated with a decrease in vascular leakage and stabilized neovascular growth. Using genetic approaches, we analyzed changes in expression levels of relevant genes in the RPE and retinas of Vldlr-/- mice during RPE-proliferation and migration. Our data indicated that RPE-cells transitioned from an epithelial to a mesenchymal state ('epithelial-mesenchymal transition', EMT), proliferated and accumulated along neovessels. Using dextran angiography and immunofluorescence, we demonstrated that the perivascular accumulation of RPE-cells reduced vascular leakage. Pharmacologic inhibition of EMT led to a decrease in pigment coverage and exacerbation of neovascular growth and exudation.\u0000Our findings indicate that the proliferation, migration and perivascular accumulation of RPE-cells may stabilize vascular proliferation and exudation, thereby exerting a protective effect on the diseased retina. We conclude that interfering with this 'natural repair mechanism' may have detrimental effects on the course of the disease and should thus be avoided.","PeriodicalId":501390,"journal":{"name":"medRxiv - Ophthalmology","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141718117","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}
Pub Date : 2024-07-12DOI: 10.1101/2024.07.11.24310293
Chenwei Wu, David Restrepo, Luis Filipe Nakayama, Lucas Zago Ribeiro, Zitao Shuai, Nathan Santos Barboza, Maria Luiza Vieira Sousa, Raul Dias Fitterman, Alexandre Durao Alves Pereira, Caio Vinicius Saito Regatieri, Jose Augusto Stuchi, Fernando Korn Malerbi, Rafael E. Andrade
This paper introduces mBRSET, the first publicly available retina dataset captured using handheld retinal cameras in real-life, high-burden scenarios, comprising 5,164 images from 1,291 patients of diverse backgrounds. This dataset addresses the lack of ophthalmological data in low- and middle-income countries (LMICs) by providing a cost-effective and accessible solution for ocular screening and management. Portable retinal cameras enable applications outside traditional hospital settings, such as community health screenings and telemedicine consultations, thereby democratizing healthcare. Extensive metadata that are typically unavailable in other datasets, including age, sex, diabetes duration, treatments, and comorbidities, are also recorded. To validate the utility of mBRSET, state-of-the-art deep models, including ConvNeXt V2, Dino V2, and SwinV2, were trained for benchmarking, achieving high accuracy in clinical tasks diagnosing diabetic retinopathy, and macular edema; and in fairness tasks predicting education and insurance status. The mBRSET dataset serves as a resource for developing AI algorithms and investigating real-world applications, enhancing ophthalmological care in resource-constrained environments.
{"title":"mBRSET: A Portable Retina Fundus Photos Benchmark Dataset for Clinical and Demographic Prediction","authors":"Chenwei Wu, David Restrepo, Luis Filipe Nakayama, Lucas Zago Ribeiro, Zitao Shuai, Nathan Santos Barboza, Maria Luiza Vieira Sousa, Raul Dias Fitterman, Alexandre Durao Alves Pereira, Caio Vinicius Saito Regatieri, Jose Augusto Stuchi, Fernando Korn Malerbi, Rafael E. Andrade","doi":"10.1101/2024.07.11.24310293","DOIUrl":"https://doi.org/10.1101/2024.07.11.24310293","url":null,"abstract":"This paper introduces mBRSET, the first publicly available retina dataset captured using handheld retinal cameras in real-life, high-burden scenarios, comprising 5,164 images from 1,291 patients of diverse backgrounds. This dataset addresses the lack of ophthalmological data in low- and middle-income countries (LMICs) by providing a cost-effective and accessible solution for ocular screening and management. Portable retinal cameras enable applications outside traditional hospital settings, such as community health screenings and telemedicine consultations, thereby democratizing healthcare. Extensive metadata that are typically unavailable in other datasets, including age, sex, diabetes duration, treatments, and comorbidities, are also recorded. To validate the utility of mBRSET, state-of-the-art deep models, including ConvNeXt V2, Dino V2, and SwinV2, were trained for benchmarking, achieving high accuracy in clinical tasks diagnosing diabetic retinopathy, and macular edema; and in fairness tasks predicting education and insurance status. The mBRSET dataset serves as a resource for developing AI algorithms and investigating real-world applications, enhancing ophthalmological care in resource-constrained environments.","PeriodicalId":501390,"journal":{"name":"medRxiv - Ophthalmology","volume":"95 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141610350","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}
Pub Date : 2024-07-11DOI: 10.1101/2024.07.11.24310270
Julius Gervelmeyer, Sarah Mueller, Kerol Djoumessi, David Merle, Simon J Clark, Lisa Koch, Philipp Berens
In the elderly, degenerative diseases often develop differently over time for individual patients. For optimal treatment, physicians and patients would like to know how much time is left for them until symptoms reach a certain stage. However, compared to simple disease detection tasks, disease progression modeling has received much less attention. In addition, most existing models are black-box models which provide little insight into the mechanisms driving the prediction. Here, we introduce an interpretable-by-design survival model to predict the progression of age-related macular degeneration (AMD) from fundus images. Our model not only achieves state-of-the-art prediction performance compared to black-box models but also provides a sparse map of local evidence of AMD progression for individual patients. Our evidence map faithfully reflects the decision-making process of the model in contrast to widely used post-hoc saliency methods. Furthermore, we show that the identified regions mostly align with established clinical AMD progression markers. We believe that our method may help to inform treatment decisions and may lead to better insights into imaging biomarkers indicative of disease progression. The project's code is available at github.com/berenslab/interpretable-deep-survival-analysis.
{"title":"Interpretable-by-design Deep Survival Analysis for Disease Progression Modeling","authors":"Julius Gervelmeyer, Sarah Mueller, Kerol Djoumessi, David Merle, Simon J Clark, Lisa Koch, Philipp Berens","doi":"10.1101/2024.07.11.24310270","DOIUrl":"https://doi.org/10.1101/2024.07.11.24310270","url":null,"abstract":"In the elderly, degenerative diseases often develop differently over time for individual patients. For optimal treatment, physicians and patients would like to know how much time is left for them until symptoms reach a certain stage. However, compared to simple disease detection tasks, disease progression modeling has received much less attention. In addition, most existing models are black-box models which provide little insight into the mechanisms driving the prediction. Here, we introduce an interpretable-by-design survival model to predict the progression of age-related macular degeneration (AMD) from fundus images. Our model not only achieves state-of-the-art prediction performance compared to black-box models but also provides a sparse map of local evidence of AMD progression for individual patients. Our evidence map faithfully reflects the decision-making process of the model in contrast to widely used post-hoc saliency methods. Furthermore, we show that the identified regions mostly align with established clinical AMD progression markers. We believe that our method may help to inform treatment decisions and may lead to better insights into imaging biomarkers indicative of disease progression. The project's code is available at github.com/berenslab/interpretable-deep-survival-analysis.","PeriodicalId":501390,"journal":{"name":"medRxiv - Ophthalmology","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141610356","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}
Pub Date : 2024-07-10DOI: 10.1101/2024.07.10.24310159
Yoseph Gizachew, Asamere Tsegaw, Tarekegn Wuletaw
Introduction: The current management of macular edema (ME) is intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) drugs and this represents an important advance in the treatment of ME. Studies done in the western eye care settings have confirmed that intravitreal injection of Avastin is effective for the treatment of ME. However, data on this drugs efficacy and safety in African eye care settings are very scarce. Objective: To assess the Safety and Effectiveness of intravitreal Bevacizumab (Avastin) injection for the treatment of Macular Edema (ME) due to retina vascular diseases at university of Gondar tertiary eye care and training center, NW Ethiopia. Method: A retrospective study was done on patients who were given intravitreal avastin (IVA) for the treatment of diabetic macular edema (DME), retinal vein occlusion (RVO) and Neovascular Age related macular degeneration (AMD). The main outcome measure was visual acuity (VA) and central macular thickness (CMT) measured by spectral domain OCT. Results: Medical records of 50 patients (66 eyes) were reviewed of which 46 (69.7%) were males and mean age of 54.2 years (range 20-80). The means of baseline VA and CMT were 1.0logMAR and 379.4 micron respectively. At the end of follow up and after mean injection of 2.5 times per eye, the mean VA improved to 0.7 logMAR (p=0.001) and the mean CMT reduced to 295 micron (p=0.0001). Baseline mean VA was significant prognostic factor for VA improvement (p=0.0001). Baseline mean CMT (P=0.007), number of injection (P=0.009) and diffuse macular edema (P=0.03) were significant factors for CMT reduction. Conclusions: IVA injection for ME edema due to retinal vascular diseases resulted in a significant improvement in mean VA (p=0.001) and CMT (p=0.0001) at the end of follow up. There was no any ocular or systemic complication of IVA injection.
{"title":"The Safety, Effectiveness and Prognostic Factors of Intravitreal Avastin (Bevacizumab) Injection for the Treatment of Macular Edema at the University of Gondar Tertiary Eye Care and Training Center, NW Ethiopia","authors":"Yoseph Gizachew, Asamere Tsegaw, Tarekegn Wuletaw","doi":"10.1101/2024.07.10.24310159","DOIUrl":"https://doi.org/10.1101/2024.07.10.24310159","url":null,"abstract":"Introduction: The current management of macular edema (ME) is intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) drugs and this represents an important advance in the treatment of ME. Studies done in the western eye care settings have confirmed that intravitreal injection of Avastin is effective for the treatment of ME. However, data on this drugs efficacy and safety in African eye care settings are very scarce. Objective: To assess the Safety and Effectiveness of intravitreal Bevacizumab (Avastin) injection for the treatment of Macular Edema (ME) due to retina vascular diseases at university of Gondar tertiary eye care and training center, NW Ethiopia.\u0000Method: A retrospective study was done on patients who were given intravitreal avastin (IVA) for the treatment of diabetic macular edema (DME), retinal vein occlusion (RVO) and Neovascular Age related macular degeneration (AMD). The main outcome measure was visual acuity (VA) and central macular thickness (CMT) measured by spectral domain OCT.\u0000Results: Medical records of 50 patients (66 eyes) were reviewed of which 46 (69.7%) were males and mean age of 54.2 years (range 20-80). The means of baseline VA and CMT were 1.0logMAR and 379.4 micron respectively. At the end of follow up and after mean injection of 2.5 times per eye, the mean VA improved to 0.7 logMAR (p=0.001) and the mean CMT reduced to 295 micron (p=0.0001). Baseline mean VA was significant prognostic factor for VA improvement (p=0.0001). Baseline mean CMT (P=0.007), number of injection (P=0.009) and diffuse macular edema (P=0.03) were significant factors for CMT reduction. Conclusions: IVA injection for ME edema due to retinal vascular diseases resulted in a significant improvement in mean VA (p=0.001) and CMT (p=0.0001) at the end of follow up. There was no any ocular or systemic complication of IVA injection.","PeriodicalId":501390,"journal":{"name":"medRxiv - Ophthalmology","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141586470","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}
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