American Journal of Ophthalmology最新文献

Purpose: Growing interest in microperimetry (MP) or fundus-controlled perimetry (FCP) as targeted psychometric testing method in geographic atrophy (GA) is warranted due to the disease subclinical/extra-foveal appearance or preexisting foveal loss with visual acuity becoming unreliable. We provide comprehensive pointwise test-retest repeatability reference values on the most widely used MP devices and combine them with targeted testing in areas of retinal pigment epithelium (RPE) as well as photoreceptor (PR) integrity loss, guiding the interpretation of sensitivity loss during the long-term follow-up of GA patients.

Design: Prospective reliability study METHODS: Patients with GA underwent consecutive testing on CenterVue (iCare) MAIA and NIDEK MP3 devices. Obtained PWS measurements were spatially co-registered to an optical coherence tomography (OCT) volume scan acquired during the same visit. Areas with RPE and PR integrity loss, drusen and PR thickness as well as the volume of hyperreflective foci (HRF) where identified and quantified using a set of validated deep learning-based algorithms. Test-retest repeatability was assessed according to areas defined by biomarker-specific morphologic changes using Bland-Altmann coefficients of repeatability (CoR). Furthermore, the inter-device correlation, the repeatability of scotoma point detection as well as any potential effects on fixation stability were assessed.

Results: 900 stimuli per device from twenty subjects were included. Identical overall PWS test-retest variance could be detected for MAIA (±6.57) and MP3 (±6.59). PR integrity loss was associated with a higher test-retest variance on both devices (MAIA: p=0.002; MP3: p<0.001). Higher CoR for stimuli in areas presenting RPE loss (±10.99 vs ±5.34) or HRF (±9.21 vs ±6.25) could only be detected on MP3 examinations (p<0.001 and p=0.01, respectively). An excellent intra-device correlation (MAIA: 0.94[0.93-0.95] MP3: 0.94[0.94-0.95]) and a good mean inter-device correlation (0.84[0.53-0.92]) could be demonstrated. The chosen device, run order or absence of foveal sparing had no significant effect on fixation stability.

Conclusion: Areas presenting automatically quantified PR integrity loss with and without underlying RPE loss are associated with higher test-retest variance for both MAIA and MP3. These findings are crucial for an accurate interpretation of GA progression during long-term follow-up and the planning of future trials with microperimetry testing as functional study endpoint.

Purpose: To highlight innovations in ophthalmic oncology through histiocytosis advancements.

Design: Perspective and retrospective review.

Methods: The literature outlining the recent advancements in histiocytosis and ocular oncology was reviewed and combined with trial data and personal recollection. Intersections between these two fields were discussed.

Results: The understanding of genetic mutations in disease-both in which cells they occur and the timing of mutation development-has expanded in tandem for the fields of ophthalmic oncology and histiocytosis. Similarly, advancements in diagnostic and treatment technology in one field can help patients in the other. For example, in one study, cell-free DNA testing reliably detected mutations in 14 of 18 (78%) patients with suspected histiocytosis. This technique has also been used in ophthalmic oncology as an alternative to invasive biopsy to avoid the risk of tumor externalization, vision impairment, and other side effects. These and other advancements have allowed both fields to utilize targeted agents to successfully treat diseases with an actionable mutation; or deliver more targeted chemotherapy via the intraarterial technique.

Conclusions: The explosion of molecular genetics technology and targeted therapies has revolutionized cancer treatment, including histiocytosis and ophthalmic oncology. Recent progress in both fields has shown how these seemingly disparate areas have many intersections, and this speaks to the collaborative spirit that is inherent in clinical research.

Purpose: To compare 7 AI-based IOL power calculation formulas in extremely long eyes DESIGN: : Retrospective accuracy and validity analysis.

Methods: SETTING: Kyiv Clinical Ophthalmology Hospital Eye Microsurgery Center, Ukraine STUDY POPULATION: : Patients with highly myopic eyes, who underwent uneventful phacoemulsification OBSERVATION PROCEDURES: Prior to cataract surgery IOL power was calculated. The power of the implanted IOL was randomly selected from the outcomes of SRK/T, Holladay 2 or Barrett Universal II. Three months after phacoemulsification, refraction was measured. Post-surgery IOL power calculations were performed utilizing the following formulas: Hill-RBF 3.0, Kane, PEARL-DGS, Ladas Super Formula AI (LSF AI), Hoffer QST, Karmona and Zhu-Lu.

Main outcome measures: root mean square absolute error (RMSAE), median absolute error (MedAE) and percentage of eyes with prediction error (PE) within ±0.50 D RESULTS: : Forty eight eyes with axial length exceeding 30.00 mm were studied. Hill-RBF 3.0 yielded the lowest RMSAE (0.788) with statistical superiority only over Karmona (0.956, p=0.021). In terms of MedAE, outcomes obtained by Hoffer QST (0.442) and Hill-RBF (0.490) were statistically significant vs LSF AI (0.800, p=0.013, p=0.008, respectively). The highest percentage of eyes with PE within ±0.50 D was achieved by Hill-RBF 3.0, Kane and Hoffer QST (54.17% each) statistically significant as follows: both Hill-RBF and Kane vs LSF AI (27.08%) and Karmona (39.58%), and Hoffer QST vs LSF AI.

Conclusion: All tested formulas demonstrated comparable trueness, with Hill-RBF 3.0 being more accurate than Karmona (RMSAE), and LSF AI being less accurate than Hoffer QST and Hill-RBF 3.0 (MedAE).

Purpose: To provide a perspective on the management of patients with neovascular age-related macular degeneration (nAMD) using a combination of sustained drug delivery strategies and remote monitoring technology.

Design: Evidence-based perspective.

Methods: Review of the literature and experience of the author.

Results: There are currently many ongoing research efforts in the retina field directed at both safe, effective sustained drug delivery and validated remote monitoring. At present, the port delivery system with ranibizumab and the Home OCT are approved by the U.S. Food and Drug Administration and available for use by clinicians. A review of available data and a case example demonstrate the potential for these combined technologies to reduce both the injection burden and the monitoring burden currently experienced by patients with nAMD. Other sustained drug delivery strategies such as tyrosine kinase inhibitor delivery systems and viral vector-mediated anti-vascular endothelial growth factor intraocular biofactory models are not yet approved for clinical use. Early experience with these technologies in clinical trials foretell the potential advantages and possible limitations of remote monitoring with a variety of sustained delivery approaches.

Conclusion: The combined use of sustained drug delivery and validated remote monitoring portends a significant change in the current nAMD treatment landscape and has the potential to reduce the injection and monitoring burden faced by patients while optimizing patient outcomes.