Vahid Mohammadzadeh, Youwei Liang, Sasan Moghimi, Pengtao Xie, Takashi Nishida, Golnoush Mahmoudinezhad, Medi Eslani, Evan Walker, Alireza Kamalipour, Eleonora Micheletti, Jo-Hsuan Wu, Mark Christopher, Linda M Zangwill, Tara Javidi, Robert N Weinreb
Background/aims To design a deep learning (DL) model for the detection of glaucoma progression with a longitudinal series of macular optical coherence tomography angiography (OCTA) images. Methods 202 eyes of 134 patients with open-angle glaucoma with ≥4 OCTA visits were followed for an average of 3.5 years. Glaucoma progression was defined as having a statistically significant negative 24-2 visual field (VF) mean deviation (MD) rate. The baseline and final macular OCTA images were aligned according to centre of fovea avascular zone automatically, by checking the highest value of correlation between the two images. A customised convolutional neural network (CNN) was designed for classification. A comparison of the CNN to logistic regression model for whole image vessel density (wiVD) loss on detection of glaucoma progression was performed. The performance of the model was defined based on the confusion matrix of the validation dataset and the area under receiver operating characteristics (AUC). Results The average (95% CI) baseline VF MD was −3.4 (−4.1 to −2.7) dB. 28 (14%) eyes demonstrated glaucoma progression. The AUC (95% CI) of the DL model for the detection of glaucoma progression was 0.81 (0.59 to 0.93). The sensitivity, specificity and accuracy (95% CI) of DL model were 67% (34% to 78%), 83% (42% to 97%) and 80% (52% to 95%), respectively. The AUC (95% CI) for the detection of glaucoma progression based on the logistic regression model was lower than the DL model (0.69 (0.50 to 0.88)). Conclusion The optimised DL model detected glaucoma progression based on longitudinal macular OCTA images showed good performance. With external validation, it could enhance detection of glaucoma progression. Trial registration number [NCT00221897][1]. Data are available upon reasonable request. The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00221897&atom=%2Fbjophthalmol%2Fearly%2F2024%2F08%2F07%2Fbjo-2023-324528.atom
{"title":"Detection of glaucoma progression on longitudinal series of en-face macular optical coherence tomography angiography images with a deep learning model","authors":"Vahid Mohammadzadeh, Youwei Liang, Sasan Moghimi, Pengtao Xie, Takashi Nishida, Golnoush Mahmoudinezhad, Medi Eslani, Evan Walker, Alireza Kamalipour, Eleonora Micheletti, Jo-Hsuan Wu, Mark Christopher, Linda M Zangwill, Tara Javidi, Robert N Weinreb","doi":"10.1136/bjo-2023-324528","DOIUrl":"https://doi.org/10.1136/bjo-2023-324528","url":null,"abstract":"Background/aims To design a deep learning (DL) model for the detection of glaucoma progression with a longitudinal series of macular optical coherence tomography angiography (OCTA) images. Methods 202 eyes of 134 patients with open-angle glaucoma with ≥4 OCTA visits were followed for an average of 3.5 years. Glaucoma progression was defined as having a statistically significant negative 24-2 visual field (VF) mean deviation (MD) rate. The baseline and final macular OCTA images were aligned according to centre of fovea avascular zone automatically, by checking the highest value of correlation between the two images. A customised convolutional neural network (CNN) was designed for classification. A comparison of the CNN to logistic regression model for whole image vessel density (wiVD) loss on detection of glaucoma progression was performed. The performance of the model was defined based on the confusion matrix of the validation dataset and the area under receiver operating characteristics (AUC). Results The average (95% CI) baseline VF MD was −3.4 (−4.1 to −2.7) dB. 28 (14%) eyes demonstrated glaucoma progression. The AUC (95% CI) of the DL model for the detection of glaucoma progression was 0.81 (0.59 to 0.93). The sensitivity, specificity and accuracy (95% CI) of DL model were 67% (34% to 78%), 83% (42% to 97%) and 80% (52% to 95%), respectively. The AUC (95% CI) for the detection of glaucoma progression based on the logistic regression model was lower than the DL model (0.69 (0.50 to 0.88)). Conclusion The optimised DL model detected glaucoma progression based on longitudinal macular OCTA images showed good performance. With external validation, it could enhance detection of glaucoma progression. Trial registration number [NCT00221897][1]. Data are available upon reasonable request. The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00221897&atom=%2Fbjophthalmol%2Fearly%2F2024%2F08%2F07%2Fbjo-2023-324528.atom","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141904558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andreas Katsimpris, Sebastian-Edgar Baumeister, Hansjörg Baurecht, Andrew J Tatham, Michael Nolde
Background The association of central corneal thickness (CCT) with primary open-angle glaucoma (POAG) remains uncertain. Although several observational studies assessing this relationship have reported an inverse association between CCT and POAG, this could be the result of collider bias. In this study, we leveraged human genetic data to assess through Mendelian randomisation (MR) the effect of CCT on POAG risk and whether this effect is mediated by intraocular pressure (IOP) changes. Methods We used 24 single-nucleotide polymorphisms (SNPs) associated with CCT (p value<5×10−8) from a genome-wide association study (GWAS) (N=17 803) provided by the International Glaucoma Genetics Consortium and 53 SNPs associated with IOP (p value<5×10−8) from a GWAS of the UK Biobank (UKBB) (N=97 653). We related these instruments to POAG using a GWAS meta-analysis of 8283 POAG cases and 753 827 controls from UKBB and FinnGen. Results MR analysis suggested a positive association between CCT and POAG (OR of POAG per 50 µm increase in CCT: 1.38; 95% CI: 1.18 to 1.61; p value<0.01). MR mediation analysis showed that 28.4% of the total effect of CCT on POAG risk was mediated through changes in IOP. The primary results were consistent with estimates of pleiotropy-robust MR methods. Conclusion Contrary to most observational studies, our results showed that a higher CCT is associated with an increased risk of POAG. Data are available upon reasonable request.
{"title":"Central corneal thickness and the risk of primary open-angle glaucoma: a Mendelian randomisation mediation analysis","authors":"Andreas Katsimpris, Sebastian-Edgar Baumeister, Hansjörg Baurecht, Andrew J Tatham, Michael Nolde","doi":"10.1136/bjo-2023-324996","DOIUrl":"https://doi.org/10.1136/bjo-2023-324996","url":null,"abstract":"Background The association of central corneal thickness (CCT) with primary open-angle glaucoma (POAG) remains uncertain. Although several observational studies assessing this relationship have reported an inverse association between CCT and POAG, this could be the result of collider bias. In this study, we leveraged human genetic data to assess through Mendelian randomisation (MR) the effect of CCT on POAG risk and whether this effect is mediated by intraocular pressure (IOP) changes. Methods We used 24 single-nucleotide polymorphisms (SNPs) associated with CCT (p value<5×10−8) from a genome-wide association study (GWAS) (N=17 803) provided by the International Glaucoma Genetics Consortium and 53 SNPs associated with IOP (p value<5×10−8) from a GWAS of the UK Biobank (UKBB) (N=97 653). We related these instruments to POAG using a GWAS meta-analysis of 8283 POAG cases and 753 827 controls from UKBB and FinnGen. Results MR analysis suggested a positive association between CCT and POAG (OR of POAG per 50 µm increase in CCT: 1.38; 95% CI: 1.18 to 1.61; p value<0.01). MR mediation analysis showed that 28.4% of the total effect of CCT on POAG risk was mediated through changes in IOP. The primary results were consistent with estimates of pleiotropy-robust MR methods. Conclusion Contrary to most observational studies, our results showed that a higher CCT is associated with an increased risk of POAG. Data are available upon reasonable request.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141904495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael Heyang, Joshua L Warren, Paulina Ocieczek, Jacque L Duncan, Mariya Moosajee, Lucian V Del Priore, Liangbo Linus Shen
Aims: To investigate the long-term natural history of ellipsoid zone (EZ) width in USH2A-retinopathy.
Methods: EZ width measurements from optical coherence tomography were retrospectively obtained from 110 eyes of 55 participants with molecularly confirmed biallelic USH2A-retinopathy. We used a hierarchical Bayesian method to construct and compare different mathematical models describing the long-term decline of EZ width.
Results: Compared with linear and quadratic models, exponential decline best represented the long-term loss of EZ width based on the deviance information criterion score. Log-transformed EZ width declined linearly over 30 years of inferred disease duration (median: 0.063 (IQR: 0.040-0.086) log (µm)/year). Compared with the raw EZ width decline rate, the log-transformed EZ width decline rate required 48% fewer patients to achieve an identically powered 1-year trial (38 vs 73 participants). Log EZ width decline rate was uncoupled from baseline EZ width (Spearman ρ=-0.18, p=0.06) and age (ρ=-0.10, p=0.31). Eyes with Usher syndrome exhibited earlier median onset ages of macular EZ width loss (18.8 (IQR: 13.1-24.7) vs 28.1 (IQR: 18.5-35.8) years, p<0.001) but comparable log EZ width decline rates (0.060 (IQR: 0.035-0.100) vs 0.065 (IQR: 0.050-0.079) log (µm)/year; p=0.42).
Conclusions: EZ width follows an exponential decline in USH2A-retinopathy. Compared with raw EZ width decline rate, log-transformed EZ width decline rate may be a superior endpoint for clinical trials. Syndromic eyes exhibit an earlier onset of macular EZ width loss but progress at comparable rates to non-syndromic eyes.
目的：研究 USH2A 视网膜病变患者椭圆形区（EZ）宽度的长期自然史：我们回顾性地从55名经分子证实患有双拷贝USH2A视网膜病变的患者的110只眼睛中获得了光学相干断层扫描的EZ宽度测量值。我们使用分层贝叶斯方法构建并比较了描述 EZ 宽度长期下降的不同数学模型：结果：与线性模型和二次模型相比，根据偏差信息标准分数，指数下降模型最能代表EZ宽度的长期下降。对数变换后的 EZ 宽度在推断的 30 年病程中呈线性下降（中位数：0.063（IQR：0.063））：0.063（IQR：0.040-0.086）对数（µm）/年）。与原始 EZ 宽度下降率相比，对数转换后的 EZ 宽度下降率需要较少 48% 的患者（38 对 73 名参与者）才能实现相同功率的 1 年试验。对数 EZ 宽度下降率与基线 EZ 宽度（Spearman ρ=-0.18，p=0.06）和年龄（ρ=-0.10，p=0.31）不相关。Usher综合征患者黄斑EZ宽度损失的中位发病年龄较早（18.8（IQR：13.1-24.7）岁 vs 28.1（IQR：18.5-35.8）岁，p结论：USH2A视网膜病变患者的EZ宽度呈指数下降。与原始 EZ 宽度下降率相比，经过对数变换的 EZ 宽度下降率可能是临床试验的更好终点。综合征眼的黄斑 EZ 宽度下降起病较早，但进展速度与非综合征眼相当。
{"title":"Long-term natural history of ellipsoid zone width in <i>USH2A</i>-retinopathy.","authors":"Michael Heyang, Joshua L Warren, Paulina Ocieczek, Jacque L Duncan, Mariya Moosajee, Lucian V Del Priore, Liangbo Linus Shen","doi":"10.1136/bjo-2024-325323","DOIUrl":"https://doi.org/10.1136/bjo-2024-325323","url":null,"abstract":"<p><strong>Aims: </strong>To investigate the long-term natural history of ellipsoid zone (EZ) width in <i>USH2A</i>-retinopathy.</p><p><strong>Methods: </strong>EZ width measurements from optical coherence tomography were retrospectively obtained from 110 eyes of 55 participants with molecularly confirmed biallelic <i>USH2A</i>-retinopathy. We used a hierarchical Bayesian method to construct and compare different mathematical models describing the long-term decline of EZ width.</p><p><strong>Results: </strong>Compared with linear and quadratic models, exponential decline best represented the long-term loss of EZ width based on the deviance information criterion score. Log-transformed EZ width declined linearly over 30 years of inferred disease duration (median: 0.063 (IQR: 0.040-0.086) log (µm)/year). Compared with the raw EZ width decline rate, the log-transformed EZ width decline rate required 48% fewer patients to achieve an identically powered 1-year trial (38 vs 73 participants). Log EZ width decline rate was uncoupled from baseline EZ width (Spearman ρ=-0.18, p=0.06) and age (ρ=-0.10, p=0.31). Eyes with Usher syndrome exhibited earlier median onset ages of macular EZ width loss (18.8 (IQR: 13.1-24.7) vs 28.1 (IQR: 18.5-35.8) years, p<0.001) but comparable log EZ width decline rates (0.060 (IQR: 0.035-0.100) vs 0.065 (IQR: 0.050-0.079) log (µm)/year; p=0.42).</p><p><strong>Conclusions: </strong>EZ width follows an exponential decline in <i>USH2A</i>-retinopathy. Compared with raw EZ width decline rate, log-transformed EZ width decline rate may be a superior endpoint for clinical trials. Syndromic eyes exhibit an earlier onset of macular EZ width loss but progress at comparable rates to non-syndromic eyes.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141892912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrew M Philip, Fatima Babiker, Carla C Fernandez-Santos, Max N Chikovsky, Andrew H Dolinko, Koosha Ramezani, Sydney Look-Why, Ambika Manhapra, Maria L Ruggeri, Peter Y Chang, Stephen Foster, Stephen D Anesi
Background/aims: To explore and characterise the clinical phenotype of acute anterior uveitis flares with delayed severity in patients with human leucocyte antigen B27 (HLA-B27)-associated anterior uveitis.
Methods: Retrospective chart review of patients with HLA-B27-associated anterior uveitis. Demographic and clinical data were recorded, as well as the clinical characteristics of acute anterior uveitis flares. A flare was considered to have delayed severity if any of the following criteria were met within 3-21 days of symptomatic onset: a two-step increase in anterior chamber inflammation on consecutive exams; a new development of hypopyon or fibrinoid aqueous reaction on consecutive examinations or a significant worsening of symptoms.
Results: A total of 371 patient charts were identified, of which 137 were included. 321 acute anterior uveitis flares were documented, with 36 (11.2%) meeting the criteria for a delayed severity flare. The average time from symptomatic onset was 10.2 days, and patients presented with an average anterior chamber cell grade of 3.5 in delayed severity flares compared with 1.6 in non-delayed severity flares. No significant difference in frequency of delayed severity presentation was noted based on the presence or absence of systemically associated rheumatological disease, papillitis on initial presentation and retinal vasculitis on initial presentation. The frequency of topical steroid therapy after symptomatic onset was not significantly different between the two flare phenotypes.
Conclusions: Our study presents the novel characterisation of a delayed severity phenotype of HLA-B27-associated acute anterior uveitis flares.
{"title":"Characterisation of delayed severity flares in patients with HLA-B27-associated anterior uveitis.","authors":"Andrew M Philip, Fatima Babiker, Carla C Fernandez-Santos, Max N Chikovsky, Andrew H Dolinko, Koosha Ramezani, Sydney Look-Why, Ambika Manhapra, Maria L Ruggeri, Peter Y Chang, Stephen Foster, Stephen D Anesi","doi":"10.1136/bjo-2024-325364","DOIUrl":"https://doi.org/10.1136/bjo-2024-325364","url":null,"abstract":"<p><strong>Background/aims: </strong>To explore and characterise the clinical phenotype of acute anterior uveitis flares with delayed severity in patients with human leucocyte antigen B27 (HLA-B27)-associated anterior uveitis.</p><p><strong>Methods: </strong>Retrospective chart review of patients with HLA-B27-associated anterior uveitis. Demographic and clinical data were recorded, as well as the clinical characteristics of acute anterior uveitis flares. A flare was considered to have delayed severity if any of the following criteria were met within 3-21 days of symptomatic onset: a two-step increase in anterior chamber inflammation on consecutive exams; a new development of hypopyon or fibrinoid aqueous reaction on consecutive examinations or a significant worsening of symptoms.</p><p><strong>Results: </strong>A total of 371 patient charts were identified, of which 137 were included. 321 acute anterior uveitis flares were documented, with 36 (11.2%) meeting the criteria for a delayed severity flare. The average time from symptomatic onset was 10.2 days, and patients presented with an average anterior chamber cell grade of 3.5 in delayed severity flares compared with 1.6 in non-delayed severity flares. No significant difference in frequency of delayed severity presentation was noted based on the presence or absence of systemically associated rheumatological disease, papillitis on initial presentation and retinal vasculitis on initial presentation. The frequency of topical steroid therapy after symptomatic onset was not significantly different between the two flare phenotypes.</p><p><strong>Conclusions: </strong>Our study presents the novel characterisation of a delayed severity phenotype of HLA-B27-associated acute anterior uveitis flares.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
For the data published by Lam et al (2020) on Defocus Incorporated Multiple Segments spectacle lenses, it is shown that, on average, the age-matched physiological axial length growth is achieved in myopic children. Few studies have reported the long-term effect of orthokeratology on the choroid. In the current 2 year prospective study, orthokeratology was found to improve the choroidal thickness and maintain the choroidal contour, but this effect diminished with time. This retrospective study of 156 patients who underwent orbital decompression surgery showed an 8% incidence (12 patients) of new-onset constant diplopia. Preoperative restricted elevation was a risk factor for postoperative diplopia. Preoperative incyclodeviation may become bothersome after orbital decompression. "The study used swept-source optical coherence tomography to measure the choroidal thickness in thyroid associated ophthalmopathy and found significant increases in the active phase. Choroid thickness could be …
{"title":"At a glance","authors":"Frank Larkin","doi":"10.1136/bjo-2024-326086","DOIUrl":"https://doi.org/10.1136/bjo-2024-326086","url":null,"abstract":"For the data published by Lam et al (2020) on Defocus Incorporated Multiple Segments spectacle lenses, it is shown that, on average, the age-matched physiological axial length growth is achieved in myopic children. Few studies have reported the long-term effect of orthokeratology on the choroid. In the current 2 year prospective study, orthokeratology was found to improve the choroidal thickness and maintain the choroidal contour, but this effect diminished with time. This retrospective study of 156 patients who underwent orbital decompression surgery showed an 8% incidence (12 patients) of new-onset constant diplopia. Preoperative restricted elevation was a risk factor for postoperative diplopia. Preoperative incyclodeviation may become bothersome after orbital decompression. \"The study used swept-source optical coherence tomography to measure the choroidal thickness in thyroid associated ophthalmopathy and found significant increases in the active phase. Choroid thickness could be …","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141750252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aaron Yap, Helen Kearns, Joanne L Sims, Rachael L Niederer
Purpose: Our aim was to describe the visual outcomes and determine the clinical factors in ischaemic retinal vasculitis (IRV) that were predictive of a poor visual prognosis or infectious aetiology.
Methods: Retrospective cohort study of consecutive presentations of IRV to Auckland District Health Board from 2009 to 2022.
Results: The median age at presentation was 39.2 years and 108 (53.7%) were women. The total median follow-up was 4.8 years. Infectious aetiology was present in 151 eyes (52.1%). Moderate visual loss (20/50 to 20/200) occurred in 20 eyes (6.9%) and severe visual loss (≤20/200) occurred in 41 eyes (14.1%). Median visual acuity was 20/30 (IQR 20/25 to 20/100) on presentation and 20/25 (IQR 20/20 to 20/50) at final follow-up. Retinitis (HR 4.675 p=0.048) and cystoid macular oedema (CME) (HR 7.265 p<0.001) were significantly associated with vision loss. There was concurrent macular ischaemia in 26 eyes (19.4%) and CME in 52 eyes (17.9%). Retinitis was predictive of infectious aetiology (p=0.006) and cotton wool spots for non-infectious aetiology (p<0.001). Retinal haemorrhage (HR 5.580 p=0.001), retinal vein occlusion (HR 5.071 p=0.001) and quadrants of ischaemia (HR 2.222 p=0.025) were significantly associated with vitreous haemorrhage.
Conclusion: In patients with IRV, 21% of affected individuals sustained moderate-to-severe vision loss over 5 years. Ultra-widefield fluorescein angiography can be used to quantify the risk of neovascular complications and guide treatment.
{"title":"Visual outcomes and prognostic factors in ischaemic retinal vasculitis.","authors":"Aaron Yap, Helen Kearns, Joanne L Sims, Rachael L Niederer","doi":"10.1136/bjo-2024-325775","DOIUrl":"https://doi.org/10.1136/bjo-2024-325775","url":null,"abstract":"<p><strong>Purpose: </strong>Our aim was to describe the visual outcomes and determine the clinical factors in ischaemic retinal vasculitis (IRV) that were predictive of a poor visual prognosis or infectious aetiology.</p><p><strong>Methods: </strong>Retrospective cohort study of consecutive presentations of IRV to Auckland District Health Board from 2009 to 2022.</p><p><strong>Results: </strong>The median age at presentation was 39.2 years and 108 (53.7%) were women. The total median follow-up was 4.8 years. Infectious aetiology was present in 151 eyes (52.1%). Moderate visual loss (20/50 to 20/200) occurred in 20 eyes (6.9%) and severe visual loss (≤20/200) occurred in 41 eyes (14.1%). Median visual acuity was 20/30 (IQR 20/25 to 20/100) on presentation and 20/25 (IQR 20/20 to 20/50) at final follow-up. Retinitis (HR 4.675 p=0.048) and cystoid macular oedema (CME) (HR 7.265 p<0.001) were significantly associated with vision loss. There was concurrent macular ischaemia in 26 eyes (19.4%) and CME in 52 eyes (17.9%). Retinitis was predictive of infectious aetiology (p=0.006) and cotton wool spots for non-infectious aetiology (p<0.001). Retinal haemorrhage (HR 5.580 p=0.001), retinal vein occlusion (HR 5.071 p=0.001) and quadrants of ischaemia (HR 2.222 p=0.025) were significantly associated with vitreous haemorrhage.</p><p><strong>Conclusion: </strong>In patients with IRV, 21% of affected individuals sustained moderate-to-severe vision loss over 5 years. Ultra-widefield fluorescein angiography can be used to quantify the risk of neovascular complications and guide treatment.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marina Roizenblatt, Peter Louis Gehlbach, Vitor Dias Gomes Barrios Marin, Arnaldo Roizenblatt, Thiago Marques Fidalgo, Vinicius Silveira Saraiva, Mauricio Hiroshi Nakanami, Luciana Cruz Noia, Sung Watanabe, Erika Sayuri Yasaki, Renato Magalhães Passos, Octaviano Magalhães Junior, Rodrigo Antonio Brant Fernandes, Francisco Rosa Stefanini, Rafael Caiado, Kim Jiramongkolchai, Michel Eid Farah, Rubens Belfort Junior, Mauricio Maia
Aim Routine alcohol testing of practicing physicians remains controversial since there are no uniform guidelines or legal regulations in the medical field. Our aim was to quantitatively study the acute and next-morning effects of breath alcohol concentration (BAC)-adjusted alcohol intake on overall simulated surgical performance and microtremor among senior vitreoretinal surgeons. Methods This prospective cohort study included 11 vitreoretinal surgeons (>10 years practice). Surgical performance was first assessed using the Eyesi surgical simulator following same-day alcohol consumption producing a BAC reading of 0.06%–0.10% (low-dose), followed by 0.11%–0.15% (high-dose). Dexterity was then evaluated after a ‘night out’ producing a high-dose BAC combined with a night’s sleep. Changes in the total score (0–700, worst-best) and tremor (0–100, best-worst) were measured. Results Surgeon performance declined after high-dose alcohol compared with low-dose alcohol (−8.60±10.77 vs −1.21±7.71, p=0.04, respectively). The performance during hangover was similar to low-dose alcohol (−1.76±14.47 vs −1.21±7.71, p=1.00, respectively). The performance during hangover tended to be better than after high-dose alcohol (−1.76±14.47 vs −8.60±10.77, p=0.09, respectively). Tremor increased during hangover compared with low-dose alcohol (7.33±21.65 vs −10.31±10.73, p=0.03, respectively). A trend toward greater tremor during hangover occurred compared with high-dose alcohol (7.33±21.65 vs −4.12±17.17, p=0.08, respectively). Conclusion Alcohol-related decline in simulated surgical dexterity among senior vitreoretinal surgeons was dose-dependent. Dexterity improved the following morning but remained comparable to after low-dose alcohol ingestion. Tremor increased during hangover compared with same-day intoxication. Further studies are needed to investigate extrapolations of these data to a real surgical environment regarding patient safety and surgeon performance. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.
目的 由于医疗领域没有统一的指导方针或法律规定，因此对执业医师进行常规酒精测试仍存在争议。我们的目的是定量研究经呼吸酒精浓度（BAC）调整后的酒精摄入量对高级玻璃体视网膜外科医生整体模拟手术表现和微震的急性和次晨影响。方法 这项前瞻性队列研究包括 11 名玻璃体视网膜外科医生（从业时间超过 10 年）。首先使用 Eyesi 手术模拟器评估当天饮酒后的手术表现，酒精浓度读数为 0.06%-0.10%（低剂量），然后是 0.11%-0.15%（高剂量）。然后，在 "夜游 "产生高浓度 BAC 后，再加上一夜睡眠，对灵活性进行了评估。对总分（0-700，最差-最佳）和震颤（0-100，最佳-最差）的变化进行了测量。结果 与小剂量酒精相比，外科医生在大剂量酒精后的表现有所下降（分别为-8.60±10.77 vs -1.21±7.71, p=0.04）。宿醉时的表现与低剂量酒精相似（分别为-1.76±14.47 vs -1.21±7.71, p=1.00）。宿醉时的表现往往优于大剂量饮酒后（分别为-1.76±14.47 vs -8.60±10.77，p=0.09）。与低剂量酒精相比，宿醉时震颤增加（分别为 7.33±21.65 vs -10.31±10.73，p=0.03）。与大剂量酒精相比，宿醉时震颤有加重趋势（分别为 7.33±21.65 vs -4.12±17.17，p=0.08）。结论 高级玻璃体视网膜外科医生模拟手术灵活性的下降与酒精剂量有关。第二天早上，灵活性有所改善，但仍与摄入低剂量酒精后相似。与当天醉酒相比，宿醉时震颤增加。还需要进一步研究将这些数据推广到真实的手术环境中，以确保患者安全和外科医生的工作表现。如有合理要求，可提供相关数据。与研究相关的所有数据均包含在文章中或作为补充信息上传。
{"title":"Vitreoretinal surgical performance after acute alcohol consumption and hangover","authors":"Marina Roizenblatt, Peter Louis Gehlbach, Vitor Dias Gomes Barrios Marin, Arnaldo Roizenblatt, Thiago Marques Fidalgo, Vinicius Silveira Saraiva, Mauricio Hiroshi Nakanami, Luciana Cruz Noia, Sung Watanabe, Erika Sayuri Yasaki, Renato Magalhães Passos, Octaviano Magalhães Junior, Rodrigo Antonio Brant Fernandes, Francisco Rosa Stefanini, Rafael Caiado, Kim Jiramongkolchai, Michel Eid Farah, Rubens Belfort Junior, Mauricio Maia","doi":"10.1136/bjo-2023-324044","DOIUrl":"https://doi.org/10.1136/bjo-2023-324044","url":null,"abstract":"Aim Routine alcohol testing of practicing physicians remains controversial since there are no uniform guidelines or legal regulations in the medical field. Our aim was to quantitatively study the acute and next-morning effects of breath alcohol concentration (BAC)-adjusted alcohol intake on overall simulated surgical performance and microtremor among senior vitreoretinal surgeons. Methods This prospective cohort study included 11 vitreoretinal surgeons (>10 years practice). Surgical performance was first assessed using the Eyesi surgical simulator following same-day alcohol consumption producing a BAC reading of 0.06%–0.10% (low-dose), followed by 0.11%–0.15% (high-dose). Dexterity was then evaluated after a ‘night out’ producing a high-dose BAC combined with a night’s sleep. Changes in the total score (0–700, worst-best) and tremor (0–100, best-worst) were measured. Results Surgeon performance declined after high-dose alcohol compared with low-dose alcohol (−8.60±10.77 vs −1.21±7.71, p=0.04, respectively). The performance during hangover was similar to low-dose alcohol (−1.76±14.47 vs −1.21±7.71, p=1.00, respectively). The performance during hangover tended to be better than after high-dose alcohol (−1.76±14.47 vs −8.60±10.77, p=0.09, respectively). Tremor increased during hangover compared with low-dose alcohol (7.33±21.65 vs −10.31±10.73, p=0.03, respectively). A trend toward greater tremor during hangover occurred compared with high-dose alcohol (7.33±21.65 vs −4.12±17.17, p=0.08, respectively). Conclusion Alcohol-related decline in simulated surgical dexterity among senior vitreoretinal surgeons was dose-dependent. Dexterity improved the following morning but remained comparable to after low-dose alcohol ingestion. Tremor increased during hangover compared with same-day intoxication. Further studies are needed to investigate extrapolations of these data to a real surgical environment regarding patient safety and surgeon performance. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141862173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Roger S Anderson, Mark Roark, Rose Gilbert, Dayyanah Sumodhee
Background/aims: Recent decades have seen significant advances in both structural and functional testing of retinal disease. However, the current clinical value of specific testing modalities, as well as future trends, need to be clearly identified in order to highlight areas for further development in routine care and clinical trials.
Methods: We designed a modified two-round Delphi study to obtain the opinion of a multidisciplinary group of 33 international experts involved in the field of retinal disease management/research to determine the level of agreement and consensus regarding the value and performance of specific structural and functional testing methods for retinal disease. On a Likert scale, a median of 1-2 indicated disagreement with the statement, and 5-6 indicated agreement with the statement. An IQR of ≤2 indicated consensus in the responses. Several questions also allowed comments on responses.
Results: There was overall agreement that structural testing currently predominates for detection and monitoring. There was moderate agreement that functional testing remains important and will continue to do so in the future because it provides complementary information. Certain respondents considered that properly designed and applied psychophysical tests are as reliable and repeatable as structural observations and that functional changes are the most important in the long run. Respondents considered future care and research to require a combination of structural and functional testing with strong consensus that the relative importance will depend on disease type and stage.
Conclusion: The study obtained important insights from a group of international experts regarding current and future needs in the management of retinal disease using a mix of quantitative and qualitative approaches. Responses provide a rich range of opinions that will be of interest to researchers seeking to design tests for future patient care and clinical trials.
{"title":"Expert CONsensus on Visual Evaluation in Retinal disease manaGEment: the CONVERGE study.","authors":"Roger S Anderson, Mark Roark, Rose Gilbert, Dayyanah Sumodhee","doi":"10.1136/bjo-2024-325310","DOIUrl":"https://doi.org/10.1136/bjo-2024-325310","url":null,"abstract":"<p><strong>Background/aims: </strong>Recent decades have seen significant advances in both structural and functional testing of retinal disease. However, the current clinical value of specific testing modalities, as well as future trends, need to be clearly identified in order to highlight areas for further development in routine care and clinical trials.</p><p><strong>Methods: </strong>We designed a modified two-round Delphi study to obtain the opinion of a multidisciplinary group of 33 international experts involved in the field of retinal disease management/research to determine the level of agreement and consensus regarding the value and performance of specific structural and functional testing methods for retinal disease. On a Likert scale, a median of 1-2 indicated disagreement with the statement, and 5-6 indicated agreement with the statement. An IQR of ≤2 indicated consensus in the responses. Several questions also allowed comments on responses.</p><p><strong>Results: </strong>There was overall agreement that structural testing currently predominates for detection and monitoring. There was moderate agreement that functional testing remains important and will continue to do so in the future because it provides complementary information. Certain respondents considered that properly designed and applied psychophysical tests are as reliable and repeatable as structural observations and that functional changes are the most important in the long run. Respondents considered future care and research to require a combination of structural and functional testing with strong consensus that the relative importance will depend on disease type and stage.</p><p><strong>Conclusion: </strong>The study obtained important insights from a group of international experts regarding current and future needs in the management of retinal disease using a mix of quantitative and qualitative approaches. Responses provide a rich range of opinions that will be of interest to researchers seeking to design tests for future patient care and clinical trials.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anamika Patel, Avinash Pathengay, Carlos Pavesio, Ilaria Testi
Purpose: To show the role of multimodal imaging in identifying choroidal involvement in acute retinal necrosis (ARN).
Methods: Retrospective case series of ARN patients. Clinical data, including medical history, clinical features and multimodal imaging findings, were collected.
Results: Three patients were included. Imaging modalities, such as indocyanine green angiography and optical coherence tomography, were critical in showing choroidal involvement in ARN.
Conclusion: Choroidal involvement may occur in ARN along with the well-known retinal features.
{"title":"Choroidal involvement in acute retinal necrosis: case series and review of the literature.","authors":"Anamika Patel, Avinash Pathengay, Carlos Pavesio, Ilaria Testi","doi":"10.1136/bjo-2024-325724","DOIUrl":"https://doi.org/10.1136/bjo-2024-325724","url":null,"abstract":"<p><strong>Purpose: </strong>To show the role of multimodal imaging in identifying choroidal involvement in acute retinal necrosis (ARN).</p><p><strong>Methods: </strong>Retrospective case series of ARN patients. Clinical data, including medical history, clinical features and multimodal imaging findings, were collected.</p><p><strong>Results: </strong>Three patients were included. Imaging modalities, such as indocyanine green angiography and optical coherence tomography, were critical in showing choroidal involvement in ARN.</p><p><strong>Conclusion: </strong>Choroidal involvement may occur in ARN along with the well-known retinal features.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141854895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Austin D Igelman, Elizabeth White, Alaa Tayyib, Lesley Everett, Ajoy Vincent, Elise Heon, Christina Zeitz, Michel Michaelides, Omar A Mahroo, Mohamed Katta, Andrew Webster, Markus Preising, Birgit Lorenz, Samer Khateb, Eyal Banin, Dror Sharon, Shahar Luski, Filip Van Den Broeck, Bart Peter Leroy, Elfride De Baere, Sophie Walraedt, Katarina Stingl, Laura Kuehlewein, Susanne Kohl, Milda Reith, Anne Fulton, Aparna Raghuram, Isabelle Meunier, Hélène Dollfus, Tomas S Aleman, Emma C Bedoukian, Erin C O'Neil, Emily Krauss, Andrea Vincent, Charlotte Jordan, Alessandro Iannaccone, Parveen Sen, Srilekha Sundaramurthy, Soumittra Nagasamy, Irina Balikova, Ingele Casteels, Shyamanga Borooah, Shaden Yassin, Aaron Nagiel, Hillary Schwartz, Xavier Zanlonghi, Irene Gottlob, Rebecca J McLean, Francis L Munier, Andrew Stephenson, Robert Sisk, Robert Koenekoop, Lorri B Wilson, Douglas Fredrick, Dongseok Choi, Paul Yang, Mark Edward Pennesi
Background/aaims: Congenital stationary night blindness (CSNB) is an inherited retinal disease that is often associated with high myopia and can be caused by pathological variants in multiple genes, most commonly CACNA1F, NYX and TRPM1. High myopia is associated with retinal degeneration and increased risk for retinal detachment. Slowing the progression of myopia in patients with CSNB would likely be beneficial in reducing risk, but before interventions can be considered, it is important to understand the natural history of myopic progression.
Methods: This multicentre, retrospective study explored CSNB caused by variants in CACNA1F, NYX or TRPM1 in patients who had at least 6 measurements of their spherical equivalent of refraction (SER) before the age of 18. A mixed-effect model was used to predict progression of SER overtime and differences between genotypes were evaluated.
Results: 78 individuals were included in this study. All genotypes showed a significant myopic predicted SER at birth (-3.076D, -5.511D and -5.386D) for CACNA1F, NYX and TRPM1 respectively. Additionally, significant progression of myopia per year (-0.254D, -0.257D and -0.326D) was observed for all three genotypes CACNA1F, NYX and TRPM1, respectively.
Conclusions: Patients with CSNB tend to be myopic from an early age and progress to become more myopic with age. Patients may benefit from long-term myopia slowing treatment in the future and further studies are indicated. Additionally, CSNB should be considered in the differential diagnosis for early-onset myopia.
{"title":"Characterising the refractive error in paediatric patients with congenital stationary night blindness: a multicentre study.","authors":"Austin D Igelman, Elizabeth White, Alaa Tayyib, Lesley Everett, Ajoy Vincent, Elise Heon, Christina Zeitz, Michel Michaelides, Omar A Mahroo, Mohamed Katta, Andrew Webster, Markus Preising, Birgit Lorenz, Samer Khateb, Eyal Banin, Dror Sharon, Shahar Luski, Filip Van Den Broeck, Bart Peter Leroy, Elfride De Baere, Sophie Walraedt, Katarina Stingl, Laura Kuehlewein, Susanne Kohl, Milda Reith, Anne Fulton, Aparna Raghuram, Isabelle Meunier, Hélène Dollfus, Tomas S Aleman, Emma C Bedoukian, Erin C O'Neil, Emily Krauss, Andrea Vincent, Charlotte Jordan, Alessandro Iannaccone, Parveen Sen, Srilekha Sundaramurthy, Soumittra Nagasamy, Irina Balikova, Ingele Casteels, Shyamanga Borooah, Shaden Yassin, Aaron Nagiel, Hillary Schwartz, Xavier Zanlonghi, Irene Gottlob, Rebecca J McLean, Francis L Munier, Andrew Stephenson, Robert Sisk, Robert Koenekoop, Lorri B Wilson, Douglas Fredrick, Dongseok Choi, Paul Yang, Mark Edward Pennesi","doi":"10.1136/bjo-2023-323747","DOIUrl":"https://doi.org/10.1136/bjo-2023-323747","url":null,"abstract":"<p><strong>Background/aaims: </strong>Congenital stationary night blindness (CSNB) is an inherited retinal disease that is often associated with high myopia and can be caused by pathological variants in multiple genes, most commonly <i>CACNA1F</i>, <i>NYX</i> and <i>TRPM1</i>. High myopia is associated with retinal degeneration and increased risk for retinal detachment. Slowing the progression of myopia in patients with CSNB would likely be beneficial in reducing risk, but before interventions can be considered, it is important to understand the natural history of myopic progression.</p><p><strong>Methods: </strong>This multicentre, retrospective study explored CSNB caused by variants in <i>CACNA1F</i>, <i>NYX</i> or <i>TRPM1</i> in patients who had at least 6 measurements of their spherical equivalent of refraction (SER) before the age of 18. A mixed-effect model was used to predict progression of SER overtime and differences between genotypes were evaluated.</p><p><strong>Results: </strong>78 individuals were included in this study. All genotypes showed a significant myopic predicted SER at birth (-3.076D, -5.511D and -5.386D) for <i>CACNA1F</i>, <i>NYX</i> and <i>TRPM1</i> respectively. Additionally, significant progression of myopia per year (-0.254D, -0.257D and -0.326D) was observed for all three genotypes <i>CACNA1F</i>, <i>NYX</i> and <i>TRPM1</i>, respectively.</p><p><strong>Conclusions: </strong>Patients with CSNB tend to be myopic from an early age and progress to become more myopic with age. Patients may benefit from long-term myopia slowing treatment in the future and further studies are indicated. Additionally, CSNB should be considered in the differential diagnosis for early-onset myopia.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141854894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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