scholarly journals A Method for En Face OCT Imaging of Subretinal Fluid in Age-Related Macular Degeneration

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Fatimah Mohammad ◽  
Justin Wanek ◽  
Ruth Zelkha ◽  
Jennifer I. Lim ◽  
Judy Chen ◽  
...  
Keyword(s):  
Healthy Subject ◽  
Macular Degeneration ◽  
Retinal Pigment ◽  
Subretinal Fluid ◽  
Age Related Macular Degeneration ◽  
Retinal Layer ◽  
Age Related ◽  
En Face Oct ◽  
En Face ◽  
Oct Imaging

Purpose. The purpose of the study is to report a method for en face imaging of subretinal fluid (SRF) due to age-related macular degeneration (AMD) based on spectral domain optical coherence tomography (SDOCT).Methods. High density SDOCT imaging was performed at two visits in 4 subjects with neovascular AMD and one healthy subject. En face OCT images of a retinal layer anterior to the retinal pigment epithelium were generated. Validity, repeatability, and utility of the method were established.Results. En face OCT images generated by manual and automatic segmentation were nearly indistinguishable and displayed similar regions of SRF. En face OCT images displayed uniform intensities and similar retinal vascular patterns in a healthy subject, while the size and appearance of a hypopigmented fibrotic scar in an AMD subject were similar at 2 visits. In AMD subjects, dark regions on en face OCT images corresponded to reduced or absent light reflectance due to SRF. On en face OCT images, a decrease in SRF areas with treatment was demonstrated and this corresponded with a reduction in the central subfield retinal thickness.Conclusion. En face OCT imaging is a promising tool for visualization and monitoring of SRF area due to disease progression and treatment.

Quantification of Early and Intermediate Age-related Macular Degeneration Using OCT “en face” Presentation

2021 ◽  
Author(s):  
Frauke Jürgens ◽  
Kai Rothaus ◽  
Henrik Faatz ◽  
Britta Heimes-Bussmann ◽  
Daniel Pauleikhoff ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Macular Degeneration ◽  
Retinal Pigment ◽  
Age Related Macular Degeneration ◽  
Fundus Photography ◽  
Slice Thickness ◽  
Age Related ◽  
En Face Oct ◽  
En Face ◽  
The Impact

Abstract Background Early and intermediate age-related macular degeneration (AMD) results in drusen deposits under the retinal pigment epithelium (RPE). These early stages of AMD exhibit different risks of progressing to late AMD. To date, early AMD has been classified and quantified by fundus photography. This does not appear to be sensitive enough for clinical trials studying the impact on drusen. SD-OCT with two-dimensional rendering of the segmented slices analysed allows for en face imaging of the drusen. The present trial studied the potential of quantifying early and intermediate AMD by en-face optical coherence tomography (OCT). Material and Methods Thirty-one eyes of 29 patients in different stages of early and intermediate AMD were studied. To this end, fundus photographs (Kowa VX-10i, Kowa, Tokyo, Japan) and en-face OCT images (RTVue XR Avanti, Optovue, Inc., Fremont, CA, USA) were taken. First, different segmentation levels (6 µm underneath the RPE, on the RPE, 6 µm and 9 µm above the RPE) and different layer thicknesses (5 µm, 10 µm, 20 µm and 30 µm) were analysed to determine the best segmentation for visualising drusen. Drusen were marked manually and their number and surface area calculated. This analysis was then compared with the standardised drusen analyses on fundus photography. Additional changes in early and intermediate AMD such as pigment epithelial detachments (PEDs) and subretinal drusenoid deposits (SDD) as well as small atrophies were also documented and compared. Outcomes The best segmentation for delineating the drusen on the en-face OCT images was found to be a segmentation 6 µm underneath the RPE with a slice thickness of 20 µm. Comparison of drusen quantification on en-face OCT images with the standardised drusen analysis on fundus photography revealed particularly good similarity. Other changes in early and intermediate AMD, such as PEDs, SDD and small atrophies, were easier to assess on the en-face OCT images. Conclusions The analysis and quantification of drusen from en-face OCT images with 20 µm segmentation at 6 µm underneath the RPE allows differentiated quantification of various drusen characteristics. Moreover, other changes in early and intermediate AMD can also be analysed. In future observational and clinical trials, this could help quantify drusen.

scholarly journals En Face OCT Imaging for the Diagnosis of Outer Retinal Tubulations in Age-Related Macular Degeneration

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Benjamin Wolff ◽  
Alexandre Matet ◽  
Vivien Vasseur ◽  
José-Alain Sahel ◽  
Martine Mauget-Faÿsse
Keyword(s):  
Macular Degeneration ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
Spectral Domain ◽  
Macular Disease ◽  
Spectral Domain Oct ◽  
Age Related ◽  
En Face Oct ◽  
En Face ◽  
Oct Imaging

Purpose. “En face” is an emerging imaging technique derived from spectral domain optical coherence tomography (OCT). It produces frontal sections of retinal layers, also called “C-scan OCT.” Outer retinal tubulations (ORTs) in age-related macular degeneration (AMD) are a recent finding evidenced by spectral-domain OCT. The aim of this study is to characterize the morphology of ORT according to the form of AMD, using “en-face” spectral domain OCT.Methods. “En face” OCT imaging was prospectively performed in 26 consecutive eyes with AMD that also had ORT.Results. There were 15 neovascular, 8 atrophic, and 3 eyes with a mixed (fibrotic and atrophic) form of AMD. Among the neovascular group, the most frequent tubulation pattern on “en-face” OCT was a branching network emanating from a fibrovascular scar; we term this pattern as “pseudodendritic.” It did not require treatment when observed as an isolated finding. In all cases of atrophic AMD, the tubular network was located at the edge of the geographic atrophy area, and formed a “perilesional” pattern. Six atrophic cases showed tubular invaginations inside this area.Conclusion. “En face” OCT is a valuable technique in the diagnosis and followup of macular disease. It revealed the main characteristic patterns of ORT associated with neovascular and atrophic AMD.

scholarly journals Fully-automated atrophy segmentation in dry age-related macular degeneration in optical coherence tomography

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yasmine Derradji ◽  
Agata Mosinska ◽  
Stefanos Apostolopoulos ◽  
Carlos Ciller ◽  
Sandro De Zanet ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Macular Degeneration ◽  
Vision Loss ◽  
Retinal Pigment ◽  
Retinal Disease ◽  
Age Related Macular Degeneration ◽  
Retinal Layer ◽  
Optical Coherence ◽  
Age Related ◽  
Layer Segmentation

AbstractAge-related macular degeneration (AMD) is a progressive retinal disease, causing vision loss. A more detailed characterization of its atrophic form became possible thanks to the introduction of Optical Coherence Tomography (OCT). However, manual atrophy quantification in 3D retinal scans is a tedious task and prevents taking full advantage of the accurate retina depiction. In this study we developed a fully automated algorithm segmenting Retinal Pigment Epithelial and Outer Retinal Atrophy (RORA) in dry AMD on macular OCT. 62 SD-OCT scans from eyes with atrophic AMD (57 patients) were collected and split into train and test sets. The training set was used to develop a Convolutional Neural Network (CNN). The performance of the algorithm was established by cross validation and comparison to the test set with ground-truth annotated by two graders. Additionally, the effect of using retinal layer segmentation during training was investigated. The algorithm achieved mean Dice scores of 0.881 and 0.844, sensitivity of 0.850 and 0.915 and precision of 0.928 and 0.799 in comparison with Expert 1 and Expert 2, respectively. Using retinal layer segmentation improved the model performance. The proposed model identified RORA with performance matching human experts. It has a potential to rapidly identify atrophy with high consistency.

scholarly journals Clinically visible progression indicators in age-related macular degeneration are transdifferentiated retinal pigment epithelium

2021 ◽  
Author(s):  
Dongfeng Cao ◽  
Belinda Leong ◽  
Jeffrey D. Messinger ◽  
Deepayan Kar ◽  
Thomas Ach ◽  
...  
Keyword(s):  
Retinal Pigment Epithelium ◽  
Macular Degeneration ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Age Related Macular Degeneration ◽  
Risk Indicators ◽  
Muller Glia ◽  
Müller Glia ◽  
Age Related ◽  
Oct Imaging

AbstractAge-related macular degeneration (AMD) is a common sight-threatening disease of older adults and treatment options are needed. Abnormalities of retinal pigment epithelium (RPE), supporting cells to photoreceptors and capillaries, are a hallmark. Clinical optical coherence tomography (OCT) imaging reveals hyperreflective foci (HRF) that confer risk for end-stage disease and are attributed to ectopic out-of-layer RPE. Using longitudinal OCT imaging of AMD patients, we demonstrate that the trajectory of one HRF form, RPE plume, parallels the retinal Henle fiber layer. Histology shows fully pigmented cells approaching and contacting retinal capillaries with RPE organelles dispersing along Müller glia columns. We used immunohistochemistry and a system of morphologic phenotypes to assess RPE functional repertoire in AMD. RPE corresponding to HRF loses immunoreactivity for retinoid processing proteins RPE65 and CRALBP, and gains immunoreactivity for immune cell markers CD68 and CD163. Müller glia retain CRALBP immunoreactivity. Gain- and loss-of-function for RPE starts with individual in-layer cells and extends to all abnormal phenotypes. Down-regulated RPE retinoid handling may contribute to slowed rod vision while Müller glia sustain cone vision. Ectopic RPE corresponding to HRF are emblematic of widespread transdifferentiation, motivating treatments targeting AMD pathology earlier than the initiation of atrophy. Data can propel new biomarkers and therapeutic strategies for AMD.One Sentence SummaryIn age-related macular degeneration retinal pigment epithelial cells transdifferentiate and migrate into the retina where they are clinically visible progression risk indicators.

scholarly journals Correlation between Visual Functions and Retinal Morphology in Eyes with Early and Intermediate Age-Related Macular Degeneration

2020 ◽  
Vol 17 (17) ◽  
pp. 6379
Author(s):  
Rituparna Ghoshal ◽  
Sharanjeet Sharanjeet-Kaur ◽  
Norliza Mohamad Fadzil ◽  
Haliza Abdul Mutalib ◽  
Somnath Ghosh ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Layer Thickness ◽  
Reading Speed ◽  
Retinal Pigment ◽  
Age Related Macular Degeneration ◽  
Morphological Alteration ◽  
Retinal Layer ◽  
Visual Functions ◽  
Age Related

In early and intermediate age related macular degeneration (ARMD), visual acuity alone has failed to explain the complete variation of vision. The aim of the present study was to determine correlation between different visual functions and retinal morphology in eyes with early and intermediate ARMD. In this single center cross sectional study, patients diagnosed as early or intermediate ARMD in at least one eye were recruited. Visual functions measured were best- corrected distance visual acuity (DVA), near vision acuity (NVA), reading speed (RS), and contrast sensitivity (CS). Parameters such as thickness (RT) and volume (RV) of the retina, outer retinal layer thickness (ORLT) and volume (ORLV), outer nuclear layer thickness (ONLT) and volume (ONLV), retinal pigment epithelium layer-Bruch’s membrane complex thickness (RPET) and volume (RPEV) were assessed employing semi-auto segmentation method of Spectralis optical coherence tomography (OCT). Twenty-six eyes were evaluated. DVA, CS, and RS showed significantly good correlation with RPET, ONLT, and ONLV, whereas NVA showed good correlation with ONLV and RPET. The present study concluded that RS, CS, NVA, and DVA represent the morphological alteration in early stages and should be tested in clinical settings. ONLT, ONLV, and RPET morphological parameters can be employed as important biomarkers in diagnosis of early to intermediate ARMD.

One-year outcome of intravitreal ziv-aflibercept therapy for non-responsive neovascular age-related macular degeneration

2017 ◽  
Vol 102 (1) ◽  
pp. 91-96 ◽  
Author(s):  
Imoro Zeba Braimah ◽  
Komal Agarwal ◽  
Ahmad Mansour ◽  
Jay Chhablani
Keyword(s):  
Adverse Events ◽  
Macular Degeneration ◽  
Retinal Pigment ◽  
Subretinal Fluid ◽  
Age Related Macular Degeneration ◽  
Secondary Outcome ◽  
Free Interval ◽  
Age Related ◽  
Significant Difference ◽  
The Mean

AimTo evaluate 12-month outcome of intravitreal ziv-aflibercept (IVZ) therapy in eyes with neovascular age-related macular degeneration (nAMD) that are non-responsive to bevacizumab and ranibizumab.MethodsThis retrospective study included 16 eyes (14 patients) with nAMD who were on prior treatment with bevacizumab and ranibizumab and were treated with as-needed IVZ (1.25 mg/0.05 mL) for 12 months. The primary outcome measure was the mean change in best corrected visual acuity (BCVA) and secondary outcome measures included mean change in central macular thickness (CMT), retinal pigment epithelial detachment (RPED) heights, longest treatment free interval, presence of subretinal fluid (SRF) and intraretinal fluid (IRF) and adverse events.ResultsThere was no change in the mean logarithm of minimum angle of resolution (logMAR) BCVA at baseline and following treatment with IVZ therapy (p=0.978). The mean number of IVZ injections during 12 months was 5.9±3.3, and the mean number of antivascular endothelial growth factors (VEGFs) injections prior to switching to IVZ was 8.4±4.7. The mean treatment free interval was longer during IVZ therapy (114.4±67.1 days) compared with 76.3±54.6 days before IVZ therapy (p=0.03). Five (31.25%) eyes had visual gains of at least 0.1 logMAR, 3 (18.75%) eyes had stable BCVA (within 0.1 logMAR) and 8 (50%) eyes had BCVA decline of at least 0.1 logMAR. There was no significant difference in the mean CMT, RPED heights and presence of IRF and SRF at 12 months compared with baseline. No adverse events were noted.ConclusionIVZ increased the treatment free interval in non-responders but no significant change in visual and anatomic outcomes.

Aflibercept as a Treatment for Age-related Macular Degeneration

2013 ◽  
Vol 06 (01) ◽  
pp. 58 ◽  
Author(s):  
Michael W Stewart ◽  
Keyword(s):  
Macular Degeneration ◽  
Vision Loss ◽  
Retinal Pigment ◽  
Subretinal Fluid ◽  
Age Related Macular Degeneration ◽  
Unit Price ◽  
Vegf Receptor ◽  
Duration Of Action ◽  
Age Related ◽  
Endothelial Growth Factor

Vascular endothelial growth factor (VEGF) plays a central role in the development of several chorioretinal vascular disorders including exudative age-related macular degeneration (AMD). Detailed understanding of VEGF biochemistry has led to the development of four drugs which specifically inhibit its actions. Bevacizumab and ranibizumab have been the dominant ophthalmic anti-VEGF drugs for seven years and their regular use has significantly decreased vision loss. In late 2011, aflibercept, a high-affinity, fusion protein that acts as a soluble VEGF receptor, was approved for the treatment of exudative AMD. Phase three trials showed that monthly and bimonthly aflibercept maintained vision in 95 % of patients, improved average visual acuity by +8.3 to +9.4 letters, and thinned the macula comparably to monthly ranibizumab. Since its approval, aflibercept has been shown to decrease retinal edema and subretinal fluid, and flatten retinal pigment epithelial detachments in eyes that have responded incompletely to frequent ranibizumab and bevacizumab injections. Aflibercept’s longer duration of action coupled with its comparable unit price (versus ranibizumab) promise to decrease the total cost of treatment.

scholarly journals Effects of subthreshold nanosecond laser therapy in age-related macular degeneration using artificial intelligence (STAR-AI Study)

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250609
Author(s):  
Verina Hanna ◽  
Jonathan Oakley ◽  
Daniel Russakoff ◽  
Netan Choudhry
Keyword(s):  
Artificial Intelligence ◽  
Macular Degeneration ◽  
San Francisco ◽  
Retinal Thickness ◽  
Outer Nuclear Layer ◽  
Retinal Pigment ◽  
Age Related Macular Degeneration ◽  
Nanosecond Laser ◽  
Retinal Layer ◽  
Age Related

Purpose To investigate changes in retinal thickness, drusen volume, and visual acuity following subthreshold nanosecond laser (SNL) treatment in patients with age-related macular degeneration (ARMD). Design Retrospective chart review. Methods Patients with intermediate ARMD treated with a single session of SNL (2RT®, Ellex R&D Pty Ltd, Adelaide, Australia) were included. Swept-source optical coherence tomography (OCT) imaging (Triton; Topcon Medical Systems, Tokyo, Japan) was performed within 6 months before and after SNL treatment. Retinal layers were segmented using the artificial intelligence-enabled Orion® software (Voxeleron LLC, San Francisco, USA). The macular region was analyzed according to the Early Treatment Diabetic Retinopathy Study map. Mean difference and standard deviation in baseline and post-treatment retinal layer thicknesses are reported. Results 37 eyes from 25 patients were included in this study (mean age 74.7±9.2 years). An average of 51±6 spots were applied around the macula of each study eye, with a mean spot power of 0.33±0.04mJ. Increases in total retinal thickness were observed within the outer temporal and inferior sectors (P<0.05). Within the annulus, there was an increase in thickness of the sub-retinal pigment epithelial (RPE) space [0.88±2.41μm, P = 0.03], defined between the RPE and Bruch’s membrane. An increase in thickness of 1.13±2.55μm (P = 0.01) was also noted in the inferior sector of the photoreceptor complex, defined from the inner and outer segment junction to the RPE. Decreases in thickness were observed within the superior sector of the inner nuclear layer (INL) [-1.08±2.55μm, P = 0.01], and within the annulus of the outer nuclear layer (ONL) [-1.44±3.55μm, P = 0.02]. Conclusions At 6 months post-SNL treatment, there were sectoral increases in OPL, photoreceptor complex, and sub-RPE space thicknesses and sectoral decreases in INL and ONL thicknesses. This pilot study demonstrates the utility of OCT combined with artificial intelligence-enabled software to track retinal changes that occur following SNL treatment in intermediate ARMD.

scholarly journals OCT Biomarkers in Neovascular Age-Related Macular Degeneration: A Narrative Review

2021 ◽  
Vol 2021 ◽  
pp. 1-16
Author(s):  
Cristian Metrangolo ◽  
Simone Donati ◽  
Marco Mazzola ◽  
Liviana Fontanel ◽  
Walter Messina ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Treatment Response ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Subretinal Fluid ◽  
Age Related Macular Degeneration ◽  
Initial Assessment ◽  
Clinical Approach ◽  
Age Related

Age-related macular degeneration (AMD) is the leading cause of legal blindness in elderly people. Neovascular AMD (nAMD) is responsible for the majority of cases of severe visual loss in eyes with AMD. Optical coherence tomography (OCT) is the most widely used technology for the diagnosis and follow-up of nAMD patients, which is widely used to study and guide the clinical approach, as well as to predict and evaluate treatment response. The aim of this review is to describe and analyze various structural OCT-based biomarkers, which have practical value during both initial assessment and treatment follow-up of nAMD patients. While central retinal thickness has been the most common and one of the first OCT identified biomarkers, today, other qualitative and quantitative biomarkers provide novel insight into disease activity and offer superior prognostic value and better guidance for tailored therapeutic management. The key importance of retinal fluid compartmentalization (intraretinal fluid, subretinal fluid, and subretinal pigment epithelium (RPE) fluid) will be discussed firstly. In the second part, the structural alterations of different retinal layers in various stages of the disease (photoreceptors layer integrity, hyperreflective dots, outer retinal tubulations, subretinal hyperreflective material, and retinal pigment epithelial tears) will be analyzed in detail. The last part of the review will focus on how alterations of the vitreoretinal interface (vitreomacular adhesion and traction) and of the choroid (sub-RPE hyperreflective columns, prechoroidal clefts, choroidal caverns, choroidal thickness and choroidal volume, and choroidal vascular index) interact with nAMD progression. OCT technology is evolving very quickly, and new retinal biomarkers are continuously described. This up-to-date review article provides a comprehensive description on how structural OCT-based biomarkers provide a valuable tool to monitor the progression of the disease and the treatment response in nAMD patients. Thus, in this perspective, clinicians will be able to allocate hospital resources in the best possible way and tailor treatment to the individual patient’s needs.

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