Clinical and Epidemiologic Research Vitreomacular Adhesion and Its Association With Age- Related Macular Degeneration in a Population-Based Setting: The Alienor Study

PURPOSE. The purpose of this study was to describe vitreomacular adhesion (VMA), diagnosed with spectral-domain optical coherence tomography (SD-OCT), its risk factors, and its association with AMD in a population-based study of French elderly subjects. METHODS. Six hundred twenty-two of 624 (99.7%) participants of the Alienor study (Bordeaux, France), ‡75 years of age, had gradable SD-OCT scans of the macula in at least one eye. VMA was defined as visible perifoveal vitreous separation with remaining vitreomacular attachment and unperturbed foveal morphologic features. Late AMD was classified from retinal color photographs, SD-OCT, and ophthalmologic history. Early AMD was classified from retinal photographs and defined by the presence of large drusen and/or reticular drusen and/or pigmentary abnormalities. RESULTS. The prevalence of VMA was 15.8%, decreased with age (18.1% in subjects 75 to 84 years of age versus 8.9% after 85 years of age), and was higher in men than women (20.6% vs. 12.8%). VMA also tended to be less frequent in eyes with a history of cataract surgery (odds ratio [OR] ¼ 0.66, P ¼ 0.05), after adjustment for age and sex. No associations of VMA with other risk factors (cardiovascular risk factors, dietary intake of omega-3 fatty acids, lifetime ultraviolet radiation exposure, major AMD genetic polymorphisms) were found. After multivariate adjustment, VMA was not significantly associated with early or late AMD (OR ¼ 1.14, P ¼ 0.70 and OR ¼ 0.78, P ¼ 0.51 for early and late AMD, respectively). CONCLUSIONS. VMA was visible on SD-OCT in 16% in this sample of elderly French subjects but was not associated with AMD. Prospective studies of the associations of VMA with AMD are needed

Lifetime exposure to ambient ultraviolet radiation and the risk for cataract extraction and age-related macular degeneration : the Alienor Study

While exposure to ultraviolet radiation (UVR) is a recognized risk factor for cataract, its association is more controversial with age-related macular degeneration (AMD). We report the associations of lifetime exposure to ambient UVR with cataract extraction and AMD. The Alienor Study is a population-based study of 963 residents of Bordeaux (France), aged 73 years or more. Lifetime exposure to ambient UVR was estimated from residential history and Eurosun satellite-based estimations of ground UVR. It was divided in three groups (lower quartile, intermediate quartiles, upper quartile), using the intermediate quartiles as the reference. Early and late AMD was classified from retinal color photographs. Cataract extraction was defined as absence of the natural lens at slit-lamp. After multivariate adjustment, subjects in the upper quartile of lifetime ambient UVR exposure were at increased risk for cataract extraction (odds ratio [OR] = 1.53; 95% confidence interval [CI], 1.04-2.26; P = 0.03) and for early AMD (OR = 1.59; 95% CI, 1.04-2.44; P = 0.03), by comparison with subjects in the intermediate quartiles. Subjects in the lower quartile of UVR exposure also were at increased risk for early AMD (OR = 1.69; 95% CI, 1.06-2.69; P = 0.03), by comparison with those with medium exposure. Associations of late AMD with UVR exposure was not statistically significant. This study further confirms the increased risk for cataract extraction in subjects exposed to high ambient UVR. Moreover, it suggests that risk for early AMD is increased in subjects exposed to high UVR, but also to low UVR, by comparison with medium exposures

Artificial Intelligence to Detect Papilledema from Ocular Fundus Photographs.

BACKGROUND: Nonophthalmologist physicians do not confidently perform direct ophthalmoscopy. The use of artificial intelligence to detect papilledema and other optic-disk abnormalities from fundus photographs has not been well studied. METHODS: We trained, validated, and externally tested a deep-learning system to classify optic disks as being normal or having papilledema or other abnormalities from 15,846 retrospectively collected ocular fundus photographs that had been obtained with pharmacologic pupillary dilation and various digital cameras in persons from multiple ethnic populations. Of these photographs, 14,341 from 19 sites in 11 countries were used for training and validation, and 1505 photographs from 5 other sites were used for external testing. Performance at classifying the optic-disk appearance was evaluated by calculating the area under the receiver-operating-characteristic curve (AUC), sensitivity, and specificity, as compared with a reference standard of clinical diagnoses by neuro-ophthalmologists. RESULTS: The training and validation data sets from 6779 patients included 14,341 photographs: 9156 of normal disks, 2148 of disks with papilledema, and 3037 of disks with other abnormalities. The percentage classified as being normal ranged across sites from 9.8 to 100%; the percentage classified as having papilledema ranged across sites from zero to 59.5%. In the validation set, the system discriminated disks with papilledema from normal disks and disks with nonpapilledema abnormalities with an AUC of 0.99 (95% confidence interval [CI], 0.98 to 0.99) and normal from abnormal disks with an AUC of 0.99 (95% CI, 0.99 to 0.99). In the external-testing data set of 1505 photographs, the system had an AUC for the detection of papilledema of 0.96 (95% CI, 0.95 to 0.97), a sensitivity of 96.4% (95% CI, 93.9 to 98.3), and a specificity of 84.7% (95% CI, 82.3 to 87.1). CONCLUSIONS: A deep-learning system using fundus photographs with pharmacologically dilated pupils differentiated among optic disks with papilledema, normal disks, and disks with nonpapilledema abnormalities. (Funded by the Singapore National Medical Research Council and the SingHealth Duke-NUS Ophthalmology and Visual Sciences Academic Clinical Program.)

Palaeogenomics of Upper Palaeolithic to Neolithic European hunter-gatherers

: Modern humans have populated Europe for more than 45,000 years1,2. Our knowledge of the genetic relatedness and structure of ancient hunter-gatherers is however limited, owing to the scarceness and poor molecular preservation of human remains from that period3. Here we analyse 356 ancient hunter-gatherer genomes, including new genomic data for 116 individuals from 14 countries in western and central Eurasia, spanning between 35,000 and 5,000 years ago. We identify a genetic ancestry profile in individuals associated with Upper Palaeolithic Gravettian assemblages from western Europe that is distinct from contemporaneous groups related to this archaeological culture in central and southern Europe4, but resembles that of preceding individuals associated with the Aurignacian culture. This ancestry profile survived during the Last Glacial Maximum (25,000 to 19,000 years ago) in human populations from southwestern Europe associated with the Solutrean culture, and with the following Magdalenian culture that re-expanded northeastward after the Last Glacial Maximum. Conversely, we reveal a genetic turnover in southern Europe suggesting a local replacement of human groups around the time of the Last Glacial Maximum, accompanied by a north-to-south dispersal of populations associated with the Epigravettian culture. From at least 14,000 years ago, an ancestry related to this culture spread from the south across the rest of Europe, largely replacing the Magdalenian-associated gene pool. After a period of limited admixture that spanned the beginning of the Mesolithic, we find genetic interactions between western and eastern European hunter-gatherers, who were also characterized by marked differences in phenotypically relevant variants

Palaeogenomics of Upper Palaeolithic to Neolithic European hunter-gatherers

Publisher Copyright: © 2023, The Author(s).Modern humans have populated Europe for more than 45,000 years1,2. Our knowledge of the genetic relatedness and structure of ancient hunter-gatherers is however limited, owing to the scarceness and poor molecular preservation of human remains from that period3. Here we analyse 356 ancient hunter-gatherer genomes, including new genomic data for 116 individuals from 14 countries in western and central Eurasia, spanning between 35,000 and 5,000 years ago. We identify a genetic ancestry profile in individuals associated with Upper Palaeolithic Gravettian assemblages from western Europe that is distinct from contemporaneous groups related to this archaeological culture in central and southern Europe4, but resembles that of preceding individuals associated with the Aurignacian culture. This ancestry profile survived during the Last Glacial Maximum (25,000 to 19,000 years ago) in human populations from southwestern Europe associated with the Solutrean culture, and with the following Magdalenian culture that re-expanded northeastward after the Last Glacial Maximum. Conversely, we reveal a genetic turnover in southern Europe suggesting a local replacement of human groups around the time of the Last Glacial Maximum, accompanied by a north-to-south dispersal of populations associated with the Epigravettian culture. From at least 14,000 years ago, an ancestry related to this culture spread from the south across the rest of Europe, largely replacing the Magdalenian-associated gene pool. After a period of limited admixture that spanned the beginning of the Mesolithic, we find genetic interactions between western and eastern European hunter-gatherers, who were also characterized by marked differences in phenotypically relevant variants.Peer reviewe

Prevalence of Age-Related Macular Degeneration in Europe: The Past and the Future

Purpose Age-related macular degeneration (AMD) is a frequent, complex disorder in elderly of European ancestry. Risk profiles and treatment options have changed considerably over the years, which may have affected disease prevalence and outcome. We determined the prevalence of early and late AMD in Europe from 1990 to 2013 using the European Eye Epidemiology (E3) consortium, and made projections for the future. Design Meta-analysis of prevalence data. Participants A total of 42 080 individuals 40 years of age and older participating in 14 population-based cohorts from 10 countries in Europe. Methods AMD was diagnosed based on fundus photographs using the Rotterdam Classification. Prevalence of early and late AMD was calculated using random-effects meta-analysis stratified for age, birth cohort, gender, geographic region, and time period of the study. Best-corrected visual acuity (BCVA) was compared between late AMD subtypes; geographic atrophy (GA) and choroidal neovascularization (CNV). Main Outcome Measures Prevalence of early and late AMD, BCVA, and number of AMD cases. Results Prevalence of early AMD increased from 3.5% (95% confidence interval [CI] 2.1%–5.0%) in those aged 55–59 years to 17.6% (95%

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Etude rétrospective observationnelle de 71 cas d'oedèmes papillaires pris en charge au CHU de Bordeaux

BUT DE L'ETUDE : Décrire les caractéristiques sociodémographiques, cliniques et paracliniques des patients ayant un œdème papillaire (OP) unilatéral ou bilatéral consultant aux urgences ophtalmologiques. MATERIELS ET METHODES : Il s'agit d'une étude rétrospective observationnelle des patients avec un OP, consultant aux urgences du centre hospitalo-universitaire de Bordeaux, entre le 1er octobre 2008 et le 31 octobre 2009. L'inclusion des patients a été prospective. Le recueil des données s'est fait par retour au dossier médical du patient. RESULTATS : Nous avons inclus 71 patients (90 yeux) dont 52 avaient un OP unilatéral et 19 avaient un OP bilatéral. 66 % des patients (n = 47) étaient adressés par leur ophtalmologiste aux urgences pour la prise en charge d'un OP. Parmi les 52 patients avec un OP unilatéral, on comptait 61,5 % de femmes (n = 32) et 38,5 % d'hommes (n = 20). La moyenne d'âge était de 53,5 ans (ơ = 22,9 ans), avec un âge plus élevé pour les hommes que pour les femmes (61,1 ans vs 48,7 ans avec p = 0,0565). Le diagnostic retenu était une neuropathie optique ischémique antérieure aigue (NOIAA) pour 27 patients, une neuropathie optique inflammatoire (NOI) pour 17 patients et une hypertension intracrânienne (HTIC) pour 3 patients. Parmi les 19 patients avec un OP bilatéral, on comptait 74 % de femmes (n = 14) et 26 % d'hommes (n = 5). La moyenne d'âge était de 36,4 ans (ơ = 20,2 ans), avec un âge plus élevé pour les hommes que pour les femmes (50,6 ans vs 31,3 ans avec p = 0,0649). Le diagnostic retenu était une HTIC pour 8 patients, une NOI pour 5 patients et une NOIAA pour 4 patients. CONCLUSION : Cette étude aura permis d'évaluer notre prise en charge des patients avec OP consultant aux urgences ophtalmologiques. Le diagnostic étiologique d'OP, parfois complexe, repose sur les données cliniques et paracliniques.BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Combinaison de l'injection sous-tenonienne d'acétonide de triamcinolone et de la photothérapie dynamique à la vertéporfine dans le traitement des néovaisseaux choroïdiens de la dégénérescence maculaire liée à l'âge

Objectif : évaluer la combinaison de la phtothérapie dynamique (PDT) avec la vertéporfine et l'injection sous-ténonienne d'acétonide de triamcinolone dans le traitement des néovaisseaux choridiens (NVC) secondaires à une dégnérescence masculaire liée à l'âge (DMLA). Type d'étude : série de cas, rétrospective sans groupe contrôle. Population : 67 yeux chez 67 patients atteints de NVC secondaires à une DMLA, sans restriction quant au type de NVC. Méthodes : Les patients ont reçu au maximum 40 mg d'acétonide de triamcinolone, injectés en sous-ténonien, succédés, dans un délai de 2 à 8 jours d'une PDT. L'acuité visuelle a été mesurée par l'échelle ETDRS. La nécessité de retraitement s'est basée sur la la présence d'une diffusion à l'angiogrphaie au 3ème mois de suivi. Plusieurs groupes ont été constitués afin de rechercher une influence liée à la notion de PDT antérieure, du type NVC et de la taille de la lésion. Critères principaux d'évaluation : acuité visuelle et nécessité de retraitement. Résultats : 57 patients ont été revus à 6 semains. L' acuité visuelle est dans l'ensemble stable avec un gain moyen de 0,42 ligne, 10 (17,5%) ont une augmentation d'au moins 2 lignes. 6 (10,5%) présentaient une diminution supérieure à 2 lignes. A 3 mois, 56 patients ont été revus. L'acuité visuelle moyenne est équivalente à l'acuité de départ. 10 (17,8%) patients ont gagné au moins 2 lignes et 10 (17,8%) ont perdu au moins 2 lignes. Il n'existe pas de différence significative d'acuité visuelle à ces points de uivi. 20 (34,5%) ont nécessité un retraitment selon les mêmes modalités. Aucun patient n'a présenté une dimunution supérieure à plus de 3 lignes. Il n'a pes été mis en évidence d'influence sur le retraitement et l'acuité visuelle, de la notion de PDT antérieure du type de néovaisseaux et de la taille de la lésion. A 6 mois il n'es pas possible d'effectuer une analyse fine compte tenu de la chete de l'effecti. Neanmoins, la tendance à la stabilisation et à la diminution des retraitements semblent se confirmer. Un patients a présenté une hypertonie requérant un traitement hypotonisant. Aucun effet indésirable autre lié à l'injection sous-ténonienne n'a été à déplorer. Conclusion : malgré un suivi trop court, la stabilisation de l'acuité visuelle et un taux de retraitement modéré, amènent à considere l'association de la triamicinolone et de la PDT comme une voie de traitement intéressante. néanmmoins d'autres investigations sont nécessaires ainsi qu'une comparaison avec la voie intravitréenne.BORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Intérêt de l'autofluorescence par imagerie grand champ dans la rétinochoroïdopathie de Birdshot (analyse descriptive de 76 yeux)

POITIERS-BU Médecine pharmacie (861942103) / SudocSudocFranceF