The use of ocular coherence tomography in evaluating optic nerve health in eyes with large disc size

Large discs are often associated with large cups; in order to exclude glaucomatous cupping a good objective tool is needed. The purpose of this study is to evaluate ocular coherence tomography (OCT) optic nerve head (ONH) parameters as indicators of ocular health in subjects with large discs. Eighty-one eyes of 53 healthy patients were evaluated; 46 eyes had large discs (disc area ≥2.6 mm2) and 35 eyes had regular size discs (disc area <2.6 mm2). All subjects underwent OCT. All ONH parameters were documented, including vertical integrated rim area (VIRA), horizontal integrated rim width (HIRW), rim area, cup area, cup-to-disc (CD) area ratio, horizontal cup to disc ratio (HCDR), vertical cup to disc ratio (VCDR), cup area topography, and cup volume. In addition, OCT retinal nerve fiber layer (RNFL) global mean thickness and four quadrants mean thicknesses were analyzed. All cup parameters were significantly higher in the large disc group compared to the normal disc group. The parameters estimating the rim varied between the groups: in the large disc group VIRA was significantly lower while HIRW was significantly higher, compared to the control group. Rim area was the only parameter with similar values in both groups (1.52±0.24 mm2 and 1.6±0.3 mm2 in the large and regular disc groups, respectively). Correlation analysis revealed significant positive association between disc area and cup parameters in the large disc group. In contrast, in the regular disc group, disc area was positively associated with rim parameters. Rim area might serve as an indicator for ocular health in large discs with large cups

Interdigitation and Ellipsoid Zones Disruption Correlate with Visual Outcomes among Treatment-Naive Patients with Diabetic Macular Edema

Publisher Copyright: © 2020 The Author(s). Published by S. Karger AG, Basel.Introduction: We have recently shown that defects in interdigitation and ellipsoid zones (IZ and EZ) can predict response to anti-VEGF therapy in a small group of treatment-naive diabetic macular edema (DME) patients. The aim of the current study is to further evaluate this association in a larger study group of patients over a longer follow-up time. Methods: Thirty eyes of 30 treatment-naive DME patients were analyzed in this retrospective study. The integrity of foveal IZ and EZ was evaluated using optical coherence tomography at the diagnosis of DME and following anti-VEGF injections. The defect size was correlated with best-corrected visual acuity (BCVA) and central macular thickness (CMT). Results: The mean patients' age at baseline was 63.0 ± 10.0 years. Patients underwent 3.9 ± 2.9 anti-VEGF injections for a mean of 9.1 ± 4.8 months. Following treatment, the mean Snellen visual acuity (VA) improved from 20/52 to 20/44 (p = 0.05), CMT decreased from 432.5 ± 141.4 μm to 375.2 ± 121.4 μm (p = 0.05) and IZ/EZ defect size decreased from 259.83 ± 375.94 μm to 65.34 ± 143.97 μm (p = 0.001). In patients with no IZ/EZ defects at baseline, the mean Snellen VA was better when compared to those with IZ/EZ defects (20/36 vs. 20/70, p = 0.031). The number of eyes with IZ/EZ defects decreased from 17 (57%) at baseline to 6 (20%) at end of follow-up (p < 0.01). BCVA gain correlated with IZ/EZ defect size reduction (r = 0.41, p = 0.02) but not with improvement in CMT (r = 0.28, p = 0.121). Conclusions: IZ/EZ defect size correlated not only with baseline BCVA but also predicted the change in BCVA after anti-VEGF treatment. Possible future automatic measurement of IZ/EZ defect size might prove helpful for the evaluation of treatment response.Peer reviewe

Donor and Recipient Sex Matching and Corneal Graft Failure in High-Risk and Non-High-Risk Patients

Purpose. It is controversial whether donor-recipient sex mismatch is a risk factor associated with corneal graft failure. The purpose of this study was to investigate the effect of sex mismatch on corneal graft failure in high-risk and non-high-risk patients. Design. A retrospective study. Methods. The medical charts of patients who underwent corneal transplantations by one surgeon between 2012 and 2017 were reviewed. Patients were defined as high-risk for failure if they had glaucoma, ocular surface disease, or corneal vascularization. Graft failure rates were compared using the Kaplan-Meier survival curves between sex matched and mismatched subjects and between male-to-female grafting and other patients. Results. One hundred and thirteen patients with a minimum follow-up of 18 months were included. In 62 non-high-risk patients, graft failure rates were similar between the sex mismatched and the sex matched recipients (p=0.645, log-rank) and in male donor to female recipient transplantations and in the other transplantations (p=0.496, log-rank). Analysis of fifty-one eyes of 51 high-risk graft recipients (mean age of 73.4 +/- 12.7 years, N = 26 females) showed that graft failure rates were significantly higher in the sex mismatched than sex matched recipients (p=0.022, log-rank) and in male donor to female recipient transplantations than in the other transplantations (p=0.002, log-rank). Conclusions. Sex matching for every patient bares logistic difficulties; however, in patients who are at high-risk for graft failure, it may be a simple way to improve outcomes and better utilize corneal grafts.Peer reviewe

The effect of sildenafil on retinal blood velocity in healthy subjects

Abstract Purpose It has been suggested that Sildenafil may have beneficial therapeutic effects in the treatment of neurodegenerative disorders. The retinal circulation is of significant interest as a marker of cerebral vascular disease since the retinal and cerebral vasculatures share many morphological and physiological properties, yet only the retinal circulation can be directly visualized. Therefore, our aim was to assess the change induced by Sildenafil on retinal blood velocity. Methods Retinal flow velocity was measured 0.5, 3 and 6 h following administration of 100 mg of Sildenafil using the Retinal Function Imager. Results No clinical change in either systemic blood pressure or retinal flow velocities were observed. However, when controlling for heart rate and blood pressure, a significant drop in venous flow velocity 6 h following treatment (mean drop 0.3 ± 0.07; 95% CI: 0.44–0.56, P = 0.023) was revealed. Conclusions In healthy volunteers, retinal venous flow velocity was significantly reduced at the 6-h time point following Sildenafil treatment. No effect was observed on arterial retinal flow velocity

Development of "Predict ME," an online classifier to aid in differentiating diabetic macular edema from pseudophakic macular edema.

PURPOSE Differentiating the underlying pathology of macular edema in patients with diabetic retinopathy following cataract surgery can be challenging. In 2015, Munk and colleagues trained and tested a machine learning classifier which uses optical coherence tomography variables in order to distinguish the underlying pathology of macular edema between diabetic macular edema and pseudophakic cystoid macular edema. It was able to accurately diagnose the underlying pathology in 90%-96% of cases. However, actually using the trained classifier required dedicated software and advanced technical skills which hindered its accessibility to most clinicians. Our aim was to package the classifier in an easy to use web-tool and validate the web-tool using a new cohort of patients. METHODS We packaged the classifier in a web-tool intended for use on a personal computer or mobile phone. We first ensured that the results from the web-tool coincide exactly with the results from the original algorithm and then proceeded to test it using data of 14 patients. RESULTS The etiology was accurately predicted in 12 out of 14 cases (86%). The cases with diabetic macular edema were accurately diagnosed in 7 out of 7 cases. Of the pseudophakic cystoid macular edema cases, 5 out of 6 were correctly interpreted and 1 case with a mixed etiology was interpreted as pseudophakic cystoid macular edema. Variable input was reported to be easy and took on average 7 ± 3 min. CONCLUSION The web-tool implementation of the classifier seems to be a valuable tool to support research into this field

Comparison of the Usability of Eye Drop Aids and the Conventional Bottle

(1) Background: Eye drops are the most common route of administration for ophthalmic medications. Administering drops can be a major hurdle for patients, potentially resulting in noncompliance and treatment failure. The purpose of this study is to compare the efficacy and safety of two different aids and the conventional bottle for eye drop instillation; (2) Methods: An interventional crossover study involving standard eye drop bottle, Opticare aid and Autodrop aid. The study included healthy subjects without a history of regular eye drop use; (3) Results: Twenty-six subjects were enrolled. Of those subjects, 96% and 92% were able to assemble the eye drop bottle into the Autodrop and the Opticare aids, respectively. Subjective assessment indicated that Autodrop was significantly easier to assemble than Opticare (95% CI: &minus;1.6802 to &minus;0.1659, p = 0.02). When using either aid, there was no contamination of the bottle tip, which occurred in 46% of subjects when no aid was used (p = 0.0005). Fewer drops were expelled when using the conventional bottle as compared to the aids (p = 0.05 compared to Autodrop, p = 0.1 compared to Opticare); (4) Conclusions: Autodrop and Opticare can assist patients with eye drop placement. These aids completely prevented bottle tip contamination, which was frequently observed when the conventional bottle was used alone