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Anatomical Characterization of an Optic Disc Notch Using SD-OCT in Glaucoma
摘要： Purpose: To characterize anatomical dimensions of a disc notch using novel methods using spectral domain optical coherence tomography (SD-OCT). Participants: All age- and severity-matched glaucoma patients with disc notch (defined as complete loss of neural rim with no residual rim between disc and cup) seen from 2014 to 2015 who underwent enhanced depth imaging with SD-OCT (Cirrus HD-OCT version 6.5, Carl Zeiss, USA) were included for this retrospective observational study. Methods: Using known dimensions of the 200 * 200 optic disc cube (6 * 6 mm), the notch width was calculated from the margins of the notch on either side using ImageJ software. The height was calculated from the lowest margin of the cup to the lowest point of the defect on the optic disc. These were compared with the quadrant retinal nerve fiber layer (qRNFT) and sectoral retinal nerve fiber layer (sRNFLT) thickness in notch and the sector 2 clock hours adjacent to the notch region (SaRNFLT). Results: The height and width of the notch in 31 eyes of 27 patients were 2.6 ± 0.48 mm and 2.23 ± 0.31 mm. The RNFL thickness in the same sector as that of the notch was 41 ± 21.06 μm while the adjacent two sectors measured 62 ± 26.5 and 64 ± 26.5 μm on either sides of the sector of the notch. The difference between the sRNFLT and saRNFLT ranged from ?9 to 67 and ?13 to 50 μm, respectively. This difference was significantly associated with height of the notch (R2 = 20.8, p = 0.01). Conclusion: Automated analysis of a notch and RNFL thickness in that sector can help in precise glaucoma monitoring in the region of interest.
关键词： glaucoma,optic disc pit,Optical coherence tomography,lamina cribrosa,optic disc notch
更新于2025-09-23 15:21:01
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In Vivo Identification of the Posttrabecular Aqueous Outflow Pathway Using Swept-Source Optical Coherence Tomography
摘要： The purpose of this study was to investigate a novel imaging technique to identify the continuous posttrabecular aqueous outflow pathway from a single B-scan, using swept-source optical coherence tomography (SS-OCT). Three-dimensional volume scans of the temporal or nasal side of the anterior segment area at the limbus were acquired from 11 eyes of 11 healthy subjects, using SS-OCT. The aqueous outflow pathway was identified using an en face OCT image and reconstructed images of the vasculature (vasculature map). Delineation of the whole aqueous outflow pathway in a single B-scan was accomplished by reslicing the volume scan. The posttrabecular aqueous outflow pathway was successfully identified in 10 eyes (90.9%). Combined with a flattening technique, the en face video and vasculature map showed a clear blood stream that could not be observed on a sequential stack of B-scans. In the en face images, the vessels were widely branched in the episclera venous plexus, perpendicularly penetrating the scleral stroma. Vessels running parallel to Schlemm’s canal and the collector channels were observed in the deeper region of the sclera. The average longitudinal diameter of the vessel was 29.7 6 6.6 lm at the episcleral venous plexus, and it was significantly larger than that in the deep scleral aqueous plexus (22.0 6 4.8 lm; P ? 0.0002). The continuous posttrabecular aqueous outflow pathway could be identified from a single B-scan and quantitatively analyzed using SS-OCT with en face imaging and volume scan reslicing.
关键词： glaucoma,aqueous flow,optical coherence tomography
更新于2025-09-23 15:21:01
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Current review of Excimer laser Trabeculostomy
摘要： Background: Excimer laser trabeculostomy (ELT) is a microinvasive glaucoma surgery (MIGS) that creates multiple laser channels through the trabecular meshwork using a cold laser system, which minimizes tissue fibrosis and aids in bypassing the main area of resistance to aqueous outflow. The purpose of this review is to evaluate the current body of evidence surrounding ELT in terms of efficacy and review the safety profile of the procedure. Main text: Studies screened had to show clear inclusion and exclusion criteria as well as well-defined outcome measures. PubMed, MEDLINE, EMBASE and the Cochrane Controlled Trial Database were searched. Preferred Reporting Items of Systematic Reviews (PRISMA) guidelines were used to assess for study quality and for any bias. Sixty-four articles were initially identified with 18 meeting preliminary screening criteria. Ultimately, 8 studies met inclusion criteria and 2 additional non-referenced publications were also included: 1 randomized control trial, 4 prospective case series and 5 retrospective studies. Overall studies showed moderate intraocular pressure (IOP) lowering of between 20% and 40% from baseline without medication washout and mostly a decrease in glaucoma medications with few complications. Conclusion: Current literature shows a significant IOP-lowering effect of ELT with a favorable safety-profile in standalone cases or combined with cataract surgery. Limitations to these studies are the lack of controls and washout IOP. Overall, ELT is an attractive MIGS option that does not require any residual device remaining in the angle.
关键词： Excimer laser trabeculostomy,ELT,Trabeculotomy,MIGS,Cataract,Intraocular pressure,Glaucoma
更新于2025-09-23 15:21:01
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[Lecture Notes in Computer Science] Pattern Recognition and Computer Vision Volume 11256 (First Chinese Conference, PRCV 2018, Guangzhou, China, November 23-26, 2018, Proceedings, Part I) || Automatic Measurement of Cup-to-Disc Ratio for Retinal Images
摘要： Glaucoma is a chronic eye disease which results in irreversible vision loss, and the optic cup-to-disc ratio (CDR) is an essential clinical indicator in diagnosing glaucoma, which means precise optic disc (OD) and optic cup (OC) segmentation become an important task. In this paper, we propose an automatic CDR measurement method. The method includes three stages: OD localization and ROI extraction, simultaneous segmentation of OD and OC, and CDR calculation. In the ?rst stage, the morphological operation and the sliding window are combined to ?nd the OD location and extract the ROI region. In the second stage, an improved deep neural network, named U-Net+CP+FL, which consists of U-shape convolutional architecture, a novel concatenating path and a multi-label fusion loss function, is adopted to simultaneously segment the OD and OC. Based on the segmentation results, the CDR value can be calculated in the last stage. Experimental results on the retinal images from public databases demonstrate that the proposed method can achieve comparable performance with ophthalmologist and superior performance when compared with other existing methods. Thus, our method can be a suitable tool for automated glaucoma analysis.
关键词： OD&OC segmentation,Glaucoma diagnosis,Deep neural network,OD localization,Cup-to-disc ratio (CDR)
更新于2025-09-23 15:21:01
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Visual Field Outcomes from the Multicenter, Randomized Controlled Laser in Glaucoma and Ocular Hypertension Trial
摘要： To compare visual field outcomes of ocular hypertensive and glaucoma patients treated with Medicine-1st against those treated with selective laser trabeculoplasty (SLT, Laser-1st). Secondary analysis of patients from Laser in Glaucoma and Ocular Hypertension (LiGHT), a multicentre randomised controlled trial. 344 patients (588 eyes) treated with Medicine-1st, 344 patients (590 eyes) treated with Laser-1st. Visual fields (VFs) were measured using standard automated perimetry and arranged in series (median length and duration: 9 VFs over 48 months). Hierarchical linear models were used to estimate pointwise VF progression rates, which were then averaged to produce a global progression estimate for each eye. Proportions of points and patients in each treatment group with fast (< -1 dB/y) or moderate (< -0.5 dB/y) progression were compared using log-binomial regression. Pointwise and global progression rates of total deviation (TD) and pattern deviation (PD). A greater proportion of eyes underwent moderate or fast TD progression in the Medicine-1st group compared with the Laser-1st group (26.2% vs. 16.9%; Risk Ratio, RR = 1.55 [1.23, 1.93], P < 0.001). A similar pattern was observed for pointwise rates (Medicine-1st 26.1% vs. Laser-1st 19.0%, RR = 1.37 [1.33, 1.42], P < 0.001). A greater proportion of pointwise PD rates were categorised as moderate or fast in the Medicine-1st group (Medicine-1st 11.5% vs. Laser-1st 8.3%, RR = 1.39 [1.32, 1.46], P < 0.001). There was no statistical difference in the proportion of eyes that underwent moderate or fast PD progression (Medicine-1st 9.9% vs. Laser-1st 7.1%, RR = 1.39 [0.95, 2.03], P = 0.0928). A slightly larger proportion of ocular hypertensive and glaucoma patients treated with Medicine-1st underwent rapid VF progression compared with those treated with Laser-1st.
关键词： Medicine-1st,Laser-1st,Glaucoma,Visual field,Ocular hypertension,Selective laser trabeculoplasty
更新于2025-09-23 15:21:01
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Relationship between the Lamina Cribrosa, Outer Retina, and Choroidal Thickness as Assessed Using Spectral Domain Optical Coherence Tomography
摘要： To evaluate the characteristics and relationship between peripapillary choroidal thickness (pCT), lamina cribrosa thickness (LCT), and peripapillary outer retinal layer thickness (pORT) as determined using spectral domain optical coherence tomography (SD-OCT) enhanced depth imaging (EDI).
关键词： Outer retinal thickness,Lamina cribrosa thickness,Optical coherence tomography,Choroidal thickness,Glaucoma
更新于2025-09-23 15:21:01
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Enhanced Structure-Function Relationship in Glaucoma With an Anatomically and Geometrically Accurate Neuroretinal Rim Measurement
摘要： PURPOSE. To evaluate the structure–function relationship between disc margin–based rim area (DM-RA) obtained with confocal scanning laser tomography (CSLT), Bruch’s membrane opening–based horizontal rim width (BMO-HRW), minimum rim width (BMO-MRW), peripapillary retinal nerve fiber layer thickness (RNFLT) obtained with spectral-domain optical coherence tomography (SD-OCT), and visual field sensitivity. METHODS. We examined 151 glaucoma patients with CSLT, SD-OCT, and standard automated perimetry on the same day. Optic nerve head (ONH) and RNFL with SD-OCT were acquired relative to a fixed coordinate system (acquired image frame [AIF]) and to the eye-specific fovea-BMO center (FoBMO) axis. Visual field locations were mapped to ONH and RNFL sectors with fixed Garway-Heath (VFGH) and patient-specific (VFPS) maps customized for various biometric parameters. RESULTS. Globally and sectorally, the structure–function relationships between DM-RA and VFGH, BMO-HRWAIF and VFGH, and BMO-HRWFoBMO and VFPS were equally weak. The R2 for the relationship between DM-RA and VFGH ranged from 0.1% (inferonasal) to 11% (superotemporal) whereas that between BMO-HRWAIF and VFGH ranged from 0.1% (nasal) to 10% (superotemporal). Relatively stronger global and sectoral structure–function relationships with BMO-MRWAIF and with BMO-MRWFoBMO were obtained. The R2 between BMO-MRWAIF and VFGH ranged from 5% (nasal) to 30% (superotemporal), whereas that between BMO-MRWFoBMO and VFPS ranged from 5% (nasal) to 25% (inferotemporal). The structure–function relationship with RNFLT was not significantly different from that with BMO-MRW, regardless of image acquisition method. CONCLUSIONS. The structure–function relationship was enhanced with BMO-MRW compared with the other neuroretinal rim measurements, due mainly to its geometrically accurate properties.
关键词： glaucoma,structure–function relationship,visual field,optic nerve head,automated perimetry
更新于2025-09-23 15:21:01
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Normal Value Ranges for Central Retinal Thickness Asymmetry in Healthy Caucasian Adults Measured by SPECTRALIS SD-OCT Posterior Pole Asymmetry Analysis
摘要： PURPOSE. To determine the normal variation in central retinal thickness asymmetry in healthy Caucasian adults using the posterior pole asymmetry analysis (PPAA) of a SPECTRALIS spectral-domain optical coherence tomography (SD-OCT) device. METHODS. Healthy Caucasian individuals aged between 18 and 45 years with a visual acuity of minimum 20/20 and a spherical equivalent between (cid:2)1.5 and t1.5 diopters were recruited. Retinal thickness and retinal nerve ?ber layer thickness (RNFL) were using measured SPECTRALIS SD-OCT. Inter- and intraocular differences in central retinal thickness were calculated using the PPAA. The association between age, sex, and interocular asymmetry was evaluated by a linear model with Gaussian correlation structure. RESULTS. A total of 105 individuals, 30 men and 75 women, were studied. The mean age 6 SD was 28.8 6 7.87 years. The grand mean interocular retinal thickness asymmetry was 5.6 lm (95% con?dence interval [CI]: 4.6–6.5) and the grand mean intraocular retinal thickness asymmetry was 8.3 lm (95% CI: 6.8–9.9) in the right eye and 8.4 lm (95% CI: 6.7–10.0) in the left eye. The highest local asymmetries were found in the nasal corners of macula were the posterior pole thickness map overlaps the temporal vascular arches. A slight general age and sex effect on the mean interocular retinal thickness asymmetry was found to be respectively 0.04 lm/year (95% CI: 0.02–0.06 lm) and 0.54 lm (95% CI: 0.19–0.88 lm) for men compared with women. CONCLUSIONS. Statistically signi?cant physiological asymmetries in inter- and intraocular central retinal thickness exist. This must be considered when early signs of glaucoma or other pathologies are evaluated based on the retinal thickness asymmetry.
关键词： glaucoma posterior segment,normal value ranges for retinal thickness asymmetry,posterior pole retinal thickness asymmetry analysis
更新于2025-09-23 15:21:01
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Development of a Pediatric Visual Field Test
摘要： Purpose: We describe a pediatric visual field (VF) test based on a computer game where software and hardware combine to provide an enjoyable test experience. Methods: The test software consists of a platform-based computer game presented to the central VF. A storyline was created around the game as was a structure surrounding the computer monitor to enhance patients’ experience. The patient is asked to help the central character collect magic coins (stimuli). To collect these coins a series of obstacles need to be overcome. The test was presented on a Sony PVM-2541A monitor calibrated from a central midpoint with a Minolta CS-100 photometer placed at 50 cm. Measurements were performed at 15 locations on the screen and the contrast calculated. Retinal sensitivity was determined by modulating stimulus in size. To test the feasibility of the novel approach 20 patients (4–16 years old) with no history of VF defects were recruited. Results: For the 14 subjects completing the study, 31 6 15 data points were collected on 1 eye of each patient. Mean background luminance and stimulus contrast were 9.9 6 0.3 cd/m2 and 27.9 6 0.1 dB, respectively. Sensitivity values obtained were similar to an adult population but variability was considerably higher – 8.3 6 9.0 dB. Conclusions: Preliminary data show the feasibility of a game-based VF test for pediatric use. Although the test was well accepted by the target population, test variability remained very high. Translational Relevance: Traditional VF tests are not well tolerated by children. This study describes a child-friendly approach to test visual fields in the targeted population.
关键词： glaucoma,visual field,children’s vision,perimetry,psychophysics
更新于2025-09-23 15:21:01
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Focusing on surgical and laser advances in glaucoma management
摘要： Introduction: Lowering the IOP remains the mainstay treatment to stop the progression of glaucoma. Different modalities can be used to achieve this including IOP lowering medications, laser, and surgeries. Nowadays, minimally invasive glaucoma surgeries and newer lasers are becoming more popular due to their safety profile, and their efficacy, allowing the patients to be less dependent on life long medications and substituting more invasive procedures as trabeculectomy, and shunt operations. Areas covered: This review will go through how lasers and surgery are used to lower the IOP, and the newest techniques, and modalities used to achieve this. Expert opinion: the authors of this review believe that in five years’ time lasers and minimally invasive glaucoma procedures will replace eye drops and surgeries like trabeculectomy and shunt procedures.
关键词： cyclophotocoagulation,trabeculectomy,shunt procedures,minimally invasive glaucoma procedures,non-penetrating glaucoma procedures,laser Trabeculoplasty,Intraocular pressure
更新于2025-09-23 15:19:57