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Annals of Biomedical Engineering Dec 2023Ophthalmic biomarkers have long played a critical role in diagnosing and managing ocular diseases. Oculomics has emerged as a field that utilizes ocular imaging... (Review)
Review
Ophthalmic biomarkers have long played a critical role in diagnosing and managing ocular diseases. Oculomics has emerged as a field that utilizes ocular imaging biomarkers to provide insights into systemic diseases. Advances in diagnostic and imaging technologies including electroretinography, optical coherence tomography (OCT), confocal scanning laser ophthalmoscopy, fluorescence lifetime imaging ophthalmoscopy, and OCT angiography have revolutionized the ability to understand systemic diseases and even detect them earlier than clinical manifestations for earlier intervention. With the advent of increasingly large ophthalmic imaging datasets, machine learning models can be integrated into these ocular imaging biomarkers to provide further insights and prognostic predictions of neurodegenerative disease. In this manuscript, we review the use of ophthalmic imaging to provide insights into neurodegenerative diseases including Alzheimer Disease, Parkinson Disease, Amyotrophic Lateral Sclerosis, and Huntington Disease. We discuss recent advances in ophthalmic technology including eye-tracking technology and integration of artificial intelligence techniques to further provide insights into these neurodegenerative diseases. Ultimately, oculomics opens the opportunity to detect and monitor systemic diseases at a higher acuity. Thus, earlier detection of systemic diseases may allow for timely intervention for improving the quality of life in patients with neurodegenerative disease.
Topics: Humans; Artificial Intelligence; Neurodegenerative Diseases; Quality of Life; Retina; Tomography, Optical Coherence; Biomarkers
PubMed: 37855949
DOI: 10.1007/s10439-023-03365-0 -
Central serous chorioretinopathy: updates in the pathogenesis, diagnosis and therapeutic strategies.Eye and Vision (London, England) Jul 2023Central serous chorioretinopathy (CSCR), first described by Albrecht von Graefe in 1866, is characterized by focal serous detachment of the neural retina and/or retinal... (Review)
Review
Central serous chorioretinopathy (CSCR), first described by Albrecht von Graefe in 1866, is characterized by focal serous detachment of the neural retina and/or retinal pigment epithelium (RPE) in the posterior pole. CSCR is the first ever described pachychoroid disease. Most recently, hypothetical venous overload choroidopathy is also proposed due to its distinguished morphological and pathological characteristics, including choroidal thickening, choriocapillaris hyperpermeability, remodelling, and intervortex venous anastomoses. Identification of genetic variants is necessary to comprehend the pathophysiology of CSCR. The novel multimodality imaging platforms, including the ultra-widefield imaging system, flavoprotein fluorescence, fluorescence lifetime imaging ophthalmoscopy, and multispectral imaging system, have been used for diagnosing and managing CSCR. Half-dose photodynamic therapy (PDT) remains the mainstay of clinical practice, with about 95% of patients with chronic CSCR improving to visual acuity (VA) of 20/30 or better. The use of oral eplerenone for routine clinical care remains controversial, and long-term randomized clinical trials are warranted to investigate its efficacy in acute and chronic CSCR. While CSCR has generally been recognized as a self-limiting disease with good prognosis, the underlying pathogenesis is still not fully understood, and treatments are often not fully effective. With new evidence emerging about pachydrusen being a disease precursor in both CSCR and polypoidal choroidal vasculopathy (PCV), it would be interesting to investigate whether CSCR can be a precursor to PCV. In this review, we highlighted the currently available evidence on the pathogenesis, diagnosis, multimodality imaging features, and management strategies, including recent findings related to CSCR.
PubMed: 37430344
DOI: 10.1186/s40662-023-00349-y -
Klinische Monatsblatter Fur... May 2024Giant cell arteritis (GCA) is the most common primary vasculitis and is associated with potential bilateral blindness. Neither clinical nor laboratory evidence is simple... (Review)
Review
Giant cell arteritis (GCA) is the most common primary vasculitis and is associated with potential bilateral blindness. Neither clinical nor laboratory evidence is simple and unequivocal for this disease, which usually requires rapid and reliable diagnosis and therapy. The ophthalmologist should consider GCA with the following ocular symptoms: visual loss or visual field defects, transient visual disturbances (amaurosis fugax), diplopia, eye pain, or new onset head or jaw claudication. An immediate ophthalmological examination with slit lamp, ophthalmoscopy, and visual field, as well as color duplex ultrasound of the temporal artery should be performed. If there is sufficient clinical suspicion of GCA, corticosteroid therapy should be initiated immediately, with prompt referral to a rheumatologist/internist and, if necessary, temporal artery biopsy should be arranged. Numerous developments in modern imaging with colour duplex ultrasonography, MRI, and PET-CT have the potential to compete with the classical, well-established biopsy of a temporal artery. Early determination of ESR and CRP may support RZA diagnosis. Therapeutically, steroid-sparing immunosuppression with IL-6 blockade or methotrexate can be considered. These developments have led to a revision of both the classification criteria and the diagnostic and therapeutic recommendations of the American College of Rheumatologists and the European League against Rheumatism, which are summarised here for ophthalmology.
Topics: Giant Cell Arteritis; Humans; Diagnosis, Differential; Adrenal Cortex Hormones; Immunosuppressive Agents; Temporal Arteries; Evidence-Based Medicine; Treatment Outcome; Biopsy
PubMed: 38593832
DOI: 10.1055/a-2252-3371 -
La Tunisie Medicale Jul 2023Pterygium surgery is a closed globe surface surgery. Although it is perfectly standard and followed by excellent results, it is not exempt from the general rule that...
INTRODUCTION
Pterygium surgery is a closed globe surface surgery. Although it is perfectly standard and followed by excellent results, it is not exempt from the general rule that there is no surgery without risk. It therefore seems important to integrate simulation as a pedagogical tool for training ophthalmology residents in pterygium surgery.
AIM
To evaluate the effectiveness of procedural simulation as a training tool for pterygium surgery.
RESULTS
During the study period, eight residents participated in the three workshops. The global assessment of residents' knowledge showed a mean score of 3/5 [1.5/5-4/5] and 4.1/5 [3.25/5-5/5] before and after the training respectively. There was a significant negative correlation between the initial score on the pre-test and the improvement of this score on the post-test, with an r'=-0.87 and a p=0.005. We noted a significant improvement in the global performance score (p<0.001) and even a significant improvement in the specific performance score (p=0.02) between the 3 workshops. The average training satisfaction score was 13.87/16 [10/16-16/16]. We noted a significant positive correlation with r=0.838 and p=0.009 between knowledge improvement and learner satisfaction.
CONCLUSION
The training of fundus examination using an ophthalmoscopic simulator can improve the skills and knowledge of ophthalmic learners. This type of training can be an innovative addition to traditional learning methods.
Topics: Humans; Pterygium; Fundus Oculi; Knowledge; Ophthalmology; Ophthalmoscopy
PubMed: 38445419
DOI: No ID Found -
Clinical Ophthalmology (Auckland, N.Z.) 2023Lattice degeneration (LD), routinely diagnosed with indirect ophthalmoscopy, is one of the most common and clinically significant peripheral retinal findings. In this... (Review)
Review
Lattice degeneration (LD), routinely diagnosed with indirect ophthalmoscopy, is one of the most common and clinically significant peripheral retinal findings. In this review, we have summarized the data on currently available imaging techniques which help to improve diagnosis and our understanding of LD pathogenesis. Ultra-wide field imaging provides reliable color fundus capturing for the primary diagnosis of LD and may also be used as a screening tool. Wide-field imaging can be used for targeted documentation of LD lesions using true colors and with minimal optical distortions. Information on the status of the vitreoretinal interface, including detection of retinal holes, detachments, and vitreous tractions, can be obtained with peripheral structural optical coherence tomography (OCT) or scanning laser ophthalmoscopy in retro-mode. These techniques clarify the associated risks of rhegmatogenous retinal detachment. Fundus autofluorescence can provide details on atrophic changes. However, the risk of retinal detachment by means of this technique requires further investigation. OCT angiography may be successfully performed for some lesions. Taken together, OCT and OCT angiography demonstrate thinning of the choroid, alteration of local choroidal microcirculation, and, in severe lesions, involvement of the sclera. OCT angiography confirms loss of retinal microcirculation within LD lesion, which was previously shown with fluorescein angiography. In conclusion, despite relatively simple primary diagnosis, imaging of LD lesions remains challenging due to their peripheral localization. However, several new strategies, including ultra-wide field imaging, peripheral OCT, and scanning laser ophthalmoscopy, make LD imaging possible on a routine basis, improving diagnosis and understanding of LD pathogenesis.
PubMed: 37605766
DOI: 10.2147/OPTH.S405200 -
Progress in Retinal and Eye Research Jul 2024The retina is an emerging CNS target for potential noninvasive diagnosis and tracking of Alzheimer's disease (AD). Studies have identified the pathological hallmarks of... (Review)
Review
The retina is an emerging CNS target for potential noninvasive diagnosis and tracking of Alzheimer's disease (AD). Studies have identified the pathological hallmarks of AD, including amyloid β-protein (Aβ) deposits and abnormal tau protein isoforms, in the retinas of AD patients and animal models. Moreover, structural and functional vascular abnormalities such as reduced blood flow, vascular Aβ deposition, and blood-retinal barrier damage, along with inflammation and neurodegeneration, have been described in retinas of patients with mild cognitive impairment and AD dementia. Histological, biochemical, and clinical studies have demonstrated that the nature and severity of AD pathologies in the retina and brain correspond. Proteomics analysis revealed a similar pattern of dysregulated proteins and biological pathways in the retina and brain of AD patients, with enhanced inflammatory and neurodegenerative processes, impaired oxidative-phosphorylation, and mitochondrial dysfunction. Notably, investigational imaging technologies can now detect AD-specific amyloid deposits, as well as vasculopathy and neurodegeneration in the retina of living AD patients, suggesting alterations at different disease stages and links to brain pathology. Current and exploratory ophthalmic imaging modalities, such as optical coherence tomography (OCT), OCT-angiography, confocal scanning laser ophthalmoscopy, and hyperspectral imaging, may offer promise in the clinical assessment of AD. However, further research is needed to deepen our understanding of AD's impact on the retina and its progression. To advance this field, future studies require replication in larger and diverse cohorts with confirmed AD biomarkers and standardized retinal imaging techniques. This will validate potential retinal biomarkers for AD, aiding in early screening and monitoring.
Topics: Alzheimer Disease; Humans; Retinal Diseases; Retina; Animals; Tomography, Optical Coherence; Amyloid beta-Peptides; Retinal Vessels
PubMed: 38759947
DOI: 10.1016/j.preteyeres.2024.101273 -
Current Diabetes Reviews May 2024Diabetic Retinopathy is a vascular microvascular disease also called diabetic eye disease caused by microangiopathy leading to progressive damage of the retina and...
Diabetic Retinopathy is a vascular microvascular disease also called diabetic eye disease caused by microangiopathy leading to progressive damage of the retina and blindness. The uncontrolled blood glycemic level or sugar level results in diabetic retinopathy. There are two stages of diabetic retinopathy: proliferative diabetic retinopathy and nonproliferative diabetic retinopathy. Symptoms of diabetic retinopathy often have no early warning signs, even muscular edema, which can cause rapid vision loss. Macular edema in which the blood vessels leak can also occur at any stage of diabetic retinopathy. Symptoms are darkened or distorted images and blurred vision that are not the same in both eyes. This review study primarily discusses the pathophysiology, genetics, and ALR, AGEs, VEGF, EPO, and eNOS involved in diabetic retinopathy. The longer a person has diabetes, the higher their risk of developing some ocular problems. During pregnancy, diabetic retinopathy may also be a problem for women with diabetes. NIH are recommends that all pregnant women with diabetes have an overall eye examination. Diagnosis of diabetic retinopathy is made during an eye examination that comprises ophthalmoscopy or fundus photography, and glow-in angiography for Fundus. Here, we present a review of the current insights into pathophysiology in diabetic retinopathy, as well as clinical treatments for diabetic retinopathy patients. Novel laboratory findings and related clinical trials are also analysed.
PubMed: 38831577
DOI: 10.2174/0115733998296228240521151050