Evaluation Of Optic Disc Photographs Research Articles

Study on relationship between intraocular pressure and hyperthyroidism

Thyroid-associated ophthalmopathy (TAO) represents a persistent autoimmune inflammatory condition impacting various ocular components, including orbital fat (OF), extraocular muscles (EOMs), the eyeball, and associated eye structures. This disorder is closely associated with autoimmune thyroid pathology. A body of research has indicated an elevated susceptibility to heightened intraocular pressure (IOP) and glaucoma among individuals with thyroid-related ailments. Nonetheless, certain studies have expressed reservations about affirming these conclusions. Furthermore, there exists a diversity of viewpoints regarding the optimal approaches for managing elevated IOP in TAO patients afflicted with ocular hypertensionA prospective research investigation was undertaken within the Department of Ophthalmology at a Tertiary Care Teaching Hospital, spanning a duration of 12 months. The techniques employed for the diagnosis of open-angle glaucoma (OAG) have been comprehensively outlined. Goldmann applanation tonometry was utilized to determine intraocular pressure (IOP). Employing a Zeiss FF3 fundus camera, a series of dilated stereoscopic 300-color retinal and optic disc images were captured. The evaluation of optic disc photographs was conducted by one of two evaluators, both of whom remained masked to the study's particulars, employing a customized protocol. In order to ascertain optic disc dimensions, adjustments for camera magnification were performed, accounting for the spherical equivalent refraction of each individual eye.A total of 90 patients were examined. Of the 90 cases, male preponderance was noted. Among 90 patients, 20 (22.2%) were hyperthyroid, 61 (67.8%) were hypothyroid, and 9 (10%) patients were euthyroid. In our study shows the frequency of different symptoms among the study group. Most of the patients came with complaint itching of (27.8%). The second most common symptom was foreign body sensation (21.1%). In this study shows the different types of signs among these two groups. In hyperthyroid lid, retraction was more common (12%). In hypothyroid lid, edema was more common (18.5%). Frequency of dry eye syndrome in patients with TD was present; 29 (26.4%) patients had dry eye disease. Among 90 patients, proptosis was present in 4 patients had proptosis. Most of the patients were myopic.Our results imply the potential link between intraocular pressure (IOP) and thyroid-related disorders, particularly in individuals undergoing thyroxine treatment. Conducting further comprehensive investigations to explore and substantiate this prospective association is advisable.

A Deep Learning System for Automated Quality Evaluation of Optic Disc Photographs in Neuro-Ophthalmic Disorders

The quality of ocular fundus photographs can affect the accuracy of the morphologic assessment of the optic nerve head (ONH), either by humans or by deep learning systems (DLS). In order to automatically identify ONH photographs of optimal quality, we have developed, trained, and tested a DLS, using an international, multicentre, multi-ethnic dataset of 5015 ocular fundus photographs from 31 centres in 20 countries participating to the Brain and Optic Nerve Study with Artificial Intelligence (BONSAI). The reference standard in image quality was established by three experts who independently classified photographs as of "good", "borderline", or "poor" quality. The DLS was trained on 4208 fundus photographs and tested on an independent external dataset of 807 photographs, using a multi-class model, evaluated with a one-vs-rest classification strategy. In the external-testing dataset, the DLS could identify with excellent performance "good" quality photographs (AUC = 0.93 (95% CI, 0.91-0.95), accuracy = 91.4% (95% CI, 90.0-92.9%), sensitivity = 93.8% (95% CI, 92.5-95.2%), specificity = 75.9% (95% CI, 69.7-82.1%) and "poor" quality photographs (AUC = 1.00 (95% CI, 0.99-1.00), accuracy = 99.1% (95% CI, 98.6-99.6%), sensitivity = 81.5% (95% CI, 70.6-93.8%), specificity = 99.7% (95% CI, 99.6-100.0%). "Borderline" quality images were also accurately classified (AUC = 0.90 (95% CI, 0.88-0.93), accuracy = 90.6% (95% CI, 89.1-92.2%), sensitivity = 65.4% (95% CI, 56.6-72.9%), specificity = 93.4% (95% CI, 92.1-94.8%). The overall accuracy to distinguish among the three classes was 90.6% (95% CI, 89.1-92.1%), suggesting that this DLS could select optimal quality fundus photographs in patients with neuro-ophthalmic and neurological disorders affecting the ONH.

Stereoscopic vs. monoscopic photographs on optic disc evaluation and glaucoma diagnosis among general ophthalmologists: A cloud-based real-world multicenter study.

PurposeTo investigate whether stereoscopic vs. monoscopic viewing condition influences the evaluation of optic disc photographs for morphologic features and glaucoma likelihood in a general ophthalmologist population from multicenters on a cloud-based platform.MethodsA cross-sectional study of 519 pairs of stereoscopic and monoscopic photographs of optic discs with adequate quality were selected and presented using a cloud-based platform. A total of 21 general ophthalmologists from 14 centers assessed 15 morphologic features based on 5R's rules and estimated glaucoma likelihood for each assigned photograph. There were 93 pairs of stereoscopic and monoscopic photographs evaluated by a panel of glaucoma specialists and set as ground truth. The main outcome measures were the agreement between estimates and ground truth and the inter-grader agreements.ResultsThere were good agreements between ground truth and both monoscopic and stereoscopic estimates (stereo κ 0.532 and mono κ 0.494). There was also a substantial intra-grader agreement between monoscopic and stereoscopic evaluation of glaucoma likelihood (κ 0.636). In eyes with probable glaucoma, the accuracy of the stereo method was greater than that of the mono method (stereo 0.238 vs. mono 0.118) When compared with ground truth, stereoscopic photographs had a better agreement for disc size (stereo κ 0.447 vs. mono κ 0.183), disc color (stereo κ 0.612 vs. mono κ 0.549), neuroretinal rim shape (stereo κ 0.356 vs. mono κ 0.274) on the whole. The stereoscopic method also had a better inter-grade agreement for disc size, disc color, neuroretinal rim shape, and glaucoma likelihood (stereo κ 0.402 vs. mono κ 0.359) on the whole.ConclusionsIn the evaluation of optic disc photographs for morphologic features and glaucoma likelihood, the stereoscopic method showed superiority compared to the monoscopic method for general ophthalmologists. The stereoscopic method is more likely to identify glaucomatous eyes which need medical intervention.

Role of visual field reliability indices in ruling out glaucoma.

Standard automated perimetry is the current criterion standard for assessment of visual field (VF) loss in glaucoma. The 3 commonly used reliability indices to judge the quality of standard automated perimetry results are fixation losses (FLs) and false-positive (FP) and false-negative (FN) response rates. However, the influence of reliability indices, when within the manufacturer-recommended limits, on VF classification has been sparsely studied. To evaluate the role of VF reliability indices in ruling out glaucoma. A cross-sectional study of 291 eyes of 291 participants referred to a tertiary eye care facility by general ophthalmologists. The participants were suspected to have glaucoma based on optic disc appearance, but the eyes were judged to be normal with physiological cupping by glaucoma experts on masked evaluation of optic disc photographs. All participants underwent VF testing with the Swedish interactive threshold algorithm standard 24-2 program. Logistic regression models were used to evaluate the associations between reliability indices and FP classifications on VF testing (glaucoma hemifield test as outside normal limits and pattern standard deviation with P < .05). Median FL, FP, and FN response rates were 7%, 1%, and 2%, respectively. Among the 241 participants with reliable VF results (FL <20% and FP response rate <15%), the VF classification was normal in 188 (78.0%) and glaucoma (FP) in 53 (22.0%). Probability of FP VF classification was associated with FN response rates (odds ratio [OR], 1.36; 95% CI, 1.25-1.48, P < .001) but did not appear to be associated with FLs (OR, 0.96; 95% CI, 0.90-1.03, P = .30) or FP response rates (OR, 0.96; 95% CI, 0.83-1.12, P = .64). Predicted probability of FP VF classification was 9% (95% CI, 6%-14%), 40% (32%-49%), and 82% (68%-91%) at FN response rates of 0%, 8%, and 16%, respectively. This study suggests that FN response rates have an effect on the ability of automated VF assessments to rule out glaucoma. Since FN response rates are ignored by the manufacturer while flagging a test as unreliable, clinicians and researchers may benefit by realizing that FN response rates can lead to FP VF classification, even when their frequencies are small.

Glaucomatous Optic Neuropathy Evaluation (GONE) Project: The Effect of Monoscopic Versus Stereoscopic Viewing Conditions on Optic Nerve Evaluation

To determine whether monoscopic vs stereoscopic viewing impacts evaluation of optic disc photographs for glaucoma diagnosis in an expert population. Prospective observational study. Twenty pairs of high-quality monoscopic and stereoscopic photographs of similar size and magnification (ie, 40 images), were selected to demonstrate a range of optic disc features from a total of 197 eyes of 197 patients with glaucoma and normal subjects recruited from a tertiary clinic. These were presented in randomized order via an interactive platform (http://stereo.gone-project.com/). Participants assessed 9 topographic features and estimated glaucoma likelihood for each photograph. Main outcome measures were intra- and inter-observer agreement. There was good intra-observer agreement between monoscopic and stereoscopic assessments of glaucoma likelihood (κw= 0.56). There was also good to substantial agreement for peripapillary atrophy (κw= 0.65), cup shape (κw= 0.65), retinal nerve fiber layer loss (κw=0.69), vertical cup-to-disc ratio (κw= 0.58), and disc shape (κw= 0.57). However, intra-observer agreement was only fair to moderate for disc tilt, cup depth, and disc size (κw= 0.46-0.49). Inter-observer agreement for glaucoma likelihood in monoscopic photographs (κw=0.61, 95% confidence interval [CI]= 0.55-0.67) was substantial and not lower than in stereoscopic photographs (κw= 0.59, CI= 0.54-0.65). Monoscopic photographs did not lead to lower levels of inter-observer agreement compared to stereoscopic photographs in the assessment of any optic disc characteristics, for example disc size (mono κw= 0.65, stereo κw= 0.52) and cup-to-disc ratio (mono κw= 0.72, stereo κw= 0.62). For expert observers in the evaluation of optic disc photographs for glaucoma likelihood, monoscopic optic disc photographs did not appear to represent asignificant disadvantage compared to stereoscopic photographs.

Ability of Different Scanning Protocols of Spectral Domain Optical Coherence Tomography to Diagnose Preperimetric Glaucoma

To evaluate the ability of the optic nerve head (ONH), retinal nerve fiber layer (RNFL), and ganglion cell complex (GCC) parameters of spectral domain optical coherence tomograph (SDOCT) in detecting preperimetric glaucoma. In a cross-sectional study, 34 preperimetric glaucoma eyes (34 patients) and 72 control eyes (72 subjects) with large physiologic optic disc cupping underwent ONH, RNFL, and GCC imaging with SDOCT. Preperimetric glaucoma was diagnosed in the presence of glaucomatous optic neuropathy on masked evaluation of optic disc photographs by two glaucoma experts and normal visual fields. The ability of SDOCT parameters to discriminate preperimetric glaucoma eyes from eyes with large physiologic cups was evaluated by areas under the receiver operating characteristic curves (AUC), sensitivities at fixed specificities, and likelihood ratios (LR). All SDOCT parameters were significantly different (P < 0.05) between the two groups. The ONH, RNFL, and GCC parameters with best AUCs to differentiate preperimetric glaucoma from eyes with large physiologic cups were vertical cup to disc ratio (0.76), inferior quadrant RNFL thickness (0.76), and inferior quadrant GCC thickness (0.75), respectively. Sensitivities at 95% specificity of SDOCT parameters ranged between 15% and 29%. Likelihood ratios of outside normal limits category of parameters ranged between 3 and 11, and within normal limits category between 0.5 and 0.8. Diagnostic abilities of ONH, RNFL, and GCC parameters of SDOCT to differentiate preperimetric glaucoma eyes from control eyes with large physiologic cupping were only moderate.

Lenticular astigmatism in tilted disc syndrome

Purpose To evaluate whether an abnormal optic disc shape in patients with tilted disc syndrome (TDS) is associated with an abnormal configuration of the crystalline lens measured as lenticular astigmatism. Setting Department of Ophthalmology, Inönü University Medical Faculty, Turgut Özal Medical Center, Malatya, Turkey. Methods This cross-sectional masked case-control study comprised 32 eyes of 32 patients with established TDS (13 men, 19 women; mean age 21.31 years ± 7.05 [SD]) and 20 age- and sex-matched healthy control subjects (8 men, 12 women; mean age 22.65 ± 7.11 years) with a comparable amount of myopic astigmatism (spherical equivalent) without TDS. The optic disc was morphometrically analyzed by planimetric evaluation of optic disc photographs. The total refractive and keratometric corneal astigmatism was obtained, and lenticular astigmatism was calculated by vector analysis. The Mann-Whitney U test was used for statistical analysis; 1 eye of each patient was evaluated in both groups. A P value less than 0.05 was considered statistically significant. Results The mean spherical equivalent refraction was comparable in TDS patients (−4.73 ± 1.12 diopters [D]) and controls (−4.28 ± 1.29 D) ( P = .210). The mean total astigmatism was higher in TDS patients (−2.96 ± 1.04 D) than in the controls (−2.51 ± 1.09 D), but the difference was not significant ( P = .151). The mean corneal astigmatism was comparable in TDS patients (−2.07 ± 0.83 D) and controls (−2.28 ± 0.87 D) ( P = .454), but the calculated mean lenticular astigmatism was significantly higher in TDS patients (−1.31 ± 0.98 D and −0.20 ± 0.35 D, respectively) ( P < .001). Twenty-nine of 32 TDS patients (90.6%) had lenticular astigmatism; in 16 (50%), it was greater than −1.00 D. Lenticular astigmatism was present in 7 controls (35%); in 2 (10%), it was greater than −1.00 D. The mean keratometry was significantly higher in TDS patients (43.84 ± 1.06 D) than in the controls (42.75 ± 1.45 D) ( P = .011). Conclusions Clinically significant lenticular astigmatism was present in TDS patients. If an abnormal optic disc shape is found on ophthalmoscopy, lenticular astigmatism as well as corneal astigmatism should be carefully evaluated to prevent an unsatisfactory refractive outcome, especially in refractive surgery candidates.