Eye Pathology Research Articles

Factors associated with vision loss in Black or Hispanic patients 1year after standalone or combined Ahmed glaucoma valve surgery.

To determine factors associated with vision loss 1year after Ahmed glaucoma valve (AGV) surgery in Black or Hispanic patients, who bear disproportionate glaucoma burdens yet have been underrepresented in pivotal trials. This retrospective study included Black or Hispanic patients who received AGVs standalone or combined with phacoemulsification and/or cyclodestructive lasers. Univariate and multivariate generalized estimating equations evaluated the effects of baseline, surgical, and postoperative factors on vision loss of two Snellen lines or more at the 1-year follow-up visit. The primary term was the hypertensive phase (HP), which signified an intraocular pressure (IOP) reading > 21mmHg within the first 3 postoperative months after reduction below 22 in the first week, without other tube malfunction. Of 241 eyes from 186 patients, vision loss of ≥ 2 lines at the 1-year follow-up visit occurred in 21.6% (N = 52). Vision loss of ≥ 2 lines occurred in 52.5% of eyes at week 1, 36.9% of eyes at month 1, and 27.0% of eyes at month 3. Between 6months and 1year, vision loss frequencies stabilized. In the multivariate model, HP (OR = 4.71 (2.14, 10.38)), total quadrants with split fixation (1.47 (1.20, 1.81)), follow-up non-glaucomatous eye pathology (2.89 (1.44, 5.80)), and concurrent cataract surgery (0.42 (0.22, 0.82)) each met significance (p < 0.05). Post-AGV vision loss in the early follow-up period among Black or Hispanic patients was often transient. Hypertensive phase and split fixation each increased the odds of vision loss at 1year, while concurrent cataract surgery decreased the odds.

Blepharoconjunctivitis and Otolaryngological Disease Trends in the Context of Mask Wearing during the COVID-19 Pandemic

(1) Purpose: In 2020, wearing of face masks was mandated in the United States in an effort to lessen transmission of the novel 2019 coronavirus disease (COVID-19) pandemic; however, long-term mask wearing may present with unintended side-effects in both ophthalmic and otolaryngologic clinical practice. This study aims to examine if mask wearing increased the incidence of primarily chalazion, blepharoconjunctivitis, and rhinitis occurrence during the mask-mandated COVID-19 pandemic period. (2) Methods: Medical records from tertiary academic center clinics were analyzed for incidence of ophthalmic and otolaryngologic diagnoses of interest (blepharoconjunctivitis- and rhinitis-related disorders). Data were collected from a pre-pandemic (March 2019–February 2020) and a mid-pandemic window (March 2020–February 2021) during which widespread mask mandates were implemented in Texas. Comparison was performed using a t-test analysis between incidence of chosen diagnoses during the described time periods. (3) Results: Incidence of ophthalmic disorders (primarily blepharoconjunctivitis and chalazion) in the pre-pandemic versus mid-pandemic windows did show a significant difference (p-value of 0.048). Similarly, comparison of otolaryngologic diagnoses (primarily rhinitis and related conditions) between the two time periods showed a significant difference (p-value of 0.044) as well. (4) Conclusion: Incidence of the chosen ophthalmic and otolaryngologic disorders did increase during periods of mask mandates. While these findings are preliminary, further studies are warranted to understand other factors that may have played a role in eye and nose pathology.

Distinctive features of eye pathology in elderly and senile people in Arkhangelsk region

Purpose: to identify the features of the pathology of the eye in elderly and senile people in the Arkhangelsk region. Material and methods. Annual reports of medical eye care facilities for the 2009 to 2019 who offered ophthalmological assistance to individuals aged 60 or older were analyzed. To estimate the differences infrequency of occurrence Pearson's Chi-square was used. Results. The incidence of eye pathologies in elderly and senile people amounts to 20.74% (17.83 % male and 22.29 % female). The most common conditions included the pathology of the lens that occurred in almost 50 % of the old people, glaucoma was diagnosed in about 20 % and retinal conditions in one out of seven people. In the age group of 60 to 74 years, the most common pathologies included glaucoma, diabetic angioretinopathy, retinal conditions and refractive errors; in the people of advanced age (75—89 years), lens pathologies and age-related macular degeneration occurred more frequently than in the younger age group while glaucoma, diabetic angioretinopathy, retinal conditions and refractive errors occurred less frequently. The oldest age group (90 years and older) showed a different pathology distribution than people of the younger age groups: they have higher occurrence of lens pathologies, age-related macular degeneration, optic disc pathology. In contrast, they have a rarer occurrence of retinal diseases, whilst diabetic angioretinopathy or refractive errors were not diagnosed at all. Gender differences of eye pathology distribution are revealed in the fact that, among people aged 60 to 89, women have a higher occurrence of age-related macular degeneration, retinal diseases and refractive errors, while men are more often diagnosed with glaucoma. Conclusion. The identified features of eye pathology in elderly and senile people living in the Arkhangelsk region should be taken into account when medical care for advanced age groups is developed and improved.

Characteristics of antibody production to individual cytomegalovirus proteins in children with keratitis and uveitis

The clinical diagnosis of cytomegalovirus (CMV) eye pathology in children needs laboratory confirmation. The disadvantages of determining antibodies to CMV in serum in enzyme-linked immunosorbent assay (ELISA) include the presence of false positive and false negative results.&#x0D; AIM: To determine the features of the synthesis of antibodies to the proteins of the tegument pp65, pp150, pp28 and the DNA-binding protein pp52 of cytomegalovirus, as well as to compare the diagnostic effectiveness of two laboratory methods of serodiagnostics of CMVI in children with uveitis and keratitis of different genesis: enzyme immunoassay and linear immunolysis.&#x0D; MATERIAL AND METHODS: A total of 30 children (age 516 years) with uveitis (n=14) and keratitis (n=16) were included in the study. The IgM and IgG antibodies to the immediate early (IE) and late antigens of the virus (serological markers of primary, chronic, and reactivation of chronic infection) were determined in the ELISA. The IgG antibodies to individual recombinant CMV antigens containing only immunodominant protein fragments of viral antigens were studied in the line immunoassay (LIA): the main nonstructural IE protein, DNA-binding phosphoprotein p52, and phosphoproteins of the tegument p150, p65, and p28. The results of LIA were evaluated visually.&#x0D; RESULTS: CMV infection (CMVI) in children with uveitis in ELISA was almost 2 times higher than that with keratitis (10/14%71% vs. 6/16%37.5%, p 0.05). Of the four positive results for detection of antibodies to IE antigen in ELISA, one was confirmed in LIA. In general, the discrepancy between the results of the determination of IgG antibodies to IE antigen in ELISA and LIA was noted in 13% of serum samples. LIA showed the increased frequency (p 0.05) and intensity (p 0.05) of antibody formation to viral antigens p65 and p52 in uveitis compared with keratitis, which confirmed the important role of CMVI in the pathogenesis of uveitis.&#x0D; CONCLUSION: Both methods revealed a higher level of CMVI in children with uveitis than those with keratitis. IgG antibodies to IE-antigen serological markers of the reactivation of chronic CMVI have clinical importance because they serve as the basis for the appointment of antiviral therapy. Discrepancies between the results of ELISA and LIA in the detection of antibodies to IE antigen indicate the expediency of confirming the results of ELISA in LIA.&#x0D; Thus, laboratory examination of sera in ELISA with subsequent analysis of antibodies to individual recombinant CMV antigens in LIA is an effective, highly sensitive, and highly specific method to verify CMVI and determine its activity. The most informative action is the determination of IgG antibodies to recombinant CMV antigens: IE antigens, p65, and p52.

Possible causes of the ineffectiveness of sinustrabeculectomy in children with congenital glaucoma

AIM: On the basis of studying the causes of errors in finding the trabecular zone to be excised during trabeculectomy in children with congenital glaucoma, this study presents a proven and effective method for simple intraoperative localization of the trabecular area.&#x0D; MATERIAL AND METHODS: The analyses of many years of experience in the examination and treatment of children with congenital glaucoma at the Department of Eye Pathology in Children of Helmholtz National Medical Research Center (100200 children annually) revealed the anatomical and morphological features of the eyes of children with congenital glaucoma and the reasons for the insufficient effectiveness of trabeculectomy.&#x0D; RESULTS: A retrospective gonioscopic analysis of the condition of the operation area and internal fistula after trabeculectomy in children with congenital glaucoma showed that erroneous choice of the area of the trabecular region to be excised during surgery is one of the reasons for the inefficiency of trabeculectomy, and it results from the incorrect determination of the projection location of the apex of anterior chamber angle (ACA) onto the sclera caused by the significantly distorted anatomical parameters of the childs eye due to the softness and extensibility of the limbus and sclera. On the stretched eyes of children with congenital glaucoma, especially those with buphthalmos and cloudy cornea, accurate determination of the boundaries of the altered cornea, limbus, and projection of the ACAs apex onto the sclera is visually impossible.&#x0D; CONCLUSION: During trabeculectomy of the eyes of children with congenital glaucoma, for the accurate localized projection of the apex of the ACAs onto the sclera and the trabecular zone to be excised, a simple and accessible method of clarifying diaphanoscopy intraoperatively must be used to correctly select the trabeculectomy zone, especially on stretched eyes.

Морфометрическое состояние макулярной зоны при атрофической форме миопической макулопатии

Purpose. Clinical assessment of morphometric parameters of the macular zone in patients with atrophic myopic maculopathy, their relationship with age and size of the anteroposterior axis (APA) of the eyes. Material and methods. The main group consisted of 143 patients (286 eyes) with acquired axial myopia with complications in the posterior pole of the eye. It identifies 3 subgroups according to the severity of myopic macular changes. The comparison group included 34 patients (68 eyes) with acquired uncomplicated axial myopia. Control group – 13 people (26 eyes) with emmetropic refraction without eye pathology. All patients underwent optical coherence tomography of the macula. The thickness of the neuroepithelium of the macular zone, the volume of the neuroepithelium of the macula, the thickness of the layer of ganglion cells, the thickness of the choroid in the center of the fovea were studied. Results. Statistical analysis made it possible to identify characteristic changes in the macular retina and choroid with an increase in the size of the posterior eye and the age of patients. Changes in the macula characteristic of the beginning of the formation of myopic maculopathy were revealed, such as a decrease in the index of the ganglion cell layer in the upper and lower temporal sector of the macular map from 76 µm or less; a decrease in the average thickness of the ganglion cell layer from 76.5 µm or less. Conclusion. With increasing age of patients, a decrease in the thickness of the choroid occurs. The progression of the severity of atrophic myopic maculopathy is accompanied by a smoothing of the profile of the macular retina, a decrease in the thickness of the layer of ganglion cells in the temporal regions. These data may allow the development of methods for predicting the development of atrophic myopic maculopathy. Keywords: atrophic myopic maculopathy, acquired axial myopia, optical coherence tomography.

Субфовеальная толщина хориоидеи при влажной форме возрастной макулярной дегенерации

Currently, optical coherence tomography in enhanced image depth (EDI-OCT) mode is actively used in the diagnosis and prognosis of treatment of many eye pathologies, including age-related macular degeneration (AMD). Purpose. To assess the subfoveal thickness of the choroid in various types of choroidal neovascularization (CNV) accompanying the wet form of AMD. Material and methods. We examined 24 patients (27 eyes) with wet AMD, who had not previously received treatment. Depending on the type of CNV, the patients were divided into 4 groups: the first group – with occult; the second group – with the classic; the third group – with mixed; the fourth group – with retinal angiomatous proliferation. The control group included 25 people (35 eyes) without eye pathology. All patients underwent standard and specialized ophthalmological examinations. Results. During the morphometric analysis of the subfoveal thickness of the choroid in patients with wet AMD, a significant decrease was recorded relative to the control (p&lt;0.05), except for the group with occult CNV. Conclusion. As a result of the study, changes in choroidal structures are noted with a decrease in the subfoveal thickness of the choroid in wet AMD, as well as in atrophic AMD. Also, when assessing this parameter for different types of CNV, a difference was noted in the eyes with a latent type. Further research is needed to analyze the subfoveal thickness of the choroid in wet AMD, due to the diagnostic and predictive value of this parameter. Key words: age-related macular degeneration, choroidal neovascularization, EDI-OCT, subfoveal thickness of the choroid

Влияние перенесенной преэклампсии на формирование сосудистых расстройств организма и органа зрения

The article presents the main pathogenetic mechanisms of endothelial dysfunction formation in complicated pregnancy and vascular pathology. The possible consequences of postponed preeclampsia are presented. The analysis of the literature suggests that preeclampsia should be considered as a pathology threatening an increased risk of the formation of vascular eye pathology, both in the short and in the long term after childbirth. Key words: preeclampsia, vascular retinal pathology, endothelial dysfunction

Association of Age-Related Macular Degeneration with Prior Hyperthyroidism and Hypothyroidism: A Case-Control Study.

Prior studies suggest a possible association between thyroid disease and the subsequent development of age-related macular degeneration (AMD), although it remains inconclusive. This study aimed to evaluate the association of AMD with prior hyper-/hypothyroidism based on nationwide population-based data. We retrieved records of the study patients from the National Health Insurance Research Database, 7522 patients with a first-time diagnosis of AMD and 7522 propensity score-matched controls. Multiple logistic regression analyses were performed to explore the association of neovascular AMD with previously diagnosed hyperthyroidism or hypothyroidism. The Chi-square test shows that there was a statistically significant difference in the prevalence of prior hyperthyroidism between cases and controls (1.18 vs. 0.13%, p < 0.001). Furthermore, there was a statistically significant difference the prevalence of prior hypothyroidism between cases and controls (0.44 vs. 0.69%, p < 0.001). Multiple logistic regression analysis reveals that AMD was statistically and significantly associated with prior hyperthyroidism after adjusting for age, sex, monthly income, geographical location, urbanization level, hypertension, hyperlipidemia, diabetes, and coronary heart disease (odds ratio (OR) = 9.074, 95% CI = 4.713–17.471). The adjusted OR of prior hypothyroidism in patients with AMD was 3.794 (95% CI: 2.099~6.858) when compared to the controls. We conclude that patients with thyroid dysfunction are at higher risk of developing AMD Results suggest that these patients could benefit from proactive regular eye checkups to detect evolving eye pathology, even while vision remains normal during the initial phases.

A Workflow for Three-Dimensional Reconstruction and Quantification of the Monkey Optic Nerve Head Vascular Network.

A comprehensive characterization of the three-dimensional (3D) vascular network of the optic nerve head (ONH) is critical to understanding eye physiology and pathology. Current in vivo imaging technologies, however, do not have simultaneous high spatial resolution and imaging depth to resolve the small vessels deep within the ONH. We describe a workflow for the 3D reconstruction and quantitative morphological analysis of the ONH vasculature. The vessels of a normal monkey ONH were perfusion labeled. Serial cryosections of the ONH were imaged using fluorescence microscopy (FM) and instant polarized light microscopy (IPOL) to visualize the labeled vessels and label-free collagen, respectively. The IPOL images were registered and used to form a stack of FM images from which the vessels were segmented and skeletonized to reconstruct the 3D vascular network. The network consisted of 12,966 vessel segments, 7989 branching points, and 1100 terminal points at the boundaries. For each vessel segment, we measured its length, tortuosity, inclination (θ), and polar orientation (φ). The length followed a lognormal distribution, whereas the distribution of the tortuosity followed an exponential decay. The vessels were mainly oriented toward the coronal plane (θ = 90 deg). For orientation, there were nearly as many vessels aligned circumferentially (φ = 90 deg) and radially (φ = 0 deg). Our results demonstrate the workflow for 3D eye-specific reconstruction and quantification of the monkey ONH vascular network. This is a critical first step to analyze the blood flow and oxygenation within the ONH, which will help understand the role of vascular dysfunction in glaucoma.

Pigment Epithelia of the Eye: Cell-Type Conversion in Regeneration and Disease.

Pigment epithelial cells (PECs) of the retina (RPE), ciliary body, and iris (IPE) are capable of altering their phenotype. The main pathway of phenotypic switching of eye PECs in vertebrates and humans in vivo and/or in vitro is neural/retinal. Besides, cells of amphibian IPE give rise to the lens and its derivatives, while mammalian and human RPE can be converted along the mesenchymal pathway. The PECs’ capability of conversion in vivo underlies the lens and retinal regeneration in lower vertebrates and retinal diseases such as proliferative vitreoretinopathy and fibrosis in mammals and humans. The present review considers these processes studied in vitro and in vivo in animal models and in humans. The molecular basis of conversion strategies in PECs is elucidated. Being predetermined onto- and phylogenetically, it includes a species-specific molecular context, differential expression of transcription factors, signaling pathways, and epigenomic changes. The accumulated knowledge regarding the mechanisms of PECs phenotypic switching allows the development of approaches to specified conversion for many purposes: obtaining cells for transplantation, creating conditions to stimulate natural regeneration of the retina and the lens, blocking undesirable conversions associated with eye pathology, and finding molecular markers of pathology to be targets of therapy.

March 6 — World Glaucoma Day

In 2008, the World Glaucoma Association and World Glaucoma Patients Association proposed March 6 to celebrate the World Day of fighting against this formidable disease, which is the cause of blindness in 13.5 % of cases. Glaucoma is a pathology of the eye, which is characterized by a constant or periodic increase in intraocular pressure, resulting in the gradual development of optic nerve atrophy, followed by partial or complete loss of vision. According to the World Health Organization, more than 100 million people suffer from glaucoma worldwide. This disease most often affects both eyes, as a rule, develops in older patients, and occurs in women about three times more often than in men. As the world's population gradually ages, there is a trend towards a slow but steady increase in the incidence of glaucoma in the world. Ophthalmologists are sounding the alarm — with timely treatment, the onset of irreversible changes in this eye pathology can at least be delayed, if not completely avoided. In order to draw public attention to this problem and increase the level of public awareness in the prevention and treatment of glaucoma, it was proposed to celebrate this memorable date.

Physical Medicine and Medical Rehabilitation in “Restorative” Ophthalmology: Historical Stages and Development Prospects

An overview of the historical stages of “restorative ophthalmology” is presented, taking into account the main directions of the concept of “Wellness of Healthy Eyes” in order to prevent and correct asthenopia in patients with visually strenuous work, based on a three-level system of prevention and correction of functional visual disorders. The first level is aimed at increasing the patient’s awareness of issues of vision protection and hygiene. The second level is aimed at reducing the adverse effects of environmental factors on the state of vision. The third level is realized in the form of methods of specific and nonspecific stimulation of the organ of vision. The urgency of considering a new scientific problem in ophthalmology related to the development of the concept of diagnostics and assessment of the therapeutic measures effectiveness from the standpoint of modern requirements for medical rehabilitation has been substantiated. It is proposed that a practical solution to this problem should be carried out through the development of qualificatory signs of the international classification of functioning, adequate questionnaires for assessing the “quality of life” in actual eye pathology (asthenopia,cataract), as well as an assessment of traditional (conservative, surgical) treatment from the standpoint of modern basic characteristics of medical rehabilitation (rehabilitation goal, rehabilitation diagnosis, rehabilitation prognosis, etc.). Conclusion. The most important task of medical focus is to preserve the functional state of the human operator’s visual analyzer at a level that allows performing professional activities with the required reliability and quality indicators.

A high-accuracy and high-efficiency digital volume correlation method to characterize in-vivo optic nerve head biomechanics from optical coherence tomography

In-vivo optic nerve head (ONH) biomechanics characterization is emerging as a promising way to study eye physiology and pathology. We propose a high-accuracy and high-efficiency digital volume correlation (DVC) method to characterize the in-vivo ONH deformation from optical coherence tomography (OCT) volumes. Using a combination of synthetic tests and analysis of OCTs from monkey ONHs subjected to acutely elevated intraocular pressure, we demonstrate that our proposed methodology overcame several challenges for conventional DVC methods: First, a pre-registration technique was used to remove large ONH rigid body motion in OCT volumes which could lead to analysis failure; second, a modified 3D inverse-compositional Gaussian Newton method was used to ensure sub-voxel accuracy of displacement calculations despite high noise and low image contrast of some OCT volumes; third, a tricubic B-spline interpolation method was applied to improve computational efficiency; fourth, a confidence parameter was introduced to guide the searching path in the displacement calculation; fifth, a confidence-weighted strain calculation method was applied to further improve the accuracy. The proposed DVC method had displacement errors smaller than 0.037 and 0.028 voxels with Gaussian and speckle noises, respectively. The strain errors in the three directions were less than 0.0045 and 0.0018 with Gaussian and speckle noises, respectively. Compared with the conventional DVC method, the proposed method reduced the errors of displacement and strain calculations by up to 70% under large body motions, with 75% lower computation time, while saving about 30% memory. Our study demonstrates the potential of the proposed technique to investigate ONH biomechanics. Statement of significanceThe biomechanics of the optic nerve head (ONH) in the posterior pole of the globe play a central role in eye physiology and pathology. The application of digital volume correlation (DVC) to the analysis of optical coherence tomography (OCT) images of the ONH has emerged as a promising way to quantify ONH biomechanics. Conventional DVC methods, however, face several important challenges when analyzing OCT images of the ONH. We introduce a high-accuracy and high-efficiency DVC method to characterize in vivo ONH deformations from OCT volumes. We demonstrate the new method using synthetic tests and actual OCT data from monkey ONHs. The new method also has the potential to be used to study other tissues, as OCT applications continue to expand.

The MOLES system to guide the management of melanocytic choroidal tumours: can optometrists apply it?

ABSTRACTClinical relevanceAlthough melanocytic choroidal tumours of the choroid are a common eye pathology, no standardised protocol exists for their management in the community.BackgroundChoroidal naevi are found in approximately 6% of the adult White population, whereas choroidal melanomas are rare, with an annual incidence of 5–10/million/year. Multimodal imaging has advanced the understanding of malignancy imaging biomarkers, but distinguishing between a small melanoma and naevus remains difficult and an algorithm for their management by community practitioners has not been uniformly adopted. One of the authors (BD) devised the MOLES scoring system, which indicates malignancy likelihood according to mushroom shape, orange pigment, large size, enlargement, and subretinal fluid. When applied by ocular oncologists, the system accurately distinguishes choroidal naevi from melanomas. The aim of this study was to evaluate whether community optometrists can appropriately manage patients with melanocytic choroidal tumours using this system.MethodsClinical images of 25 melanocytic choroidal tumours were presented in an online survey, including colour fundus photographs, fundus autofluorescence, optical coherence tomography, and B-scan ultrasound images. Using the MOLES system, 39 optometrists diagnosed tumours as naevus or probable melanoma and decided between community monitoring and ophthalmologist referral. Responses were compared to MOLES grading of the same clinical images by ocular oncologists.ResultsUsing MOLES, optometrists correctly identified 389/406 probable melanomas (95.8% sensitivity) and 331/516 choroidal naevi (64.1% specificity); correctly referred 773/778 tumours to an ophthalmologist (99.4% sensitivity); and correctly managed 80/144 lesions (55.6% specificity) in the community.ConclusionOptometrists safely applied the MOLES scoring system in this survey. Further measures are indicated to reduce choroidal naevi over-referral and evaluate MOLES system usage in clinical optometric practice, where some imaging modalities may not be readily available.

Analysis of postoperative intraocular pathologies in patients with mature cataracts.

To examine the prevalence and risk factors of intraocular pathologies after mature cataract surgery. The medical records of 115 patients (115 eyes) diagnosed with brunescent or white cataracts, who underwent surgery at a single primary center between January 2018 and August 2021 were retrospectively reviewed. Dense cataracts precluded preoperative fundus examination in all eyes; however, patients with fundus examination results within 3 months after cataract surgery were included. Logistic regression analyses were performed to identify factors associated with intraocular pathologies. Intraocular pathologies were observed in 37 eyes (32.2%) 11.8 ± 13.9 days postoperatively. The most common abnormalities were drusen (6.1%), myopic degeneration (5.2%) and diabetic retinopathy (4.3%). Intraocular pathology in the fellow eye was associated with posterior segment pathology in mature cataract eyes (odds ratio, 47.72; P < 0.001). The prevalence of each intraocular pathology found after mature cataract surgery was unremarkable. This study provides clinically useful evidence for clinicians to explain the risk of posterior segment pathology in patients with mature cataracts.

Diagnosis of Choroidal Disease With Deep Learning-Based Image Enhancement and Volumetric Quantification of Optical Coherence Tomography.

PurposeThe purpose of this study was to quantify choroidal vessels (CVs) in pathological eyes in three dimensions (3D) using optical coherence tomography (OCT) and a deep-learning analysis.MethodsA single-center retrospective study including 34 eyes of 34 patients (7 women and 27 men) with treatment-naïve central serous chorioretinopathy (CSC) and 33 eyes of 17 patients (7 women and 10 men) with Vogt-Koyanagi-Harada disease (VKH) or sympathetic ophthalmitis (SO) were imaged consecutively between October 2012 and May 2019 with a swept source OCT. Seventy-seven eyes of 39 age-matched volunteers (26 women and 13 men) with no sign of ocular pathology were imaged for comparison. Deep-learning-based image enhancement pipeline enabled CV segmentation and visualization in 3D, after which quantitative vessel volume maps were acquired to compare normal and diseased eyes and to track the clinical course of eyes in the disease group. Region-based vessel volumes and vessel indices were utilized for disease diagnosis.ResultsOCT-based CV volume maps disclose regional CV changes in patients with CSC, VKH, or SO. Three metrics, (i) choroidal volume, (ii) CV volume, and (iii) CV index, exhibit high sensitivity and specificity in discriminating pathological choroids from healthy ones.ConclusionsThe deep-learning analysis of OCT images described here provides a 3D visualization of the choroid, and allows quantification of features in the datasets to identify choroidal disease and distinguish between different diseases.Translational RelevanceThis novel analysis can be applied retrospectively to existing OCT datasets, and it represents a significant advance toward the automated diagnosis of choroidal pathologies based on observations and quantifications of the vasculature.

An Academic Ophthalmology Curriculum as a Model for Introducing Preprofessional Students to Careers in Ophthalmology

AbstractOphthalmology is one of the most rewarding and fulfilling medical careers in medicine due to the broad practice scope (including a combination of medicine and surgery); patient population (treatment of pediatric and adult patients); diverse patient and pathology mix (healthy eye exams, refractions, and pathology); high patient and provider satisfaction rates; and highly specialized technology and treatments. Unfortunately, academic exposure to ophthalmology as a career in medical school curricula has had a global decline for decades. While most of the evidence-based interventions found in the literature have resulted in enhanced educational outcomes, ophthalmology exposure should be initiated earlier which provided an impetus for developing and implementing a structured curriculum for introducing preprofessional students to careers in ophthalmology. Educational programs offered in the pipeline from high school to college can reach students who are still undecided about higher education and career choices, thus providing an opportunity for increasing the numbers of students in medical and health professions. We describe a structured, academic curriculum model for pregraduate and undergraduate students to enhance interest and to increase academic exposure to basic clinical, research, and educational domains in ophthalmology. The Houston Methodist Hospital (HMH) Academic Institute offers an unparalleled 10-week summer student research program that matches HMH faculty members with students from multiple levels (e.g., high school, college undergraduates, and medical school). Students undergo prerequisite virtual training; attend weekly didactic lectures given by mentors, invited speakers, and other local leaders; shadow health care providers in active clinical settings as observers; participate in active research projects; present at local conferences; and are encouraged to eventually publish their work. We describe the structured curriculum from our first Summer Internship Program for High Schoolers in ophthalmology. To our knowledge an ophthalmology internship program for preprofessional students has not been previously published in the literature.

Structure of corneal opacities in children in a specialized hospital practice

AIM: To evaluate the nosological structure of various etiologies in a specialized pediatric ophthalmosurgical center for 5 years (from 2016 to 2020)&#x0D; MATERIAL AND METHODS: This prospective study was conducted at the Department of Eye Pathology in Children of the Helmholtz Moscow Research Institute of Eye Diseases from January 01, 2016, to December 31, 2020, and collected and summarized clinical observations in children with corneal opacity (CO) of various etiologies. Statistical annual reports and case histories of children who were hospitalized in the pediatric surgical department were analyzed. The analysis of discharge epicrisis was conducted only in children with corneal changes of various natures.&#x0D; RESULTS: The proportion of children with corneal opacities from 2016 to 2020 was 13.5% (954 children out of 7066 hospitalized). Secondary CO was determined in most cases and amounted to 75.2%. The leading nosologies were congenital corneal opacities (24.8%), post-traumatic changes (33.6%), and post-inflammatory corneal degenerations (37.1%). Penetrating keratoplasty was more often performed in congenital pathology (55.8%), and scarification was more often used in the group of children with postuveal CO (96.3%).&#x0D; CONCLUSION: Corneal opacities in children have a significant role in the overall structure of the visual organ pathology in children and have a large polymorphism. CO was secondary in the vast majority of children. Therefore, methods of CO prevention were searched. The general nosological structure did not undergo significant fluctuations throughout the study period.

Range of Clinical Neuro-Ophthalmopathology: more than Tumors

The importance of close co-operation of ophthalmologists, neurologists, neurosurgeons and neuro-ophthalmopathologists as well in clinical as in scientific settings is underlined. Typical neuro-ophthalmopathological examples of frequent and rare cases from pathology of the eyelid, the cornea, intraocular tumors, ocular trauma and tumors of the orbit are presented as well as systemic pathologies such as inflammatory diseases of the eye, phakomatoses, malformations and mitochondrial disorders in which the histopathological investigation by neuro-ophthalmopathologists may contribute to diagnosis and therapeutic decision-making. The chosen examples should provide a narrow focus on some clinical queries answered by neuro-ophthalmopathology and exemplify methodological options, but – in the given frame – cannot represent the full range of eye pathology. Relevant literature is included for further reading. Ophthalmologists, neurologists and neurosurgeons should be aware from the additional value of a concise neuro-ophthalmopathological diagnosis for the optimal treatment of eye diseases and should insist in a professional neuro-ophthalmopathological investigation whenever and wherever possible.