Optical Coherence Tomography Testing Research Articles

Assessing the efficacy of 2D and 3D CNN algorithms in OCT-based glaucoma detection

Glaucoma is a progressive neurodegenerative disease characterized by the gradual degeneration of retinal ganglion cells, leading to irreversible blindness worldwide. Therefore, timely and accurate diagnosis of glaucoma is crucial, enabling early intervention and facilitating effective disease management to mitigate further vision deterioration. The advent of optical coherence tomography (OCT) has marked a transformative era in ophthalmology, offering detailed visualization of the macula and optic nerve head (ONH) regions. In recent years, both 2D and 3D convolutional neural network (CNN) algorithms have been applied to OCT image analysis. While 2D CNNs rely on post-prediction aggregation of all B-scans within OCT volumes, 3D CNNs allow for direct glaucoma prediction from the OCT data. However, in the absence of extensively pre-trained 3D models, the comparative efficacy of 2D and 3D-CNN algorithms in detecting glaucoma from volumetric OCT images remains unclear. Therefore, this study explores the efficacy of glaucoma detection through volumetric OCT images using select state-of-the-art (SOTA) 2D-CNN models, 3D adaptations of these 2D-CNN models with specific weight transfer techniques, and a custom 5-layer 3D-CNN-Encoder algorithm. The performance across two distinct datasets is evaluated, each focusing on the macula and the ONH, to provide a comprehensive understanding of the models’ capabilities in identifying glaucoma. Our findings demonstrate that the 2D-CNN algorithm consistently provided robust results compared to their 3D counterparts tested in this study for glaucoma detection, achieving AUC values of 0.960 and 0.943 for the macular and ONH OCT test images, respectively. Given the scarcity of pre-trained 3D models trained on extensive datasets, this comparative analysis underscores the overall utility of 2D and 3D-CNN algorithms in advancing glaucoma diagnostic systems in ophthalmology and highlights the potential of 2D algorithms for volumetric OCT image-based glaucoma detection.

Progression or Aging? A Deep Learning Approach for Distinguishing Glaucoma Progression From Age-Related Changes in OCT Scans

To develop deep learning (DL) algorithm to detect glaucoma progression using optical coherence tomography (OCT) images, in the absence of a reference standard. Retrospective cohort study. Glaucomatous and healthy eyes with ≥5 reliable peripapillary OCT (Spectralis, Heidelberg Engineering) circle scans were included. A weakly supervised time-series learning model, called Noise Positive-Unlabeled (Noise-PU) DL was developed to classify whether sequences of OCT B-scans showed glaucoma progression. The model used two learning schemes, one to identify age-related changes by differentiating test sequences from glaucoma vs. healthy eyes, and the other to identify test-retest variability based on scrambled OCTs of glaucoma eyes. Both models' bases were convolutional neural networks (CNN) and long short-term memory (LSTM) networks which were combined to form a CNN-LSTM model. Model features were combined and jointly trained to identify glaucoma progression, accounting for age-related loss. The DL model's outcomes were compared with ordinary least squares (OLS) regression of retinal nerve fiber layer (RNFL) thickness over time, matched for specificity. The hit ratio was used as a proxy for sensitivity. 8,785 follow-up sequences of 5 consecutive OCT tests from 3253 eyes (1859 subjects) were included in the study. Mean follow-up time was 3.5±1.6 years. In the test sample, the hit ratios of the DL and OLS methods were 0.498 (95%CI:0.470-0.526) and 0.284 (95%CI:0.258-0.309) respectively (P<0.001) when the specificities were equalized to 95%. A DL model was able to identify longitudinal glaucomatous structural changes in OCT B-scans using a surrogate reference standard for progression.

Using Fused Data from Perimetry and Optical Coherence Tomography to Improve the Detection of Visual Field Progression in Glaucoma.

Perimetry and optical coherence tomography (OCT) are both used to monitor glaucoma progression. However, combining these modalities can be a challenge due to differences in data types. To overcome this, we have developed an autoencoder data fusion (AEDF) model to learn compact encoding (AE-fused data) from both perimetry and OCT. The AEDF model, optimized specifically for visual field (VF) progression detection, incorporates an encoding loss to ensure the interpretation of the AE-fused data is similar to VF data while capturing key features from OCT measurements. For model training and evaluation, our study included 2504 longitudinal VF and OCT tests from 140 glaucoma patients. VF progression was determined from linear regression slopes of longitudinal mean deviations. Progression detection with AE-fused data was compared to VF-only data (standard clinical method) as well as data from a Bayesian linear regression (BLR) model. In the initial 2-year follow-up period, AE-fused data achieved a detection F1 score of 0.60 (95% CI: 0.57 to 0.62), significantly outperforming (p < 0.001) the clinical method (0.45, 95% CI: 0.43 to 0.47) and the BLR model (0.48, 95% CI: 0.45 to 0.51). The capacity of the AEDF model to generate clinically interpretable fused data that improves VF progression detection makes it a promising data integration tool in glaucoma management.

Acute retinal pigment epitheliitis during treatment of hyperprolactinaemia

BackgroundAcute retinal pigment epitheliitis (ARPE) is a rare, idiopathic and self-limiting disease. The article aims to present ARPE in a patient using D2 dopamine receptor agonists for the treatment of hyperprolactinemia.Case presentationA 28-year-old female during hyperprolactinaemia treatment suffered from a dyschromatopsia and a central visual field defect in the left eye. She noticed a deterioration of vision and discontinued the cabergoline administration. The woman had not been diagnosed with other chronic conditions and exhibited no symptoms of infection. Upon admission, the patient was subjected to a test for COVID-19, which was negative.The ophthalmological examination revealed a decrease in visual acuity to distance in the left eye, which amounted to 18/20 on the Snellen chart. A central scotoma was noted on the Amsler chart and a loss of pigment epithelium was visible on the fundus of the left eye. Fluorescein angiography showed a discrete window defect in the left one, with no signs of leakage. Optical coherence tomography (OCT) scans of the maculae revealed a characteristic change in the photoreceptor layer and retinal pigment epithelium (RPE) in the fovea in the left eye. The electrophysiological tests revealed decreased function of cells in macular region.A magnetic resonance imaging (MRI) of the head and orbits demonstrated an asymmetric pituitary gland without chiasm compression and discrete signal enhancement from the left optic nerve.The patient underwent observation during hospitalisation. She reported improved colour vision and a decreased scotoma in the centre of her visual field.In regular outpatient follow-ups, successive improvements in visual acuity, as well as a decreased RPE damage and outer photoreceptor layer loss during an OCT test were observed.ConclusionsA case of ARPE is reported in a patient taking medications for hyperprolactinemia. The role of dopamine receptor antagonists in the photoreceptor function and causation of ARPE needs further evaluation.

Impact of social determinants of health on follow-up adherence, testing completion, and outcomes among pediatric glaucoma patients at a tertiary care center

PurposeTo identify patient characteristics associated with visit attendance, treatment outcomes, and optical coherence tomography (OCT) testing in pediatric glaucoma patients at an urban tertiary care center. MethodsThe records of patients with childhood glaucoma seen from 2015 to 2021 were reviewed. Primary outcomes were the proportion of scheduled visits completed, visual acuity and intraocular pressure (IOP) at most recent follow-up, and rates of OCT testing. Social determinants of health evaluated included race and ethnicity, distance of residence from clinic, insurance carrier type and residence within Baltimore City County, the latter two serving as proxies for socioeconomic status. ResultsA total of 99 patients met inclusion criteria: 61% were male; 47%, white (non-Hispanic); 25%, black (non-Hispanic); 11%, Hispanic/Latino; and 7% Asian/Pacific Islander. Mean distance from clinic was 45.3 miles. Mean visit completion rate was 90.4%; there was no statistically significant variation in visit completion rates by patient characteristics. IOP outcomes did not vary across patient groups, but visual acuity outcomes in affected eyes were significantly worse among Baltimore City County residents compared with non-residents. Only 22% of the cohort received ≥1 OCT per year, and patients living 0-29.9 miles from clinic had significantly lower odds of reaching the threshold than more distant patients. Patients with state-based insurance had significantly lower odds of being ≥50th percentile for rate of OCTs received compared to patients with commercial insurance. ConclusionsIn children with glaucoma, residence within Baltimore City County was associated with significantly worse visual acuity outcomes, and close proximity to clinic was an independent predictor of lower rates of OCT testing, despite similar visit attendance rates and IOP outcomes across all groups.

Longitudinal Rates of Change in Structural Parameters of Optical Coherence Tomography in Primary Angle Closure Glaucoma following Laser Iridotomy along with Peripheral Iridoplasty.

This study aimed to investigate longitudinal rates of change (LRCs) of structural parameters from optical coherence tomography (OCT) in patients with primary angle closure glaucoma (PACG) after laser iridotomy (LI) along with laser peripheral iridoplasty (PI). Among 146 patients diagnosed with PACG, thirty-two subjects (32 eyes) who underwent LI plus PI and accomplished more than five times of reliable OCT tests were included in the current retrospective study. Retinal nerve fiber layer (RNFL) and Bruch's membrane opening-minimum rim width (BMO-MRW) were measured by spectral-domain OCT with three month interval. LRCs of global and six Garway-Heath sectors were investigated using the linear mixed-effects model which adjusted BMO area, sex, and age. Imaging of dual Scheimpflug analyzer was performed before and at 1 week after LI with PI and yearly thereafter. The mean follow-up period was 32.28 ± 13.34 months with a mean number of 10.18 ± 3.33 OCT images. Baseline characteristics are as follows: age, 63 ± 7.9 years; female, 62.5%; intraocular pressure(IOP), 15.48 ± 4.79 mmHg; anterior chamber depth, 2.09 ± 0.18 mm; and mean deviation, -7.97 ± 8.48 dB. Global LRC of BMO-MRW was 0.86 ± 1.34 μm/yr and RNFL was -0.64 ± 0.22 μm/yr. IOP decreased significantly to 13.06 ± 2.21 mmHg (p=0.001) while anterior chamber volume (p=0.011) and mean anterior chamber angle (p=0.022) increased significantly after LI along with PI compared to the baseline at the final visit. LRC of a new parameter, BMO-MRW, and LRC of RNFL were relatively low in patients with PACG, following LI along with PI. After widening of the anterior chamber angle and decrease of IOP due to LI plus PI, PACG might show stable structural prognosis assessed by OCT.

The role of electrophysiology tests and multimodal imaging in evaluation of nystagmus

Purpose This work aimed to highlight the role of electrophysiology testing and multimodal imaging in evaluation of nystagmus. Patients and methods This is a retrospective multi-centered analytic study that recruited patients with nystagmus from the outpatient clinics referred to the electrophysiology units of the hospitals of the University of Minia, Ain Shams, Banha, and Cairo, Egypt. The study included 60 (120 eyes) patients. The performed investigations included full-field electroretinography (ffERG), pattern electroretinography, flash visual evoked potential (FVEP), pattern visual evoked potential, optical coherence tomography (OCT), OCT-angiography (OCT-A), and fundus autofluorescence (FAF), whenever possible. Results There were no or minimal detectable fundus changes in 78 (65%) eyes, of which 40 (33.3%) eyes showed severe loss of photopic responses on ffERG, with Bull’s eye pattern observed on FAF and loss of foveal photoreceptors in OCT, while 18 (12.5%) eyes showed reduced photopic and scotopic responses in ffERG with loss of foveal photoreceptors and thinned parafovea in OCT, 14 (11.7%) eyes showed average photopic and scotopic responses with different stages of foveal hypoplasia in OCT and OCT-A, and six (5%) eyes showed normal results in tests assessing the function and structure of the macula and optic nerve, including ERG, FVEP, and OCT. On the other hand, macular or optic nerve abnormalities were observed in 42 (35%) eyes, of which 20 (16.7%) eyes showed significant loss of photopic responses in ffERG and abnormal fovea in OCT and FAF tests, 10 (8.3%) eyes showed loss of photopic and scotopic responses in ffERG and abnormal results in the OCT and FAF, four (3.3%) eyes had normal results in ERG and FVEP, but showed fovea hypoplasia in OCT, and eight (6.7%) eyes had normal photopic and scotopic responses by ffERG, but with abnormal visual evoked potential responses and thinning of the nerve fiber layer in the OCT. Conclusion Electrophysiological tests and multimodal imaging are crucial to diagnosing the underlying causes of nystagmus, especially in patients with normal fundus.

'Pitfalls for differentiating basal cell carcinoma from non-basal cell carcinoma on optical coherence tomography: A clinical series'.

Optical coherence tomography (OCT), a non-invasive diagnostic modality, may replace biopsy for diagnosing basal cell carcinoma (BCC) if a high-confidence BCC diagnosis can be established. In other cases, biopsy remains necessary to establish a histopathological diagnosis and treatment regimen. It is, therefore, essential that OCT assessors have a high specificity for differentiating BCC from non-BCC lesions. To establish high-confidence BCC diagnoses, specific morphological BCC characteristics on OCT are used. This study aimed to review several cases of non-BCC lesions that were misclassified as BCC by experienced OCT assessors, thereby providing insight into the causes of these misclassifications and how they may be prevented. The study population consisted of patients who had a histopathologically-verified non-BCC lesion. Patients from Maastricht University Medical Center+ from February 2021 to April 2021 were included in the study. Two independent OCT assessors assessed OCT scans. One OCT assessor recorded the presence or absence of validated morphological BCC characteristics. A false-positive OCT test result was defined as certainty of BCC presence in a non-BCC lesion. The frequency of misclassifications and the presence or absence of morphological BCC features are discussed. A total of 124 patients with non-BCC lesions were included. Six patients were misclassified by both OCT assessors and are discussed in more detail. Histopathological diagnoses were squamous cell carcinoma (n = 2/21), actinic keratosis (n = 2/29), squamous cell carcinoma insitu/Bowen's disease (n = 1/16), or interphase dermatitis (n = 1/4). In all misclassified cases, multiple, apparent morphological BCC characteristics on OCT were present. Most non-BCC lesions are recognized as such by OCT assessors. However, there remains a small risk that a high-confidence BCC diagnosis is established in non-BCC lesions wherein features mimicking validated BCC characteristics are present. Misclassification may be prevented by careful delineation of epidermal layers and good differentiation between dermal ovoid structures typical of BCC versus squamous cell carcinoma.

A Retrospective Cohort Study on the Difficulties of Diagnosing and Managing Glaucoma in Patients with Coexistent Neurodegenerative Disease.

To investigate the limitations of diagnosing glaucoma in patients with coexistent neurodegenerative disease (NDD) by collecting information on demographics, examination findings, optical coherence tomography (OCT), and visual field (VF) tests. Retrospective cohort study of patients with primary open-angle glaucoma and coexistent dementia, multiple sclerosis (MS), Parkinson's disease (PD), or cerebrovascular accident (CVA) from 2014 to 2020. We included patients with a minimum of 3 years of follow-up. Demographics, ophthalmic exam, OCT, and VF findings were reported and compared across NDD groups using the Chi-squared and analysis of variance tests. We included 199 patients with glaucoma and coexistent NDD, including dementia (51.3%), CVA (11.2%), PD (18.1%), and MS (19.6%). Cupping, neuroretinal rim thinning, pallor, and peripapillary atrophy of the optic nerve were most frequently observed. There was a high number of missing values from OCT to VF tests, and zero patients had a complete OCT or VF test. Additionally, 67.8 and 77.4% of patients received <1 OCT and VF/year, respectively. Retinal nerve fiber layer (RNFL) thinning was observed most frequently in the superior (33.2% OD and 30.7% OS) and inferior (25.6% OD and 30.2% OS) quadrants, with the most significant thinning seen in CVA patients compared to other NDDs (p < 0.05). Glaucoma hemifield tests (GHTs) were abnormal in 23.1% OD and 22.6% OS, and the average mean deviation was -7.43 [standard deviation (SD) 8.23] OD and -8.79 (SD 7.99) OS. The OCT and VF tests are frequently unavailable and may be confounded in patients with coexistent glaucoma and NDDs, complicating glaucoma diagnosis and management. Diagnosing and managing glaucoma in patients with coexistent NDD is difficult, given the lack of available and reliable OCT and VF testing data. Providers may be forced to rely on intraocular pressure (IOP) and other imperfect measures. Ciociola EC, Patel K, Blahnik T, et al. A Retrospective Cohort Study on the Difficulties of Diagnosing and Managing Glaucoma in Patients with Coexistent Neurodegenerative Disease. J Curr Glaucoma Pract 2023;17(3):126-133.

Pediatric Optic Pathway Gliomas Resource Utilization and Prevalence in the OptumLabs Data Warehouse.

Although significant progress has been made in improving the rate of survival for pediatric optic pathway gliomas (OPGs), data describing the methods of diagnosis and treatment for OPGs are limited in the modern era. This retrospective study aims to provide an epidemiological overview in the pediatric population and an update on eye care resource utilization in OPG patients using big data analysis. Using the OptumLabs Data Warehouse, 9-11 million children from 2016 to 2021 assessed the presence of an OPG claim. This data set was analyzed for demographic distribution data and clinical data including average ages for computed tomography (CT), MRI, strabismus, and related treatment (surgery, chemotherapy, and radiation), as well as yearly rates for optical coherence tomography (OCT) and visual field (VF) examinations. Five hundred fifty-one unique patients ranging in age from 0 to 17 years had an OPG claim, with an estimated prevalence of 4.6-6.1 per 100k. Among the 476 OPG patients with at least 6 months of follow-up, 88.9% had at least one MRI and 15.3% had at least one CT. Annual rates for OCT and VF testing were similar (1.26 vs 1.35 per year), although OCT was ordered for younger patients (mean age = 9.2 vs 11.7 years, respectively). During the study period, 14.1% of OPG patients had chemotherapy, 6.1% had either surgery or radiation, and 81.7% had no treatment. This study updates OPG demographics for the modern era and characterizes the burden of the treatment course for pediatric OPG patients using big data analysis of a commercial claims database. OPGs had a prevalence of about 0.005% occurring equally in boys and girls. Most did not receive treatment, and the average child had at least one claim for OCT or VF per year for clinical monitoring. This study is limited to only commercially insured children, who represent approximately half of the general child population.

Decreased perifoveal ganglion cell complex thickness - a first sign for macular damage in patients using hydroxychloroquine.

Aim: To examine ganglion cell complex (GCC) thickness detected by optical coherence tomography (OCT) in patients using hydroxychloroquine (HCQ), without any structural and functional macular changes to evaluate the initial symptoms of macular toxicity for early diagnosis before clinical evaluation. Methods: Eighty eyes of forty patients (Group 1) and forty eyes of twenty healthy volunteer persons (Group 2) were included in the study. Detailed ophthalmologic and mydriatic fundus examination were applied to all patients and volunteers (controls). Spectral domain OCT, visual field (VF) and color vision test were performed. Measurements of macula thickness, GCC thickness (involving nerve fiber layer, ganglion cell layer and inner plexiform layer) and peripapillary retinal nerve fiber layer (RNFL) were performed with OCT. Patients with retinal pigment epithelial changes, VF paracentral scotoma and defected color vision were excluded from the planned study. Results: Perifoveal GCC layer thickness in all quadrants was significantly thinner in group 1 compared to group 2 (p=0.017, p=0.001, p=0.019, p=0.001). The mean global inferior hemifield and nasal quadrant RNFL thickness were lower than in the control groups (p=0,012, p=0,009, p=0,005, respectively). Conclusion: Changes in the thickness of nerve fiber layer and ganglion cell layer detected by optical coherence tomography can be thought to be used as a diagnostic aid for the early diagnosis of hydroxychloroquine-toxic maculopathy Abbreviations: GCC = Ganglion cell complex, OCT = Optical coherence tomography, HCQ = Hydroxychloroquine, BCVA = Best-corrected visual acuity, IOP = Intraocular pressure, VF = Visual field, RNFL = Retinal nerve fiber layer, SD OCT = Spectral-domain optical coherence tomography, mfERG = Multifocal electroretinogram, FAF = Fundus autofluorescence, IS/ OS = Inner segment-outer segment junction, SITA = Swedish Interactive Threshold Algorithm, RA = Rheumatoid arthritis, SLE = Systemic lupus erythematosus, SS = Sjogren syndrome.

DAPSONE-INDUCED TOXIC MACULOPATHY IN LEPROSY PATIENT

Introduction: Dapsone has been widely used as a part of multidrug therapy for leprosy patients. Ocular side effects are rare. Ocular toxicity manifestations include retinal necrosis, optic atrophy, macular infarction, bilateral exudative retinal detachment, and choroidal detachment. We reported a rare case of dapsone-induced toxic maculopathy in a leprosy patient. Case Report: A 32-year-old male complained of blurred vision and a gray spot in central vision in the left eye (LE) for one month prior to admission. He had been treated with multidrug therapy (MDT) for leprosy for seven months. The MDT consists of dapsone, clofazimine, and rifampicin. The best-corrected visual acuity (BCVA) of the right eye (RE) and the LE were 6/6 and 6/12, respectively. A funduscopy of the LE showed decreased macular reflex. A color vision defect following the tritan axis was found in the LE. The Humphrey visual field (HVF) test of the LE revealed a central scotoma. Macular optical coherence tomography (OCT) showed intraretinal hyperreflectivity and subretinal fluid. Dapsone was then stopped in collaboration with a dermatologist. Two months after the discontinuation of Dapsone, the BCVA of the LE improved to 6/7.5, then 6/6 three months later. Color vision, macular OCT, and HVF tests revealed improvements. Multifocal ERG of both eyes (BE) also showed improvement in N1 and P1 wave amplitude in both eyes on 9-month follow-up after dapsone discontinuation. Discussion: Instead of direct drug toxicity, the mechanism of ocular side effects is thought to be ischemia caused by two distinct mechanisms. Macular ischemia is caused by acute, severe peripheral hypoxia and the physical effect of red cell fragmentation due to the hemolytic process. After discontinuation of dapsone, this case showed improvement in visual function and macular structure. Conclusion: Toxic maculopathy may be present in leprosy patients receiving dapsone treatment, although it is uncommon. Regular follow-up and evaluation of visual function and macular involvement are essential. Early detection of dapsone-induced toxic maculopathy and prompt discontinuation of dapsone may result in an improvement of visual functions.

Is retina affected in Huntington's disease? Is optical coherence tomography a good biomarker?

Comparative cross-sectional study of retinal parameters in Huntington's disease and their evaluation as marker of disease progression. Huntington's disease (HD) is a neurodegenerative disorder with dominant motor and neuropsychiatric symptoms. Involvement of sensory functions in HD has been investigated, however studies of retinal pathology are incongruent. Effect sizes of previous findings were not published. OCT data of the subjects in previous studies have not been published. Additional examination of structural and functional parameters of retina in larger sample of patients with HD is warranted. This is a prospective cross-sectional study that included: peripapillary retinal nerve fiber layer thickness (RNFL) and total macular volume (TMV) measured by spectral domain optical coherence tomography (OCT) of retina, Pelli-Robson Contrast Sensitivity test, Farnsworth 15 Hue Color discrimination test, ophthalmology examination and Unified Huntington's disease Rating Scale (UHDRS). Ninety-four eyes of 41 HD patients examined in total 47 visits and 82 eyes of 41 healthy controls (HC) examined in total 41 visits were included. Analyses were performed by repeated measures linear mixed effects model with age and gender as covariates. False discovery rate was corrected by Benjamini-Hochberg procedure. HD group included 21 males and 20 females (age 50.6±12.0 years [mean ± standard deviation], disease duration 7.1±3.6 years, CAG triplet repeats 44.1±2.4). UHDRS Total Motor Score (TMS) was 30.0±12.3 and Total Functional Capacity 8.2±3.2. Control group (HC) included 19 males and 22 females with age 48.2±10.3 years. There was no statistically significant difference between HD and HC in age. The effect of the disease was not significant in temporal segment RNFL thickness. It was significant in the mean RNFL thickness and TMV, however not passing false discovery rate adjustment and with small effect size. In the HD group, the effect of disease duration and TMS was not significant. The Contrast Sensitivity test in HD was within normal limits and the 15-hue-test in HD did not reveal any specific pathology. The results of our study support possible diffuse retinal changes in global RNFL layer and in macula in Huntington's disease, however, these changes are small and not suitable as a biomarker for disease progression. We found no other structural or functional changes in retina of Huntington's disease patients using RNFL layer and macular volume spectral domain OCT and Contrast Sensitivity Test and 15-hue-test. Current retinal parameters are not appropriate for monitoring HD disease progression.

Structural and functional analysis of binocularity after surgery for long‐standing strabismus

AbstractPurpose: Assess structurally and functionally binocularity and deviation before and after strabismus surgery on patients with long‐standing strabismus.Methods: Four patients with strabismus of more than 1 year of evolution were evaluated in three visits: 1 week before surgery (preoperative), in the first week (immediate postoperative) and 1 month after (delayed postoperative). For functional assessment, visual acuity test with Snellen optotype, near vision test, TNO and Titmus test to assess stereopsis, quantification of deviation with prisms and binocular computerized campimetry were performed. For structural analysis, optical coherence tomography (OCT) was performed with Spectralis and Triton devices.Results: All patients presented significant changes with respect to the preoperative period both in the number of prismatic diopters and in the results of the OCT test in the immediate and delayed postoperative period. The binocular campimetric results also showed significant differences in the delayed postoperative period with respect to the patient's preoperative situation. In none of the cases were significant variations observed in the thickness of retinal ganglion cells, inner plexiform layer or retinal nerve fibres.Conclusions: Strabismus surgery provides improvements, not only in the correction of the alignment of both eyes, but also in the patient's stereopsis and binocular visual field. The traction movements of the eyeball or the changes caused during surgery do not seem to be a risk factor for axonal damage or damage to the inner retinal layers.

Bilateral optic nerve glioma in a paediatric patient with neurofibromatosis type 1

AbstractPurpose: To describe the presentation and management of gliomas of both optic nerves in a paediatric patient with neurofibromatosis type 1 (NF1).Methods: A 4‐year‐old female patient referred for ophthalmological evaluation due to a recent diagnosis of neurofibromatosis type 1. She presented better corrected visual acuity (BCVA) of 20/40 in both eyes (OU). Symmetrical and normoreactive pupils, normal extrinsic ocular motility, no proptosis or exophthalmos. In biomicroscopy Lisch nodules are observed in OU. Funduscopy of normal appearance except slight pallor of both optic papillae Refraction measurements with cycloplegia showed anisometropia: Right eye: +0.75–0.25 at 180°; Left eye: +1.75–2.75 at 170°. Stereopsis: 120 s of arc. Correction is prescribed and a follow‐up visit is scheduled. In subsequent visits we found a slight decrease in BCVA (20/50). In the Optical Coherence Tomography (OCT) we observed a clear decrease in the thickness of the retinal nerve fibre layer (RNFL) in the temporal sector. Visual campimetry and colour vision test cannot be performed Because of the patient's age. Due the clinical situation of decreased BCVA without justifiable cause in a patient with NF1, Magnetic Resonance Imaging of the brain and orbit is requested and a fusiform thickening of both optic nerves in their intraorbital portions with prolongation towards the optic chiasm is evidenced.Results: Due the clinical progression and deterioration on the RNFL OCT tests, an interconsultation with the Paediatric Oncology Department was made and it was decided to start systemic treatment with vinblastine.Conclusions: A complete ophthalmological examination adjusted to age is currently considered to be of choice in patients with NF1, being necessary annually until the age of 8 years and every 2 years until the age of 18. However, this examination in younger children, who are at greatest risk of developing gliomas, can be complex and requires experience.

Difference between before and after Compensating for Cyclotorsion by Optical Coherence Tomography Guided Progression Analysis

Purpose: This study evaluated the difference in parameters before and after the application of optical coherence tomography (OCT) Guided Progression Analysis (GPA) to compensate for cyclotorsion during image acquisition.Methods: Among glaucomatous eyes with ≥4 OCT tests, eyes with correction for cyclotorsion in GPA printouts defined as rotated OCT fundus images were included. The degree of cyclotorsion (i.e., the degree of fundus image rotation), direction of cyclotorsion (incyclotorsion or excyclotorsion), difference in optic nerve head (ONH) parameters, and retinal nerve fiber layer (RNFL) thickness before and after correction were analyzed.Results: Correction for cyclotorsion was seen in 33 of the 401 eyes (12.2%). Incyclotorsion was observed in 16 eyes (48.5%) and excyclotorsion in 17 (51.5%). The mean degree of cyclotorsion was 5.5 ± 2.3 degrees. The ONH parameters were unchanged after correcting for cyclotorsion. The mean overall, inferior, and superior quadrant RNFL thicknesses were 73.6 ± 14.8, 79.3 ± 26.3, and 90.1 ± 24.7 μm before correction and 73.6 ± 14.9, 79.6 ± 26.6, 89.7 ± 24.8 μm afterwards (p &gt; 0.05). The difference in RNFL thickness after correction ranged from 0 to 6 μm.Conclusions: The difference in RNFL thickness before and after cyclotorsion correction by GPA was not large. GPA did not correct the ONH parameters induced by cyclotorsion. Regarding this, GPA algorithm improvements may be needed.

Effect of Testing Frequency on the Time to Detect Glaucoma Progression With Optical Coherence Tomography (OCT) and OCT Angiography

To determine how the frequency of testing affects the time required to detect statistically significant glaucoma progression for circumpapillary retinal nerve fiber layer (cpRNFL) with optical coherence tomography (OCT) and circumpapillary capillary density (cpCD) with OCT angiography (OCTA). Retrospective, observational cohort study. In this longitudinal study,156 eyes of 98 patients with glaucoma followed up over an average of 3.5 years were enrolled. Participants with 4 or more OCT and OCTA tests were included to measure the longitudinal rates of cpRNFL thickness and cpCD change over time using linear regression. Estimates of variability were then used to re-create real-world cpRNFL and cpCD data by computer simulation to evaluate the time required to detect progression for various loss rates and different testing frequencies. The time required to detect a statistically significant negative cpRNFL and cpCD slope decreased as the testing frequency increased, albeit not proportionally. cpCD detected progression slightly earlier than cpRNFL. Eighty percent of eyes with a cpCD loss of -1%/y were detected after 6.0, 4.2, and 4 years when testing was performed 1, 2, and 3 times per year, respectively. Progression in 80% of eyes with a cpRNFL loss of -1 µm/y was detected after 6.3, 5.0, and 4.2 years, respectively. cpRNFL and cpCD are comparable in detecting progression. As there were only small changes in the time to detect progression when testing increased from 2 to 3 times per year, testing twice per year may provide sufficient information for detecting progression with either OCT or OCTA in clinical settings.

Predictive value of macular ganglion cell-inner plexiform layer thickness in visual field defect of pituitary adenoma patients: a case-control study

The present study explored the association between preoperative macular ganglion cell-inner plexiform layer thickness (GCIPL) and retinal nerve fiber layer thickness (RNFL) measured by optical coherence tomography (OCT) and the recovery of visual field (VF) defect after surgery in pituitary adenoma patients. This case-control study included patients with pituitary adenoma in the Neurosurgery Department of Shanxi Provincial People's Hospital between October 2019 and June 2021. Cranial MRI examination, three-dimensional OCT, and VF testing (Humphrey Field Analyzer II750) were performed before and at 6months after the surgery. Fifty-three pituitary adenoma patients (81 eyes) were enrolled; 15 patients (23 eyes) were in the visual field did not recover group (VFNR), and 38 patients (58 eyes) were in the visual field recovered group (VFR). The temporal RNFL (P = 0.002) and average RNFL (P = 0.009) in the VFNR group were significantly lower than in the VFR group. The superior nasal GCIPL (P = 0.001), inferior nasal GCIPL (P = 0.001) and average GCIPL (P = 0.01) were significantly lower in the VFNR group than in the VFR group (all P < 0.01).The multivariable logistic regression analysis showed that nasal inferior GCIPL was an independent risk factor for VF recovery (odds ratio (OR) = 1.376,95% confidence interval (CI):1.089-1.739,P = 0.007). In the received operating characteristics (ROC) analysis, the area under the ROC curve (AUROCs) was the highest for nasal inferior GCIPL (AUROC = 0.739). In patients who underwent resection of pituitary adenoma, nasal inferior GCIPL was an independent risk factor of visual field defect recover after surgery.

Effect of Inconsistent Optical Coherence Tomography Scan Location on Glaucoma Progression Analysis.

Circumpapillary retinal nerve fiber layer (RNFL) thickness change induced by optical coherence tomography (OCT) scan circle location displacement was not completely compensated despite the use of Guided Progression Analysis (GPA), especially when the "R1" registration method was applied. The purpose of this study was to evaluate the effect of inconsistent OCT scan location on glaucoma progression detection using GPA. Eighty-four glaucomatous eyes with at least 4 serial OCT tests were included. To evaluate the ability of OCT GPA to adjust the OCT scan location, an analysis was performed without manipulation (control set), and after the OCT scan of the latest test was intentionally moved inferotemporally (test set). The eyes were classified into the adjustment and nonadjustment groups based on the superior or inferior quadrant RNFL thickness agreement between the control and test sets. When the OCT GPA parameters between the control and test sets were compared, the test set showed a greater superior RNFL thickness and lesser inferior RNFL thickness compared with the control set (P<0.05). The eyes in the nonadjustment group (n=21, 25%) had a lower chance of applying the eye-tracking function (P=0.003) and a higher frequency of the "R1" registration method of OCT GPA (P<0.001) than the adjustment group (n=63, 75%); all eyes with the "R1" method were in the nonadjustment group and all eyes with the "R2" method were in the adjustment group. Inconsistent OCT scan location induced changes in RNFL thickness that were not completely compensated despite the use of OCT GPA, especially when the "R1" registration method was applied. These findings indicates a potential for misidentified glaucoma progression.

Electrophysiological and psychophysical studies in assessment of visual functions in patients with hereditary optic neuropathy

To study the capabilities of electrophysiological and psychophysical examination methods for assessment of the functional state of ganglion cells, retina and optic nerve in patients with hereditary optic neuropathy (HON). The study included 60 patients (118 eyes) with a genetically confirmed diagnosis of HON. All study patients underwent visual field test (VFT), spectral optical coherence tomography (OCT), flash and pattern visual evoked potentials (VEP) (Flash-VEP, FVEP; Pattern-VEP, PVEP), photopic electroretinography with photonegative response (PhNR) registration and the color vision test. In 24 patients (46 eyes), these parameters were assessed before the start of treatment and one year later. The treatment involved the mitochondria-targeted antioxidant SkQ1 - plastoquinonyl-decyl-triphenylphosphonium bromide (PDTP) in the form of eye drops. The main PVEP components for 1.0° and 0.3° were registered in 20% and in 14% of patient eyes with HON and high visual functions, respectively. After one year of PDTP use, a significant decrease in P100 peak latency was found only in the group with disease duration of ≤1.5 years as of the time of treatment start (p<0.05). Significant differences were observed in the PhNR amplitude (p<0.004) between patients of the main and the control groups, as well as in the PhNR amplitude between patients with visual acuity of ≤0.1 and ≥0.13 (p<0.01). Patients with high visual functions were found to have a correlation between the PhNR amplitude, GCC thickness and the global loss index (GLV). Along with VFT, OCT and color vision tests, electrophysiological studies are one of the main methods of examining patients with HON. After one year of PDTP use, there was a significant decrease in the FVEP P2 peak latency in the group with a disease duration of ≤1.5 years as of the time of treatment start. The PhNR amplitude in patients with high visual functions was found to correlate with structural changes in the ganglion cell layer and the retinal nerve fiber layer.