Spectral Optical Coherence Tomography Research Articles

A Metascore of Multiple Imaging Methods to Measure Long-Term Glaucoma Structural Progression.

PurposeTo develop a structural metascore (SMS) that combines measurements from different devices and expresses them on a single scale to facilitate their long-term analysis.MethodsThree structural measurements (Heidelberg Retina Tomograph II [HRT] rim area, HD-Cirrus optical coherence tomography [OCT] average retinal nerve fiber layer [RNFL] thickness, Spectralis OCT RNFL global thickness) were normalized on a scale of 0 to 100 and converted to a reference value. The resultant metascores were plotted against time. SMS performance was evaluated to predict future values (internal validation), and correlations between the average grades assigned by three clinicians were compared with the SMS slopes (external validation).ResultsThe linear regression fit with the variance approach, and adjustment to a Spectralis equivalent was the best-performing approach; this was denominated metascore. Plots were created for 3416 eyes of 1824 patients. The average baseline age (± standard deviation) was 69.8 (±13.9), mean follow-up was 11.6 (±4.7) years, and mean number of structural scans per eye was 10.0 (±4.7). The mean numbers of scans per device were 3.8 (±2.5), 5.0 (±2.9), and 1.3 (±3.0) for HRT, Cirrus, and Spectralis, respectively. The metascore slopes’ median was −0.3 (interquartile range 1.1). Correlations between the average grades assigned by the three clinicians and the metascore slopes were −0.51, −0.49, and −0.69 for the first (structural measurement printouts alone), second (metascore plots alone), and third (printouts + metascore plots) series of gradings, respectively. The average absolute predictive ability was 7.63/100 (whereas 100 = entire normalized scale).ConclusionsWe report a method that converts Cirrus global RNFL and HRT global rim area normalized measurements to Spectralis global RNFL equivalent values to facilitate long-term structural follow-up.Translational RelevanceBecause glaucoma changes usually occur slowly, patients are often examined with different instruments during their follow-up, a method that “unifies” structural measurements provided by different devices, which could assist patients’ longitudinal structural follow-up.

Parapapillary gamma zone associated with increased peripapillary scleral bowing: the Beijing Eye Study 2011

AimsTo investigate the association between the backward configuration of the peripapillary sclera (PPS), measured as PPS angle (PPSA), and presence and extent of parapapillary gamma zone.MethodsOut of the population-based Beijing...

Analysis of the signal measured in spectral-domain optical coherence tomography based on nonlinear interferometers

We analyze and compare the output signals obtained in three different configurations of optical coherence tomography (OCT). After appropriate processing, these signals are used to retrieve an image of the sample under investigation. One of the configurations considered is the common choice in most OCT applications and is based on the use of a Michelson interferometer. For brevity, here we refer to it as standard OCT. The other two configurations are two types of optical coherence tomography based on the use of so-called nonlinear interferometers, interferometers that contain optical parametric amplifiers inside. The goal is to highlight the differences and similarities between the output signals measured in standard OCT and in these two OCT schemes, with the aim of evaluating if retrieval of information about the sample can be better done in one case over the others. We consider schemes where the optical sectioning of the sample is obtained by measuring the output signal spectrum (spectral or Fourier-domain OCT), since it shows better performance in terms of speed and sensitivity than the counterpart time-domain OCT.

Diagnostic Ability and Capacity of Optical Coherence Tomography-Angiography to Detect Retinal and Vascular Changes in Patients with Fibromyalgia.

Background To evaluate the neuroretina and retinal vasculature of fibromyalgia (FM) patients and calculate a linear discriminant function (LDF) to improve retinal parameters' contribution to FM diagnosis. Methods Fifty FM patients and 232 healthy controls underwent retinal evaluation using swept-source optical coherence tomography (SS-OCT) angiography (Triton plus; Topcon) and spectral domain OCT (SD-OCT) (Spectralis; Heidelberg). The macular (m) and peripapillary (p) retinal nerve fibre layer (RNFL) and ganglion cell layer (GCL) were assessed, as was the macular vascular density. A logistic regression analysis was performed, and an LDF was calculated to evaluate OCT's contribution to FM diagnosis. Results With Triton OCT, the patients presented pRNFL thinning in the temporal sector (p=0.006). Spectralis OCT measurements showed decreased pRNFL in patients in the following sectors: superonasal, p=0.001; nasal, p=0.001; inferonasal, p=0.006; temporal, p=0.001; and inferotemporal, p=0.001. No significant differences were observed in the macular vascular plexus between patients and controls. However, vascular density in the superior sector showed a strong inverse correlation with disease duration (r = −0.978, p=0.022). The LDF calculated for Spectralis OCT yielded an area under the ROC curve of 0.968. Conclusions FM patients present RNFL thinning observable using SS- and SD-OCT. However, these patients show similar vascular density in the macular area to healthy controls. The LDF that combines several RNFL parameters obtained using Spectralis OCT gives this device a powerful ability to differentiate between healthy individuals and individuals with FM.

Clinical usefulness of layer-by-layer deviation maps of Spectralis OCT: comparison with Cirrus OCT

Background/aimsTo compare the diagnostic abilities of Spectralis (Heidelberg Engineering, Heidelberg, Germany) and Cirrus (Carl Zeiss Meditec, Dublin, California, USA) spectral domain–optical coherence tomography (OCT) for retinal nerve fibre layer (RNFL)...

Optical Coherence Tomography as a Biomarker for Differential Diagnostics in Nystagmus: Ganglion Cell Layer Thickness Ratio.

In albinism, with the use of optical coherence tomography (OCT), a thinning of the macular ganglion cell layer was recently reported. As a consequence, the relevant OCT measure, i.e., a reduction of the temporal/nasal ganglion cell layer thickness quotient (GCLTQ), is a strong candidate for a novel biomarker of albinism. However, nystagmus is a common trait in albinism and is known as a potential confound of imaging techniques. Therefore, there is a need to determine the impact of nystagmus without albinism on the GCLTQ. In this bi-center study, the retinal GCLTQ was determined (OCT Spectralis, Heidelberg Engineering, Heidelberg, Germany) for healthy controls (n = 5, 10 eyes) vs. participants with nystagmus and albinism (Nalbinism, n = 8, 15 eyes), and with nystagmus of other origins (Nother, n = 11, 17 eyes). Macular OCT with 25 horizontal B scans 20 × 20° with 9 automated real time tracking (ART) frames centered on the retina was obtained for each group. From the sectoral GCLTs of the early treatment diabetic retinopathy study (ETDRS) circular thickness maps, i.e., 3 mm and 6 mm ETDRS rings, GCLTQ I and GCLTQ II were determined. Both GCLTQs were reduced in Nalbinism (GCLTQ I and II: 0.78 and 0.77, p < 0.001) compared to Nother (0.91 and 0.93) and healthy controls (0.89 and 0.95). The discrimination of Nalbinism from Nother via GCLTQ I and II had an area under the curve of 80 and 82% with an optimal cutoff point of 0.86 and 0.88, respectively. In conclusion, lower GCLTQ in Nalbinism appears as a distinguished feature in albinism-related nystagmus as opposed to other causes of nystagmus.

Hyper-reflective retinal foci as possible in vivo imaging biomarker of microglia activation in von Hippel-Lindau disease.

Purposevon Hippel-Lindau (VHL) disease is caused by a mutation of the VHL gene and characterized by the development of retinal hemangioblastomas (RH). Current pathophysiologic mechanisms of RH development and progression are still insufficient to predict RH behavior. VHL gene is involved in the cellular response to hypoxia and in many intracellular signaling pathways expressed both in angiogenesis and inflammation. Optical coherence tomography (OCT) allows to identify hyper-reflective retinal foci (HRF) known as aggregates of activated microglial cells as possible in vivo biomarker of local inflammation. The aim of the present study was to investigate the presence of HRF in patients with genetically confirmed VHL disease.MethodsIn this cross-sectional study, patients with VHL underwent complete ophthalmological examination and OCT with HRA + OCT Spectralis. HRF were manually identified and calculated in inner (IR), outer (OR) and full retina. Age-matched healthy subjects were enrolled as controls.Results113 eyes of 63 VHL patients and 56 eyes of 28 healthy subjects were evaluated. HRF number was significantly higher in VHL than in controls in IR (28.06 ± 7.50 vs 25.25 ± 6.64, p = 0.042). No difference was observed in OR and in full retina (OR: 7.73 ± 2.59 vs 7.95 ± 2.51, p = 0.599; full retina: 35.79 ± 8.77 vs 33.20 ± 7.47, p = 0.093).ConclusionThe increase of HRF, which mirror retinal microglial activation, characterizes VHL eyes. The role of activated microglia in the retina of VHL eyes needs to be better investigated, mainly considering local VHL disease manifestations.

Within-eye and between-subject variability for reflectance of the retinal nerve fibre layer.

Reflectance of retinal nerve fibre layer (RNFL) can contribute to detecting the presence of glaucomatous damage and defining its extent. As a step towards developing a normative database for RNFL reflectance, we assessed within-eye and between-subject variability for RNFL reflectance in healthy eyes. Vertical 30° × 15° volume scans at the optic disc were gathered using SD-OCT (Spectralis OCT) from people free of eye disease. Scans were gathered for both eyes of 30 younger adults (mean ± SD=27 ± 3 years) and for one eye of 30 older adults (68 ± 8 years). Reflectance was quantified for each voxel as the depth-resolved attenuation coefficient (AC). Values for AC were extracted for four slabs (0-52, 24-52, 24-36 and 36-60 μm) and at depths from 24 to 60 μm below the inner limiting membrane (ILM) in 4μm steps. Between-subject and within-eye standard deviations (SDs) for the logarithm of AC were similar; median differences were 0.02-0.03 log unit across all four slabs and depths from 24 to 48 μm. Means for the logarithm of AC were higher for younger than older eyes by ~0.1 log unit; this age effect was not due to differences in the raw reflectance of the RNFL, but rather to age-related changes in reflectance of deeper retina affecting the calculation of AC. In both groups, within-eye variability in RNFL reflectance near the optic disc was similar to between-subject variability. A better understanding of within-eye variability would be useful for developing normative databases.

The effect of axial length to basement-membrane opening to fovea distance on optical coherence tomography.

Optical Coherence Tomography (OCT) lateral scaling is influenced by axial length (AL). There is a need to incorporate a method to correct this measurement bias for accurate lateral OCT measurement. To identify the correlation of optic-nerve-to-fovea distance measurement to AL by OCT) as an internal factor for lateral scaling. Using Heidelberg Spectralis OCT, distance from the basement membrane opening at the optic disc margin to the centre of the fovea (BMO-fovea distance) was measured in 135 eyes (77 subjects, ages 25-85). These measurements were correlated with AL measurements from Zeiss IOLMaster 700 using linear regression before and after correction for ocular magnification. Statistical analysis including Shapiro-Wilk test for normality, Pearson correlation, and multivariate analysis of the association between disc-fovea distance and AL was performed using Wizard statistical software for mac. After lateral scaling, the mean distance between the fovea and BMO was 3.60 ± 0.25 mm (median: 3.59; range 3.07-4.23 mm). There was a significant positive correlation between AL and Bennett's formula-corrected BMO-fovea distance (p <0.001, r = 0.354). While there is significant variability in BMO-fovea distances, it is positively correlated with AL. A standard method is needed to improve the lateral scaling measurements in order to unify the results for enface OCT imaging.

Variance in the macular sublayers' volume as a diagnostic tool for primary open-angle glaucoma.

To assess the variance of macular sublayers' volume in glaucoma patients compared with normal individuals. This case-control observational study included 63 cases of primary open-angle glaucoma and 57 healthy controls. Macular volumetric scans were captured at the 6mm ETDRS circle for each retinal sublayer using Spectralis OCT2. The studied macular sublayers included the retinal nerve fiber layer, ganglion cell layer, inner plexiform layer, inner nuclear layer, outer plexiform layer, outer nuclear layer, and outer retinal layers (external limiting membrane to the retinal pigment epithelium). Standard deviation (SD) and coefficient of variation (CoV) of macular sublayers' volume were calculated. An unpaired Student t test (or its nonparametric equivalent) was used to compare each variable between groups. The receiver operating characteristic curve (ROC) was used to investigate the discriminative ability of each parameter. There was no significant difference for age or sex between the groups. The SD (of all sublayers' volume) was greater in the glaucomatous eyes compared with controls (0.620 ± 0.073vs.0.524 ± 0.056 mm3, respectively; P < 0.001). The same pattern was observed for CoV (7.890 ± 0.979vs.6.128 ± 0.583; P < 0.001). The area under curves (AUCs) for SD and CoV were 0.855and0.930, respectively (P = 0.05). The best cutoff value for the CoV was 6.712. The CoV and ganglion cell layer (GCL) volume revealed similar sensitivity (80.75) at 95% specificity for diagnosing glaucoma. The CoV detected 5 patients with glaucoma who had normal GCC volume. This study showed that the macular sublayers' volume variance parameters could be viable OCT biomarkers for detecting glaucomatous changes.

Spectral OCT Angiography in the Assessment of Biomarkers of Diabetic Macular Edema in Navigation Laser Treatment

Purpose — to study visualized biomarkers before and after navigation laser treatment in patients with diabetic macular edema (DMO) using optical coherence tomography-angiography (OCT-A).Methods. 85 patients (85 eyes) with focal DMO were under observation. The patients were divided into two groups, depending on the method of laser treatment used: group 1 consisted of 50 patients (50 eyes) who underwent navigation sub-threshold laser exposure in micro-pulse and continuous modes with individual selection of energy parameters according to the developed technology (patent RF for invention No. 2752544 of 27.01.2021), in group 2 (35 patients, 35 eyes) laser coagulation was performed according to the type of “modified grid”. The treatment was carried out on the NAVILAS 577S navigation laser system (“OD-OS”, Germany). All patients in both groups underwent high-resolution OCT-A according to the Angio Retina 3×3 mm and HD Angio Retina 6×6 mm protocol. The following biomarkers were evaluated by the OCT-A method: vascular density of the superficial vascular plexus (SCP), deep vascular complex (DCP); the number of microaneurysms and hyperreflective points; the area of the foveal avascular zone, as well as cysts and zones of disorganization of the inner layers of the retina (DRIL), at various times before and after (1, 3 and 6 months) treatment.Results. According to OCT-A, as a result of treatment in group 1, there was an increase in total vascular density from 38.45 ± 0.4 % to 44.85 ± 0.66 % in SCP and from 43.55 ± 0.38 % to 44.85 ± 0.66 % in DCP by 6 months of follow–up. In group 2, the total vascular density in SCP increased from 37.4 ± 0.36 % to 37.85 ± 0.34 %, in DCP from 43.35 ± 0.38 % to 44.05 ± 0.41 %. The number of microaneurysms decreased on average from 12 ± 0.42 to 9 ± 0.3 by 3 months and 7.5 ± 0.26 by 6 months in group 1 and, from 19 ± 0.7 to 15.5 ± 0.6 (3 months) and 13 ± 0.5 (6 months) — in group 2. The number of hyperreflective points decreased in terms of 3 and 6 months in both groups. The area of cysts progressively decreased, and the area of FAZ and DRILS was stable throughout all the follow-up period.Conclusion. OCT-A is a highly informative diagnostic method that allows noninvasively to identify visualized OCT-A biomarkers, as well as to evaluate the effectiveness of navigation laser exposure in patients with diabetic maculopathy with focal diabetic macular edema.

Coronary plaque characterization assessed by delayed enhancement dual-layer spectral CT angiography and optical coherence tomography.

This study aimed to prospectively evaluate delayed enhancement imaging by spectral computed tomography using soluble iodine containing contrast media to improve the in vivo characterization of coronary plaque types based on the quantification of delayed iodine enhancement. Patients with known or suspected coronary artery disease (CAD) underwent spectral coronary CT-angiography (SCCTA). Absolute delayed iodine enhancement in all visible coronary plaques was assessed. Patients with significant CAD (> 50% stenosis) further underwent invasive coronary angiography (ICA) including optical coherence tomography (OCT). We identified 50 non-calcified coronary plaques in 72 patients undergoing SCCTA. 17 patients with significant CAD underwent further ICA including OCT imaging. In those, we were able to match 35 plaques by both SCCTA and OCT. Based on OCT imaging, 22/35 matched plaques (63%) were characterized as high-risk coronary plaques (thin-cap fibroatheroma n = 2, fibroatheroma n = 20), whereas 13/35 (37%) were characterized as low-risk plaques (fibrocalcific lesion n = 3, fibrous plaques n = 9, and early-onset fibroatheroma n = 1). All plaques showed similar HU's and could not be classified into high-risk or low-risk plaques by conventional CT measures. Minimal delayed iodine enhancement within plaques as quantified by SCCTA demonstrated significantly lower values in high-risk as compared to low-risk coronary plaques (1.0 ± 1.5mg/ml vs. 2.2 ± 1.1mg/ml, p = 0.021) which allowed estimation of high-risk plaques with high sensitivity and moderate specificity (77% and 56%). Measurement of delayed enhancement iodine uptake within stable coronary artery plaques using dual-layer SCCTA might contribute to a more precise estimation of plaque vulnerability surpassing conventional CT techniques.

Analysis of optical coherence tomography of the optic nerve head and of the retinal macular area in multiple sclerosis patients

BACKGROUND: Multiple sclerosis is a chronic autoimmune demyelinating disease of the central nervous system. Early diagnosis of the disease is extremely important for the just-in-time start of specific therapy. Optical coherence tomography (OCT) of the optic nerve head and retina can become an early marker of the neurodegenerative process in multiple sclerosis.&#x0D; AIM: To determine OCT-changes in the retinal nerve fiber layer (RNFL) thickness and retinal thickness in the macular area being most specific for multiple sclerosis.&#x0D; MATERIALS AND METHODS: 197 patients were examined, the study group consisted of 136 patients (274 eyes) with an established diagnosis of multiple sclerosis and the disease duration of at least 6 months. The control group included 61 healthy people (122 eyes). All patients underwent a standard ophthalmological examination, OCT was performed on Spectralis OCT (Heidelberg Engineering, Germany) using 2 scanning protocols: ONH-RC-Scan (Optic Nerve Head-Radial Circle Scan) and PPAA (Posterior Pole Asymmetry Analysis)&#x0D; RESULTS: Only 11 patients (8.1%) had a history of retrobulbar neuritis, the best corrected visual acuity was 0.7 and higher in 83 (81%) patients with multiple sclerosis, while the optic nerve head and retinal nerve fiber layer OCT-changes typical for multiple sclerosis were found in 118 patients (87%). The most prominent thinning of the retinal nerve fiber layer in group with multiple sclerosis was revealed in the temporal part of the optic nerve head (59.9 14.8 in the study group versus 76.6 12.0 in the control group; p 0.001), the least thinning was in the nasal half (66.6 14.3 in the study group versus 69.3 12.4 in the control group; p = 0.013). The retina in the macular area in multiple sclerosis patients was thinned over the entire area, the most significant changes were in the Outer Nasal 7 zone (303.3 20.4 in the study group versus 324.3 10.0 in the control group; p 0.001). Cluster analysis found 6 new retinal zones for mapping the macular area using the scanning protocol PPAA. In order to determine the prognostic value of the obtained zones, a logistic regression model was constructed, which with a sensitivity of 87.1% and a specificity of 81.6% allows concluding on the probability of having multiple sclerosis.&#x0D; CONCLUSION: OCT data using the proposed mapping of the macular area with the mathematical model analysis could be used to diagnose specific optic nerve atrophy, to reveal typical thinning of the retinal nerve fiber layer associated with multiple sclerosis, and in the long run, to become an additional criterion for establishing the diagnosis of multiple sclerosis.

Accommodative movements of the choroid in the optic nerve head region of human eyes, and their relationship to the lens

The ciliary muscle (CM) powers the accommodative response, and during accommodation the CM pulls the choroid forward in the region of the ora serrata. Our goal was to elucidate the accommodative movements of the choroid in the optic nerve region in humans and to determine whether these movements are related to changes in the lens dimensions that occur with aging, in the unaccommodated and accommodated state.Both eyes of 12 human subjects (aged 18–51 yrs) were studied. Homatropine (1 drop/5%) was used to relax the ciliary muscle (unaccommodated or “resting” eye) and pilocarpine was used to induce the maximum accommodative response (2 drops/4%) (accommodated eye). Images of the fundus and choroid were collected in the region of the optic nerve (ON) via Spectralis OCT (infrared and EDI mode), and choroidal thickness was determined. Ultrasound biomicroscopy (UBM; 50 MHz, 35 MHz) images were collected in the region of the lens/capsule and ciliary body. OCT and UBM images were collected in the resting and accommodated state.The unaccommodated choroidal thickness declined significantly with age (p = 0.0073, r = 0.73) over the entire age range of the subjects studied (18–51 years old). The choroidal thickness was significantly negatively correlated with lens thickness in the accommodated (p = 0.01) and the unaccommodated states (p = 0.005); the thicker the lens the thinner the choroid.Choroid movements around the optic nerve during accommodation were statistically significant; during accommodation the choroid both thinned and moved centrifugally (outward/away from the optic nerve head). The accommodative choroid movements did not decline significantly with age and were not correlated with accommodative amplitude.Measurement of the choroidal thickness is possible with the Spectralis OCT instrument using EDI mode and can be used to determine the accommodative changes in choroidal thickness. The choroidal thickness decreased with age and during accommodation. It may be that age-related choroidal thinning is due to changes in the geometry of the accommodative apparatus to which it is attached (i.e., ciliary muscle/lens complex) such that when the lens is thicker, the choroid is thinner. Accommodative decrease in choroidal thickness and stretch of the retina/choroid may indicate stress/strain forces in the region of the optic nerve during accommodation and may have implications for glaucoma.

Automated measurement of the foveal avascular zone in healthy eyes on Heidelberg spectralis optical coherence tomography angiography

PurposeTo develop and evaluate an automated method to measure the foveal avascular zone (FAZ) area in healthy eyes on Heidelberg Spectralis Optical Coherence Tomography Angiography (HS-OCTA). This method is referred to as the modified Kanno-Saitama macro (mKSM) which is an evolution of the Kanno-Saitama macro (KSM) approach. MethodsThis cross-sectional study included 29 eyes of 25 healthy volunteers who underwent HS-OCTA at the macular area twice at the same time. Regardless of the quality of the images, all of them were included. Macular data on the superficial vascular plexus, intermediate capillary plexus (ICP) and deep capillary plexus were processed by mKSM. The FAZ area was measured twice automatically using the mKSM and KSM and twice manually by two independent examiners. ResultsFrom 174 images, KSM could not measure correctly 31% while mKSM could successfully measure all of them. Intrascan intraclass coefficient ranged from 0,948 to 0,993 for manual measurements and was 1 for mKSM method. Despite that the difference between human examiners is smaller than between human examiners and mKSM according to Bland–Altman plots, the scatterplots show a strong correlation between human and automatic measurements. The best results are obtained in ICP. ConclusionsWith mKSM, the automated determination of the FAZ area in HS-OCTA is feasible and less human-dependent. It solves the inability of KSM to measure the FAZ area in suboptimal quality images which are frequent in daily clinical practice. Therefore, the mKSM processing could contribute to our understanding of the three vascular plexuses.

Предварительное клиническое исследование нового метода лечения ожоговых дефектов роговицы

Purpose. Of the work is to compare the effectiveness of treatment of burn ulcers with canned amnion and amnion saturated with lysate of autologous platelet-rich plasma (PRP). Material and methods. To compare the effectiveness of treatment of canned amnion and lysate-soaked PRP, 10 patients with ulcers with an area of more than ½ of the cornea after fresh burns of 2–3 degrees aged from 26 to 53 were observed, divided into 2 equal groups. In the comparison group, the treatment of ulcers was carried out against the background of conservative treatment by covering the cornea with an amniotic membrane for 7 days, after which the amnion was removed and the condition of the cornea was monitored. If necessary, the procedure was repeated. In the experimental group, an amniotic membrane saturated with lysate of autologous PRP was used. The assessment of the condition of the cornea was carried out using clinical and instrumental studies, including visometry, biomicroscopy with fluorescein staining, photoregistration and OCT on the Heidelberg Engineering “OCT Spectralis” apparatus. Results. In patients of the experimental group, transplantation of an amniotic membrane impregnated with PRP lysate, in comparison with conventional amnion, led to epithelization of ulcers faster by an average of 7 days, the cornea remained more transparent, and visual acuity was higher by 0,17. Conclusions. The use of an amniotic membrane saturated with PRP lysate may be a promising method of treating corneal burn ulcers. Keywords: amnion; platelet-rich plasma; platelet lysate; corneal ulcers; corneal burns.

Retinal Nerve Fiber Layer Analysis in Children With Migraine With and Without Aura Using Optical Coherence Tomography: A Case-Control Study.

To evaluate retinal nerve fiber layer (RNFL) thickness in children with migraine, with and without aura, compared to healthy controls using optical coherence tomography (OCT). In this cross-sectional case-control study, patients with a diagnosis of migraine with aura (MwA) or without aura (MwoA) were considered and healthy children were included as controls. Age, sex, duration of migraine, number of episodes per month, duration of episodes, and use of prophylactic treatment with magnesium were recorded. All patients underwent complete ophthalmologic, neurologic, and pediatric examination. Optic nerve OCT images were obtained using Heidelberg Spectralis OCT (Heidelberg Engineering) and mean global RNFL thickness and the average thickness for each sector were noted. Thirty-seven children were included: 17 with migraine (9 MwoA and 8 MwA) and 20 controls, the mean age being 13.8 ± 2.9 (range: 8 to 16) and 13.4 ± 2.5 (range: 7 to 16) years, respectively. No significant differences in RNFL thickness were found when comparing all patients who had migraine with healthy controls. However, children with MwA showed statistically significant reductions in RNFL thickness in the temporal (mean difference: 7.83; 95% CI: 0.52 to 15.14, P = .027) and inferior-temporal (mean difference: 16.06; 95% CI: 1.95 to 30.16, P = .027) sectors compared to patients with MwoA. None of the other sectors showed statistically significant differences between groups (all P > .05). In the migraine group, negative correlations were detected between the number of episodes per month and RNFL thickness in the nasal-superior quadrant (r = -.420; P = .021). Children with MwA may present a decrease in RNFL thickness, which is associated with the number of episodes per month. [J Pediatr Ophthalmol Strabismus. 2023;60(3):196-202.].

Retinal single-layer analysis with optical coherence tomography (OCT) in schizophrenia spectrum disorder

Introduction Volume reductions in brain structures of patients with schizophrenia spectrum disorder (SSD) have repeatedly been found in voxel-based morphometry MRI studies. Hence, an underlying neurodegenerative etiological component of SSD is currently being discussed. In recent years, the imaging method of optical coherence tomography (OCT) has shown its potential in evaluating structural changes in the retina in patients with confirmed neurodegenerative disorders, providing a window into the brain.ObjectivesTo evaluate potential differences in measurements of retinal layers between patients with schizophrenia spectrum disorder and healthy controls with OCT.MethodsTwenty-six patients with schizophrenia or schizoaffective disorder and 23 age- and sex-matched healthy controls were examined with the Heidelberg Spectralis OCT system to derive a single-layer analysis of both retinas. The segmentation of retinal layers was manually corrected to minimize artifacts and software imprecisions.ResultsCompared to the control group, SSD patients showed reduced thickness and volume measurements for nearly all retinal layers, and these differences reached significance for macular volume, macular thickness, retinal nerve fiber layer (RNFL) and inner nucleiform layer (INL). Furthermore, a significant correlation between the duration of illness and the total volume of the RNFL was found.ConclusionsOur OCT measurements demonstrate reduced single retinal layer thickness in patients with SSD. In the context of the MRI volume changes, our results provide further evidence that structural changes seen in the brain of patients are also observable in the retina, potentially allowing further insights into the different components of the nervous system that are altered in this highly etiologically complex disorder.DisclosureNo significant relationships.

EFFECT OF RANIBIZUMAB AND AFLIBERCEPT ON RETINAL PIGMENT EPITHELIAL DETACHEMENT, SUBRETINAL AND INTRARETINAL FLUID IN AGE-RELATED MACULAR DEGENERATION.

The aim of the study was to compare the effect of three initial doses of the anti-VEGF ranibizumab and aflibercept medication on serous pigment epithelial detachment (PED), subretinal fluid (SRF) and intraretinal fluid (IRF) in the macula of treatment naive neovascular AMD (nvAMD) patients. The cohort consists of 148 patients, of which 74 patients were treated with ranibizumab (51 females and 23 males) and 74 with aflibercept (46 females and 28 males). The data was recorded prospectively from the moment of diagnosis and start of treatment for a period of 3 months. At the moment of diagnosis and 3 months later, an OCT examination (Spectralis OCT, Heidelberg Engineering, Heidelberg, Germany) was performed. The OCT examination included a macular scan with 25 scans. Using the OCT instrument software, we measured the maximum anterior-posterior elevation of serous PED, the highest thickness of SRF and the largest diameter of the intraretinal cystic space. The statistical significance of differences between groups was evaluated using the t-test for continuous data and the Fisher exact test for categorical data. Changes in values of continuous variables over time were evaluated using the Wilcoxon paired test. Paired comparisons of binary parameters were determined by the McNemar test. Full regression of PED, SRF and IRF occurred in 3 (4.1%), 25 (39%) and 20 (51%) patients treated with ranibizumab, and in 5 (7.9%, p = 0.470), 28 (47%, p = 0.470) and 25 (57%, p = 0.827) patients treated with aflibercept, respectively. The average regression of PED, SRF and IRF was -60.4 &#956;m (median -37.5 &#956;m), -84.3 &#956;m (median -85 &#956;m) and -109.3 &#956;m (median -81 &#956;m) in patients treated with ranibizumab, and -46.3 &#956;m (median -30 &#956;m, p = 0.389), -127.7 &#956;m (median -104 &#956;m, p = 0.096) and -204.4 &#956;m (median -163 &#956;m, p = 0.005) in patients treated with aflibercept, respectively. We did not show a statistically significant difference in the regression rates of PED, SRF and IRF between the ranibizumab and aflibercept groups. (in patients with IRF after adjustment of the higher baseline IRF volumes in patients treated with aflibercept, p = 0.891). We are convinced that ranibizumab and aflibercept have the same effect on serous PED, SRF and IRF in the macula in patients with treatment naive nvAMD during the initial loading phase.

Retinal examination with curcumin in Alzheimer's disease

Background: Currently there is no definite cure for Alzheimer's therefore early detection is critical. Undetected Alzheimer's Disease (AD) can lead to severe accidents, neglecting to take essential medications, injury to oneself or others, and/or financial problems. Currently, biomarkers are the most promising way to detect Alzheimer's early on. Biomarkers such as beta-amyloid and tau levels taken through invasive mehods or brain scans that involve radiation are among them [20]. Objectives: Alzheimer's Disease (AD) presents itself in the body with an increase in ß-amyloid (Aß) plaque deposition, neurofibrillary tangle formation (NFT), and inflammation. As the retina is an extension of the brain and the brain structure it is possible to detect misfolded proteins via retinal examination non-invasively. One of the main objectives of this study is to determine the effectiveness of curcumin which is a phytochemical which can bind to amyloid-beta and Tau and can be used both for the diagnosis and early treatment of AD. The aim of this study was to discover the binding property of curcumin to both Tau and AB in the retina as a potential biomarker for AD.Methods: In this study, 20 patients were invited with mild AD who had undergone retinal examination within the past 2 years. All the patients had retinal imaging with curcumin which revealed misfolded proteins during the examination and then they were advised to take daily curcumin. The mean age of the patients was 71, and the patients were instructed to take Curcumin Meriva in 500 mg supplements once daily after their prior examinations. All patients had tests repeated with FAF and Heidelberg Spectralis OCT device. The regions with abnormal lesions on FAF were detected and the layer of the defect was scanned by OCT plus compared with the previous imaging of the patients. The images were examined in a masked fashion by 2 specialists.Results: The images disclosed hyperfluorescent lesions on FAF and OCT revealed accumulations in the inner layers of the retina. Some accumulations had dot shapes and others had fibril-tangle shapes. Some lesions were present in prior exams, but they were more pronounced and shinier after curcumin use. Their size and shape were in concordance with misfolded proteins in the brain [Fig.2,3,4,5,6].Conclusion: Retinal examination with curcumin revealed AB plaques in the retina in prior studies. Our study is the first that may demonstrate an easy way to detect the culprit plaque Tau inside the retina of live patients. Keywords: Alzheimer's Disease, curcumin, neurofibrillary tangle formation (NFT), inflammation, retina, ß-amyloid (Aß) plaque deposition, Misfolded proteins, Fundus Autofluorescence (FAF), Tau, amyloid-beta, treatment