Javier Zarranz-Ventura

Repeatability and Reproducibility of Choroidal Vessel Layer Measurements in Diabetic Retinopathy Using Enhanced Depth Optical Coherence Tomography

PURPOSEnTo describe novel segmentation protocols for choroidal layers, Sattlers medium and Hallers large vessel layers, using enhanced depth imaging optical coherence tomography (EDI-OCT), and to examine the repeatability and reproducibility of these measurements in eyes with diabetic retinopathy.nnnMETHODSnFifty-one patients with Type 2 diabetes mellitus were imaged using custom EDI scanning protocols. Detailed segmentation was performed to quantify the retina, choroid, Hallers large, and Sattlers medium vessel layers in the total macular circle (TMC) and foveal central subfield (FCS). The coefficient of repeatability (CR) and intraclass correlation coefficient (ICC) were used as a measure of repeatability and relative reliability within graders. Reproducibility or interobserver variability was assessed using Bland-Altman plots and 95% limits of agreement (LoA).nnnRESULTSnIntragrader CR of the retina, choroid, Sattlers, and Hallers layers for thickness measurements were 19.2, 26.9, 35.2, and 29.2 μm, respectively. Intergrader 95% LoA were 27.9, 41.5, 38.6, 31.1 μm (thickness), respectively. Choroidal sublayer measurements showed good intraobserver reliability (ICC 0.78-0.98). Interobserver variability for retinal and choroidal measurements was not significantly different (P > 0.45). Measurements from the TMC showed slightly better repeatability and agreement compared with the FCS alone. Mean intergrader differences were reduced after training, and were most apparent in choroidal sublayers.nnnCONCLUSIONSnThe choroidal vascular sublayers can be quantified with good reliability, repeatability, and reproducibility. Accurate quantitative assessment of these sublayers may provide new insights into the role of the choroid in visual loss in patients with diabetic retinopathy, and prove useful for future clinical trials.

The neovascular age-related macular degeneration database: report 2: incidence, management, and visual outcomes of second treated eyes.

PURPOSEnTo study the characteristics of second treated eyes in patients with neovascular age-related macular degeneration (nAMD) treated with ranibizumab in the United Kingdom National Health Service.nnnDESIGNnMulticenter national nAMD database study.nnnPARTICIPANTSnTwelve thousand nine hundred fifty-one treatment-naïve eyes of 11,135 patients receiving 92,976 ranibizumab injections.nnnMETHODSnUp to 5 years of routinely collected, anonymized data within electronic medical record systems were extracted remotely from 14 centers. Participating centers exclusively used ranibizumab to treat nAMD (loading phase of 3 monthly injections followed by monthly visits and pro re nata re-treatment). The minimum data set included: age, logarithm of the minimum angle of resolution (logMAR) visual acuity (VA) at baseline and at all subsequent visits, and injection episodes.nnnMAIN OUTCOME MEASURESnBaseline, change and actual VA over 3 years, and number of treatments and clinic visits.nnnRESULTSnDuring the study, 1816 (16.3%) of the 11 135 patients received treatment to the fellow eye. Mean baseline and final VA were 0.66 (standard deviation, 0.32) and 0.65 (0.40) for first treated eyes and 0.41 (0.34) and 0.56 (0.40) for second treated eyes. The rate of VA loss after the loading phase was similar in first and second treated eyes (0.03 and 0.05 logMAR units/year). When fellow eyes with baseline VA worse than 20/200 were excluded to restrict analyses to eyes at risk of nAMD, the rate of second-eye involvement was 14.0% per year (42%/3 years). Mean number of injections/visits in years 1, 2, and 3 were similar for first and second treated eyes (5.6/8.2, 3.9/8.0, 3.8/8.2 and 5.5/8.7, 3.6/9.4, and 3.8/9.1, respectively).nnnCONCLUSIONSnSecond treated eyes with nAMD commence treatment with better baseline VA, do not show significant vision gain but maintain better VA than first treated eyes at all time points for at least 3 years, making them the more important eye functionally. These data highlight the high burden of second eye involvement, with almost half of all eyes at risk requiring bilateral treatment by 3 years, and the need for regular monitoring of fellow eyes for best visual outcomes which theoretically may reduce the benefits of extended monitoring regimens.