Jose M. Larrosa

Retinal layer segmentation in patients with multiple sclerosis using spectral domain optical coherence tomography.

PURPOSE To evaluate the thickness of the 10 retinal layers in the paramacular area of patients with multiple sclerosis (MS) compared with healthy subjects using the new segmentation technology of spectral domain optical coherence tomography (OCT). To examine which layer has better sensitivity for detecting neurodegeneration in patients with MS. DESIGN Observational, cross-sectional study. PARTICIPANTS Patients with MS (n = 204) and age-matched healthy subjects (n = 138). METHODS The Spectralis OCT system (Heidelberg Engineering, Inc., Heidelberg, Germany) was used to obtain automated segmentation of all retinal layers in a parafoveal scan in 1 randomly selected eye of each participant, using the new segmentation application prototype. MAIN OUTCOME MEASURES The thicknesses of 512 parafoveal points in the 10 retinal layers were obtained in each eye, and the mean thickness of each layer was calculated and compared between patients with MS and healthy subjects. The analysis was repeated, comparing patients with MS with and without previous optic neuritis. Correlation analysis was performed to evaluate the association between each retinal layer mean thickness, duration of disease, and functional disability in patients with MS. A logistic regression analysis was performed to determine which layer provided better sensitivity for detecting neurodegeneration in patients with MS. RESULTS All retinal layers, except the inner limiting membrane, were thinner in patients with MS compared with healthy subjects (P < 0.05). Greater effects were observed in the inner retinal layers (nerve fiber, ganglion cells, inner plexiform, and inner nuclear layers) of eyes with previous optic neuritis (P < 0.05). The retinal nerve fiber layer and ganglion cell layer thicknesses were inversely correlated with the functional disability score in patients with MS. The ganglion cell layer and inner plexiform layer thicknesses could predict axonal damage in patients with MS. CONCLUSIONS Analysis based on the segmentation technology of the Spectralis OCT revealed retinal layer atrophy in patients with MS, especially of the inner layers. Reduction of the ganglion cell and inner plexiform layers predicted greater axonal damage in patients with MS.

Distribution of retinal layer atrophy in patients with Parkinson disease and association with disease severity and duration.

PURPOSE To evaluate the thickness of the 10 retinal layers in the paramacular area of Parkinson disease patients using a new segmentation technology of optical coherence tomography (OCT) to examine whether the thickness of specific layers predicts neurodegeneration or Parkinson disease severity. DESIGN Observational prospective study. METHODS Parkinson disease patients (n = 129) and age-matched healthy subjects (n = 129) were enrolled. The Spectralis OCT system was used to automatically segment all retinal layers in a parafoveal scan using the new segmentation application prototype. Mean thickness of each layer was calculated and compared between Parkinson disease patients and healthy subjects, and between Parkinson disease patients with disease durations of less than or at least 10 years. A correlation analysis was performed to evaluate the association between retinal layer thickness, duration of disease, and Parkinson disease severity. Logistic regression analysis was performed to determine the most sensitive layer for predicting axonal atrophy. RESULTS Parkinson disease patients showed statistically significant reduced thickness in the retinal nerve fiber, ganglion cell, inner plexiform, and outer plexiform layers and increased thickness in the inner nuclear layer compared with healthy subjects (P < .05). The inner retinal layers were more affected in Parkinson disease patients with long disease duration. The ganglion cell layer thickness was inversely correlated with disease duration and Parkinson disease severity, and was predictive of axonal damage in Parkinson disease patients. CONCLUSIONS The segmentation application of the Spectralis OCT revealed retinal layer atrophy in Parkinson disease patients, especially in the inner layers of patients with long disease duration. Ganglion cell layer reduction was associated with increased axonal damage.

A Randomized Trial of a Schlemm's Canal Microstent with Phacoemulsification for Reducing Intraocular Pressure in Open-Angle Glaucoma

PURPOSE To assess the safety and effectiveness of the Hydrus Microstent (Ivantis, Inc, Irvine, CA) with concurrent cataract surgery (CS) for reducing intraocular pressure (IOP) in open-angle glaucoma (OAG). DESIGN Prospective, multicenter, randomized, single-masked, controlled clinical trial. PARTICIPANTS One hundred eyes from 100 patients 21 to 80 years of age with OAG and cataract with IOP of 24 mmHg or less with 4 or fewer hypotensive medications and a washed-out diurnal IOP (DIOP) of 21 to 36 mmHg. METHODS On the day of surgery, patients were randomized 1:1 to undergo CS with the microstent or CS alone. Postoperative follow-up was at 1 day, 1 week, and 1, 3, 6, 12, 18, and 24 months. Washout of hypotensive medications was repeated at 12 and 24 months. MAIN OUTCOME MEASURES Response to treatment was defined as a 20% or more decrease in washed out DIOP at 12 and 24 months of follow-up compared with baseline. Mean DIOP at 12 and 24 months, the proportion of subjects requiring medications at follow-up, and the mean number of medications were analyzed. Safety measures included change in visual acuity, slit-lamp observations, and adverse events. RESULTS The proportion of patients with a 20% reduction in washed out DIOP was significantly higher in the Hydrus plus CS group at 24 months compared with the CS group (80% vs. 46%; P = 0.0008). Washed out mean DIOP in the Hydrus plus CS group was significantly lower at 24 months compared with the CS group (16.9±3.3 mmHg vs. 19.2±4.7 mmHg; P = 0.0093), and the proportion of patients using no hypotensive medications was significantly higher at 24 months in the Hydrus plus CS group (73% vs. 38%; P = 0.0008). There were no differences in follow-up visual acuity between groups. The only notable device-related adverse event was focal peripheral anterior synechiae (1-2 mm in length). Otherwise, adverse event frequency was similar in the 2 groups. CONCLUSIONS Intraocular pressure was clinically and statistically significantly lower at 2 years in the Hydrus plus CS group compared with the CS alone group, with no differences in safety.

Electrophysiology and Optical Coherence Tomography to Evaluate Parkinson Disease Severity

PURPOSE To evaluate correlations between visual evoked potentials (VEP), pattern electroretinogram (PERG), and macular and retinal nerve fiber layer (RNFL) thickness measured by optical coherence tomography (OCT) and the severity of Parkinson disease (PD). METHODS Forty-six PD patients and 33 age and sex-matched healthy controls were enrolled, and underwent VEP, PERG, and OCT measurements of macular and RNFL thicknesses, and evaluation of PD severity using the Hoehn and Yahr scale to measure PD symptom progression, the Schwab and England Activities of Daily Living Scale (SE-ADL) to evaluate patient quality of life (QOL), and disease duration. Logistical regression was performed to analyze which measures, if any, could predict PD symptom progression or effect on QOL. RESULTS Visual functional parameters (best corrected visual acuity, mean deviation of visual field, PERG positive (P) component at 50 ms -P50- and negative (N) component at 95 ms -N95- component amplitude, and PERG P50 component latency) and structural parameters (OCT measurements of RNFL and retinal thickness) were decreased in PD patients compared with healthy controls. OCT measurements were significantly negatively correlated with the Hoehn and Yahr scale, and significantly positively correlated with the SE-ADL scale. Based on logistical regression analysis, fovea thickness provided by OCT equipment predicted PD severity, and QOL and amplitude of the PERG N95 component predicted a lower SE-ADL score. CONCLUSIONS Patients with greater damage in the RNFL tend to have lower QOL and more severe PD symptoms. Foveal thicknesses and the PERG N95 component provide good biomarkers for predicting QOL and disease severity.

Reproducibility of Optical Coherence Tomography Measurements in Children

PURPOSE To determine the interobserver and intraobserver reproducibility of a Fourier-domain optical coherence tomography device (Cirrus HD OCT; Carl Zeiss Meditec, Dublin, California, USA) in normal pediatric eyes. DESIGN Prospective cross-sectional study. METHODS One hundred healthy children were recruited prospectively and consecutively. Only 1 randomly chosen eye per subject was included in the study. The eye underwent 3 scans centered on the optic disc and another 3 scans centered on the macula that were acquired by a single operator. A fourth examination was performed by a second operator. Interobserver and intraobserver reproducibility were described by intraclass correlation coefficients (ICCs) and coefficients of variation (COVs). RESULTS The mean age was 9.15 years (range, 6.22 to 11.31 years; standard deviation, 1.05 years). Mean retinal nerve fiber layer thickness was 99.53 μm (standard deviation, 10.10 μm), and mean macular thickness was 282.91 μm (standard deviation, 11.83 μm). All the parameters evaluated were highly reproducible. Intraobserver COVs of the retinal nerve fiber layer measurements ranged from 2.24% to 5.52%, and the COV of macular thickness was 0.97%. The intraclass correlation coefficient was greater than 0.8 for all the parameters. The interobserver COV ranged from 2.23% to 5.18%, and the COV of macular thickness was 0.82%. In all the evaluated parameters, the intraclass correlation coefficient was more than 0.75. Repeatability was slightly better in children older than 10 years than in children younger than 9 years. CONCLUSIONS Retinal nerve fiber layer and macular measurements obtained by Fourier-domain optical coherence tomography showed good repeatability for healthy eyes in the pediatric population. Cirrus HD OCT examinations of the retina are reliable in children.

Predictive value of short-wavelength automated perimetry: A 3-year follow-up study

PURPOSE To determine whether structural changes in the retinal nerve fiber layer (RNFL) and functional abnormalities in short-wavelength automated perimetry (SWAP) can predict the onset of functional losses in standard automated perimetry patients suspected of having glaucoma. DESIGN Prospective observational case series. PARTICIPANTS A total of 160 eyes of ocular hypertensive subjects (intraocular pressure greater than 21 mmHg and normal standard automated perimetry) were included in the study. INTERVENTIONS The subjects underwent RNFL photographic evaluation and SWAP. Standard automated perimetries were repeated after 3 years to evaluate glaucomatous losses. MAIN OUTCOME MEASURES Onset of glaucomatous defects in conventional automated perimetry after 3 years of follow-up, with or without prior glaucomatous defects in RNFL and SWAP. RESULTS At the beginning of the study, 77 eyes showed RNFL losses (48%), and 58 eyes showed abnormalities in SWAP (36%). After the 3-year follow-up period, 14 of 77 eyes with RNFL losses had standard automated perimetry abnormalities (predicting sensitivity 93%), whereas 11 of 58 eyes with abnormal SWAP had standard automated perimetry losses (73% sensitivity). CONCLUSIONS RNFL and SWAP losses are signs of early glaucomatous damage and can predict functional losses in standard automated perimetry.

Anatomic results and complications in a long-term follow-up of pneumatic retinopexy cases.

Background: The use of pneumatic retinopexy is controversial because 1) intraocular gas could increase the risk of proliferate vitreoretinopathy and 2) it has been reported to achieve low rates of success after a single procedure. Methods: A total of 219 consecutive cases of SF6 pneumatic retinopexy were reviewed retrospectively. The follow‐up period ranged from 2 to 5 years. Results: A total of 179 (81.73%) of 219 eyes were treated successfully with a single procedure. The success rate increased with reoperations to 98.89%. Preoperative factors related to primary failure or redetachment were aphakia or pseudophakia (P = 0.0058) and breaks localized on horizontal meridia (P = 0.0305). Cryopexy was significantly associated with failure (P = 0.0007). A total of 31.05% of eyes showed early complications. The most frequent incidence was delay in subretinal fluid reabsorption (36.76%), followed by new breaks (26.47%). Late complications were observed in 6.84% of the eyes (six eyes with macular pucker, three with new retinal detachments, three with cataracts, and three with new breaks without detachment). Conclusions: Failures of pneumatic retinopexy were related to lens status, localization of the break, and cryopexy. The occurrence of early and late complications was similar to that in other procedures.

Potential New Diagnostic Tool for Alzheimer's Disease Using a Linear Discriminant Function for Fourier Domain Optical Coherence Tomography

PURPOSE We calculated and validated a linear discriminant function (LDF) for Fourier domain optical coherence tomography (OCT) to improve the diagnostic ability of retinal and retinal nerve fiber layer (RNFL) thickness parameters in the detection of Alzheimers disease (AD). METHODS We enrolled AD patients (n = 151) and age-matched, healthy subjects (n = 61). The Cirrus and Spectralis OCT systems were used to obtain retinal measurements and circumpapillary RNFL thickness for each participant. An LDF was calculated using all retinal and RNFL OCT measurements. Receiver operating characteristic (ROC) curves were plotted and compared among the LDF and the standard parameters provided by OCT devices. Sensitivity and specificity were used to evaluate diagnostic performance. A validating set was used in an independent population to test the performance of the LDF. RESULTS The optimal function was calculated using the RNFL thickness provided by Spectralis OCT, using the 768 points registered during peripapillary scan acquisition (grouped to obtain 24 uniformly divided locations): 18.325 + 0.056 × (315°-330°) - 0.122 × (300°-315°) - 0.041 × (285°-300°) + 0.091 × (255°-270°) + 0.041 × (225°-240°) + 0.183 × (195°-210°) - 0.108 × (150°-165°) - 0.092 × (75°-90°) + 0.051 × (30°-45°). The largest area under the ROC curve was 0.967 for the LDF. At 95% fixed specificity, the LDF yielded the highest sensitivity values. CONCLUSIONS Measurements of RNFL thickness obtained with the Spectralis OCT device differentiated between healthy and AD individuals. Based on the area under the ROC curve, the LDF was a better predictor than any single parameter.

Diagnostic ability of the Heidelberg retina tomograph, optical coherence tomograph, and scanning laser polarimeter in open-angle glaucoma.

PurposeTo compare the ability to discriminate between healthy and glaucomatous eyes of different criteria based on parameters from 3 optical imaging devices: Heidelberg retina tomograph (HRT-II), optical coherence tomograph (Stratus OCT 3000) and scanning laser polarimeter (GDx VCC). DesignCross-sectional study. ParticipantsA total of 139 eyes from 139 subjects were enrolled in this study and classified into 66 healthy subjects and 73 glaucomatous patients according to intraocular pressure and standard automated perimetry. MethodsAll the subjects underwent complete ophthalmic examination, including HRT-II, OCT, and GDx VCC evaluations. Main Outcome MeasuresSeveral parameters were obtained by these techniques and 8 diagnostic criteria were assessed. Receiver operating characteristics curves were plotted and compared among them, and sensitivity for specificity higher than 95% was calculated for every criterion. Agreement among the 3 technologies was assessed by means of Venn diagrams. ResultsThe best criteria discriminating between healthy and glaucomatous eyes were Moorfields regression analysis out of the 95% confidence interval (HRT-II), OCT retinal nerve fiber layer average thickness <77 μm, and nerve fiber indicator >37 (GDx VCC) with sensitivities of 85%, 66%, and 48%, with specificity higher than 95%. Sixty-six patients out of 73 were correctly identified by at least 1 of the devices and 30 were detected by the 3 of them. ConclusionsStructural criteria assessed by the optical imaging devices evaluated in this study are useful to discriminate glaucomatous damage.

Neuro-ophthalmologic evaluation, quality of life, and functional disability in patients with MS

Objective: To evaluate correlations between longitudinal changes in neuro-ophthalmologic measures and quality of life (QOL) and disability in patients with multiple sclerosis (MS), using optical coherence tomography (OCT), visual evoked potentials (VEP), and visual field examination. Methods: Fifty-four patients with relapsing-remitting MS were enrolled in this study and underwent Multiple Sclerosis Quality of Life questionnaire (54 items) (MSQOL-54) and Expanded Disability Status Scale (EDSS) evaluation, as well as complete neuro-ophthalmologic examination including visual field testing and retinal nerve fiber layer (RNFL) measurements using Cirrus and Spectralis OCT and VEP. All patients were re-evaluated at 12, 24, and 36 months. Logistical regression was performed to analyze which measures, if any, could predict QOL. Results: Overall, RNFL thickness results at the baseline evaluation were significantly different from those at 3 years (p ≤ 0.05), but there were no differences in functional measures (visual acuity, contrast sensitivity, color vision, visual field, and VEP). A reduced MSQOL-54 score was associated with an increase in EDSS score and a decrease in both functional and structural parameters. Patients with longer MS duration presented with a lower MSQOL-54 score (reduction in QOL). Conclusions: Patients with progressive axonal loss as seen in RNFL results had a lower QOL and more functional disability.