Structural OCT Signs Suggestive of Subclinical Nonexudative Macular Neovascularization in Eyes with Large Drusen

Narita, Callum; Wu, Zhichao; Rosenfeld, Philip J.; Yang, Jin; Lyu, Cancan; McGuinness, Myra B; McGuinness, Myra; Guymer, Robyn H.

doi:10.1016/j.ophtha.2019.11.007

Cited by 58 publications

(53 citation statements)

References 28 publications

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“…[ 2 ] For progression evaluation, effective grading may guide clinical treatment based on the DR severity. However, conventional diagnostics using fluorescence angiography (FA) [2b, 3] or optical coherence tomography (OCT) [ 4 ] are limited, concerning the nonquantitative examinations, invasive sampling, time‐consuming analysis, and high costs. [ 5 ] In addition, the shortage of trained ophthalmologists places strained access for patients, especially from remote or undeveloped areas.…”

Section: Introductionmentioning

confidence: 99%

Vanadium Core–Shell Nanorods Inspect Metabolic Changes of Diabetic Retinopathy

Vedarethinam

Huang

Zhang

et al. 2020

Adv Funct Materials

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Diabetic retinopathy (DR) is the most common microvascular complication of diabetes and ranks as the fifth leading cause of visual impairment, but an understanding of DR development has been hampered by the lack of an efficient metabolomic tool. Herein, vanadium core–shell nanorods are developed for metabolic fingerprinting to probe molecular variation in DR. First, a series of vanadium core–shells are constructed with different elemental composition and structural parameters, using silica nanorods to support vanadium oxide. The plasma metabolic fingerprints (MFs) are extracted by the optimized vanadium core–shell nanorod‐assisted laser desorption/ionization mass spectrometry, by analyzing 500 nL of native plasma in seconds. As a result, DR patients are differentiated from non DR controls with a sensitivity of 94% and specificity of 90% using a classification model built on the plasma MFs. Furthermore, DR progression is monitored by a panel of plasma metabolic signatures with gradual changes. This work provides an advanced molecular tool for the metabolomic characterization of DR and may guide the clinical decision making in DR for personalized medicine in the future.

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Section: Introductionmentioning

confidence: 99%

Vanadium Core–Shell Nanorods Inspect Metabolic Changes of Diabetic Retinopathy

Vedarethinam

Huang

Zhang

et al. 2020

Adv Funct Materials

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“…Multivariable logistic regression analysis identified SIRE with sub-RPE hyperreflectivity, as well as SHRM, as significant predictive factors for the presence of CNV on OCTA. SIRE or "double-layer sign" is described in the literature as long and shallow RPE elevation on OCT B-scans in AMD and pachychoroid spectrum [26][27][28][29][30][31]. In neovascular CSCR, CNV is likely to cause the elevation of RPE, with hyperreflectivity representing the fibrovascular tissue [31,32].…”

Section: Discussionmentioning

confidence: 99%

Multimodal Imaging in the Management of Choroidal Neovascularization Secondary to Central Serous Chorioretinopathy

Hagag

Chandra

Khalid

et al. 2020

JCM

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The diagnosis and treatment of choroidal neovascularization (CNV) in eyes with chronic central serous chorioretinopathy (CSCR) can be challenging. The purpose of this study was to classify eyes with suspected CNV using multimodal imaging. The effect of intravitreal anti-vascular endothelial growth factor (VEGF) was assessed and compared to controls. This retrospective study included chronic CSCR patients with suspected secondary CNV who received intravitreal bevacizumab. Eyes were divided into “definite CNV” and “no CNV” based on optical coherence tomography angiography (OCTA). Eyes that did not undergo OCTA imaging were considered as “presumed CNV”. One-year outcome in visual acuity (VA) and central foveal thickness (CFT) were investigated and compared to non-treated control patients to assess the response to anti-VEGF. Logistic regression analysis was used to explore predictive biomarkers of CNV detection and improvement after anti-VEGF. Ninety-two eyes with chronic CSCR from 88 participants were included in this study. Sixty-one eyes received bevacizumab and 31 eyes were non-treated control subjects. The presence of subretinal hyperreflective material (SHRM) and shallow irregular retinal pigment epithelium (RPE) elevation (SIRE) with sub-RPE hyperreflectivity on OCT was associated with a significantly increased risk of detecting CNV on OCTA. Intravitreal anti-VEGF caused significant functional and anatomical improvement in patients with neovascular CSCR as compared to non-treated eyes. In contrast, VA and CFT changes were not significantly different between treated and non-treated CSCR with no evidence of CNV on OCTA. No clinical or anatomical biomarkers were found to be associated with response to treatment. In conclusion, OCTA should be used to confirm the presence CNV in suspected chronic CSCR patients. Intravitreal anti-VEGF treatment resulted in a significantly better one-year outcome in patients with definitive OCTA evidence of CNV.

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“…We recently described key common structural characteristics of the RPE elevations seen on OCT that were suggestive for the presence of NE‐MNV 48 . We described a shallow, irregular RPE elevation (SIRE) above Bruch's membrane, with an arbitrary length ≥1000 μm of shallow elevation and a height above Bruch's membrane of predominantly <100 μm.…”

Section: Multimodal Imaging: Reveals More Than Meets the Eyementioning

confidence: 99%

“…8) We identified these features in 10% of eyes with large drusen and when identified, it had a positive predictive value of 25%, where 1 in 4 cases with SIRE were found to have NE‐MNV on OCTA, and the negative predictive value of 100% for NE‐MNV. We suggest the SIRE sign can be used to screen for NE‐MNV, which significantly increases the risk of nAMD 48 …”

Section: Multimodal Imaging: Reveals More Than Meets the Eyementioning

confidence: 99%

Age‐related macular degeneration (AMD): More than meets the eye. The role of multimodal imaging in today's management of AMD—A review

Guymer

2020

Clinical Exper Ophthalmology

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Multimodal imaging (MMI) allows a more granular grading of age-related macular degeneration (AMD) disease severity, with many novel risk factors having been recently identified. With this imaging information, we are better able to counsel our patients with more accurate and individualized progression scenarios. MMI also allows identification of anatomical features that increase our understanding of disease processes involved in progression to late AMD. Treatment protocols for neovascular AMD (nAMD) depend largely on the optical coherence tomography (OCT) appearance to determine disease activity, which allows us to individualize treatment. In geographic atrophy (GA), new intervention trials require the ability to define the extent of GA, so that GA growth rate can be determined. This is achieved through fundus autofluorescence (FAF) imaging, which allows greater accuracy of border identification, as well as revealing FAF patterns predictive of growth rates. As we strive to bring interventions earlier in the disease course, OCT imaging provides an ability to identify the first signs of atrophy, which may serve as novel surrogate biomarkers for GA, thereby facilitating trials. In the future, the use of artificial intelligence (AI) to automatically identify relevant features on MMI could further enhance our ability to determine disease severity, predict progression and assist in identifying disease activity parameters to support clinical decision making when treating nAMD. Newer developments may allow frequent, remote capturing of images, reducing clinic visits, detecting progression and monitoring neovascular activity in-between clinic visits. Being aware of these new imaging insights in AMD, greatly enhance our clinical management of AMD.

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Structural OCT Signs Suggestive of Subclinical Nonexudative Macular Neovascularization in Eyes with Large Drusen

Cited by 58 publications

References 28 publications

Vanadium Core–Shell Nanorods Inspect Metabolic Changes of Diabetic Retinopathy

Vanadium Core–Shell Nanorods Inspect Metabolic Changes of Diabetic Retinopathy

Multimodal Imaging in the Management of Choroidal Neovascularization Secondary to Central Serous Chorioretinopathy

Age‐related macular degeneration (AMD): More than meets the eye. The role of multimodal imaging in today's management of AMD—A review

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