Showing papers by "Philip J. Rosenfeld published in 2018"
TL;DR: SS-OCTA can image the choriocapillaris in vivo, and the repeatability of flow void measurements is high in the presence of drusen, which should prove useful in understanding disease onset, progression, and response to therapies.
Abstract: Purpose To achieve reproducible imaging of the choriocapillaris and associated flow voids using swept-source OCT angiography (SS-OCTA). Methods Subjects were enrolled and SS-OCTA was performed using the 3 × 3 mm scan pattern. Blood flow was identified using the complex optical microangiography (OMAG) algorithm. The choriocapillaris was defined as a slab from the outer boundary of Bruch's membrane (BM) to approximately 20 μm below BM. Compensation for the shadowing effect caused by the RPE and BM complex on the choriocapillaris angiogram was achieved by using the structural information from the same slab. A thresholding method to calculate the percentage of flow voids from a region was developed based on a normal database. Results Twenty normal subjects and 12 subjects with drusen were enrolled. SS-OCTA identified the choriocapillaris in normal subjects as a lobular plexus of capillaries in the central macula and the lobular arrangement became more evident toward the periphery. In all eyes, signal compensation resulted in fewer choriocapillaris flow voids with improved repeatability of measurements. The best repeatability for the measurement was achieved by using 1 standard deviation (SD) for the thresholding strategy. Conclusions SS-OCTA can image the choriocapillaris in vivo, and the repeatability of flow void measurements is high in the presence of drusen. The ability to image the choriocapillaris and associated flow voids should prove useful in understanding disease onset, progression, and response to therapies.
209 citations
TL;DR: GA enlargement, which was influenced by lesion features, was relentless, resulting in rapid central vision loss, and the genetic variants associated with faster enlargement were partially distinct from those associated with risk of incident GA.
112 citations
TL;DR: Emmixustat did not reduce the growth rate of GA in AMD and the most common adverse events were ocular in nature and likely related to the drug's mechanism of action.
99 citations
TL;DR: A method was developed to improve the robust estimation of choriocapillaris flow deficits by removing the small flow deficits corresponding to normal intercapillary spacing and fewer repeats were required for image averaging to achieve comparable accuracy of flow deficit measurements with SS-OCTA.
Abstract: Background To estimate choriocapillaris flow deficits beyond normal intercapillary distance with swept source optical coherence tomography angiography (SS-OCTA). Methods Subjects were enrolled and repeated SS-OCTA scans were performed using the 3 mm × 3 mm scan pattern. Blood flow was identified using the complex optical microangiography (OMAGc) algorithm. The choriocapillaris (CC) was defined as a 20 µm slab of the flow volume beneath the outer boundary of Bruch's membrane (BM) and was compensated with the corresponding structural image for flow deficits measurement. Flow deficits were segmented based on one mean standard deviation from a normal database. A histogram based thresholding method was developed to remove small flow deficits that were determined by examining intercapillary spacing within normal CC networks. A registration method based on affine and B-spline transformation was utilized for the CC angiogram averaging. Four repeated scans were averaged, and results were compared with and without removal of small flow deficits after averaging a different number of scans (N=1, group 1; N=2, group 2; N=3, group 3 and N=4, group 4). Results Seven normal subjects were enrolled. Intercapillary distance was found to be 24 µm for the CC networks under OCTA, which was used as the threshold to exclude small flow deficits for CC quantification. After averaging, significant reduction in background noise and improvement in continuity of blood vessel networks were observed both on retinal and choriocapillaris angiograms. Flow deficit percentages of the choriocapillaris were significantly reduced with averaging (group 1 vs. group 2: P<0.0001; group 2 vs. group 3: P<0.001; group 3 vs. group 4: P<0.001). The flow deficit percentages were also significantly reduced after removing the small flow deficits (≤24 µm in diameter) in all groups (P<0.01). A statistically significant difference was found after removing small flow deficits (≤24 µm in diameter) between group 1 and group 2 (P<0.001), between group 2 and group 3 (P<0.05), and between group 3 and group 4 (P<0.05). However, the significance was decreased compared to that without small flow deficits removal. Conclusions A method was developed to improve the robust estimation of choriocapillaris flow deficits by removing the small flow deficits corresponding to normal intercapillary spacing. After the removal of small flow deficits, fewer repeats were required for image averaging to achieve comparable accuracy of flow deficit measurements with SS-OCTA.
65 citations
TL;DR: An approach that applies attenuation correction on SS-OCT structural scans to facilitate accurate automatic segmentation of the choroid and provides visualization of theChoroidal vasculature without the necessity of OCT angiography is reported.
Abstract: Swept source optical coherence tomography (SS-OCT) is being used more widely in clinical studies to investigate the choroid due to its deeper penetration under the retinal pigment epithelium and improved image quality compared with spectral domain OCT. However, automatic methods to reliably assess choroidal thickness and vasculature are still limited. This paper reports an approach that applies attenuation correction on SS-OCT structural scans to facilitate accurate automatic segmentation of the choroid and provides visualization of the choroidal vasculature without the necessity of OCT angiography. After attenuation correction, enhanced interlayer contrast at the choroidal-scleral interface was observed (from 0.13 ± 0.05 to 0.29 ± 0.10; P < 0.001). An algorithm that segmented the choroid from attenuation compensated B-scans achieved significantly higher accuracy when compared with an automated segmentation performed on regular OCT scans (91.8 ± 3.7% vs.74.5 ± 8.0%; P < 0.01). After attenuation correction, en face images of choroidal vessels were achieved with fewer artifacts from retinal vessels. Measurements of mean choroidal thickness and vessel density showed high repeatability. The attenuation correction assisted segmentation of the choroid and visualization of the choroidal vasculature will be helpful in studying the quantitative changes that occur in a myriad of diseases involving the choroid such as age-related macular degeneration, polypoidal choroidal vasculopathy, pathologic myopia, central serous chorioretinopathy, and inflammatory eye conditions.
52 citations
TL;DR: Clinical data suggest that SSPiM is a novel imaging feature of retinal vascular diseases that was not appreciated prior to the use of OCTA and demonstrated that at least in some cases it resolves with residual hard exudate.
46 citations
TL;DR: Intravenous amyloid β inhibition with GSK933776 did not slow the rate of GA enlargement compared with placebo, and no clinically meaningful differences relative to placebo were observed in visual function testing over 18 months.
41 citations
TL;DR: The investment in OCT over 2 decades has been recouped many times over in just a few years through better personalized therapy, and the overall cost-benefit ratio of government-sponsored research is difficult to estimate.
30 citations
TL;DR: The cost savings from the use of bevacizumab from 2008 to 2015 for Medicare fee-for-service patients undergoing treatment for exudative AMD was estimated at $17.3 billion, which corresponded to a $13.8 billion savings to Medicare and a $3.5 billion Savings to patients.
24 citations
TL;DR: Outcomes were generally poor, and the worst were associated with Streptococcus, the most common isolates were coagulase-negative Staphylococcus and StrePTococcus.
Abstract: Background and objective To report the incidence rates, causative organisms, and visual acuity (VA) outcomes in patients with endophthalmitis associated with intravitreal injection of anti-vascular endothelial growth factor inhibitors. Patients and methods Retrospective case series between 2005 and 2017. Results The study included 39 eyes of 39 patients, including 27 (69%) referred and 12 (31%) institutional patients. The use of topical antibiotics after an injection was gradually phased out at the authors' institution, where the preinjection rate of all clinically suspected endophthalmitis was 0.013% (24 of 183,898). The most common isolates were coagulase-negative Staphylococcus and Streptococcus. A VA of 5/200 or better was achieved in 21 of 39 eyes (54%) overall and in two of 15 eyes (13%) infected with Streptococcus. Conclusions The rate of post-intravitreal injection endophthalmitis is low. Outcomes were generally poor, and the worst were associated with Streptococcus. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:313-319.].
23 citations
TL;DR: There are strong correlations and satisfactory agreement between SD method and FCM method for CC quantification and stronger correlations in the central macula compared to parafoveal and perifoveal regions for both FDD and MFDS.
Abstract: Background To investigate the correlation and agreement of two previously published choriocapillaris (CC) quantification methods using a normal database with swept-source optical coherence tomography angiography (SS-OCTA). Methods Normal adult subjects from all age groups imaged by SS-OCTA were used in this study. Each subject was imaged with 3 mm × 3 mm and 6 mm × 6 mm scan patterns centered on fovea, upon which en face CC images were generated by segmenting volumetric OCTA data. After signal compensation and removal of projection artifacts and noise, CC images were analyzed to identify flow deficits (FD) using two published methods. The first method utilized standard deviation from a young normal database (SD method) as the global thresholding while the second method utilized fuzzy C-means algorithm (FCM method) with local thresholding. Both methods segmented FDs from CC images and quantified FD density (FDD) and mean FD size (MFDS). In each 3 mm × 3 mm scan, three regions were quantified: a 1 mm circle (C1), a 1.5 mm rim (R1.5) and a 2.5 mm circle (C2.5). In each 6 mm × 6 mm scan, five regions were quantified: C1, R1.5, C2.5, a 2.5 mm rim (R2.5) and a 5 mm circle (C5). Spearman correlation and Bland-Altman plot analyses were conducted to compare the two methods. Results Data obtained from 164 normal subjects (age: 56±19, 59% females) were used in this study. Strong correlations were observed between the two methods in all comparisons (r: 0.78-0.94, all P<0.0001). Overall MFDS provided higher or comparable correlation coefficients (r) compared to FDD. We have also observed stronger correlations in the central macula compared to parafoveal and perifoveal regions for both FDD and MFDS. In regions of C1, R1.5 and C2.5, 6 mm × 6 mm scans resulted in better agreement (smaller mean bias, similar or tighter limit of agreement) between the two methods for both FDD and MFDS compared to 3 mm × 3 mm scans. Conclusions There are strong correlations and satisfactory agreement between SD method and FCM method. SD method requires the reference to a normal database for CC quantification while FCM does not. Both methods could be used for the analysis of CC FDs in clinical settings depending on specific study designs such as the availability of a normal database.
TL;DR: Multimodal imaging is helpful for the interpretation and management of asymptomatic SRF in iAMD and the entity of nonexudative detachment of the neurosensory retina is highlighted as the acronym NEDNR is used.
TL;DR: Upon closer inspection of these 3 failed phase III trials, it was found that they did not adhere to 2 basic rules of drug development that should provide the best chance of a phase III trial success.
TL;DR: The research by Chakravarthy et al (see http:// www.aaojournal.org/article/S0161-6420(17)32513-7/fulltext) in this issue highlights the enormous impact of GA in nonexudative AMD.
TL;DR: A 73-year-old woman with 2 weeks of progressive painless vision loss was found to have bilateral corneal edema, jaw claudication, and temporal headache, and giant cell arteritis (GCA) was confirmed by a temporal artery biopsy.
Abstract: A 73-year-old woman with 2 weeks of progressive painless vision loss was found to have bilateral corneal edema, jaw claudication, and temporal headache. Multimodal imaging revealed an Amalric choroidal infarct in the left eye visualized by widefield indocyanine green angiography and swept-source optical coherence tomography angiography (SS-OCTA). Prompt intravenous corticosteroid treatment resulted in 20/20 vision, and giant cell arteritis (GCA) was confirmed by a temporal artery biopsy. The case underscores the use of widefield SS-OCTA as a non-invasive test to aid in the diagnosis of GCA, as well as bilateral cornea edema as a rare presentation of GCA. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e157-e160.].
TL;DR: A patient previously diagnosed with Alport Syndrome was evaluated using multimodal imaging, and Optical coherence tomography demonstrated significant thinning of the inner retina within the macula, and inner retinal cysts were found in the peripheral macula.
Abstract: A patient previously diagnosed with Alport Syndrome was evaluated using multimodal imaging. Optical coherence tomography (OCT) demonstrated significant thinning of the inner retina within the macula, and inner retinal cysts were found in the peripheral macula. OCT angiography demonstrated loss of the choriocapillaris. Abnormal collagen appears to have multiple deleterious effects on the retinal and choroidal structure and vasculature. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:138-141.].
TL;DR: In eyes with exudative AMD, SS-OCTA imaging and commercially available boundary-specific segmentation strategies were used to distinguish between type 1 and type 2 MNV.
Abstract: Background and objective Swept-source optical coherence tomography angiography (SS-OCTA) and different boundary-specific segmentation strategies were used to distinguish type 1 macular neovascularization (MNV) from type 2 MNV in eyes with exudative age-related macular degeneration (AMD). Patients and methods Eyes with exudative AMD were enrolled in a prospective study. Segmentation strategies included a slab from the outer retina (OR) to the choriocapillaris (CC) for the entire MNV, a slab from the retinal pigment epithelium (RPE) to the CC for the type 1 MNV, and a slab from the OR to the RPE for the type 2 MNV. Results In 13 eyes, SS-OCTA B-scans and en face images using different segmentation strategies were able to identify type 1 and type 2 components of the MNV. Conclusion In eyes with exudative AMD, SS-OCTA imaging and commercially available boundary-specific segmentation strategies were used to distinguish between type 1 and type 2 MNV. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:878-886.].
TL;DR: BVN and type 2 NV can coexist in the same PCV eye and communicate with each other, suggesting that polyps may represent a structural variant of neovascular tissue rather than a distinct pathogenic process in NV.
Abstract: Background and objective To demonstrate the coexistence of polypoidal choroidal vasculopathy (PCV) with type 2 neovascularisation (NV), we used multimodal imaging, including spectral-domain optical coherence tomography angiography (SD-OCTA), to identify both types of lesions in the same eye. Study design This retrospective case series reviewed patients with PCV diagnosed with indocyanine green angiography (ICGA), fluorescein angiography (FA), SD-OCT and SD-OCTA. Results 15 eyes of 14 patients were imaged and diagnosed with PCV by ICGA. ICGA identified polyps in all these eyes, while SD-OCTA imaging identified polypoidal lesions in only 11 (73%) of these eyes with PCV. Branching vascular networks (BVNs) were detected in 12 eyes (80%) by ICGA and SD-OCTA. Type 2 NV was detected in four eyes (27%) by FA and SD-OCTA. In these eyes, a combination of polyps, BVNs and type 2 NV were detected using FA, ICGA and SD-OCTA. Conclusion BVN and type 2 NV can coexist in the same PCV eye and communicate with each other. This suggests that polyps may represent a structural variant of neovascular tissue rather than a distinct pathogenic process in NV.
TL;DR: This is the first report of using SS-OCTA to diagnose CNV associated with a choroidal nevus masquerading as neovascular AMD, and it is shown that the CNV appeared to arise from an adjacent choroid neVus.
Abstract: Swept-source optical coherence tomography angiography (SS-OCTA) was used to diagnose choroidal neovascularization (CNV) arising from a choroidal nevus. A 61-year-old woman initially presented with submacular hemorrhage. She was diagnosed with neovascular age-related macular degeneration (AMD) and received three injections of bevacizumab (Avastin; Genentech, South San Francisco, CA). At a follow-up visit, SS-OCTA showed that the CNV appeared to arise from an adjacent choroidal nevus. This is the first report of using SS-OCTA to diagnose CNV associated with a choroidal nevus masquerading as neovascular AMD. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:360-363.].
19 Feb 2018
TL;DR: The results indicate that the strength of the OCT signal from choroidal vasculature is dependent on the health and function of the RPE, and may not necessarily directly reflect the health
Abstract: With the onset of clinically available spectral domain (SD-OCT) and swept source (SS-OCT) systems, clinicians are now easily able to recognize sub retinal microstructure and vascularization in the choroidal and scleral regions. As the bloodrich choroid supplies nutrients to the upper retinal layers, the ability to monitor choroid function accurately is of vital importance for clinical assessment of retinal health. However, the physical appearance of the choroid blood vessels (darker under a healthy Retinal Pigmented Epithelium (RPE) compared to regions displaying an RPE atrophic lesion) has led to confusion within the OCT ophthalmic community. The differences in appearance between each region in the OCT image may be interpreted as different vascular patterns when the vascular networks are in fact very similar. To explain this circumstance, we simulate light scattering phenomena in the RPE and Choroid complexes using the finite difference time domain (FDTD) method. The simulation results are then used to describe and validate imaging features in a controlled multi-layered tissue phantom designed to replicate human RPE, choroid, and whole blood microstructure. Essentially, the results indicate that the strength of the OCT signal from choroidal vasculature is dependent on the health and function of the RPE, and may not necessarily directly reflect the health and function of the choroidal vasculature.
TL;DR: This case demonstrates how a noninvasive, safe, 12 mm × 12 mm SS-OCTA image of a CRVO is useful in evaluating the retinal perfusion at presentation and follow-up during pregnancy.
Abstract: To avoid fluorescein angiography in a pregnant woman diagnosed with a central retinal vein occlusion (CRVO), swept-source optical coherence tomography angiography (SS-OCTA) was performed and showed no evidence of decreased central retinal perfusion leading to the diagnosis of a nonischemic CRVO. Five months after an intravitreal injection of steroid, both her vision and the retinal appearance had returned to normal. This case demonstrates how a noninvasive, safe, 12 mm × 12 mm SS-OCTA image of a CRVO is useful in evaluating the retinal perfusion at presentation and follow-up during pregnancy. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:206-208.].
TL;DR: OCTA is an important tool for the correct diagnosis of MacTel2 in older patients with the concomitant or masquerading diagnosis of AMD.
Abstract: Background and objective To demonstrate the advantage of optical coherence tomography angiography (OCTA) for the diagnosis and management of proliferative macular telangiectasia type 2 (MacTel2) masquerading as neovascular age-related macular degeneration (AMD). Patients and methods This is an observational cases series. Three patients referred with the diagnosis of neovascular AMD were identified in this retrospective study. In addition to color fundus, fluorescein angiography, and spectral-domain OCT (SD-OCT) imaging, SD-OCTA (AngioPlex; Carl Zeiss Meditec, Dublin, CA) was performed. Results SD-OCTA revealed bilateral parafoveal retinal microvascular changes in three patients and unambiguously confirmed the diagnosis of MacTel2. Conclusion OCTA is an important tool for the correct diagnosis of MacTel2 in older patients with the concomitant or masquerading diagnosis of AMD. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:303-312.].
TL;DR: A 30-year-old woman with photopsias and decreased vision was diagnosed with multiple evanescent white dot syndrome with an atypical inflammatory subfoveal retinal pigment epithelial detachment and SS-OCT imaging revealed a focal area of attenuated choriocapillaris underneath the PED.
Abstract: A 30-year-old woman with photopsias and decreased vision was diagnosed with multiple evanescent white dot syndrome (MEWDS) with an atypical inflammatory subfoveal retinal pigment epithelial detachment (PED) and imaged using swept-source optical coherence tomography (SS-OCT) during several visits. SS-OCT imaging revealed a focal area of attenuated choriocapillaris underneath the PED. An attempt to treat the presumed macular inflammatory lesion with corticosteroids resulted in bilateral exudation consistent with central serous chorioretinopathy. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:145-151.].
Journal Article•
TL;DR: In this paper, a novel paradigm for segmenting optical coherence tomography (OCT) and OCTA is presented, which is called "OCT-OCTA segmentation" and demonstrated by segmenting the Bruch's Membrane (BM) in the presence of drusen.
Abstract: In this work, a novel paradigm for segmenting optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) is presented [1]. Since it uses OCT and OCTA information jointly it is called “OCT-OCTA segmentation” and its usefulness is demonstrated by segmenting the Bruch’s Membrane (BM) in the presence of drusen. Therefore a fully automatic graph-cut algorithm was developed and evaluated by comparing the automatic segmentation results with manual segmentation in 7 eyes (6 patients; 73.8 ± 5.7 y/o) with nascent geographic atrophy and/or drusen associated geographic atrophy.