Cost-effectiveness of incorporating self-imaging optical coherence tomography into fundus photography-based diabetic retinopathy screening
Ontology highlight
ABSTRACT:
SUBMITTER: Liu Z
PROVIDER: S-EPMC11344775 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:PurposeTo compare the detection rate of diabetic retinopathy (DR) lesions and the agreement of DR severity grading using the ultra-widefield color fundus photography (UWF CFP) combined with high-speed ultra-widefield swept-source optical coherence tomography angiography (UWF SS-OCTA) or fluorescein angiography (FFA).MethodsThis prospective, observational study recruited diabetic patients who had already taken the FFA examination from November 2021 to June 2022. These patients had either no DR or any stage of DR. All participants were imaged with a 200° UWF CFP and UWF SS-OCTA using a 24 × 20 mm scan model. Images were independently evaluated for the presence or absence of DR lesions including microaneurysms (MAs), intraretinal hemorrhage (IRH), non-perfusion areas (NPAs), intraretinal microvascular abnormalities (IRMAs), venous beading (VB), neovascularization elsewhere (NVE), neovascularization of the optic disc (NVD), and vitreous or preretinal hemorrhage (VH/PRH). Agreement of DR severity grading based on UWF CFP plus UWF SS-OCTA and UWF CFP plus FFA was compared. All statistical analyses were performed using SPSS V.26.0.ResultsOne hundred and fifty-three eyes of 86 participants were enrolled in the study. The combination of UWF CFP with UWF SS-OCTA showed a similar detection rate compared with UWF CFP plus FFA for all the characteristic DR lesions (p>0.05), except NPAs (p = 0.039). Good agreement was shown for the identification of VB (κ = 0.635), and very good agreement for rest of the DR lesions between the two combination methods (κ-value ranged from 0.858 to 0.974). When comparing the grading of DR severity, very good agreement was achieved between UWF CFP plus UWF SS-OCTA and UWF CFP plusr FFA (κ = 0.869).ConclusionUWF CFP plus UWF SS-OCTA had a very good agreement in detecting DR lesions and determining the severity of DR compared with UWF CFP plus FFA. This modality has the potential to be used as a fast, reliable, and non-invasive method for DR screening and monitoring in the future.
| S-EPMC9667033 | biostudies-literature
Project description:Proliferative diabetic retinopathy (PDR) is a major cause of blindness in diabetic individuals. Optical coherence tomography (OCT) and OCT-angiography (OCTA) are noninvasive imaging techniques useful for the diagnosis and assessment of PDR. We aim to review several recent developments using OCT and discuss their present and potential future applications in the clinical setting. An electronic database search was performed so as to include all studies assessing OCT and/or OCTA findings in PDR patients published from 1 January 2020 to 31 May 2021. Thirty studies were included, and the most recently published data essentially focused on the higher detection rate of neovascularization obtained with widefield-OCT and/or OCTA (WF-OCT/OCTA) and on the increasing quality of retinal imaging with quality levels non-inferior to widefield-fluorescein angiography (WF-FA). There were also significant developments in the study of retinal nonperfusion areas (NPAs) using these techniques and research on the impact of PDR treatment on NPAs and on vascular density. It is becoming increasingly clear that it is critical to use adequate imaging protocols focused on optimized segmentation and maximized imaged retinal area, with ongoing technological development through artificial intelligence and deep learning. These latest findings emphasize the growing applicability and role of noninvasive imaging in managing PDR with the added benefit of avoiding the repetition of invasive conventional FA.
| S-EPMC8535055 | biostudies-literature
Project description:PurposeTo evaluate the use of optical coherence tomography angiography (OCTA), structural OCT and fundus fluorescein angiography (FFA) to distinguish neovascularisation elsewhere (NVE) from intra retinal microvascular abnormalities (IRMA) and their use in early detection and possible risk assessment for vitreous haemorrhage.MethodsA cross-sectional study of a consecutive series of patients with suspected NVE and IRMA using clinical examination and FFA, were examined further with OCT and OCTA. Treated and untreated eyes were also compared.ResultsImages from 33 eyes of 26 patients, showed 27 NVE and 14 IRMA lesions based on clinical examination +/- FFA. Lesions were re-classified as NVE in 22 eyes. Ten eyes had received past treatment. In all 10 treated eyes, vascular flow and vitreous connection were found but not FFA leakage. In 18/22 eyes with NVE there was a breach of the internal limiting membrane (ILM), in 4 eyes there was FFA leak, ILM outpouching but no breach. In two eyes, NVE originated from sea fan IRMA. Ten eyes images were classified as IRMA only with no FFA leak, or ILM breach. The relation of pre-retinal NVE to the vitreous can be visualised.ConclusionLesions, considered to be NVE, after further assessment with OCT and OCTA, can be intra-retinal, with ILM disruption but no ILM breach and leakage on FFA. ILM disruption maybe one of the earliest signs of the development of neovascularisation. Visualisation of the relation to the posterior vitreous is likely to be useful in assessing risk of vitreous haemorrhage.
| S-EPMC8956662 | biostudies-literature
Project description:Background/objectivesTo analyse retinal nerve fibre layer (RNFL) defect measurements obtained from red-free fundus photography and optical coherence tomography (OCT) en face imaging, respectively, and to compare them for the strength of the structure-function association.Subjects/methodsTwo hundred and fifty-six glaucomatous eyes of 256 patients with localized RNFL defect on red-free fundus photography were enrolled. A subgroup analysis included 81 highly myopic eyes (≤ -6.0 dioptres). Angular width of RNFL defect was compared between red-free fundus photography (i.e., red-free RNFL defect) and OCT en face imaging (i.e., en face RNFL defect). The correlation between angular width of each RNFL defect and functional outcomes, reported as mean deviation (MD) and pattern standard deviation (PSD), were assessed and compared.ResultsThe angular width of en face RNFL defect was measured smaller than that of red-free RNFL defect in 91.0% eyes (mean difference, 19.98°). The association of en face RNFL defect with MD and PSD was stronger (R2 = 0.311 and R2 = 0.372, respectively) than that of red-free RNFL defect with MD and PSD (R2 = 0.162 and R2 = 0.137, respectively) (P < 0.05 for all). Especially in highly myopic eyes, the association of en face RNFL defect with MD and PSD was much stronger (R2 = 0.503 and R2 = 0.555, respectively) than that of red-free RNFL defect with MD and PSD (R2 = 0.216 and R2 = 0.166, respectively) (P < 0.05 for all).ConclusionsEn face RNFL defect showed a higher correlation with severity of visual field loss than did red-free RNFL defect. The same dynamic was observed for highly myopic eyes.
| S-EPMC10517176 | biostudies-literature
Project description:PurposeTo compare the quantification of intraretinal hard exudate (HE) using en face optical coherence tomography (OCT) and fundus photography.MethodsConsecutive en face images and corresponding fundus photographs from 13 eyes of 10 patients with macular edema associated with diabetic retinopathy or Coats' disease were analyzed using the machine-learning-based image analysis tool, "ilastik."ResultsThe overall measured HE area was greater with en face images than with fundus photos (en face: 0.49 ± 0.35 mm2 vs. fundus photo: 0.34 ± 0.34 mm2, P < 0.001). However, there was an excellent correlation between the two measurements (intraclass correlation coefficient [ICC] = 0.844). There was a negative correlation between HE area and central macular thickness (CMT) (r = -0.292, P = 0.001). However, HE area showed a positive correlation with CMT in the previous several months, especially in eyes treated with anti-vascular endothelial growth factor (VEGF) therapy (CMT 3 months before: r = 0.349, P = 0.001; CMT 4 months before: r = 0.287, P = 0.012).ConclusionIntraretinal HE can be reliably quantified from either en face OCT images or fundus photography with the aid of an interactive machine learning-based image analysis tool. HE area changes lagged several months behind CMT changes, especially in eyes treated with anti-VEGF injections.
| S-EPMC11624656 | biostudies-literature
Project description:PurposeWe determine the feasibility and accuracy of a computer-assisted diagnostic (CAD) system to diagnose and grade nonproliferative diabetic retinopathy (NPDR) from optical coherence tomography (OCT) images.MethodsA cross-sectional, single-center study was done of type II diabetics who presented for routine screening and/or monitoring exams. Inclusion criteria were age 18 or older, diagnosis of diabetes mellitus type II, and clear media allowing for OCT imaging. Exclusion criteria were inability to image the macula, posterior staphylomas, proliferative diabetic retinopathy, and concurrent retinovascular disease. All patients underwent a full dilated eye exam and spectral-domain OCT of a 6 × 6 mm area of the macula in both eyes. These images then were analyzed by a novel CAD system that segments the retina into 12 layers; quantifies the reflectivity, curvature, and thickness of each layer; and ultimately uses this information to train a neural network that classifies images as either normal or having NPDR, and then further grades the level of retinopathy. A first dataset was tested by "leave-one-subject-out" (LOSO) methods and by 2- and 4-fold cross-validation. The system then was tested on a second, independent dataset.ResultsUsing LOSO experiments on a dataset of images from 80 patients, the proposed CAD system distinguished normal from NPDR subjects with 93.8% accuracy (sensitivity = 92.5%, specificity = 95%) and achieved 97.4% correct classification between subclinical and mild/moderate DR. When tested on an independent dataset of 40 patients, the proposed system distinguished between normal and NPDR subjects with 92.5% accuracy and between subclinical and mild/moderate NPDR with 95% accuracy.ConclusionsA CAD system for automated diagnosis of NPDR based on macular OCT images from type II diabetics is feasible, reliable, and accurate.
| S-EPMC6018370 | biostudies-literature
Project description:PurposeThis study aimed to verify the feasibility of using vascular complexity features for objective differentiation of controls and nonproliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) patients.MethodsThis was a cross-sectional study conducted in a tertiary, subspecialty, academic practice. The cohort included 20 control subjects, 60 NPDR patients, and 56 PDR patients. Three vascular complexity features, including the vessel complexity index, fractal dimension, and blood vessel tortuosity, were derived from each optical coherence tomography angiography image. A shifting-window measurement was further implemented to identify local feature distortions due to localized neovascularization and mesh structures in PDR.ResultsWith mean value analysis of the whole-image, only the vessel complexity index and blood vessel tortuosity were able to classify NPDR versus PDR patients. Comparative shifting-window measurement revealed increased sensitivity of complexity feature analysis, particularly for NPDR versus PDR classification. A multivariate regression model indicated that the combination of all three vascular complexity features with shifting-window measurement provided the best classification accuracy for controls versus NPDR versus PDR.ConclusionVessel complexity index and blood vessel tortuosity were the most sensitive in differentiating NPDR and PDR patients. A shifting-window measurement increased the sensitivity significantly for objective optical coherence tomography angiography classification of diabetic retinopathy.
| S-EPMC8267972 | biostudies-literature
Project description:PurposeTo describe a new technique for mapping parafoveal intercapillary areas (PICAs) using optical coherence tomography angiography (OCTA), and demonstrate its utility for quantifying parafoveal nonperfusion in diabetic retinopathy (DR).MethodsNineteen controls, 15 diabetics with no retinopathy (noDR), 15 with nonproliferative diabetic retinopathy (NPDR), and 15 with proliferative diabetic retinopathy (PDR) were imaged with 10 macular OCTA scans. PICAs were automatically delineated on the averaged superficial OCTA images. Following creation of an eccentricity-specific reference database from the controls, all PICAs greater than 2 SD above the reference means for PICA area and minor axis length were identified as nonperfused areas. Regions of interest (ROI) at 300 μm and 1000 μm from the foveal avascular zone (FAZ) margin were analyzed. Percent nonperfused area was defined as summed nonperfused areas divided by ROI area. Values were compared using Kruskal-Wallis and post-hoc Mann-Whitney U tests.ResultsMedian values for total percent nonperfused area at the 300-μm ROI were 2.09, 2.44, 18.08, and 27.55 in the control, noDR, NPDR, and PDR groups, respectively. Median values at the 1000-μm ROI were 3.10, 3.31, 13.42, and 23.00. While there were no significant differences between the control and noDR groups, significant differences were observed between all other groups at both ROIs.ConclusionsPercent nonperfused area can quantify parafoveal nonperfusion in DR and can be calculated through automatic delineation of PICAs in an eccentricity-specific manner using a standard deviation mapping approach.Translational relevancePercent nonperfused area shows promise as a metric to measure disease severity in diabetic retinopathy.
| S-EPMC6042523 | biostudies-literature
Project description:BackgroundTo analyze the distribution of manifest lesions of diabetic retinopathy (DR) by fundus fluorescein angiography (FFA) and color fundus photography (FP).MethodsA total of 566 eyes of 324 Chinese patients diagnosed with DR were included in this retrospective study. DR severity was graded by the international grading criterion. The distributions of microaneurysms (MA), intraretinal hemorrhages/exudates (He/Ex), intraretinal microvascular abnormality (IRMA), capillary nonperfusion areas (NPA), and neovascularization (NV) were estimated by multiple logistic regression analyse based on nine-field FFA and FP images.ResultsIn mild nonproliferative diabetic retinopathy (NPDR), the highest frequency of MA was found in the posterior pole (67.7%), followed by the inferior nasal (59.4%), and the nasal (55.4%) fields. In moderate NPDR, MA frequently distributed in the posterior pole (98.0%), nasal (97.0%), superior (96.0%), inferior nasal (94.9%), and inferior (92.9%) fields, whereas He/Ex were most prevalent in the posterior pole (69.7%). In severe NPDR and proliferative DR, IRMA, NPA, and NV were more frequent in the nasal field, particularly in the inferior nasal field (60.3, 38.7, and 76.0%, respectively). All lesions were more observed in the combined posterior pole, nasal, and inferior nasal fields than in the posterior pole or combined two fields in the early and severe stages of DR (P < 0.05).ConclusionsThe manifest lesions of DR were common in the nasal field besides the posterior pole in Chinese patients. A combined examination of the posterior pole, nasal, and inferior nasal mid-peripheral retina would help to detect different retinal lesions of DR.Trial registrationClinicalTrial. gov, NCT03528720 . Registered 18 May 2018 - Retrospectively registered.
| S-EPMC7709243 | biostudies-literature
Project description:Vitreomacular interface plays an important role in the pathogenesis and progression of proliferative diabetic retinopathy (PDR). This study investigated the prevalence and risk factors of vitreomacular interface disorders (VMID) in PDR. The macular optical coherence tomography (OCT) scans of 493 eyes from 378 PDR patients were retrospectively reviewed to detect VMID, including vitreomacular adhesion (VMA), vitreomacular traction (VMT), epiretinal membrane (ERM), lamellar hole-associated epiretinal proliferation (LHEP), and macular hole (MH). The associations between VMID and baseline factors, intraretinal structure, and visual acuity were analyzed. The prevalence was 78.9% for ERM, 13.4% for VMT, 4.8% for MH, 2.2% for LHEP, and 2.0% for VMA, respectively. On multivariable analyses (odds ratio, 95% confidence interval), fibrovascular proliferation (FVP) was positively associated with MH (8.029, 1.873-34.420), VMT (3.774, 1.827-7.798), and ERM (2.305, 1.460-3.640). High-risk PDR was another risk factor of ERM (1.846, 1.101-3.090). Female gender was positively associated with MH (3.836, 1.132-13.006), while vitreous hemorrhage was negatively associated with MH (0.344, 0.133-0.890). Eyes with all VMID subtypes showed more frequent macular cysts and tractional retinal detachment with poorer visual acuity (p ≤ 0.001). Therefore, the prevalence of VMID was considerably high, indicating that this distinct entity should be considered in interventions for PDR.
| S-EPMC9224563 | biostudies-literature