Click Here to view online. |
|
Advertisement
|
|
ARVO Annual Meeting
|
May 4, 2022
|
Highlights from Day 3 in Denver covering the latest in vision and ophthalmology!
|
Self-Imaging with Home OCT Appears Accurate for nAMD
People with neovascular age-related AMD (nAMD) may be able to accurately scan their own eyes at home with optical coherence tomography (OCT). In a prospective trial, 15 people who had at least one eye with nAMD undergoing anti-vascular endothelial growth factor (VEGF) treatments scanned themselves at home every day for 3 months with the Notal Vision Home OCT. The system uploaded the images to the cloud, where the Notal OCT Analyzer artificial intelligence (AI) system analyzed them. The mean age of the participants was 70.4 years and their mean visual acuity was 20/40. They conducted an average of 5.7 scans of their eyes per week. The median scan time was 40 seconds, and the scans went faster as participants got more practice. Ninety-three percent of scans could be analyzed. Human experts looking at the images produced by the home OCT agreed with 83% of the retinal fluid status determinations made by the AI analyzer. Looking at images of the same eyes produced by a Spectralis OCT system, the experts agreed with the AI analysis of the home OCT images 96% of the time. Daily imaging showed fluctuations in fluid volume in relation to anti-VEGF injections, and the researchers proposed that this data could be used to guide treatment decisions.
AI System Could Identify Inherited Retinal Diseases
An artificial intelligence (AI) algorithm could identify inherited retinal diseases, allowing more people to get treatment or participate in clinical trials. Retinal scans can reveal causative genes, but the diseases affect about 1 in 3,000 people in the world, and not enough inherited retinal disease experts are available to interpret scans. Investigators at University College London Institute of Ophthalmology and elsewhere in the United Kingdom and Germany trained the Eye2Gene AI algorithm with 44,817 images from 1,907 people with inherited retinal diseases diagnosed at an eye hospital. The images were obtained by fundus autofluorescence, infrared, and spectral domain optical coherence tomography (SD-OCT). The investigators validated the algorithm by using it to analyze images from another 264 patients they had held out from the same hospital. The Eye2Gene produced a top-five accuracy of 88%. Analyzing images from 37 patients from a different hospital, the algorithm’s accuracy dropped to 83%. The researchers next used the Eye2Gene to assess a subset of 50 fundus autofluorescence images. This time the algorithm was 72% accurate. By comparison, eight ophthalmologists analyzing the same 50 fundus autofluorescence images were 78% accurate.
|
A Simplified Evaluation Protocol for nAMD Could Save Time
|
Skipping visual acuity measurements and fundus examinations at some visits could make clinics more efficient in treating nAMD without affecting visual acuity. Because retina clinics are experiencing an overload of patients, the Hadassah Medical Center Department of Ophthalmology in Jerusalem, Israel, created a modified treat-and-extend protocol. In the conventional treat-and-extend protocol, patients get a full evaluation at every visit consisting of a dilated fundus examination, visual acuity measurement and OCT to determine when to administer anti-VEGF injections. In the modified treat-and-extend protocol, patients underwent a full evaluation once in three visits; the only evaluation in the other two visits was by OCT. The researchers compared a cohort of 135 eyes treated through the conventional protocol to a cohort of 119 with similar baseline characteristics treated through the modified protocol. After 36 months of follow-up, the two cohorts had similar anatomical and visual outcomes. But service and waiting times at the OCT-only evaluations were an average of 41 minutes shorter.
|
Steroid Challenges Can Accurately Predict IOP Spikes with Fluocinolone Implants
|
Steroid challenges can accurately predict the risk of a spike in intraocular pressure from a 0.19 mg fluocinolone acetonide implant (Iluvien) in eyes with diabetic macular edema (DME), the results of the phase IV PALADIN study suggest. Compared to intravitreal injections of anti-VEGF drugs, fluocinolone implants require far less frequent interventions, reducing the burden of treatment. However intraocular pressure (IOP) can increase sharply in some eyes implanted with fluocinolone. To evaluate the post-market safety and efficacy of the fluocinolone implants, researchers followed 202 eyes of which 94 were available for follow-up after 36 months. At baseline the eyes had a mean best-corrected visual acuity (BCVA) of 62.3 ETDRS letters. Treated with fewer anti-VEGF injections than optimal, the eyes had been losing visual acuity for 36 months prior to the fluocinolone implants. After receiving the implants, the eyes gained a mean of 4.5 letters in BCVA and also received fewer anti-VEGF treatments over the next 36 months. IOP elevation exceeded 25 mmHg at some point in the 36 months in 29.79% in the 94 patients who completed the study. And 96.6% of these eyes averaged less than 25 mmHg over that period. The researchers determined the predictive value of a steroid challenge by calculating the percentage of eyes whose IOP remained at or below 25 mmHg during the steroid challenge and never exceeded that level after receiving the implant. That percentage was 85.7 if the steroid challenge was one dexamethasone implant, 68.29 if the challenge was more than one dexamethasone implant and 76.92 if the challenge was intravitreal triamcinolone.
|
Signs of Schizophrenia Detected in the Retina
|
Patterns in the branching of retinal blood vessels are associated schizophrenia in people who also have diabetes, and these patterns could be used in screening for the mental health disorder, the results of a new study suggest. Retinal blood vessels exhibit a repeating motif on every magnifying scale. The complexity of this pattern can be measured using fractal dimension. Researchers at Moorfields Eye Hospital NHS Foundation Trust and the University of Dundee in the United Kingdom extracted fractional dimension from 96,995 patients, 676 with schizophrenia, using a software program called Vascular Assessment and Measurement Platform for Images of the Retina (VAMPIRE). After adjusting for age, sex, and hypertension, they found that schizophrenia was associated with reduced retinal fractal dimension (β coefficient= - 0.0034, [P=0.003]), but only among people with diabetes. They theorized that diabetes and schizophrenia could have a compounding effect on cerebral vasculature, or that schizophrenia affects adherence to diabetic medications.
|
That concludes our coverage of the ARVO Annual Meeting!
|
|
Follow us: |
|
|