Glaucoma is a chronic, progressive disease leading to irreversible blindness if left untreated; however, since reducing intraocular pressure has proven to be successful in slowing disease ...progression, little is known about the natural history of untreated glaucoma. This knowledge can be valuable in guiding management decisions in the era of personalized medicine. A systematic search was performed in Medline (PubMed), Embase, and Web of Science in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRIMSA) guidelines. The rate of structural and/or functional progression and conversion to glaucoma or to a more advanced stage of glaucoma are discussed for ocular hypertension and different types of open-angle glaucoma. Forty-three studies were included. Different rates of progression were found both among and within the different diagnostic groups that belong to the open-angle glaucoma spectrum. The highest rate was found in pseudoexfoliation glaucoma, followed by high tension glaucoma, normal tension glaucoma, and ocular hypertension, in decreasing order. The lowest rate was observed in glaucoma suspects. The known rates of progression provide valuable prognostic information for ophthalmologists and patients. Nonetheless, due to high variability among patients, individual progression cannot be accurately predicted and repeated follow-up examinations are required to estimate individual progression.
This umbrella review aimed to summarise the evidence presented in systematic reviews and meta-analyses regarding the effect of physical activity on academic achievement of school-age children and ...adolescents.
A comprehensive electronic search for relevant systematic reviews and meta-analyses were performed in Pubmed, Cochrane Library, Web of Science, Scopus, and Latin American and Caribbean of Health Sciences Information System, and reference lists of the included studies, from inception to May 2020. Studies were included if they were systematic reviews or meta-analyses, included school-age children or adolescents, the intervention included physical activity, and the outcome was the academic achievement. Two independent authors screened the text of potentially eligible studies and assessed the methodological quality of the studies using the AMSTAR 2 tool.
Forty-one systematic reviews and meta-analyses that examined the effects of physical activity on children and adolescents' academic achievement were identified. Overall, the systematic reviews reported small positive or mixed associations between physical activity and academic achievement. From meta-analyses, it was observed that physical activity had null or small-to-medium positive effects on academic achievement. Chronic physical activity showed a medium positive effect on academic achievement, and acute physical activity did not demonstrate benefits.
Physical activity seems not to be detrimental to school-age children and adolescents' academic achievement, and may, in fact, be beneficial.
Although unprecedented sensitivity and specificity values are reported, recent glaucoma detection deep learning models lack in decision transparency. Here, we propose a methodology that advances ...explainable deep learning in the field of glaucoma detection and vertical cup-disc ratio (VCDR), an important risk factor. We trained and evaluated deep learning models using fundus images that underwent a certain cropping policy. We defined the crop radius as a percentage of image size, centered on the optic nerve head (ONH), with an equidistant spaced range from 10-60% (ONH crop policy). The inverse of the cropping mask was also applied (periphery crop policy). Trained models using original images resulted in an area under the curve (AUC) of 0.94 95% CI 0.92-0.96 for glaucoma detection, and a coefficient of determination (R
) equal to 77% 95% CI 0.77-0.79 for VCDR estimation. Models that were trained on images with absence of the ONH are still able to obtain significant performance (0.88 95% CI 0.85-0.90 AUC for glaucoma detection and 37% 95% CI 0.35-0.40 R
score for VCDR estimation in the most extreme setup of 60% ONH crop). Our findings provide the first irrefutable evidence that deep learning can detect glaucoma from fundus image regions outside the ONH.
A growing number of studies have reported a link between vascular damage and glaucoma based on optical coherence tomography angiography (OCTA) imaging. This multitude of studies focused on different ...regions of interest (ROIs) which offers the possibility to draw conclusions on the most discriminative locations to diagnose glaucoma. The objective of this work was to review and analyse the discriminative capacity of vascular density, retrieved from different ROIs, on differentiating healthy subjects from glaucoma patients. PubMed was used to perform a systematic review on the analysis of glaucomatous vascular damage using OCTA. All studies up to 21 April 2019 were considered. The ROIs were analysed by region (macula, optic disc and peripapillary region), layer (superficial and deep capillary plexus, avascular, whole retina, choriocapillaris and choroid) and sector (according to the Garway–Heath map). The area under receiver operator characteristic curve (AUROC) and the statistical difference (p‐value) were used to report the importance of each ROI for diagnosing glaucoma. From 96 screened studies, 43 were eligible for this review. Overall, the peripapillary region showed to be the most discriminative region with the highest mean AUROC (0.80 ± 0.09). An improvement of the AUROC from this region is observed when a sectorial analysis is performed, with the highest AUROCs obtained at the inferior and superior sectors of the superficial capillary plexus in the peripapillary region (0.86 ± 0.03 and 0.87 ± 0.10, respectively). The presented work shows that glaucomatous vascular damage can be assessed using OCTA, and its added value as a complementary feature for glaucoma diagnosis depends on the region of interest. A sectorial analysis of the superficial layer at the peripapillary region is preferable for assessing glaucomatous vascular damage.
•REFUGE, the first challenge on glaucoma assessment from fundus images.•A data set of 1200 images with reliable ground truth labels is publicly released.•An evaluation setup for glaucoma ...classification and optic disc/cup segmentation.•12 deep learning methods participating in the challenge are evaluated and discussed.•Good practices are identified based on the outcomes of the participating teams.
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Glaucoma is one of the leading causes of irreversible but preventable blindness in working age populations. Color fundus photography (CFP) is the most cost-effective imaging modality to screen for retinal disorders. However, its application to glaucoma has been limited to the computation of a few related biomarkers such as the vertical cup-to-disc ratio. Deep learning approaches, although widely applied for medical image analysis, have not been extensively used for glaucoma assessment due to the limited size of the available data sets. Furthermore, the lack of a standardize benchmark strategy makes difficult to compare existing methods in a uniform way. In order to overcome these issues we set up the Retinal Fundus Glaucoma Challenge, REFUGE (https://refuge.grand-challenge.org), held in conjunction with MICCAI 2018. The challenge consisted of two primary tasks, namely optic disc/cup segmentation and glaucoma classification. As part of REFUGE, we have publicly released a data set of 1200 fundus images with ground truth segmentations and clinical glaucoma labels, currently the largest existing one. We have also built an evaluation framework to ease and ensure fairness in the comparison of different models, encouraging the development of novel techniques in the field. 12 teams qualified and participated in the online challenge. This paper summarizes their methods and analyzes their corresponding results. In particular, we observed that two of the top-ranked teams outperformed two human experts in the glaucoma classification task. Furthermore, the segmentation results were in general consistent with the ground truth annotations, with complementary outcomes that can be further exploited by ensembling the results.
ABSTRACT
Purpose
To present real‐world adalimumab (ADA) efficacy and safety outcomes in non‐infectious uveitis (NIU) from a single United Kingdom (UK) tertiary centre.
Methods
Retrospective review of ...adult patients with NIU treated with ADA. Data were collected at baseline, 6 and 12 months. The primary goal was to evaluate the rate of treatment failure, using the VISUAL‐I/II studies criteria, during 12 months of follow‐up. Secondary aims were to quantify corticosteroid‐sparing effect; to identify safety issues; to assess change in visual acuity; to identify reasons for treatment failure and to compare treatment outcomes at 6 and 12 months for patients classified as active or inactive at baseline.
Results
Fifty‐one patients (102 eyes) with mean age of 48.3 years were included. One third had a known underlying systemic disease and 47.6% had panuveitis. The most common indication for ADA was failure to respond to oral immunosuppression. Treatment failure occurred in 9/51 patients (10 eyes) after 6 months and 13/51 (20 eyes) patients after 12 months. The need for rescue treatment in the 12 months prior to ADA was significantly associated with treatment failure at 12 months. The mean prednisolone dosage was <10 mg/day at 6 and 12 months. There were no serious adverse events.
Conclusion
Patients with NIU who received ADA therapy for 12 months were likely to achieve disease control, to stabilize or improve visual acuity, to experience a reduction in immunosuppression and to reduce corticosteroid dosage. No new safety events were observed.
Purpose
Vascular factors have been suggested to influence the development and progression of glaucoma. They are thought to be especially relevant for normal‐tension glaucoma (NTG) patients. We aim to ...investigate which vascular factors, including advanced vascular examinations, better describe patients with NTG comparing to those with primary open‐angle glaucoma (POAG).
Methods
The Leuven Eye Study database (182 NTG and 202 POAG patients; similar structural and functional damage) was used to compute three multivariate logistic regression models: a conventional model (conventional parameters only, including vascular‐related self‐reported phenomena, such as migraine or peripheral vasospasm); an advanced vascular model (advanced vascular parameters only: colour Doppler imaging (CDI), retinal oximetry, ocular pulse amplitude and choroidal thickness); and a global model, in which both types of parameters were allowed. Receiver operating characteristic (ROC) curves and corresponding areas under the curve (AUC) were calculated and compared between models.
Results
Patients with NTG had a higher resistive index and lower early systolic acceleration (ESA) in their retrobulbar vessels and a smaller arteriovenous retinal oxygen saturation difference. The global model (AUC 0.743) showed a significantly better discriminative ability when compared to either the conventional (AUC 0.687, p = 0.049) or the advanced vascular (AUC 0.677, p = 0.005) models. Also, the conventional and the advanced vascular models showed a similar discriminative ability (p = 0.823).
Conclusion
Patients with NTG have more signs of vascular dysfunction. Clinical conventional parameters, such as asking simple vascular‐related questions, combined with advanced vascular examinations provide information to better understand the value that non‐IOP‐related factors play in NTG.
Purpose
Glaucoma studies have long taken into account the blood pressure (BP) status of patients. This study summarizes and evaluates the impact of the different criteria that have been used for ...BP‐related variables in glaucoma research.
Methods
Studies included in two meta‐analyses that reviewed the role of BP in glaucoma were analyzed. Additional studies published after the search periods of the meta‐analyses were also included. Criteria for the definition of arterial hypertension and other BP‐related variables, such as mean arterial pressure (MAP) and mean ocular perfusion pressure (MOPP), were retrieved.
Results
Sixty‐four studies were evaluated. One‐third used 140 mmHg as a systolic BP cut‐off to define hypertension, 20% used 160 mmHg and the remaining half used various other criteria. Less than 20% of studies reported MAP and/or MOPP. While eight of the ten studies reporting MAP used a correct formula that only happened for five of the eleven studies reporting MOPP. Using as an example average blood pressure values, incorrectly used formulas could have led to an overestimation of more than 100% of the expected values.
Conclusion
Considerable heterogeneity exists in BP‐related variables in glaucoma research and different definitions can lead to large disparities. Glaucoma research would benefit from a consensus regarding blood pressure parameters.
Management of ocular arterial ischemic diseases: a review Vilares-Morgado, Rodrigo; Nunes, Hugo Miguel Meireles; dos Reis, Ricardo Soares ...
Graefe's archive for clinical and experimental ophthalmology,
01/2023, Letnik:
261, Številka:
1
Journal Article
Recenzirano
Purpose
To summarize the existing treatment options regarding central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO), arteritic anterior ischemic optic neuropathy (AAION), ...non-arteritic anterior ischemic optic neuropathy (NAION), and ocular ischemic syndrome (OIS), proposing an approach to manage and treat these patients.
Methods
A systematic literature search of articles published since 1st January 2010 until 31st December 2020 was conducted using MEDLINE (PubMed), Scopus, and Web of Science. Exclusion criteria included case reports, non-English references, articles not conducted in humans, and articles not including diagnostic or therapeutic options. Further references were gathered through citation tracking, by hand search of the reference lists of included studies, as well as topic-related European society guidelines.
Results
Acute ocular ischemia, with consequent visual loss, has a variety of causes and clinical presentations, with prognosis depending on an accurate diagnosis and timely therapeutic implementation. Unfortunately, most of the addressed entities do not have a standardized management, especially regarding their treatment, which often lacks good quality evidence on whether it should or not be used to treat patients.
Conclusion
Ophthalmologic signs and symptoms may be a warning sign of cardiovascular or cerebrovascular events, namely stroke. Most causes of acute ocular ischemia do not have a standardized management, especially regarding their treatment. Timely intervention is essential to improve the visual, and possibly vital, prognosis. Awareness must be raised among non-ophthalmologist clinicians that might encounter these patients. Further research should focus on assessing the benefit of the management strategies already being employed .
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