1. Articles from pearse a. keane

    1-24 of 89 1 2 3 4 »
    1. The eye, the kidney, and cardiovascular disease: old concepts, better tools, and new horizons

      The eye, the kidney, and cardiovascular disease: old concepts, better tools, and new horizons

      Chronic kidney disease (CKD) is common, with hypertension and diabetes mellitus acting as major risk factors for its development. Cardiovascular disease is the leading cause of death worldwide and the most frequent end point of CKD. There is an urgent need for more precise methods to identify patients at risk of CKD and cardiovascular disease. Alterations in microvascular structure and function contribute to the development of hypertension, diabetes, CKD, and their associated cardiovascular disease. Homology between the eye and the kidney suggests that noninvasive imaging of the retinal vessels can detect these microvascular alterations to improve targeting of at-risk patients ...

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    2. Predicting conversion to wet age-related macular degeneration using deep learning

      Predicting conversion to wet age-related macular degeneration using deep learning

      Progression to exudative ‘wet’ age-related macular degeneration (exAMD) is a major cause of visual deterioration. In patients diagnosed with exAMD in one eye, we introduce an artificial intelligence (AI) system to predict progression to exAMD in the second eye. By combining models based on three-dimensional (3D) optical coherence tomography images and corresponding automatic tissue maps, our system predicts conversion to exAMD within a clinically actionable 6-month time window, achieving a per-volumetric-scan sensitivity of 80% at 55% specificity, and 34% sensitivity at 90% specificity. This level of performance corresponds to true positives in 78% and 41% of individual eyes, and false ...

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    3. Widefield optical coherence tomography angiography for early detection and objective evaluation of proliferative diabetic retinopathy

      Widefield optical coherence tomography angiography for early detection and objective evaluation of proliferative diabetic retinopathy

      Purpose To evaluate the utility of widefield optical coherence tomography angiography (WF-OCTA) compared with clinical examination in grading diabetic retinopathy in patients diagnosed clinically with proliferative diabetic retinopathy (PDR) or severe non-proliferative diabetic retinopathy (NPDR). Design This retrospective observational case series included patients diagnosed clinically with PDR or severe NPDR. Patients underwent standard clinical examination and WF-OCTA imaging (PLEX Elite 9000, Carl Zeiss Meditec AG) using 12×12 montage scans between August 2018 and January 2019. Two trained graders identified neovascularisation at the disc (NVD) and neovascularisation elsewhere (NVE) on WF-OCTA which were compared with the clinical examination, and to ...

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    4. Automated Pupillometry using a Prototype Binocular Optical Coherence Tomography System

      Automated Pupillometry using a Prototype Binocular Optical Coherence Tomography System

      Purpose To determine the test-retest reliability and diagnostic accuracy of a binocular optical coherence tomography (OCT) prototype (Envision Diagnostics, USA) for pupillometry. Design Assessment of diagnostic reliability and accuracy. Methods Fifty participants with RAPD confirmed using the swinging flashlight method (mean age 49.6 years) and 50 healthy controls (mean age 31.3 years) were examined. Participants twice underwent an automated pupillometry exam using a binocular OCT system that presents a stimulus and simultaneously captures OCT images of the iris-pupil plane of both eyes. Participants underwent a single exam on the RAPDx (Konan Inc, USA), an automated infrared pupillometer. Pupil ...

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    5. Subclinical Macular Changes And Disease Laterality In Pediatric Coats Disease Determined By Quantitative Optical Coherence Tomography Angiography

      Subclinical Macular Changes And Disease Laterality In Pediatric Coats Disease Determined By Quantitative Optical Coherence Tomography Angiography

      Purpose: To determine vascular change at the macula in both eyes in unilateral pediatric Coats disease using optical coherence tomography angiography. Methods: Retrospective case-series. Thirteen eyes of pediatric patients with a diagnosis of unilateral Coats disease of various stages were compared with 13 fellow eyes. Optical coherence tomography angiography images were acquired using the RTVue XR Avanti. Scans were analyzed with novel projection artifact removal software and improved segmentation. Vascular density and foveal avascular zone area were calculated. Results: Vascular density was significantly decreased in eyes with Coats disease in comparison with fellow eyes in both the superficial capillary plexus ...

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    6. Optical coherence tomography (OCT) in unconscious and systemically unwell patients using a mobile OCT device: a pilot study

      Optical coherence tomography (OCT) in unconscious and systemically unwell patients using a mobile OCT device: a pilot study

      Objective This study aims to evaluate the feasibility of retinal imaging in critical care using a novel mobile optical coherence tomography (OCT) device. The Heidelberg SPECTRALIS FLEX module (Heidelberg Engineering, Heidelberg, Germany) is an OCT unit with a boom arm, enabling ocular OCT assessment in less mobile patients. Design We undertook an evaluation of the feasibility of using the SPECTRALIS FLEX for undertaking ocular OCT images in unconscious and critically ill patients. Setting This study was conducted in the critical care unit of a large tertiary referral unit in the United Kingdom. Participants 13 systemically unwell patients admitted to the ...

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    7. Objective evaluation of proliferative diabetic retinopathy using optical coherence tomography

      Objective evaluation of proliferative diabetic retinopathy using optical coherence tomography

      Purpose To present the routine use of optical coherence tomography (OCT) and OCT angiography (OCTA) for the objective diagnosis and monitoring of proliferative diabetic retinopathy (PDR). Design Retrospective observational case series. Subjects Patients with diabetic retinopathy imaged using a standardized PDR-protocol Methods Patients routinely imaged with a standardized PDR-protocol between March 2017 and January 2019 were included. This included a 12x9 mm structural OCT volume centered on the macula and a 6x6 mm OCTA scan centered on the optic nerve head obtained using a Topcon swept-source system (DRI OCT-1 Triton, Topcon, Tokyo, Japan). Ultra-widefield fluorescein angiography (FA) was also performed ...

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    8. OCT Angiography in Acute Posterior Multifocal Placoid Pigment Epitheliopathy

      OCT Angiography in Acute Posterior Multifocal Placoid Pigment Epitheliopathy

      BACKGROUND AND OBJECTIVE: To describe retinal and choroidal findings in different stages of acute posterior multifocal placoid pigment epitheliopathy (APMPPE). PATIENTS AND METHODS: Retrospective, noncomparative case series studied by fundus biomicroscopy, fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography (ICGA), spectral-domain optical coherence tomographic (SD-OCT), and swept-source OCT angiography (SS-OCTA). RESULTS: Six eyes of three patients with bilateral APMPPE were included. FAF showed multifocal, branched patches of hyperautofluorescence with areas of hypoautofluorescence; FA disclosed early hypofluorescence, with late-phase hyperfluorescence; ICGA showed early and late-phase hypofluorescence. SD-OCT imaging revealed bilateral retinal thinning, external limiting membrane (ELM) disruption, and severe alteration ...

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    9. Anterior segment optical coherence tomographic angiography assessment of acute chemical injury

      Anterior segment optical coherence tomographic angiography assessment of acute chemical injury

      Purpose To compare routine clinical examination with optical coherence tomography angiography (OCTA) for the assessment of limbal conjunctival ischemia following a chemical burn. Setting Validity analysis Methods We assessed ten participants (15 eyes) with an acute chemical injury. Clinical photographs were used to determine the extent of any limbal conjunctival epithelial defect and ischemia. These were compared with the extent of limbal ischemia identified on OCTA images of the ocular surface. Quantitative and longitudinal analysis using the OCTA software were also performed. Correlations with visual outcome were sought using clinical and OCTA-derived variables. Results The extent of clinically determined limbal ...

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    10. Effect of total anti-VEGF treatment exposure on patterns of choroidal neovascularisation assessed by optical coherence tomography angiography in age-related macular degeneration: a retrospective case series

      Effect of total anti-VEGF treatment exposure on patterns of choroidal neovascularisation assessed by optical coherence tomography angiography in age-related macular degeneration: a retrospective case series

      Objective To compare clinical characteristics of patients suffering from neovascular age-related macular degeneration (nAMD) with mature and immature choroidal neovascularisation (CNV) as assessed by optical coherence tomography angiography (OCTA). To explore the effect of total anti-vascular endothelial growth factor exposure on the occurrence of mature CNV when correcting for potential confounders. Methods and analysis In this retrospective case series, we included 40 eyes of 36 patients with nAMD with CNV assessed by OCTA at the Manchester Eye Hospital between June 2016 and June 2017. A retinal specialist masked to patient information graded CNV depicted on OCTA scans. For statistical comparisons ...

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    11. Test performance of optical coherence tomography angiography in detecting retinal diseases: a systematic review and meta-analysis

      Test performance of optical coherence tomography angiography in detecting retinal diseases: a systematic review and meta-analysis

      Objective To investigate the diagnostic accuracy of optical coherence tomography angiography (OCTA) in detecting vascular characteristics of chorio-retinal disease. Methods Evidence acquisition: We searched Web of Science, Scopus, and Medline by the citation of references and complemented these electronic searches by checking the list of references of included and review articles. Screening, selection, assessment, and extraction was performed in parallel by two authors. Results Evidence synthesis: Systematic review and exploratory meta-analysis. The ten studies that contributed to the meta-analysis enrolled 440 eyes and allowed constructing ten two-by-two tables. The tables reported on detection of choroidal neovascularization (CNV) in eyes suffering ...

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      Mentions: Pearse A. Keane
    12. Predicting optical coherence tomography-derived diabetic macular edema grades from fundus photographs using deep learning

      Predicting optical coherence tomography-derived diabetic macular edema grades from fundus photographs using deep learning

      Diabetic eye disease is one of the fastest growing causes of preventable blindness. With the advent of anti-VEGF (vascular endothelial growth factor) therapies, it has become increasingly important to detect center-involved diabetic macular edema. However, center-involved diabetic macular edema is diagnosed using optical coherence tomography (OCT), which is not generally available at screening sites because of cost and workflow constraints. Instead, screening programs rely on the detection of hard exudates as a proxy for DME on color fundus photographs, often resulting in high false positive or false negative calls. To improve the accuracy of DME screening, we trained a deep ...

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    13. Artificial intelligence and deep learning in ophthalmology

      Artificial intelligence and deep learning in ophthalmology

      Artificial intelligence (AI) based on deep learning (DL) has sparked tremendous global interest in recent years. DL has been widely adopted in image recognition, speech recognition and natural language processing, but is only beginning to impact on healthcare. In ophthalmology, DL has been applied to fundus photographs, optical coherence tomography and visual fields, achieving robust classification performance in the detection of diabetic retinopathy and retinopathy of prematurity, the glaucoma-like disc, macular oedema and age-related macular degeneration. DL in ocular imaging may be used in conjunction with telemedicine as a possible solution to screen, diagnose and monitor major eye diseases for ...

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    14. Clinically applicable deep learning for diagnosis and referral in retinal disease

      Clinically applicable deep learning for diagnosis and referral in retinal disease

      The volume and complexity of diagnostic imaging is increasing at a pace faster than the availability of human expertise to interpret it. Artificial intelligence has shown great promise in classifying two-dimensional photographs of some common diseases and typically relies on databases of millions of annotated images. Until now, the challenge of reaching the performance of expert clinicians in a real-world clinical pathway with three-dimensional diagnostic scans has remained unsolved. Here, we apply a novel deep learning architecture to a clinically heterogeneous set of three-dimensional optical coherence tomography scans from patients referred to a major eye hospital. We demonstrate performance in ...

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    15. Feature Of The Week 07/08/2018: Retinal Nerve Fibre Layer Thickness & Cognition - Results from UK Biobank

      Feature Of The Week 07/08/2018: Retinal Nerve Fibre Layer Thickness & Cognition - Results from UK Biobank

      Importance: Identifing potential screening tests for future cognitive decline is a priority for developing treatments for and the prevention of dementia. Objective: To examine the potential of retinal nerve fiber layer (RNFL) thickness measurement in identifying those at greater risk of cognitive decline in a large community cohort of healthy people. Design, Setting, and Participants: UK Biobank is a prospective, multicenter, community-based study of UK residents aged 40 to 69 years at enrollment who underwent baseline retinal optical coherence tomography imaging, a physical examination, and a questionnaire. The pilot study phase was conducted from March 2006 to June 2006, and ...

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    16. Association of Retinal Nerve Fiber Layer Thinning With Current and Future Cognitive Decline A Study Using Optical Coherence Tomography

      Association of Retinal Nerve Fiber Layer Thinning With Current and Future Cognitive Decline A Study Using Optical Coherence Tomography

      Importance Identifing potential screening tests for future cognitive decline is a priority for developing treatments for and the prevention of dementia. Objective To examine the potential of retinal nerve fiber layer (RNFL) thickness measurement in identifying those at greater risk of cognitive decline in a large community cohort of healthy people. Design, Setting, and Participants UK Biobank is a prospective, multicenter, community-based study of UK residents aged 40 to 69 years at enrollment who underwent baseline retinal optical coherence tomography imaging, a physical examination, and a questionnaire. The pilot study phase was conducted from March 2006 to June 2006, and ...

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    17. Use of a Binocular Optical Coherence Tomography System to Evaluate Strabismus in Primary Position

      Use of a Binocular Optical Coherence Tomography System to Evaluate Strabismus in Primary Position

      Importance Current clinical methods for assessing strabismus can be prone to error. Binocular optical coherence tomography (OCT) has the potential to assess and quantify strabismus objectively and in an automated manner. Objective To evaluate the use of a binocular OCT prototype to assess the presence and size of strabismus. Design, Setting, and Participants Fifteen participants with strabismus were recruited in 2016 as part of the EASE study from Moorfields Eye Hospital National Health Service Foundation Trust, London, England, and 15 healthy volunteers underwent automated anterior segment imaging using the binocular OCT prototype. All participants had an orthoptic assessment, including alternating ...

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    18. Optical coherence tomography angiography: a review of current and future clinical applications

      Optical coherence tomography angiography: a review of current and future clinical applications

      Optical coherence tomography angiography is a non-invasive imaging technique that now allows for simultaneous in vivo imaging of the morphology as well as the vasculature in the eye. In this review, we provide an update on the existing clinical applications of optical coherence tomography angiography technology from the anterior to posterior segment of the eye. We also discuss the limitations of optical coherence tomography angiography technology, as well as the caveats to the interpretation of images. As current optical coherence tomography angiography systems are optimized for the retina, most studies have focused on interpreting images from conditions such as age ...

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    19. Characteristic optical coherence tomography findings in patients with primary vitreoretinal lymphoma: a novel aid to early diagnosis

      Characteristic optical coherence tomography findings in patients with primary vitreoretinal lymphoma: a novel aid to early diagnosis

      Background The diagnosis of primary vitreoretinal lymphoma (PVRL) poses significant difficulties; presenting features are non-specific and confirmation usually necessitates invasive vitreoretinal biopsy. Diagnosis is often delayed, resulting in increased morbidity and mortality. Non-invasive imaging modalities such as spectral domain optical coherence tomography (SD-OCT) offer simple and rapid aids to diagnosis. We present characteristic SD-OCT images of patients with biopsy-positive PVRL and propose a number of typical features, which we believe are useful in identifying these lesions at an early stage. Methods Medical records of all patients attending Moorfields Eye Hospital between April 2010 and April 2016 with biopsy-positive PVRL were ...

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    20. Segmentation error in spectral domain optical coherence tomography measures of the retinal nerve fibre layer thickness in idiopathic intracranial hypertension

      Segmentation error in spectral domain optical coherence tomography measures of the retinal nerve fibre layer thickness in idiopathic intracranial hypertension

      Background Optical Coherence Tomography (OCT) imaging is being increasingly used in clinical practice for the monitoring of papilloedema. The aim is to characterise the extent and location of the Retinal Nerve Fibre Layer (RNFL) Thickness automated segmentation error (SegE) by manual refinement, in a cohort of Idiopathic Intracranial Hypertension (IIH) patients with papilloedema and compare this to controls. Methods Baseline Spectral Domain OCT (SDOCT) scans from patients with IIH, and controls with no retinal or optic nerve pathology, were examined. The internal limiting membrane and RNFL thickness of the most severely affected eye was examined for SegE and re-segmented. Using ...

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    21. A Study of the Natural History of Vitreomacular Traction Syndrome by OCT

      A Study of the Natural History of Vitreomacular Traction Syndrome by OCT

      Purpose To examine the natural history of vitreomacular traction syndrome (VMTS) in the absence of other ocular comorbidities. Design Retrospective clinical case series. Participants A total of 183 eyes of 159 patients diagnosed with VMTS with no other ocular comorbidity. Methods Patients with VMTS were identified from an OCT database at Moorfields Eye Hospital, London. Sequential OCT scans and patient notes were reviewed over a minimum period of 6 months. Data collected included patient demographics, best-corrected visual acuity, and OCT features of vitreomacular adhesion. Contingency tests and binary logistic modeling were used to identify baseline predictors of stability and progression ...

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      Mentions: Pearse A. Keane
    22. Optical coherence tomography angiography of foveal hypoplasia

      Optical coherence tomography angiography of foveal hypoplasia

      Aims To discuss foveal development in the context of detailed retinal vasculature imaging in foveal hypoplasia using optical coherence tomography angiography. Methods In this case series, the optical coherence tomography angiography results of four patients with idiopathic foveal hypoplasia and two patients with foveal hypoplasia secondary to oculocutaneous albinism are presented. Results Cases with intact visual acuity demonstrated lower grades of foveal hypoplasia on optical coherence tomography, while those with poor vision demonstrated high grades of foveal hypoplasia. The superficial retinal capillary plexus was intact in the foveal area in all cases, with no demonstrable foveal avascular zone. The deep ...

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    23. Human Factor and Usability Testing of a Binocular Optical Coherence Tomography System

      Human Factor and Usability Testing of a Binocular Optical Coherence Tomography System

      Purpose : To perform usability testing of a binocular optical coherence tomography (OCT) prototype to predict its function in a clinical setting, and to identify any potential user errors, especially in an elderly and visually impaired population. Methods : Forty-five participants with chronic eye disease (mean age 62.7 years) and 15 healthy controls (mean age 53 years) underwent automated eye examination using the prototype. Examination included ‘whole-eye' OCT, ocular motility, visual acuity measurement, perimetry, and pupillometry. Interviews were conducted to assess the subjective appeal and ease of use for this cohort of first-time users. Results : All participants completed the full suite ...

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    24. The Application of Infrared Imaging and Optical Coherence Tomography of the Lacrimal Punctum in Patients Undergoing Punctoplasty for Epiphora

      The Application of Infrared Imaging and Optical Coherence Tomography of the Lacrimal Punctum in Patients Undergoing Punctoplasty for Epiphora

      Purpose To determine the application of imaging the stenotic lacrimal punctum with infrared photographs and optical coherence tomography (OCT) and to identify characteristics of the lacrimal punctum in patients who benefit from punctoplasty. Design Case-control study. Participants Twenty patients with epiphora who were listed for punctoplasty and 20 healthy controls. Methods Prospectively, 20 patients listed for punctoplasty were asked to rate their epiphora, using the Munk score, before and after punctoplasty. They also underwent preoperative OCT and infrared imaging of the affected punctum. They were divided into 2 groups, depending on whether the epiphora improved, and were compared with 20 ...

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      Mentions: Pearse A. Keane
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