1. Articles from Cynthia A. Toth

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    1. OCULAR MANIFESTATIONS OF PORETTI-BOLTSHAUSER SYNDROME: FINDINGS FROM MULTIMODAL IMAGING AND ELECTROPHYSIOLOG

      OCULAR MANIFESTATIONS OF PORETTI-BOLTSHAUSER SYNDROME: FINDINGS FROM MULTIMODAL IMAGING AND ELECTROPHYSIOLOG

      Background/Purpose: Poretti-Boltshauser syndrome is a rare, nonprogressive neurologic syndrome with characteristic cerebellar cysts on neuroimaging due to mutations in LAMA1 . The ophthalmic findings in Poretti-Boltshauser syndrome are not well described. Here, we report the ophthalmic findings from multimodal imaging and electrophysiology of a patient with genetically confirmed Poretti-Boltshauser syndrome . Methods: A 3-year-old boy with confirmed mutations in LAMA1 underwent examination under anesthesia with electroretinography and multimodal imaging including fundus photography, fluorescein angiography , optical coherence tomography , and optical coherence tomography angiography . Results: Dilated fundus examination was notable for retinal vascular anomalies, including a large area of nonperfusion in the temporal ...

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    2. Microvascular Features of Treated Retinoblastoma Tumors in Children Assessed Using OCTA

      Microvascular Features of Treated Retinoblastoma Tumors in Children Assessed Using OCTA

      BACKGROUND AND OBJECTIVE: To describe the microvascular features of treated, clinically regressed, or reactivated retinoblastoma lesions using an investigational portable optical coherence tomography angiography (OCTA) system. PATIENTS AND METHODS: Single-center, prospective, cross-sectional, consecutive case-series of children with previously treated retinoblastoma who underwent portable OCTA of posterior retinoblastoma lesions. RESULTS: Eight tumors from seven eyes of five children with retinoblastoma were included. Tumors with types 1 (calcified remnant, n = 3), 2 (non-calcified remnant, n = 1), and 3 (both calcified and noncalcified remnants, n = 1) regression revealed persistent intrinsic superficial vasculature on OCTA (five of five lesions; 100%). Lesions with type 4 ...

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    3. Appearance of pediatric choroidal neovascular membranes on optical coherence tomography angiography

      Appearance of pediatric choroidal neovascular membranes on optical coherence tomography angiography

      Purpose Compared with fluorescein angiography (FA), the gold standard for diagnosing choroidal neovascularization (CNV) activity, optical coherence tomography angiography (OCTA) is non-invasive without risks associated with fluorescein dye use, and may be especially advantageous in the diagnosis and monitoring of children with CNV. Methods Eight eyes from eight patients aged 12 months to 18 years were imaged with the investigational Spectralis OCTA (version 6.9, Heidelberg Engineering, Heidelberg, Germany) and the RTVue XR Avanti (Optovue Inc., Fremont, CA, USA). Two patients were imaged during examination under anesthesia while six patients were imaged in the clinic. Demographic information, ocular characteristics, treatment ...

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    4. Handheld Optical Coherence Tomography Normative Inner Retinal Layer Measurements for Children <5 Years

      Handheld Optical Coherence Tomography Normative Inner Retinal Layer Measurements for Children <5 Years

      Purpose Measurements of the ganglion cell complex (GCC), comprising the retinal nerve fiber (RNFL), ganglion cell, and inner plexiform layers, can be correlated with vision loss caused by optic nerve disease. Handheld optical coherence tomography (HH-OCT) can be used with sedation in children not amenable to traditional imaging. Purpose: to report GCC and RNFL measurements in normal children using HH-OCT. Design Prospective observational study of normal children ≤ 5-years of age. Methods Healthy, full-term children ≤5 years-old undergoing sedation or anesthesia were enrolled. Exclusion criteria: prematurity, pre-existing neurologic, genetic, metabolic or intraocular pathology. Demographic data, axial length (Master-Vu Sonomed Escalon, NY ...

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    5. Handheld Optical Coherence Tomography Normative Inner Retinal Layer Measurements for Children

      Handheld Optical Coherence Tomography Normative Inner Retinal Layer Measurements for Children

      Purpose Measurements of the ganglion cell complex (GCC), comprising the retinal nerve fiber (RNFL), ganglion cell, and inner plexiform layers, can be correlated with vision loss caused by optic nerve disease. Handheld optical coherence tomography (HH-OCT) can be used with sedation in children not amenable to traditional imaging. Purpose: to report GCC and RNFL measurements in normal children using HH-OCT. Design Prospective observational study of normal children ≤ 5-years of age. Methods Healthy, full-term children ≤5 years-old undergoing sedation or anesthesia were enrolled. Exclusion criteria: prematurity, pre-existing neurologic, genetic, metabolic or intraocular pathology. Demographic data, axial length (Master-Vu Sonomed Escalon, NY ...

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    6. Macular Microvascular Findings in Familial Exudative Vitreoretinopathy on Optical Coherence Tomography Angiography

      Macular Microvascular Findings in Familial Exudative Vitreoretinopathy on Optical Coherence Tomography Angiography

      BACKGROUND AND OBJECTIVE: To describe depth-resolved macular microvasculature abnormalities in patients with familial exudative vitreoretinopathy (FEVR) using optical coherence tomography angiography (OCTA). PATIENTS AND METHODS: Twenty-two eyes (11 eyes of six patients with FEVR and 11 control eyes) were imaged with OCTA. Graders qualitatively analyzed the OCTA images of the superficial and deep vascular complexes for abnormal vascular features and compared to fluorescein angiography (FA). RESULTS: Seven of 11 eyes with FEVR displayed abnormal macular vascular findings. Abnormalities in the superficial vascular complex included dilation, disorganization, straightening, heterogeneous vessel density, and curls/loops. In the deep vascular complex, abnormalities included ...

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    7. Handbook of Pediatric Retinal OCT and the Eye-Brain Connection 1st Edition (Textbook)

      Handbook of Pediatric Retinal OCT and the Eye-Brain Connection 1st Edition (Textbook)

      Optical Coherence Tomography (OCT) plays a vital role in pediatric retina diagnosis , often revealing unrecognized retinal disorders and connections to brain injury, disease, and delayed neurodevelopment. Handbook of Pediatric Retinal OCT and the Eye-Brain Connection provides authoritative, up-to-date guidance in this promising area , showing how to optimize imaging in young children and infants, how to accurately interpret these images, and how to identify links between these images and brain and developmental disorders.

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    8. Comparison of Optical Coherence Tomography With Fundus Photographs, Fluorescein Angiography, and Histopathologic Analysis in Assessing Coats Disease

      Comparison of Optical Coherence Tomography With Fundus Photographs, Fluorescein Angiography, and Histopathologic Analysis in Assessing Coats Disease

      Importance Coats disease is a rare pediatric vitreoretinopathy that can cause devastating visual and anatomic outcomes. Objective To compare optical coherence tomography (OCT) with fundus photographs, fluorescein angiography (FA), and histopathologic findings in Coats disease. Design, Setting, and Participants This retrospective cohort study was conducted in a single tertiary institution (Duke Eye Center) and identified 28 children with Coats disease through a review of medical records from December 2002 to January 2018. Four eyes were obtained from a biorepository for histopathologic analysis. Main Outcomes and Measures Macular OCT, fundus photographs, and FA results were reviewed and compared for morphological changes ...

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    9. Depth-Based, Motion-Stabilized Colorization of Microscope-Integrated Optical Coherence Tomography Volumes for Microscope-Independent Microsurgery

      Depth-Based, Motion-Stabilized Colorization of Microscope-Integrated Optical Coherence Tomography Volumes for Microscope-Independent Microsurgery

      Purpose : We develop and assess the impact of depth-based, motion-stabilized colorization (color) of microscope-integrated optical coherence tomography (MIOCT) volumes on microsurgical performance and ability to interpret surgical volumes. Methods : Color was applied in real-time as gradients indicating axial position and stabilized based on calculated center of mass. In a test comparing colorization versus grayscale visualizations of prerecorded intraoperative volumes from human surgery, ophthalmologists ( N = 7) were asked to identify retinal membranes, the presence of an instrument, its contact with tissue, and associated deformation of the retina. In a separate controlled trial, trainees ( N = 15) performed microsurgical skills without conventional optical ...

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    10. Vascular Findings In A Small Retinoblastoma Tumor Using OCT-A

      Vascular Findings In A Small Retinoblastoma Tumor Using OCT-A

      Retinoblastoma (RB) is the most common primary intraocular malignancy of children. 1 Improvements in screening tactics and treatment methods have dramatically increased both patient and globe survival. 1,2 Imaging modalities such as fluorescein angiography (FA) have demonstrated retinal vascular abnormalities in both large and small caliber retinal vessels in eyes with retinoblastoma, 1 and optical coherence tomography (OCT) can reveal or confirm otherwise subclinical lesions. 2 OCT angiography (OCT-A) is a non-invasive imaging modality allowing for in vivo visualization of retinal and choroidal vasculature.

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    11. Imaging infant retinal vasculature with optical coherence tomography angiography

      Imaging infant retinal vasculature with optical coherence tomography angiography

      Study of infant retinal vascular development has been limited to histopathological reports. We report herein depth-resolved visualization of full-term infant parafoveal microvasculature and their similarity to that of young children using a portable optical coherence tomography angiography system.

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    12. Macular Features on Spectral-Domain Optical Coherence Tomography Imaging Associated With Visual Acuity in Coats' Disease

      Macular Features on Spectral-Domain Optical Coherence Tomography Imaging Associated With Visual Acuity in Coats' Disease

      Purpose : To investigate the association between macular features on spectral-domain optical coherence tomography (SD-OCT) and visual acuity (VA) in Coats' disease. Methods : Thirty-nine eyes (39 patients) with SD-OCT from January 1, 2008 to December 31, 2016 were reviewed for SD-OCT features. Central subfield (CSF) SD-OCT findings were analyzed relative to VA (logarithm of the minimum angle of resolution) at baseline and final visit (when follow-up ≥ 6 months) and across visits. Results : Mean VA ± standard deviation at baseline (37 eyes) was 0.92 ± 0.82. SD-OCT features associated with worse VA included, for treatment-naïve eyes ( n = 21), outer retinal atrophy ...

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    13. Volumetric Measurement of Subretinal Blebs Using Microscope-Integrated Optical Coherence Tomography

      Volumetric Measurement of Subretinal Blebs Using Microscope-Integrated Optical Coherence Tomography

      Purpose : We advance studies of subretinal treatments by developing a microscope-integrated optical coherence tomography (MIOCT) image-based method for measuring the volume of therapeutics delivered into the subretinal space. Methods : A MIOCT image-based volume measurement method was developed and assessed for accuracy and reproducibility by imaging an object of known size in model eyes. This method then was applied to subretinal blebs created by injection of diluted triamcinolone. Bleb volumes obtained from MIOCT were compared to the intended injection volume and the surgeon's estimation of leakage. Results : Validation of the image-based volume measurement method showed accuracy to ±1.0 μL ...

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    14. Characterization of Long Working Distance Optical Coherence Tomography for Imaging of Pediatric Retinal Pathology

      Characterization of Long Working Distance Optical Coherence Tomography for Imaging of Pediatric Retinal Pathology

      Purpose : We determined the feasibility of fovea and optic nerve head imaging with a long working distance (LWD) swept source optical coherence tomography (OCT) prototype in adults, teenagers, and young children. Methods : A prototype swept source OCT system with a LWD (defined as distance from the last optical element of the imaging system to the eye) of 350 mm with custom fixation targets was developed to facilitate imaging of children. Imaging was performed in 49 participants from three age groups: 26 adults, 16 children 13 to 18 years old (teenagers), and seven children under 6 years old (young children) under ...

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    15. Optical Coherence Tomography Predictors of Risk for Progression to Non-Neovascular Atrophic Age-Related Macular Degeneration

      Optical Coherence Tomography Predictors of Risk for Progression to Non-Neovascular Atrophic Age-Related Macular Degeneration

      Purpose Appearance of geographic atrophy (GA) on color photography (CP) is preceded by specific features on spectral-domain optical coherence tomography (SD OCT). We aimed to build SD OCT–based risk assessment models for 5-year new onset of GA and central GA on CP. Design Prospective, longitudinal study. Participants Age-Related Eye Disease Study 2 Ancillary SD OCT study participants with age-related macular degeneration (AMD) with bilateral large drusen or noncentral GA and at least 1 eye without advanced disease (n = 317). Methods For 1 eye per participant, qualitative and quantitative SD OCT variables were derived from standardized grading and semiautomated segmentation ...

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    16. HANDHELD SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY IMAGING THROUGH THE UNDILATED PUPIL IN INFANTS BORN PRETERM OR WITH HYPOXIC INJURY OR HYDROCEPHALUS

      HANDHELD SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY IMAGING THROUGH THE UNDILATED PUPIL IN INFANTS BORN PRETERM OR WITH HYPOXIC INJURY OR HYDROCEPHALUS

      Purpose: The authors investigated feasibility of undilated handheld spectral domain optical coherence tomography (SDOCT) retinal imaging in preterm infants and children with neurologic abnormalities. Methods: Under an institutional review board-approved protocol, the authors attempted handheld SDOCT imaging of the retina, choroid, and optic nerve in infants and young children without pupil dilation. Scans were analyzed for quality and successful capture of foveal, optic nerve, and retinal structural parameters and abnormalities. Results: The authors obtained images through an undilated pupil of 11 infants/children over 28 eye imaging sessions, 27 at the bedside without sedation, and one under anesthesia. Infants had ...

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    17. Optical Coherence Tomography and Wide-Field Fluorescein Angiography in Retinopathy of Prematurity (Book Chapter)

      Optical Coherence Tomography and Wide-Field Fluorescein Angiography in Retinopathy of Prematurity (Book Chapter)

      The advent and adaptation of many imaging modalities promise to revolutionize our understanding of retinopathy of prematurity (ROP) by improving the detection, diagnosis, and monitoring of response to treatment of this disease. Diagnosis and classification of ROP traditionally relies on an eye exam by an ophthalmologist expert in this area who characterizes extent and character of retinal vascularization via indirect ophthalmoscopy. Many tools now exist that allow for data acquisition by nurses, technicians, and other trained staff with the images analyzed in a more centralized location. We will focus on two rapidly evolving technologies, optical coherence tomography (OCT), and wide ...

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    18. Microscope-Integrated Optical Coherence Tomography Angiography in the Operating Room in Young Children With Retinal Vascular Disease

      Microscope-Integrated Optical Coherence Tomography Angiography in the Operating Room in Young Children With Retinal Vascular Disease

      Importance Intraoperative optical coherence tomography (OCT) has gained traction as an important adjunct for clinical decision making during vitreoretinal surgery, and OCT angiography (OCTA) has provided novel insights in clinical evaluation of retinal diseases. To date, these two technologies have not been applied in combination to evaluate retinal vascular disease in the operating suite. Objective To conduct microscope-integrated, swept-source OCTA (MIOCTA) in children with retinal vascular disease. Design, Setting, and Participants In this case report analysis, OCT imaging in pediatric patients, MIOCTA images were obtained during examination under anesthesia from a young boy with a history of idiopathic vitreous hemorrhage ...

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    19. Review of intraoperative optical coherence tomography: technology and applications [Invited]

      Review of intraoperative optical coherence tomography: technology and applications [Invited]

      During microsurgery, en face imaging of the surgical field through the operating microscope limits the surgeon’s depth perception and visualization of instruments and sub-surface anatomy. Surgical procedures outside microsurgery, such as breast tumor resections, may also benefit from visualization of the sub-surface tissue structures. The widespread clinical adoption of optical coherence tomography (OCT) in ophthalmology and its growing prominence in other fields, such as cancer imaging, has motivated the development of intraoperative OCT for real-time tomographic visualization of surgical interventions. This article reviews key technological developments in intraoperative OCT and their applications in human surgery. We focus on handheld ...

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    20. History of Intraoperative OCT

      History of Intraoperative OCT

      Pars plana vitrectomy is almost a half-century old, and the earliest probes were powered by batteries, said Cynthia A. Toth, MD, the Joseph A.C. Wadsworth professor of ophthalmology at Duke University Medical Center. OCT imaging has “revolutionized our pre- and postoperative assessment,” she said, “but while our tools have advanced, our microscopes have not.” Although OCT granted surgeons the ability to visualize anatomical abnormalities in the retina, surgeons returned to en face OCT-free views during surgery. Dr. Toth noted there are “three staged developments in OCT – stage A was intraoperative OCT,” where a two-dimensional view outside the microscope gave ...

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    21. Four-dimensional Microscope-Integrated Optical Coherence Tomography to Visualize Suture Depth in Strabismus Surgery

      Four-dimensional Microscope-Integrated Optical Coherence Tomography to Visualize Suture Depth in Strabismus Surgery

      The authors report the use of swept-source microscope-integrated optical coherence tomography (SS-MIOCT), capable of live four-dimensional (three-dimensional across time) intraoperative imaging, to directly visualize suture depth during lateral rectus resection. Key surgical steps visualized in this report included needle depth during partial and full-thickness muscle passes along with scleral passes.

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    22. Long working distance OCT with a compact 2f retinal scanning configuration for pediatric imaging

      Long working distance OCT with a compact 2f retinal scanning configuration for pediatric imaging

      Young and/or autistic children cannot be imaged with tabletop or handheld optical coherence tomography (OCT) because of their lack of attention and fear of large objects close to their face. We demonstrate a prototype retinal swept-source OCT system with a long working distance (from the last optical element to the subject’s eye) to facilitate pediatric imaging. To reduce the number of optical elements and axial length compared to the traditional 4

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    23. Optical Coherence Tomography Reflective Drusen Substructures Predict Progression to Geographic Atrophy in Age-related Macular Degeneration

      Optical Coherence Tomography Reflective Drusen Substructures Predict Progression to Geographic Atrophy in Age-related Macular Degeneration

      Purpose Structural and compositional heterogeneity within drusen comprising lipids, carbohydrates, and proteins have been previously described. We sought to detect and define phenotypic patterns of drusen heterogeneity in the form of optical coherence tomography–reflective drusen substructures (ODS) and examine their associations with age-related macular degeneration (AMD)–related features and AMD progression. Design Retrospective analysis in a prospective study. Participants Patients with intermediate AMD (n = 349) enrolled in the multicenter Age-Related Eye Disease Study 2 (AREDS2) ancillary spectral-domain optical coherence tomography (SD OCT) study. Methods Baseline SD OCT scans of 1 eye per patient were analyzed for the presence of ...

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