Exploring the Heidelberg Retinal Tomograph 3 diagnostic accuracy across disc sizes and glaucoma stages: a multicenter study

To investigate and compare the diagnostic accuracy of the Heidelberg Retinal Tomograph 3 (HRT3) diagnostic algorithms and establish whether they are affected by optic disc size and glaucoma severity

Detecting abnormality in optic nerve head images using a feature extraction analysis

Imaging and evaluation of the optic nerve head (ONH) plays an essential part in the detection and clinical management of glaucoma. The morphological characteristics of ONHs vary greatly from person to person and this variability means it is difficult to quantify them in a standardized way. We developed and evaluated a feature extraction approach using shiftinvariant wavelet packet and kernel principal component analysis to quantify the shape features in ONH images acquired by scanning laser ophthalmoscopy (Heidelberg Retina Tomograph [HRT]). The methods were developed and tested on 1996 eyes from three different clinical centers. A shape abnormality score (SAS) was developed from extracted features using a Gaussian process to identify glaucomatous abnormality. SAS can be used as a diagnostic index to quantify the overall likelihood of ONH abnormality. Maps showing areas of likely abnormality within the ONH were also derived. Diagnostic performance of the technique, as estimated by ROC analysis, was significantly better than the classification tools currently used in the HRT software – the technique offers the additional advantage of working with all images and is fully automated

Automated Glaucoma Detection Using Hybrid Feature Extraction in Retinal Fundus Images

Glaucoma is one of the most common causes of blindness. Robust mass screening may help to extend the symptom-free life for affected patients. To realize mass screening requires a cost-effective glaucoma detection method which integrates well with digital medical and administrative processes. To address these requirements, we propose a novel low cost automated glaucoma diagnosis system based on hybrid feature extraction from digital fundus images. The paper discusses a system for the automated identification of normal and glaucoma classes using higher order spectra (HOS), trace transform (TT), and discrete wavelet transform (DWT) features. The extracted features are fed to a support vector machine (SVM) classifier with linear, polynomial order 1, 2, 3 and radial basis function (RBF) in order to select the best kernel for automated decision making. In this work, the SVM classifier, with a polynomial order 2 kernel function, was able to identify glaucoma and normal images with an accuracy of 91.67%, and sensitivity and specificity of 90% and 93.33%, respectively. Furthermore, we propose a novel integrated index called Glaucoma Risk Index (GRI) which is composed from HOS, TT, and DWT features, to diagnose the unknown class using a single feature. We hope that this GRI will aid clinicians to make a faster glaucoma diagnosis during the mass screening of normal/glaucoma images

Classification and Statistical Trend Analysis in Detecting Glaucomatous Visual Field Progression

Aim. To evaluate the agreement between different methods in detection of glaucomatous visual field progression using two classification-based methods and four statistical approaches based on trend analysis. Methods. This is a retrospective and longitudinal study. Twenty Caucasian patients (mean age 73.8 \ub1 13.43 years) with open-Angle glaucoma were recruited in the study. Each visual field was assessed by Humphrey Field Analyzer, program SITA standard 30-2 or 24-2 (Carl Zeiss Meditec, Inc., Dublin, CA). Full threshold strategy was also accepted for baseline tests. Progression was analyzed by using Hodapp-Parrish-Anderson classification and the Advanced Glaucoma Intervention Study visual field defect score. For the statistical analysis, linear regression (r2) was calculated for mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI), and when it was significant, each series of visual field was considered progressive. We also used Progressor to look for a significant progression of each visual field series. The agreement between methods, based on statistical analysis and classification, was evaluated using a weighted kappa statistic. Results. Thirty-eight visual field series were analyzed. The mean follow-up time was 6.2 \ub1 1.53 years (mean \ub1 standard deviation). At baseline, the mean MD was-7.34 \ub1 7.18 dB; at the end of the follow-up, the mean MD was-9.25 \ub1 8.65 dB; this difference was statistically significant (p<0.001). The agreement to detect progression was fair between all methods based on statistical analysis and classification except for PSD r2. A substantial agreement ( = 0.698 \ub1 0.126) was found between MD r2 and VFI r2. With the use of all the statistical analysis, there was a better time-saving. Conclusions. The best agreement to detect progression was found between MD r2 and VFI r2. VFI r2 showed the best agreement with all the other methods. GPA2 can help ophthalmologists to detect glaucoma progression and to help in treatment decisions. PSD r2 was the worse method to detect progression

Clinical assessment of retinal changes by spectral-domain OCT.

Purpose: To evaluate optical coherence tomography changes in patients with retinal thinning at the posterior pole. Methods: In this cross-sectional and retrospective study, 648 files were reviewed, and 67 patients were selected. Optical coherence tomography images that showed an area with a retinal thickness reduction at the macular region by using the Asymmetry Analysis Map in Heidelberg Spectralis were selected. The presence of hemisphere asymmetry in the same eye and asymmetry between the paired eyes were calculated and used for the analysis. Retinal thickness was measured in 3 different retinal areas (squares): (1) the area (square) involved by the pathology (IA), (2) the specular area (square) in the opposite hemifield (SA), and (3) the corresponding IA in the contralateral eye (CIA) (area used to recruit the patients). Retinal layer morphology was analyzed observing the Spectralis screen. Results: The thickness of the IA was 235.54 \ub1 39.95 \u3bcm (mean \ub1 standard deviation), while it was 269.84 \ub1 36.16 \u3bcm and 293.81 \ub1 37.52 \u3bcm for SA and CIA, respectively. Conclusions: Different retinal layers could be involved in reduction of the retinal thickness: a reduction of the inner layers was related to disease in which ciliary or retinal arterial vessel flow was involved, while a reduction of the outer retinal layer was related to pathologies related to choroidal flow diseases

Swollen Optic Disc and Sinusitis

Purpose: To present a case of optic disc swelling caused by sinusitis. Methods: Ocular symptoms were investigated using computed tomography imaging of the facial bones to detect the relationship between the sinus inflammation and the optic nerve. Results: A particular configuration of the optic nerve was detected. Optic nerve course through the inflamed sphenoidal sinus is a condition associated with a greater risk of inflammation. Conclusion: Sinusitis is a rare but treatable cause of optic neuritis. The choice of the correct radiological investigation to be done to set up a proper treatment of the sinus pathological condition is also essential for the resolution of ocular symptoms

Visual Field Loss Morphology in High- and Normal-Tension Glaucoma

Purpose. To determine whether the patterns of visual field damage between high-tension glaucoma (HTG) and normal-tension glaucoma (NTG) are equivalent. Methods. In this retrospective cross-sectional study, fifty-one NTG and 57 HTG patients were recruited. For each recruited patient only the left eye was chosen. Glaucomatous patients had abnormal visual fields and/or glaucomatous changes at the optic nerve head. They were classified as HTG or NTG on the basis of intraocular pressure (IOP) measurements. Patients' visual fields were analyzed by using Humphrey Field Analyzer (HFA), program 30-2, full threshold. The visual field sensitivity values and the pattern deviation map values of the 72 tested points were considered. Then a pointwise analysis and an area analysis, based on the Glaucoma Hemifield test criteria, were performed, and a comparison between the two subgroups was made by Student's t test. Results. Between NTG and HTG, no significant difference was found pointwise for almost all the visual field points, except for two locations. One was under the blind spot, and the other was in the inferior hemifield around the twenty-degree position. When area analysis was considered, three areas showed a significantly different sensitivity between HTG and NTG. Conclusions. These data suggested that there was no relevant difference in the pointwise analysis between NTG and HTG; however, when visual field areas were compared, no difference in paracentral areas was found between NTG and HTG, but superior nasal step and inferior and superior scotomata showed to be deeper in HTG than in NTG

Cystoid macular edema after cataract surgery in a patient with previous severe iritis following argon laser peripheral iridoplasty

This report describes a patient who had exaggerated responses to different inflammatory stimuli represented by laser and incisional surgery, respectively. These separate episodes should have a common link represented by a genetic predisposition to abnormal release of proinflammatory mediators within the eye. This 51-year old Hispanic woman showed a narrow iridocorneal angle with plateau iris configuration. Nd-YAG laser peripheral iridotomy was successfully performed to both eyes. No substantial changes in the iridotrabecular angle occurred despite patent iridotomies, thus confirming the diagnosis of plateau iris configuration. Argon laser iridoplasty was then performed to the right eye, while the left eye was scheduled for a later session. A severe inflammatory reaction within the anterior chamber developed after tapering of a one-week course of steroid therapy. Phacoemulsification of the lens was performed some months later when no signs of inflammation were detectable; no intraoperative complications occurred during surgery and an intraocular lens was placed. Cystoid macular edema developed four weeks after surgery despite no apparent risk factors, and resolved completely after anti-inflammatory medical therapy. Based on this case report, the unusual occurrence of severe iritis after laser treatment should be regarded as a risk factor for any other incisional or nonincisional procedures because it might indicate that the patient’s ocular tissues are prone to release of abnormally elevated proinflammatory mediators. Although further studies are needed to confirm this predisposition, prophylactic adjunctive topical nonsteroidal anti-inflammatory drug administration after cataract surgery should be considered in such cases in order to prevent potentially sight-threatening conditions

Motor skills in children affected by strabismus

Objectives: To compare motor skills in patients with infantile strabismus and age and sex-matched control subjects aged 5–11 years. Methods: Motor performances were assessed by the Italian version of Developmental Coordination Disorder Questionnaire 2007 (DCDQ) in children with infantile strabismus and age and sex-matched control subjects. Patients affected by specific neurological, cognitive and behavioural disorders were excluded from the study. Results: There were 43 patients included in the study, 23 in the strabismus group (14 males, 9 females, mean age 7.5 ± 2.0 years) and 24 in the control group (14 males and 10 females, mean age 7.2 ± 1.7 years. The overall DCDQ score was significantly lower in children with strabismus compared with control subjects (58.7 ± 11.3 vs. 74.2 ± 1.5; P < 0.001). Children with strabismus and no stereopsis showed a lower DCDQ score compared with those with normal stereopsis (50.8 ± 9.5 vs. 67.3 ± 4.8; P < 0.001). Conclusion: Motor skills are reduced in children with strabismus compared with control subjects. Strabismus and lack of binocular vision are factors potentially contributing to developmental coordination disorder