Advances in multi-modal non-invasive imaging techniques in the diagnosis and treatment of polypoidal choroidal vasculopathy

Polypoidal choroidal vasculopathy (PCV) is a disease characterized by subretinal pigment epithelium (RPE) orange-red polypoidal lesions and abnormal branching neovascular networks (BNNs). In recent years, various non-invasive imaging technologies have rapidly developed, especially the emergence of optical coherence tomography angiography (OCTA), multi-spectral imaging, and other technologies, which enable the observation of more features of PCV. In addition, these technologies are faster and less invasive compared to indocyanine green angiography (ICGA). Multi-modal imaging, which combined multiple imaging techniques, provides important references for the diagnosis and treatment of PCV with the assistance of regression models, deep learning, and other algorithms. In this study, we reviewed the non-invasive imaging techniques, multi-modal imaging diagnosis, and multi-scene therapeutic applications of PCV, with the aim of providing a reference for non-invasive multi-modal diagnosis and treatment of PCV

Central and peripheral changes in the retina and choroid in patients with diabetes mellitus without clinical diabetic retinopathy assessed by ultra-wide-field optical coherence tomography angiography

BackgroundTo explore the central and peripheral retinal and choroidal changes in diabetic patients without clinical diabetic retinopathy (DM-NoDR) using ultra-wide-field swept-source optical coherence tomography angiography (UWF-SS-OCTA).Methods67 DM-NoDR eyes and 32 age-matched healthy eyes were recruited. Retinal and choroidal parameters, including qualitative retinal microangiopathy, vessel flow (VFD) and linear density (VLD), thickness, and volume, were measured in the central and peripheral areas of the 24 × 20 mm2 UWF-SS-OCTA images.ResultsDM-NoDR eyes had significantly more nonperfusion area and capillary tortuosity than controls in the central and peripheral areas (p < 0.05). The presence of central capillary tortuosity was associated with higher levels of serum creatinine (OR 1.049, 95%CI 1.001–1.098; p = 0.044) and blood urea nitrogen (OR 1.775, 95%CI 1.051–2.998; p = 0.032) in DM-NoDR eyes. For DM-NoDR eyes versus controls, VFD in the 300-μm annulus around the foveal avascular zone, superficial capillary plexus (SCP), and full retina, and SCP-VLD significantly decreased, while VFD in the deep capillary plexus (DCP), retinal thickness, and retinal volume increased (p < 0.05). Analysis in the central and peripheral areas recapitulated all these findings, except for decreased peripheral thickness and volume and no difference in peripheral DCP-VFD. In DM-NoDR eyes, choriocapillaris-VFD, choroidal thickness, and choroidal volume increased in the central area, while VFD in the large and medium choroidal vessel layer decreased in the whole image (p < 0.05).ConclusionRetinal and choroidal changes already existed in the central and/or peripheral areas of DM-NoDR eyes. UWF-SS-OCTA, enabling the visualization of the peripheral fundus area, is a promising image technique for the early detection of fundus changes in DM-NoDR patients

Development and evaluation of a deep learning model for the detection of multiple fundus diseases based on colour fundus photography.

AIM: To explore and evaluate an appropriate deep learning system (DLS) for the detection of 12 major fundus diseases using colour fundus photography. METHODS: Diagnostic performance of a DLS was tested on the detection of normal fundus and 12 major fundus diseases including referable diabetic retinopathy, pathologic myopic retinal degeneration, retinal vein occlusion, retinitis pigmentosa, retinal detachment, wet and dry age-related macular degeneration, epiretinal membrane, macula hole, possible glaucomatous optic neuropathy, papilledema and optic nerve atrophy. The DLS was developed with 56 738 images and tested with 8176 images from one internal test set and two external test sets. The comparison with human doctors was also conducted. RESULTS: The area under the receiver operating characteristic curves of the DLS on the internal test set and the two external test sets were 0.950 (95% CI 0.942 to 0.957) to 0.996 (95% CI 0.994 to 0.998), 0.931 (95% CI 0.923 to 0.939) to 1.000 (95% CI 0.999 to 1.000) and 0.934 (95% CI 0.929 to 0.938) to 1.000 (95% CI 0.999 to 1.000), with sensitivities of 80.4% (95% CI 79.1% to 81.6%) to 97.3% (95% CI 96.7% to 97.8%), 64.6% (95% CI 63.0% to 66.1%) to 100% (95% CI 100% to 100%) and 68.0% (95% CI 67.1% to 68.9%) to 100% (95% CI 100% to 100%), respectively, and specificities of 89.7% (95% CI 88.8% to 90.7%) to 98.1% (95%CI 97.7% to 98.6%), 78.7% (95% CI 77.4% to 80.0%) to 99.6% (95% CI 99.4% to 99.8%) and 88.1% (95% CI 87.4% to 88.7%) to 98.7% (95% CI 98.5% to 99.0%), respectively. When compared with human doctors, the DLS obtained a higher diagnostic sensitivity but lower specificity. CONCLUSION: The proposed DLS is effective in diagnosing normal fundus and 12 major fundus diseases, and thus has much potential for fundus diseases screening in the real world

Multi-dimensional epidemiology and informatics data on COVID-19 wave at the end of zero COVID policy in China

BackgroundChina exited strict Zero-COVID policy with a surge in Omicron variant infections in December 2022. Given China’s pandemic policy and population immunity, employing Baidu Index (BDI) to analyze the evolving disease landscape and estimate the nationwide pneumonia hospitalizations in the post Zero COVID period, validated by hospital data, holds informative potential for future outbreaks.MethodsRetrospective observational analyses were conducted at the conclusion of the Zero-COVID policy, integrating internet search data alongside offline records. Methodologies employed were multidimensional, encompassing lagged Spearman correlation analysis, growth rate assessments, independent sample T-tests, Granger causality examinations, and Bayesian structural time series (BSTS) models for comprehensive data scrutiny.ResultsVarious diseases exhibited a notable upsurge in the BDI after the policy change, consistent with the broader trajectory of the COVID-19 pandemic. Robust connections emerged between COVID-19 and diverse health conditions, predominantly impacting the respiratory, circulatory, ophthalmological, and neurological domains. Notably, 34 diseases displayed a relatively high correlation (r > 0.5) with COVID-19. Among these, 12 exhibited a growth rate exceeding 50% post-policy transition, with myocarditis escalating by 1,708% and pneumonia by 1,332%. In these 34 diseases, causal relationships have been confirmed for 23 of them, while 28 garnered validation from hospital-based evidence. Notably, 19 diseases obtained concurrent validation from both Granger causality and hospital-based data. Finally, the BSTS models approximated approximately 4,332,655 inpatients diagnosed with pneumonia nationwide during the 2 months subsequent to the policy relaxation.ConclusionThis investigation elucidated substantial associations between COVID-19 and respiratory, circulatory, ophthalmological, and neurological disorders. The outcomes from comprehensive multi-dimensional cross-over studies notably augmented the robustness of our comprehension of COVID-19’s disease spectrum, advocating for the prospective utility of internet-derived data. Our research highlights the potential of Internet behavior in predicting pandemic-related syndromes, emphasizing its importance for public health strategies, resource allocation, and preparedness for future outbreaks

Clinical efficacy of a head-mounted device for central vision loss

Abstract Central vision loss (CVL) is a major form of low vision that remains inadequately managed worldwide. This study evaluated the clinical efficacy of a novel head-mounted device (HMD), Onyx, designed to enhance visual function and vision-related quality of life for CVL patients. It employs a projection system that enables patients to leverage their residual peripheral vision for environmental awareness. It also integrates artificial intelligence to augment the automatic recognition of text, faces, and objects. In this single-center, prospective cohort study, 41 binocularly low vision patients with CVL were instructed to use Onyx for 4 to 6 h daily over a one-month period. Various metrics were assessed, including near and distance visual acuity (VA), recognition abilities for faces and objects, and the low vision quality-of-life (LVQOL) questionnaire scores, at the start and end of the study. The results showed significant improvements in near VA for 60.98% of the participants, distance VA for 80.49%, and recognition ability for 90.24%. 68.29% of the participants showed significant improvements in the LVQOL scores. Improvement in recognition ability was negatively correlated with baseline recognition ability. Additionally, improvement in the LVQOL scores was correlated with age and the baseline LVQOL score. Overall, the study found that the novel HMD significantly improved visual function and vision-related quality of life for low vision patients with CVL, highlighting the potential benefits and the need for further evaluation of such devices

Recent Advances in Imaging Polypoidal Choroidal Vasculopathy with Swept-Source Optical Coherence Tomography Angiography

The gold standard for polypoidal choroidal vasculopathy (PCV) diagnosis is indocyanine green angiography (ICGA), but optical coherence tomography angiography (OCTA) has shown promise for PCV imaging in recent years. However, earlier generations of OCTA technology lacked the diagnostic efficacy to replace ICGA. Swept-source optical coherence tomography angiography (SS-OCTA), the latest generation of OCTA technology, has significantly improved penetrating ability, scanning speed, scanning range, and overall image quality compared with earlier generations of OCTA. SS-OCTA reveals a “tangled vasculature” pattern of polypoidal lesions (PLs), providing evidence that they are neovascular rather than aneurysmal structures. New choroidal biomarkers, such as the choriocapillaris flow void (FV), have been identified to explain the development of PCV lesions. Although no direct comparison between SS-OCTA and previous OCTA generations in terms of diagnostic capability has been performed, SS-OCTA has shown several advantages in differential diagnosis and monitoring early reactivation for PCV. These improvements make SS-OCTA a valuable tool for PCV diagnosis and follow-up, and it may become more important for this disease in the future. This review summarized recent advances in PCV morphology and structure, as well as the possible pathogenesis based on SS-OCTA findings. The value of SS-OCTA for PCV management is discussed, along with remaining issues, to provide an updated understanding of PCV and OCTA-guided management

Phenolic Esters of O-Desmethylvenlafaxine with Improved Oral Bioavailability and Brain Uptake

O-Desmethylvenlafaxine (desvenlafaxine, ODV) is a recently approved antidepressant which in some clinical studies failed to meet a satisfactory end-point. The aim of this study was to prepare a series of phenolic esters of ODV and evaluate their potential as ODV prodrugs with improved brain uptake. Fifteen phenolic esters (compounds 1a–o) were synthesized and their pharmacokinetic profiles evaluated in rat. The four compounds producing the highest relative bioavailability of ODV in rat (compounds 1c, 1e, 1n, 1o) were then studied to evaluate their brain uptake. Of these four compounds, compound 1n (the piperonylic acid ester of ODV) demonstrated the highest Cmax of ODV both in the rat hypothalamus and total brain. Finally the pharmacokinetics of 1n were evaluated in beagle dog where the increase in relative bioavailability of ODV was found to be as great as in rat. This high relative bioavailability of ODV coupled with its good brain penetration make 1n the most promising candidate for development as an ODV prodrug

Data_Sheet_1_Central and peripheral changes in the retina and choroid in patients with diabetes mellitus without clinical diabetic retinopathy assessed by ultra-wide-field optical coherence tomography angiography.PDF

BackgroundTo explore the central and peripheral retinal and choroidal changes in diabetic patients without clinical diabetic retinopathy (DM-NoDR) using ultra-wide-field swept-source optical coherence tomography angiography (UWF-SS-OCTA).Methods67 DM-NoDR eyes and 32 age-matched healthy eyes were recruited. Retinal and choroidal parameters, including qualitative retinal microangiopathy, vessel flow (VFD) and linear density (VLD), thickness, and volume, were measured in the central and peripheral areas of the 24 × 20 mm2 UWF-SS-OCTA images.ResultsDM-NoDR eyes had significantly more nonperfusion area and capillary tortuosity than controls in the central and peripheral areas (p ConclusionRetinal and choroidal changes already existed in the central and/or peripheral areas of DM-NoDR eyes. UWF-SS-OCTA, enabling the visualization of the peripheral fundus area, is a promising image technique for the early detection of fundus changes in DM-NoDR patients.</p

Development and evaluation of a deep learning model for the detection of multiple fundus diseases based on colour fundus photography

AimTo explore and evaluate an appropriate deep learning system (DLS) for the detection of 12 major fundus diseases using colour fundus photography.MethodsDiagnostic performance of a DLS was tested on the detection of normal fundus and 12 major fundus diseases including referable diabetic retinopathy, pathologic myopic retinal degeneration, retinal vein occlusion, retinitis pigmentosa, retinal detachment, wet and dry age-related macular degeneration, epiretinal membrane, macula hole, possible glaucomatous optic neuropathy, papilledema and optic nerve atrophy. The DLS was developed with 56 738 images and tested with 8176 images from one internal test set and two external test sets. The comparison with human doctors was also conducted.ResultsThe area under the receiver operating characteristic curves of the DLS on the internal test set and the two external test sets were 0.950 (95% CI 0.942 to 0.957) to 0.996 (95% CI 0.994 to 0.998), 0.931 (95% CI 0.923 to 0.939) to 1.000 (95% CI 0.999 to 1.000) and 0.934 (95% CI 0.929 to 0.938) to 1.000 (95% CI 0.999 to 1.000), with sensitivities of 80.4% (95% CI 79.1% to 81.6%) to 97.3% (95% CI 96.7% to 97.8%), 64.6% (95% CI 63.0% to 66.1%) to 100% (95% CI 100% to 100%) and 68.0% (95% CI 67.1% to 68.9%) to 100% (95% CI 100% to 100%), respectively, and specificities of 89.7% (95% CI 88.8% to 90.7%) to 98.1% (95%CI 97.7% to 98.6%), 78.7% (95% CI 77.4% to 80.0%) to 99.6% (95% CI 99.4% to 99.8%) and 88.1% (95% CI 87.4% to 88.7%) to 98.7% (95% CI 98.5% to 99.0%), respectively. When compared with human doctors, the DLS obtained a higher diagnostic sensitivity but lower specificity.ConclusionThe proposed DLS is effective in diagnosing normal fundus and 12 major fundus diseases, and thus has much potential for fundus diseases screening in the real world.</jats:sec