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1. A fluorescein angiography-based computer-aided algorithm for assessing the retinal vasculature in diabetic retinopathy

Author

Amir Abbasnejad, Oren Tomkins-Netzer, Aaron Winter, Alon Friedman, Alan Cruess, Yonatan Serlin, and Jaime Levy

Subjects
Ophthalmology
Abstract

To present a fluorescein angiography (FA)‒based computer algorithm for quantifying retinal blood flow, perfusion, and permeability, in patients with diabetic retinopathy (DR). Secondary objectives were to quantitatively assess treatment efficacy following panretinal photocoagulation (PRP) and define thresholds for pathology based on a new retinovascular function (RVF) score for quantifying disease severity.FA images of 65 subjects (58 patients and 7 healthy volunteers) were included. Dye intensity kinetics were derived using pixel-wise linear regression as a measure of retinal blood flow, perfusion, and permeability. Maps corresponding to each measure were then generated for each subject and segmented further using an ETDRS grid. Non-parametric statistical analyses were performed between all ETDRS subfields. For 16 patients, the effect of PRP was measured using the same parameters, and an amalgam of RVF was used to create an RVF index. For ten post-treatment patients, the change in FA-derived data was compared to the macular thickness measured using optical coherence tomography.Compared to healthy controls, patients had significantly lower retinal and regional perfusion and flow, as well as higher retinal permeability (p 0.05). Moreover, retinal flow was inversely correlated with permeability (R = -0.41; p 0.0001). PRP significantly reduced retinal permeability (p 0.05). The earliest marker of DR was reduced retinal blood flow, followed by increased permeability. FA-based RVF index was a more sensitive indicator of treatment efficacy than macular thickness.Our algorithm can be used to quantify retinovascular function, providing an earlier diagnosis and an objective characterisation of disease state, disease progression, and response to treatment.

Published
2022

2. Response of Pediatric Choroidal Neovascularization to Anti-Vascular Endothelial Growth Factor

Author

Sunil Ruparelia, Aishwarya Sundaram, Mishari Dahrab, Chris Symonds, and Alan Cruess

Subjects
ophthalmology, retina, genetic structures, anti-vegf, General Engineering, choroidal neovascular membrane, sense organs, pediatric ophthalmology, eye diseases
Abstract

Choroidal neovascularization (CNV) is a rare condition in children but poses a substantial threat to vision. Anti-vascular endothelial growth factor (anti-VEGF) therapy is commonly used in the pediatric population to treat retinopathy of prematurity. However, the use of anti-VEGF is less common for childhood CNV due to the rarity of CNV in the pediatric population. We report the case of a 10-year-old male presenting with an idiopathic choroidal neovascular membrane. Following a relapse of subretinal fluid after photodynamic therapy, anti-VEGF (bevacizumab) was injected and resulted in remission of the neovascular membrane and improved visual outcome. Further studies are required to elucidate the long-term outcomes associated with the use of anti-VEGF in pediatric patients.

Published
2021

3. Three-Year, Randomized, Sham-Controlled Trial of Dexamethasone Intravitreal Implant in Patients with Diabetic Macular Edema

Author

David S. Boyer, 1 Young Hee Yoon, MD, PhD, 2 Rubens Belfort, Jr, MD, PhD, 3 Francesco Bandello, 4 Raj K. Maturi, 5 Albert J. Augustin, 6 Xiao Yan Li, 7 Harry Cui, 7 Yehia Hashad, 7 Scott M. Whitcup, MDThe MEAD Study Group Principal Investigators: Suel Abujamra, James Acton, Fareed Ali, Andrew Antoszyk, Albert J. Augustin, Carl C. Awh, Adiel Barak, Karl Ulrich Bartz Schmidt, Caroline R. Baumal, Rubens Belfort, J.r., Muna Bhende, William Z. Bridges, David M. Brown, Trevor Carmichael, Ken Carnevale, Antonio M. Casella, Tom Chang, Daniel Chechik, San Ni Chen, Lawrence P. Chong, Victor Chong, Joel Corwin, Catherine Creuzot Garcher, Alan Cruess, Mark Daniell, Marcos P. de Avila, Haroldo Vieira de Moraes, Robert G. Devenyi, Bernard H. Doft, Mark Donaldson, Richard Dreyer, Dean Eliott, Harry M. Engel, Jan Ernest, Thomas F. Essman, Philip M. Falcone, Sharon Fekrat, Joseph R. Ferencz, Joao L. Ferreira, Joao Figueira, Ivan Fiser, Bradley Foster, Gregory M. Fox, William R. Freeman, S. P. Garg, Mark Gillies, David Glaser, Burton G. Goldstein, Andre M. V. Gomes, John R. Gonder, Lingam Gopal, Petrus Gous, Amod Gupta, Anurag Gupta, Lawrence Halperin, Dennis Han, Seenu M. Hariprasad, Frank G. Holz, Peter Kaiser, Bohdana Kalvodova, Barrett Katz, Randy S. Katz, Dariusz Kecik, Judianne Kellaway, Itamar Klemperer, Baruch Kuppermann, Paolo Lanzetta, Rosangela Lattanzio, Won Ki Lee, John Lehr, Monique Leys, Isaac Loose, Andrew Lotery, Da Wen Lu, Paul McCartney, Ajit B. Majji, Jose A. Martinez, Pascale Massin, Raj K. Maturi, Ugo Menchini, Geeta Menon, Mark Michels, Edoardo Midena, James Miller, Paul Mitchell, Joseph Moisseiev, Lawrence Morse, Rafael Navarro, Janos Nemeth, Henry Newland, Richard Newsom, John Nichols, Juan Orellana, Nicola Orzalesi, Augusto Paranhos, Robert Park, Susanna Park, Maurizio Battaglia Parodi, Peter R. Pavan, James Peace, Don J. Perez Ortiz, Ayala Pollack, Kim Ramaswamy, Ramakrishna Ratnakaram, Giuseppe Ravalico, Jiri Rehak, Kourous Rezaei, Stanislao Rizzo, Francisco J. Rodriguez Alvira, Jean Paul Romanet, Steven Rose, Richard B. Rosen, Luca Rossetti, Jose Maria Ruiz Moreno, SriniVas Sadda, Kenneth Sall, Dirk Sandner, Alvaro Fernandez Vega Sanz, Gil Sartani, Stefanie Schmickler, Steven D. Schwartz, Y. R. Sharma, Shwu Jiuan Sheu, Michael Singer, Sobha Sivaprasad, Gisele Soubrane, Petr Soucek, Eric H. Souied, Giovanni Staurenghi, Jan Studnicka, Marta Suarez Figueroa, Walter Y. Takahashi, Patrick L. Tsai, Lawrence J. Ulanski, Harvey Uy, Monica Varano, Miroslav Veith, Igor Vicha, Francesco Viola, Linda Visser, Dov Weinberger, Glenn L. Wing, Edmund Wong, Tien Wong, Edward Wylegala, Jiong Yan, Young Hee Yoon, Lucy H. Young, Hyeong G. Yu, Ingrid E. Zimmer Galler, TOGNETTO, DANIELE, Boyer, D, Yoon, Yh, Belfort, R, Bandello, Francesco, Maturi, Rk, Augustin, Aj, Li, Xy, Cui, H, Hashad, Y, Whitcup, Sm, David S., Boyer, Md, 1 Young Hee, Yoon, Md, Phd, 2 Rubens, Belfort, Jr, Md, Phd, 3 Francesco, Bandello, 4 Raj K., Maturi, 5 Albert J., Augustin, 6 Xiao Yan, Li, 7 Harry, Cui, Ms, 7 Yehia, Hashad, 7 Scott M., Whitcup, MDThe MEAD Study Group Principal Investigators: Suel, Abujamra, James, Acton, Fareed, Ali, Andrew, Antoszyk, Albert J., Augustin, Carl C., Awh, Adiel, Barak, Karl Ulrich Bartz, Schmidt, Caroline R., Baumal, Rubens, Belfort, J., R., Muna, Bhende, William Z., Bridge, David M., Brown, Trevor, Carmichael, Ken, Carnevale, Antonio M., Casella, Tom, Chang, Daniel, Chechik, San Ni, Chen, Lawrence P., Chong, Victor, Chong, Joel, Corwin, Catherine Creuzot, Garcher, Alan, Crue, Mark, Daniell, Marcos P., de Avila, Haroldo Vieira de, Morae, Robert G., Devenyi, Bernard H., Doft, Mark, Donaldson, Richard, Dreyer, Dean, Eliott, Harry M., Engel, Jan, Ernest, Thomas F., Essman, Philip M., Falcone, Sharon, Fekrat, Joseph R., Ferencz, Joao L., Ferreira, Joao, Figueira, Ivan, Fiser, Bradley, Foster, Gregory M., Fox, William R., Freeman, S. P., Garg, Mark, Gillie, David, Glaser, Burton G., Goldstein, Andre M. V., Gome, John R., Gonder, Lingam, Gopal, Petrus, Gou, Amod, Gupta, Anurag, Gupta, Lawrence, Halperin, Dennis, Han, Seenu M., Hariprasad, Frank G., Holz, Peter, Kaiser, Bohdana, Kalvodova, Barrett, Katz, Randy S., Katz, Dariusz, Kecik, Judianne, Kellaway, Itamar, Klemperer, Baruch, Kuppermann, Paolo, Lanzetta, Rosangela, Lattanzio, Won Ki, Lee, John, Lehr, Monique, Ley, Isaac, Loose, Andrew, Lotery, Da Wen, Lu, Paul, Mccartney, Ajit B., Majji, Jose A., Martinez, Pascale, Massin, Raj K., Maturi, Ugo, Menchini, Geeta, Menon, Mark, Michel, Edoardo, Midena, James, Miller, Paul, Mitchell, Joseph, Moisseiev, Lawrence, Morse, Rafael, Navarro, Janos, Nemeth, Henry, Newland, Richard, Newsom, John, Nichol, Juan, Orellana, Nicola, Orzalesi, Augusto, Paranho, Robert, Park, Susanna, Park, Maurizio Battaglia, Parodi, Peter R., Pavan, James, Peace, Don J., Perez Ortiz, Ayala, Pollack, Kim, Ramaswamy, Ramakrishna, Ratnakaram, Giuseppe, Ravalico, Jiri, Rehak, Kourous, Rezaei, Stanislao, Rizzo, Francisco J., Rodriguez Alvira, Jean Paul, Romanet, Steven, Rose, Richard B., Rosen, Luca, Rossetti, Jose Maria Ruiz, Moreno, Srinivas, Sadda, Kenneth, Sall, Dirk, Sandner, Alvaro Fernandez Vega, Sanz, Gil, Sartani, Stefanie, Schmickler, Steven D., Schwartz, Y. R., Sharma, Shwu Jiuan, Sheu, Michael, Singer, Sobha, Sivaprasad, Gisele, Soubrane, Petr, Soucek, Eric H., Souied, Giovanni, Staurenghi, Jan, Studnicka, Marta Suarez, Figueroa, Walter Y., Takahashi, Tognetto, Daniele, Patrick L., Tsai, Lawrence J., Ulanski, Ii, Harvey, Uy, Monica, Varano, Miroslav, Veith, Igor, Vicha, Francesco, Viola, Linda, Visser, Dov, Weinberger, Glenn L., Wing, Edmund, Wong, Tien, Wong, Edward, Wylegala, Jiong, Yan, Young Hee, Yoon, Lucy H., Young, Hyeong G., Yu, and Ingrid E., Zimmer Galler

Subjects
Adult, Male, Intraocular pressure, Triamcinolone acetonide, Visual acuity, genetic structures, Anti-Inflammatory Agents, Visual Acuity, Phases of clinical research, Dexamethasone, Macular Edema, law.invention, Randomized controlled trial, law, Health Sciences, Dexamethasone Intravitreal Implant (Ozurdex, Dexamethasone Intravitreal Implant, Humans, Medicine, Aged, Aged, 80 and over, Drug Implants, Diabetic Retinopathy, business.industry, Area under the curve, Middle Aged, Ophthalmology, DEX implant Diabetic Macular Edemat, Area Under Curve, Anesthesia, Intravitreal Injections, Dexamethasone Intravitreal Implant (Ozurdex, DEX implant Diabetic Macular Edemat, Female, Implant, medicine.symptom, business, hormones, hormone substitutes, and hormone antagonists, medicine.drug
Abstract

Purpose: To evaluate the safety and efficacy of dexamethasone intravitreal implant (Ozurdex, DEX implant) 0.7 and 0.35 mg in the treatment of patients with diabetic macular edema (DME).Design: Two randomized, multicenter, masked, sham-controlled, phase III clinical trials with identical protocols were conducted. Data were pooled for analysis.Participants: Patients (n = 1048) with DME, best-corrected visual acuity (BCVA) of 20/50 to 20/200 Snellen equivalent, and central retinal thickness (CRT) of ≥300 μm by optical coherence tomography.Methods: Patients were randomized in a 1:1:1 ratio to study treatment with DEX implant 0.7 mg, DEX implant 0.35 mg, or sham procedure and followed for 3 years (or 39 months for patients treated at month 36) at ≤40 scheduled visits. Patients who met retreatment eligibility criteria could be retreated no more often than every 6 months.Main Outcome Measures: The predefined primary efficacy endpoint for the United States Food and Drug Administration was achievement of ≥15-letter improvement in BCVA from baseline at study end. Safety measures included adverse events and intraocular pressure (IOP).Results: Mean number of treatments received over 3 years was 4.1, 4.4, and 3.3 with DEX implant 0.7 mg, DEX implant 0.35 mg, and sham, respectively. The percentage of patients with ≥15-letter improvement in BCVA from baseline at study end was greater with DEX implant 0.7 mg (22.2%) and DEX implant 0.35 mg (18.4%) than sham (12.0%; P ≤ 0.018). Mean average reduction in CRT from baseline was greater with DEX implant 0.7 mg (−111.6 μm) and DEX implant 0.35 mg (−107.9 μm) than sham (−41.9 μm; P < 0.001). Rates of cataract-related adverse events in phakic eyes were 67.9%, 64.1%, and 20.4% in the DEX implant 0.7 mg, DEX implant 0.35 mg, and sham groups, respectively. Increases in IOP were usually controlled with medication or no therapy; only 2 patients (0.6%) in the DEX implant 0.7 mg group and 1 (0.3%) in the DEX implant 0.35 mg group required trabeculectomy.Conclusions: The DEX implant 0.7 mg and 0.35 mg met the primary efficacy endpoint for improvement in BCVA. The safety profile was acceptable and consistent with previous reports.

Published
2014

4. Current state and future direction of tele-ophthalmology in Canada: First Canadian Ophthalmic Telemedicine Symposium

Author

Alan Cruess, Raymond LeBlanc, David Maberley, Charlene Muller, Dawn Hay, Mark Greve, Chris Rudnisky, Matthew Tennant, Kevin Colleaux, Tessa Laubscher, Andrew Mis, John Gonder, Howard Hansford, Christopher Hudson, Charles Pavlin, Martin Steinbach, Bruce Jackson, Carole Boucher, Jacques Gresset, George Bresnick, Vladimir Kosoucek, Anita Stevens, Judy Parks, Iain Begg, Martine Gagnon, James Whelan, Kali Bilowus, Debra Gillis, Lorraine Gordon, Duane Morrisseau-Beck, Dave Burton, Dominique Gagne, Len Reznik, Keith Gordon, Eric Ng, Marc Teutenberg, Vern Steffen, Al Brooks, Guy Girard, Gary Martin, Mike Dimitrovas, Moosah Gulam, and Robert Wehkamp

Subjects
Ophthalmology, medicine.medical_specialty, Telemedicine, business.industry, Medicine, Optometry, General Medicine, State (computer science), Current (fluid), business
Published
2003

5. Screening for diabetic retinopathy in James Bay, Ontario: a cost-effectiveness analysis

Author

David, Maberley, Hugh, Walker, Anita, Koushik, and Alan, Cruess

Subjects
Ontario, Ophthalmology, Diabetic Retinopathy, Vision Screening, Cost-Benefit Analysis, Research, Indians, North American, Photography, Humans, Quality-Adjusted Life Years, Monte Carlo Method
Abstract

Retinopathy is a common complication of diabetes mellitus that if detected early by regular retinal examinations can be treated; thus, blindness can be delayed or prevented. Providing high-quality retinal screening is difficult, especially in rural and remote areas. Canada's First Nations population has a higher prevalence of diabetes and is, in general, more geographically isolated than the broader Canadian population. We modelled the cost-effectiveness of retinopathy screening by travelling retina specialists versus retinal photography with a portable digital camera in an isolated First Nations cohort with diabetes.The 2 screening programs were modelled to run concurrently for 5 years, with outcomes evaluated over 10 years. To construct economic models for the population of Cree individuals living in the western James Bay area of northern Ontario, we used available data on the prevalence of diabetes in the area and estimates of the incidence of retinopathy derived from the published literature. We compared the screening models and calculated total costs, visual outcome, costs per sight-year saved and costs per quality-adjusted life year (QALY). We also estimated the costs of implementing a screening program for all First Nations individuals in Ontario with diabetes and no access to an ophthalmologist.From the perspective of the health care system the camera program was preferable to the specialist-based program. Over 10 years, 67 v. 56 sight years were saved, compared with no screening, at costs of 3900 Canadian dollars v. 9800 Canadian dollars per sight year and 15,000 Canadian dollars v. 37,000 Canadian dollars per QALY. Generalizing these results to the province of Ontario, the camera system could allow most isolated First Nations people with diabetes to be screened for 5 years for approximately 1.2 million Canadian dollars.A portable retinal camera is a cost-effective means of screening for diabetic retinopathy in isolated communities of at-risk individuals.

Published
2003

8. Excerpt from the Canadian Ophthalmological Society evidence-based clinical practice guidelines for the management of diabetic retinopathy.

Author

Hooper P, Boucher MC, Cruess A, Dawson KG, Delpero W, Greve M, Kozousek V, Lam WC, and Maberley DAL

Subjects
Adult, Aged, Canada, Diabetes Mellitus, Type 1 epidemiology, Diabetes Mellitus, Type 2 epidemiology, Diabetic Retinopathy epidemiology, Female, Humans, Incidence, Male, Middle Aged, Practice Patterns, Physicians', Diabetic Retinopathy diagnosis, Diabetic Retinopathy therapy, Evidence-Based Medicine, Ophthalmology organization & administration, Societies, Medical
Published
2017
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