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1. Discriminating retinal microvascular and neuronal differences related to migraines: Deep Learning based Crossectional Study

Author

Tang, Feilong, Trinh, Matt, Duong, Annita, Ly, Angelica, Stapleton, Fiona, Chen, Zhe, Ge, Zongyuan, and Razzak, Imran

Subjects
Electrical Engineering and Systems Science - Image and Video Processing, Computer Science - Computer Vision and Pattern Recognition, Quantitative Biology - Neurons and Cognition
Abstract

Migraine, a prevalent neurological disorder, has been associated with various ocular manifestations suggestive of neuronal and microvascular deficits. However, there is limited understanding of the extent to which retinal imaging may discriminate between individuals with migraines versus without migraines. In this study, we apply convolutional neural networks to color fundus photography (CFP) and optical coherence tomography (OCT) data to investigate differences in the retina that may not be apparent through traditional human-based interpretations of retinal imaging. Retrospective data of CFP type 1 [posterior pole] and type 2 [optic nerve head (ONH)] from 369 and 336 participants respectively were analyzed. All participants had bilaterally normal optic nerves and maculae, with no retinal-involving diseases. CFP images were concatenated with OCT default ONH measurements, then inputted through three convolutional neural networks - VGG-16, ResNet-50, and Inceptionv3. The primary outcome was performance of discriminating between with migraines versus without migraines, using retinal microvascular and neuronal imaging characteristics. Using CFP type 1 data, discrimination (AUC [95% CI]) was high (0.84 [0.8, 0.88] to 0.87 [0.84, 0.91]) and not significantly different between VGG-16, ResNet-50, and Inceptionv3. Using CFP type 2 [ONH] data, discrimination was reduced and ranged from poor to fair (0.69 [0.62, 0.77] to 0.74 [0.67, 0.81]). OCT default ONH measurements overall did not significantly contribute to model performance. Class activation maps (CAMs) highlighted that the paravascular arcades were regions of interest. The findings suggest that individuals with migraines demonstrate microvascular differences more so than neuronal differences in comparison to individuals without migraines.

Published
2024

13. American Academy of Optometry Microbial Keratitis Think Tank.

Author

Szczotka-Flynn, Loretta B, Shovlin, Joseph P, Schnider, Cristina M, Caffery, Barbara E, Alfonso, Eduardo C, Carnt, Nicole A, Chalmers, Robin L, Collier, Sarah, Jacobs, Deborah S, Joslin, Charlotte E, Kroken, Abby R, Lakkis, Carol, Pearlman, Eric, Schein, Oliver D, Stapleton, Fiona, Tu, Elmer, and Willcox, Mark DP

Subjects
Eye Disease and Disorders of Vision, Emerging Infectious Diseases, Pediatric, Prevention, Infectious Diseases, Infection, Academies and Institutes, Acanthamoeba Keratitis, Contact Lenses, Epidemiologic Studies, Eye Infections, Bacterial, Eye Infections, Fungal, Eye Infections, Parasitic, Humans, Incidence, Keratitis, Optometry, Risk Factors, United States, Medical and Health Sciences, Ophthalmology & Optometry
Abstract

SignificanceThink Tank 2019 affirmed that the rate of infection associated with contact lenses has not changed in several decades. Also, there is a trend toward more serious infections associated with Acanthamoeba and fungi. The growing use of contact lenses in children demands our attention with surveillance and case-control studies.PurposeThe American Academy of Optometry (AAO) gathered researchers and key opinion leaders from around the world to discuss contact lens-associated microbial keratitis at the 2019 AAO Annual Meeting.MethodsExperts presented within four sessions. Session 1 covered the epidemiology of microbial keratitis, pathogenesis of Pseudomonas aeruginosa, and the role of lens care systems and storage cases in corneal disease. Session 2 covered nonbacterial forms of keratitis in contact lens wearers. Session 3 covered future needs, challenges, and research questions in relation to microbial keratitis in youth and myopia control, microbiome, antimicrobial surfaces, and genetic susceptibility. Session 4 covered compliance and communication imperatives.ResultsThe absolute rate of microbial keratitis has remained very consistent for three decades despite new technologies, and extended wear significantly increases the risk. Improved oxygen delivery afforded by silicone hydrogel lenses has not impacted the rates, and although the introduction of daily disposable lenses has minimized the risk of severe disease, there is no consistent evidence that they have altered the overall rate of microbial keratitis. Overnight orthokeratology lenses may increase the risk of microbial keratitis, especially secondary to Acanthamoeba, in children. Compliance remains a concern and a significant risk factor for disease. New insights into host microbiome and genetic susceptibility may uncover new theories. More studies such as case-control designs suited for rare diseases and registries are needed.ConclusionsThe first annual AAO Think Tank acknowledged that the risk of microbial keratitis has not decreased over decades, despite innovation. Important questions and research directions remain.

Published
2021

23. Infectious corneal ulceration: a proposal for neglected tropical disease status

Author

Ung, Lawson, Acharya, Nisha R, Agarwal, Tushar, Alfonso, Eduardo C, Bagga, Bhupesh, Bispo, Paulo JM, Burton, Matthew J, Dart, John KG, Doan, Thuy, Fleiszig, Suzanne MJ, Garg, Prashant, Gilmore, Michael S, Gritz, David C, Hazlett, Linda D, Iovieno, Alfonso, Jhanji, Vishal, Kempen, John H, Lee, Cecilia S, Lietman, Thomas M, Margolis, Todd P, McLeod, Stephen D, Mehta, Jod S, Miller, Darlene, Pearlman, Eric, Prajna, Lalitha, Prajna, N Venkatesh, Seitzman, Gerami D, Shanbhag, Swapna S, Sharma, Namrata, Sharma, Savitri, Srinivasan, Muthiah, Stapleton, Fiona, Tan, Donald TH, Tandon, Radhika, Taylor, Hugh R, Tu, Elmer Y, Tuli, Sonal S, Vajpayee, Rasik B, Van Gelder, Russell N, Watson, Stephanie L, Zegans, Michael E, and Chodosh, James

Subjects
Anti-Bacterial Agents, Bacterial Infections, Corneal Ulcer, Developing Countries, Global Health, Health Promotion, Humans, Leprosy, Neglected Diseases, Onchocerciasis, Ocular, Trachoma, Medical and Health Sciences, Tropical Medicine
Published
2019

30. TFOS: Unique challenges and unmet needs for the management of ocular surface diseases throughout the world

Author

Erickson, Susan, Sullivan, Amy Gallant, Abad, Juan Carlos, Alves, Monica, Barabino, Stefano, Craig, Jennifer P., Eid, Maroun, Farrant, Sarah, Gomes, José A.P., Heydenrych, Leonard, Iyer, Geetha, Jarade, Elias F., Kinoshita, Shigeru, Kobia-Acquah, Emmanuel, Lazreg, Sihem, Margolis, Todd, Mechleb, Nicole, Navas, Alejandro, Nsubuga, Naomi, Said, Reeda Bou, Shaheen, Mohamed Shafik, Sotozono, Chie, Stapleton, Fiona, Vehof, Jelle, Versura, Piera, and Sullivan, David A.

Published
2021
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35. TFOS DEWS II pain and sensation report.

Author

Belmonte, Carlos, Nichols, Jason, Cox, Stephanie, Brock, James, Begley, Carolyn, Bereiter, David, Dartt, Darlene, Galor, Anat, Hamrah, Pedram, Ivanusic, Jason, Jacobs, Deborah, Rosenblatt, Mark, Stapleton, Fiona, Wolffsohn, James, and McNamara, Nancy

Subjects
Central nervous system, Cold receptors, Corneal esthesiometry, Dry eye disease, In vivo confocal microscopy, Mechano-nociceptors, Neuropathic pain, Ocular surface dryness, Pain, Peripheral sensory nerves, Polymodal nociceptors, Sensation, TRP channels, Trigeminal brainstem nuclear complex, Animals, Cornea, Dry Eye Syndromes, Nociceptors, Pain, Sensation, Thermoreceptors
Abstract

Pain associated with mechanical, chemical, and thermal heat stimulation of the ocular surface is mediated by trigeminal ganglion neurons, while cold thermoreceptors detect wetness and reflexly maintain basal tear production and blinking rate. These neurons project into two regions of the trigeminal brain stem nuclear complex: ViVc, activated by changes in the moisture of the ocular surface and VcC1, mediating sensory-discriminative aspects of ocular pain and reflex blinking. ViVc ocular neurons project to brain regions that control lacrimation and spontaneous blinking and to the sensory thalamus. Secretion of the main lacrimal gland is regulated dominantly by autonomic parasympathetic nerves, reflexly activated by eye surface sensory nerves. These also evoke goblet cell secretion through unidentified efferent fibers. Neural pathways involved in the regulation of meibomian gland secretion or mucin release have not been identified. In dry eye disease, reduced tear secretion leads to inflammation and peripheral nerve damage. Inflammation causes sensitization of polymodal and mechano-nociceptor nerve endings and an abnormal increase in cold thermoreceptor activity, altogether evoking dryness sensations and pain. Long-term inflammation and nerve injury alter gene expression of ion channels and receptors at terminals and cell bodies of trigeminal ganglion and brainstem neurons, changing their excitability, connectivity and impulse firing. Perpetuation of molecular, structural and functional disturbances in ocular sensory pathways ultimately leads to dysestesias and neuropathic pain referred to the eye surface. Pain can be assessed with a variety of questionaires while the status of corneal nerves is evaluated with esthesiometry and with in vivo confocal microscopy.

Published
2017

38. BCLA CLEAR - Evidence-based contact lens practice

Author

Wolffsohn, James S., Dumbleton, Kathy, Huntjens, Byki, Kandel, Himal, Koh, Shizuka, Kunnen, Carolina M.E., Nagra, Manbir, Pult, Heiko, Sulley, Anna L., Vianya-Estopa, Marta, Walsh, Karen, Wong, Stephanie, and Stapleton, Fiona

Published
2021
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39. BCLA CLEAR – Medical use of contact lenses

Author

Jacobs, Deborah S., Carrasquillo, Karen G., Cottrell, Paul D., Fernández-Velázquez, Fernando J., Gil-Cazorla, Raquel, Jalbert, Isabelle, Pucker, Andrew D., Riccobono, Kellen, Robertson, Danielle M., Szczotka-Flynn, Loretta, Speedwell, Lynne, and Stapleton, Fiona

Published
2021
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50. Appropriateness of Questionnaires for the Diagnosis and Monitoring Treatment of Dry Eye Disease

Author

Wolffsohn, James S., Travé-Huarte, Sònia, Craig, Jennifer P., Muntz, Alex, Stapleton, Fiona J., Wolffsohn, James S., Travé-Huarte, Sònia, Craig, Jennifer P., Muntz, Alex, and Stapleton, Fiona J.

Abstract

Objectives: If questionnaires contributing to the diagnosis of dry eye disease are to be recommended as alternatives to existing questionnaires, they must be comparable, with similar repeatability and treatment sensitivity. Comparability was thus examined for three common dry eye questionnaires along with identifying the individual questions that most strongly predicted overall scores. Methods: Anonymised data ( n = 329) collected via the Ocular Surface Disease Index (OSDI), 5-item Dry Eye Questionnaire (DEQ-5) and Symptom Assessment in Dry Eye (SANDE) questionnaires (including responses to individual questions) from consenting patients were drawn from real-world dry eye clinics/registries in the United Kingdom, Australia and New Zealand; at follow-up, normalised changes were evaluated in 54 of these patients. Treatment data were also analysed from a 6-month, randomised controlled trial assessing artificial tear supplement treatments with 43 responders and 13 non-responders to treatment identified. The questions extracted from the OSDI which form the abbreviated 6-item OSDI were also analysed. Results: The agreement between the questionnaires ranged from r = 0.577 to 0.754 (all p < 0.001). For the OSDI, three questions accounted for 89.1% of the variability in the total score. The correlation between the OSDI and OSDI-6 was r = 0.939, p < 0.001. For the DEQ-5, two questions accounted for 88.5% of the variance in the total score. Normalised treatment changes were also only moderately correlated between the questionnaires (r = 0.441 to 0.595, p < 0.01). For non-responders, variability was 7.4% with both OSDI and OSDI-6, 9.7% with DEQ-5, 12.1% with SANDE-frequency and 11.9% with SANDE-severity scale. For responders, improvement with drops was detected with a 19.1% change in OSDI, 20.2% in OSDI-6, 20.9% in DEQ-5, and 27.5%/23.6% in SANDE-frequency/severity scales. Conclusions: Existing commonly used dry eye questionnaire scores do not show high levels of correlation. Th

Published
2024

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