"Graefe's Archive" is a distinguished international journal that presents original clinical reports and clinically relevant experimental studies. Founded in 1854 by Albrecht von Graefe to serve as a source of useful clinical information and a stimulus for discussion, the journal has published articles by leading ophthalmologists and vision research scientists for more than a century. With peer review by an international Editorial Board and prompt English-language publication, "Graefe's Archive" provides rapid dissemination of clinical and clinically related experimental information.

Graefe's archive for clinical and experimental ophthalmology

Artificial intelligence (AI) based on deep learning (DL) has sparked tremendous global interest in recent years. DL has been widely adopted in image recognition, speech recognition and natural language processing, but is only beginning to impact on healthcare. In ophthalmology, DL has been applied to fundus photographs, optical coherence tomography and visual fields, achieving robust classification performance in the detection of diabetic retinopathy and retinopathy of prematurity, the glaucoma-like disc, macular oedema and age-related macular degeneration. DL in ocular imaging may be used in conjunction with telemedicine as a possible solution to screen, diagnose and monitor major eye diseases for patients in primary care and community settings. Nonetheless, there are also potential challenges with DL application in ophthalmology, including clinical and technical challenges, explainability of the algorithm results, medicolegal issues, and physician and patient acceptance of the AI ‘black-box’ algorithms. DL could potentially revolutionise how ophthalmology is practised in the future. This review provides a summary of the state-of-the-art DL systems described for ophthalmic applications, potential challenges in clinical deployment and the path forward.

https://bjo.bmj.com/content/bjophthalmol/103/2/167.full.pdf

Artificial intelligence and deep learning in ophthalmology

Deep learning is effective for the classification of OCT images of normal versus Age-related Macular Degeneration.

Age-Related Eye Disease Study 2 (特集 臨床において必要なサプリメントの知識)

Age-related macular degeneration (AMD) is the leading cause of severe central visual impairment among the elderly and is associated both with environmental factors such as smoking and with genetic factors. Here, 167 unrelated AMD patients were screened for alterations in ABCR, a gene that encodes a retinal rod photoreceptor protein and is defective in Stargardt disease, a common hereditary form of macular dystrophy. Thirteen different AMD-associated alterations, both deletions and amino acid substitutions, were found in one allele of ABCR in 26 patients (16%). Identification of ABCR alterations will permit presymptomatic testing of high-risk individuals and may lead to earlier diagnosis of AMD and to new strategies for prevention and therapy.

Mutation of the Stargardt Disease Gene (ABCR) in Age-related Macular Degeneration

Purpose. To investigate retinal function using microperimetry in patients affected by idiopathic epiretinal membrane (iERM) and cataract who underwent combined surgery: 4-year follow-up. Design. Prospective, interventional case series. Methods. 30 eyes of 30 consecutive patients with iERM and age-related cataract underwent 25-gauge vitrectomy and cataract surgery. At baseline, 90 and 180 days, and 1 and 4 years, we examined retinal mean sensitivity (MS), retinal mean defect (MD), fixation stability, and frequency of microscotomas using MP1 microperimetry. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) using a spectral domain optical coherence tomography (SD-OCT) were also performed. Results. All patients completed 1-year follow-up, while 23 patients reached last follow-up. Baseline MS and MD (10.48 ± 4.17 and -9.18 ± 4.40 dB) significantly changed at one year (12.33 ± 3.66 and -7.49 ± 3.31 dB, p < 0.01), at four years (14.18 ± 3.46 and -4.66 ± 2.85, p < 0.01), and between one and four years (p < 0.01) after surgery. Compared to baseline, CRT and BCVA significantly changed at one year and remained stable at four years. No variations were observed in fixation stability and frequency of microscotomas compared to baseline. Conclusions. Long-term follow-up using microperimetry seems useful to evaluate patients after iERM surgery: retinal sensitivity changes even when BCVA and CRT remain stable.

/pdf/microperimetric-assessment-after-epiretinal-membrane-surgery-4dz4b3a2yy.pdf

Microperimetric Assessment after Epiretinal Membrane Surgery: 4-Year Follow-Up

Purpose. To evaluate agreement between measured and intended distance of Keraring (Mediphacos, Belo Horizonte, Brazil) intracorneal ring segments from the anterior and posterior corneal surfaces. Methods. Twenty-six Keraring ICRS implanted in 24 keratoconic eyes were examined. The distance from the Keraring apex to the anterior corneal surface and the distance from the inner and the outer corners to the posterior corneal surface were measured 3 months postoperatively using spectral-domain optical coherence tomography. Agreement between measured distance and intended distance was assessed by calculating the absolute differences and 95% limits of agreement (95% LoA). Results. The mean absolute difference was significantly lower (p < 0.001) for the measurements taken at the inner corner (23.54 ± 15.90 μm) than that for those taken at the apex (108.92 ± 62.72 μm) and the outer corner (108.35 ± 56.99 μm). The measurements taken at the inner corner were within ±25 and ±50 μm of the intended distance in 15/26 (57.7%) and 24/26 (92.3%) cases, respectively, and showed the narrowest 95% LoA with the intended distance (-57.61 to 55.15 μm). Conclusions. The distance of the inner corner from the posterior corneal surface showed the best agreement with the intended distance. This measurement is suitable for determining whether the actual Keraring depth matches the intended depth.

/pdf/keraring-intrastromal-segment-depth-measured-by-spectral-2fhnbz4irg.pdf

Keraring Intrastromal Segment Depth Measured by Spectral-Domain Optical Coherence Tomography in Eyes with Keratoconus

Topographic Analysis of the Choriocapillaris in Intermediate Age-related Macular Degeneration

OCT Risk Factors for Development of Late Age-Related Macular Degeneration in the Fellow Eyes of Patients Enrolled in the HARBOR Study.

Aims To evaluate the choriocapillaris (CC) flow alterations around geographic atrophy (GA) in eyes with dry age-related macular degeneration. Methods Using a swept-source optical coherence tomography angiography (SS-OCTA) device, two volume 6×6 mm scans were acquired in patients with GA presenting between June and December 2017 at the Doheny-UCLA Eye Centers. The area of GA was delineated on the en face structural OCT fundus images. For each eye, the en face OCTA slabs at the level of the CC from the two acquisitions were averaged and compensated for signal loss using the corresponding structural en face images. The resulting images were binarised and analysed for the percentage of flow voids in the para-atrophy zone (a 500 µm wide ring around the immediate edge of the atrophy) and in the peri-atrophy zone (a 500 µm wide ring around the para-atrophy zone edge), the latter considered as a reference in the comparative analysis. Results Thirty eyes of 20 patients were enrolled. The percentage of flow voids in the para-atrophy zone was 27.23%±6.29% and was significantly higher than in the surrounding peri-atrophy zone (23.4%±6.01%; p Conclusions A significant impairment of the CC flow is present in the zone immediately surrounding the GA lesions strengthening the hypothesis that CC alterations may be relevant to the progression of GA.

https://bjo.bmj.com/content/bjophthalmol/103/7/911.full.pdf

Choriocapillaris impairment around the atrophic lesions in patients with geographic atrophy: a swept-source optical coherence tomography angiography study.

Marco Nassisi

Papers

Microperimetric Assessment after Epiretinal Membrane Surgery: 4-Year Follow-Up

Keraring Intrastromal Segment Depth Measured by Spectral-Domain Optical Coherence Tomography in Eyes with Keratoconus

Topographic Analysis of the Choriocapillaris in Intermediate Age-related Macular Degeneration

OCT Risk Factors for Development of Late Age-Related Macular Degeneration in the Fellow Eyes of Patients Enrolled in the HARBOR Study.

Choriocapillaris impairment around the atrophic lesions in patients with geographic atrophy: a swept-source optical coherence tomography angiography study.