Abstract: Idiopathic intracranial hypertension (IIH) is a condition in which elevated pressure in the cerebrospinal fluid can lead to optic nerve head (ONH) dysfunction and subsequent visual impairment. Physicians are currently limited in their ability to monitor and manage this condition, as clinical symptoms and exam findings are often delayed in response to changes in intracranial pressure. In order to find other biomarkers of disease, researchers are using imaging modalities such as optical coherence tomography (OCT) to observe microscopic changes in the eye in this condition. OCT can create 2-dimensional and 3-dimensional high definition images of the retina of the ONH and has been used to study various conditions such as glaucoma and multiple sclerosis. Numerous studies have used OCT in IIH as well, and they have shown that certain retinal layers and the ONH change in thickness and shape in both the short and long term with intracranial pressure changes. OCT is a promising modality for clinical and scientific evaluation of IIH as it is a noninvasive and practical tool to obtain in depth images. This review will discuss how OCT can be used to assess a patient with IIH, both before and after treatment, along with its limitations and future applications.
Abstract: Ischemic optic neuropathies are among the most common causes of sudden vision loss, especially in patients over age 50. The cause and prognosis of these disorders, and in particular non-arteritic anterior ischemic optic neuropathy, is poorly understood, and treatments remain poor in terms of restoring or preserving vision. Optical coherence tomography (OCT) and OCT angiography have allowed us to identify early and late structural changes in the optic nerve head and retina that may assist in predicting visual outcomes and may lead to greater understanding of pathogenesis and thus the development of effective medical interventions.
Abstract: The objective of the paper is to provide a general view for automatic cup to disc ratio (CDR) assessment in fundus images. As for the cause of blindness, glaucoma ranks as the second in ocular diseases. Vision loss caused by glaucoma cannot be reversed, but the loss may be avoided if screened in the early stage of glaucoma. Thus, early screening of glaucoma is very requisite to preserve vision and maintain quality of life. Optic nerve head (ONH) assessment is a useful and practical technique among current glaucoma screening methods. Vertical CDR as one of the clinical indicators for ONH assessment, has been well-used by clinicians and professionals for the analysis and diagnosis of glaucoma. The key for automatic calculation of vertical CDR in fundus images is the segmentation of optic cup (OC) and optic disc (OD). We take a brief description of methodologies about the OC and disc optic segmentation and comprehensively presented these methods as two aspects: hand-craft feature and deep learning feature. Sliding window regression, super-pixel level, image reconstruction, super-pixel level low-rank representation (LRR), deep learning methodologies for segmentation of OD and OC have been shown. It is hoped that this paper can provide guidance and bring inspiration to other researchers. Every mentioned method has its advantages and limitations. Appropriate method should be selected or explored according to the actual situation. For automatic glaucoma screening, CDR is just the reflection for a small part of the disc, while utilizing comprehensive factors or multimodal images is the promising future direction to furthermore enhance the performance.
Abstract: The most prominent causes of loss of vision in individuals over 50 years include age-related macular degeneration (AMD), glaucoma, and diabetic retinopathy (DR). While it is important to screen for these diseases effectively, current eye care is not properly doing so for much of the population, resulting in unfortunate visual disability and high costs for patients. Innovative functional testing can be unified with other screening methods for a more robust and safer screening and prediction of disease. The goal in the creation of functional testing modalities is to develop highly sensitive screening tests that are easy to use, accessible to all users, and inexpensive. The tests herein are deployed on an iPad with easily understood and intuitive instructions for rapid, streamlined, and automatic administration. These testing modalities could become highly sensitive screenings for early detection of potentially blinding diseases. The applications from our collaborators at AMA Optics include a cone photostress recovery test for detection of AMD and diabetic macular edema (DME), brightness balance perception for optic nerve dysfunction and especially glaucoma, color vision testing which is a broad screening tool, and visual acuity test. Machine learning with the combined structural and functional data will optimize identification of disease and prediction of outcomes. Here, we review and assess various tests of visual function that are easily administered on a tablet for screening in primary care. These user-friendly and simple screening tests allow patients to be identified in the early stages of disease for referral to specialists, proper assessment and treatment.
Abstract: Pediatric glaucoma is a potentially sight-threatening disease and is considered the second leading cause of treatable childhood blindness. Pediatric glaucoma is a clinical entity including a wide range of conditions: primary congenital glaucoma, glaucoma secondary to ocular (e.g., aniridia, Peter’s anomaly), or systemic disease (e.g., Sturge Weber) and glaucoma secondary to acquired condition (pseudophakic, traumatic, uveitic glaucoma). The treatment algorithm of childhood glaucoma is a step-by-step approach, often starting with surgery, as in primary congenital glaucoma cases. Medical therapy is also crucial in the management of pediatric glaucoma. Here we reported the results of the randomized, controlled, clinical trials carried out in children treated with topical anti-glaucoma drugs. It is worth knowing that prostaglandin analogues showed an excellent systemic safety profile, while serious systemic events have been reported in children taking topical beta-blockers. Angle surgery is the first surgical option in patients diagnosed with primary congenital glaucoma, with ab interno and ab externo approaches showing similar outcomes. Trabeculectomy in children can be troublesome, as mitomycin C (MMC) can lead to bleb complications and a higher endophthalmitis rate than in adults. Glaucoma drainage devices (GDD) are no longer a last resort and can be considered a suitable option for the management of uncontrolled pediatric glaucoma after angle surgery failure.
