A 20-year-old male patient presented at our clinic complaining of strange visual experiences (neither decreased nor blurred) and a mild headache while reading. His best corrected visual acuity revealed 20/20 with a fo...A 20-year-old male patient presented at our clinic complaining of strange visual experiences (neither decreased nor blurred) and a mild headache while reading. His best corrected visual acuity revealed 20/20 with a fort myopic correction. Intraocular pressures measured with Dynamic Contour Tonometer (DCT) (Swiss Microtechnology AG, Port, Switzerland) were 23.3 mmHg in the right eye (OD) and 27.4 mmHg in the left eye (OS) with cenral corneal thicknesses (CCTs) of 588 (OD) and 591 (OS) microns, respectively. Optic discs were bilateral pale with indistinct and scalloped margins without cupping. Red free photos showed autofluorescence of both optic discs, representative of optic disc drusen. Visual field analysis (VFA) of both eyes revealed sensitivity depression with localized defects consistent with the Optical Coherence Tomography (OCT) findings. Optic nerve head drusen (ONHD), myopia and high intraocular pressures (IOPs), may cause ganglion cell damage resulting in RNFL thinning and visual field loss. Because of the difficulty in detecting the exact cause and the extent of the damage, patients with ONHD associated with high IOPs and myopia should be examined closely with serial monitoring using OCT and VFA. In case of RNFL thinning and visual field defects, topical antiglaucomatous therapy should also be determined.展开更多
Optic disc drusen are eye abnormalities characterised by calcific degeneration affecting some axons of the optic nerve. Alport syndrome is a collagen IV related nephropathy with well-described pathognomonic ocular fea...Optic disc drusen are eye abnormalities characterised by calcific degeneration affecting some axons of the optic nerve. Alport syndrome is a collagen IV related nephropathy with well-described pathognomonic ocular features. We present the case of a child who following series of investigations was found to have bilateral optic disc drusen, and eventually a further diagnosis of Alport syndrome confirmed. Literature is clear on the underlined aetiology responsible for both renal and extra renal abnormalities of Alport syndrome, which is not related to development of optic disc drusen. The case described makes it pertinent that not only the associated eye signs of Alport syndrome are monitored, but also early detection of other possible co-existing diseases that may influence outcomes.展开更多
AIM: To assess the association between buried optic disc drusen(BODD) location using spectral-domain optical coherence tomography(SD-OCT) and the location of associated visual field defects(VFD) using the Garway-Heath...AIM: To assess the association between buried optic disc drusen(BODD) location using spectral-domain optical coherence tomography(SD-OCT) and the location of associated visual field defects(VFD) using the Garway-Heath mapping.METHODS: This monocentric retrospective crosssectional study was led at the authors’ institution. Adult patients diagnosed with BODD who had complete records with a reliable Humphrey? 24-2 visual field, macular, and papillary OCT were enrolled. Fisher’s exact test was used to measure the association between BODD location and VFD distribution according to Garway-Heath’s mapping.RESULTS: Totally 20 eyes of 15 patients were included(60% females). The median age(interquartile range) was 63(43)y and the median best corrected visual acuity(BCVA) was-0.08(0.08) log MAR. BODD were mostly located in zones A, E, and F. The minimal rim width(MRW) was globally preserved. The retinal nerve fiber layer(RNFL) was predominantly altered in zones D, E, and F. There was a significant correlation between BODD location and that of RNFL alterations in zones D(P=0.03) and E(P=0.025);Moreover, the presence of BODD in the E zone was significantly related to damaged RNFL in the neighbouring sectors D and F(P=0.012;P=0.02 respectively). Sixty-three percent(12/19) of visual fields were abnormal and there was a significant match(Phi=0.7, P=0.009) between drusen location and VFD only in zone D.CONCLUSION: BODD do not only affect young patients and can be more harmful than usually expected, as we found VFD in 63% of cases. There is a correspondence between BODD location, RNFL damage, and VFD distributions. The presence of BODD induces the overestimation of MRW,thereby disrupting its sensitivity as an early indicator of ganglion fibers damage.展开更多
Optic disc drusen (ODD) are hyaline deposits in the optic nerve head, occurring in approximately 2% of the population. ODD may be superficial and visible, or buried and either invisible or seen only as elevation of th...Optic disc drusen (ODD) are hyaline deposits in the optic nerve head, occurring in approximately 2% of the population. ODD may be superficial and visible, or buried and either invisible or seen only as elevation of the optic disc, mimicking optic disc edema. Advanced optic nerve imaging, including optical coherence tomography (OCT) can be used to diagnose and characterize ODD with very high resolution. Enhanced depth imaging (EDI-OCT) in particular has emerged as the optimal modality to directly visualize ODD. This modality has led to a greater ability to differentiate ODD from optic disc edema and prevent misdiagnosis or invasive testing. We review the characteristic findings of ODD on OCT, their distinguishing features, and the use of OCT as a biomarker in the neuro-ophthalmic assessment of ODD.展开更多
Background:Age-related macular degeneration(AMD)is a common cause of severe vision impairment in populations over 50 years old.It is characterized by drusen;the accumulation of waste between the retinal pigment epithe...Background:Age-related macular degeneration(AMD)is a common cause of severe vision impairment in populations over 50 years old.It is characterized by drusen;the accumulation of waste between the retinal pigment epithelium and Bruch’s membrane.Drusen have been identified in the eyes of Alzheimer’s patients,post-mortem.Further,beta-amyloid,best known as a pathological component of the senile plaques in Alzheimer’s disease,has been identified as a component of drusen in AMD.Researchers have also demonstrated an increased prevalence of cognitive impairment in individuals with AMD.The current study uses optical coherence tomography(OCT)and a cognitive assessment to investigate the potential use of drusen as a biomarker of cognitive impairment.The overall number of drusen detectable on the OCT scans of individuals who exhibit mild cognitive impairment is compared to the number of drusen detectable on the OCT scans of individuals who do not exhibit mild cognitive impairment.Methods:To date,10 participants(nine women)aged 74 to 95 years with a diagnosis of AMD and/or drusen have been recruited.The Optos®OCT/SLO imaging system was used to take cross-sectional images of the retina.The images were then manually graded by two trained graders to determine the number of drusen present along the retina.The Montreal Cognitive Assessment(MoCA)was used to assess overall cognitive status.Results:Of the 10 participants,three passed the full MoCA(i.e.scored at or above 26 out of 30 possible points)and seven did not pass,scoring positive for mild cognitive impairment(Mpass=27.33,SDpass=0.58;Mfail=21.86,SDfail=2.55).Preliminary analyses have demonstrated that individuals who pass the MoCA seem to have fewer drusen present overall(Mdn=35)compared to those who score positive for cognitive impairment(Mdn=63).However,a Mann-Whitney U test revealed that these findings are not significant;U=5,P=0.27.Conclusions:The results agree with previous literature demonstrating an increased prevalence of mild cognitive impairment in individuals with AMD.The larger average number of drusen found in individuals who score positive for cognitive impairment points to a difference in retinal abnormalities based on cognitive status.Beyond sample size,the insignificance of the difference between groups at this stage can be explained by the number of individuals who failed the MoCA who have wet AMD(n=5).The wet AMD makes grading of drusen on OCT scans more difficult due to scarring and warping of the retina.This could result in an under-representation of the number of drusen.Data collection is still underway,and an accurate depiction is expected with a larger sample size.Researchers have also suggested the importance of peripherally located drusen and its link to cognitive impairment,therefore,future analysis will consider this as well.展开更多
Background:Soft drusen and basal linear deposit(BLinD)are two forms of the same extracellular lipid rich material that together make up an Oil Spill on Bruch’s membrane(BrM).Drusen are focal and can be recognized cli...Background:Soft drusen and basal linear deposit(BLinD)are two forms of the same extracellular lipid rich material that together make up an Oil Spill on Bruch’s membrane(BrM).Drusen are focal and can be recognized clinically.In contrast BLinD is thin and diffusely distributed,and invisible clinically,even on highest resolution OCT,but has been detected on en face hyperspectral autofluorescence(AF)imaging ex vivo.We sought to optimize histologic hyperspectral AF imaging and image analysis for recognition of drusen and sub-RPE deposits(including BLinD and basal laminar deposit),for potential clinical application.Methods:Twenty locations specifically with drusen and 12 additional locations specifically from fovea,perifovea and mid-periphery from RPE/BrM flatmounts from 4 AMD donors underwent hyperspectral AF imaging with 4 excitation wavelengths(λex 436,450,480 and 505 nm),and the resulting image cubes were simultaneously decomposed with our published non-negative matrix factorization(NMF).Rank 4 recovery of 4 emission spectra was chosen for each excitation wavelength.Results:A composite emission spectrum,sensitive and specific for drusen and presumed sub-RPE deposits(the SDr spectrum)was recovered with peak at 510-520 nm in all tissues with drusen,with greatest amplitudes at excitationsλ_(ex)436,450 and 480 nm.The RPE spectra of combined sources Lipofuscin(LF)/Melanolipofuscin(MLF)were of comparable amplitude and consistently recapitulated the spectra S1,S2 and S3 previously reported from all tissues:tissues with drusen,foveal and extra-foveal locations.Conclusions:A clinical hyperspectral AF camera,with properly chosen excitation wavelengths in the blue range and a hyperspectral AF detector,should be capable of detecting and quantifying drusen and sub-RPE deposits,the earliest known lesions of AMD,before any other currently available imaging modality.展开更多
Background:With a large portion of older adults living longer,the number of individuals diagnosed with low vision is increasing.The use of optical coherence tomography/scanning laser ophthalmoscope(OCT/SLO)to diagnose...Background:With a large portion of older adults living longer,the number of individuals diagnosed with low vision is increasing.The use of optical coherence tomography/scanning laser ophthalmoscope(OCT/SLO)to diagnose retinal disease has become common place in the last 10 years,yet currently there are no OCT/SLO databases for pathological vision.Our aim is to develop a clinical database of individuals who have drusen(i.e.,lipid deposits found under the retina),or have been diagnosed with age-related macular degeneration(AMD),with information as to how the structure of the diseased retina changes over time,as well as measures of visual and cognitive functional performance.Methods:Fundus photographs and retinal scans will be taken using the same model of optos OCT/SLO located in three test sites(MAB-Mackay Rehabilitation Centre,School of Optometry Clinic at the University of Montreal,and the Lighthouse Institute,New York,USA).For each individual entry in the database,demographic and diagnosis information will be available.All OCT/SLO images will be graded according to the Age-related Eye Disease Study standard,in addition to number and size of drusen,severity of geographic atrophy,severity of pigment mottling and presence of choroidal neovascularization.Retinal topography and Raster scans from the OCT/SLO will provide a cross-sectional look at affected retinas.Fixation stability will be recorded using the SLO function,and present four different tasks that are designed to reproduce typical tasks of daily vision,with each task lasting for 10 seconds.The tasks are cross fixation,face recognition,visual search,and reading.These tasks in addition to the retinal scans will be used to determine the eccentricity of a preferred retinal locus from the anatomical fovea,and can be used as an outcome measure for clinical interventions in visually impaired patients.Results:The database will be available to professors training eye-care practitioners and rehabilitation specialists as a teaching tool.Students will be able to familiarize themselves with the retina and a variety of AMD-related pathologies before they start working with patients.The database will also be accessible by researchers interested in studying AMD from basic science to epidemiology,to investigate how drusen and AMD impact visual and cognitive functional performance.Conclusions:The common infrastructure is easily accessible to all VHRN members on request.The database will also be accessible online in 2018(see http://cvl.concordia.ca for more information).展开更多
Background Large drusen is a known risk factor for the development of late complications of age-related macular degeneration （AMD） and drusen reduction has been found by our previous study. To prospectively evaluate...Background Large drusen is a known risk factor for the development of late complications of age-related macular degeneration （AMD） and drusen reduction has been found by our previous study. To prospectively evaluate the efficacy and safety of prophylactic laser treatment in Chinese patients with bilateral soft drusen, we examined the structure and function of the macula 8 years after treatment.Methods Ten patients with more than 10 soft drusen （〉125 mm） and best corrected visual acuity 〉20/25 in each eye participated in the study. One eye, with relatively more drusen, was exposed to an argon laser （514 nm） to achieve a barely visible retinal lesion. The contralateral eye was used as a control. Fluorescein angiography, Amsler tests,Fourier-domain optical coherence tomography and visual evoked potential tests were carried out 8 years later.Results No choroidal neovascularization was seen in the laser-treated eyes or control eyes. There were no significant differences in visual acuity or P100 latency and amplitude between the laser treated eyes and contralateral eyes （t=1.685,1.184; P〉0.05）. The thickness of the retinal pigment epithelium of the treated eyes was less than that of the contralateral eyes （t=-4.540; P 〈0.05）. The full retinal thickness in treated eyes was slightly, but insignificantly, reduced relative to contralateral eyes （t=-1.746; P 〉0.05）.Conclusions The treatment was associated with a reduction in retinal pigment epithelium thickness elevation compared with the contralateral eyes. Macular function was not impaired.展开更多
文摘A 20-year-old male patient presented at our clinic complaining of strange visual experiences (neither decreased nor blurred) and a mild headache while reading. His best corrected visual acuity revealed 20/20 with a fort myopic correction. Intraocular pressures measured with Dynamic Contour Tonometer (DCT) (Swiss Microtechnology AG, Port, Switzerland) were 23.3 mmHg in the right eye (OD) and 27.4 mmHg in the left eye (OS) with cenral corneal thicknesses (CCTs) of 588 (OD) and 591 (OS) microns, respectively. Optic discs were bilateral pale with indistinct and scalloped margins without cupping. Red free photos showed autofluorescence of both optic discs, representative of optic disc drusen. Visual field analysis (VFA) of both eyes revealed sensitivity depression with localized defects consistent with the Optical Coherence Tomography (OCT) findings. Optic nerve head drusen (ONHD), myopia and high intraocular pressures (IOPs), may cause ganglion cell damage resulting in RNFL thinning and visual field loss. Because of the difficulty in detecting the exact cause and the extent of the damage, patients with ONHD associated with high IOPs and myopia should be examined closely with serial monitoring using OCT and VFA. In case of RNFL thinning and visual field defects, topical antiglaucomatous therapy should also be determined.
文摘Optic disc drusen are eye abnormalities characterised by calcific degeneration affecting some axons of the optic nerve. Alport syndrome is a collagen IV related nephropathy with well-described pathognomonic ocular features. We present the case of a child who following series of investigations was found to have bilateral optic disc drusen, and eventually a further diagnosis of Alport syndrome confirmed. Literature is clear on the underlined aetiology responsible for both renal and extra renal abnormalities of Alport syndrome, which is not related to development of optic disc drusen. The case described makes it pertinent that not only the associated eye signs of Alport syndrome are monitored, but also early detection of other possible co-existing diseases that may influence outcomes.
文摘AIM: To assess the association between buried optic disc drusen(BODD) location using spectral-domain optical coherence tomography(SD-OCT) and the location of associated visual field defects(VFD) using the Garway-Heath mapping.METHODS: This monocentric retrospective crosssectional study was led at the authors’ institution. Adult patients diagnosed with BODD who had complete records with a reliable Humphrey? 24-2 visual field, macular, and papillary OCT were enrolled. Fisher’s exact test was used to measure the association between BODD location and VFD distribution according to Garway-Heath’s mapping.RESULTS: Totally 20 eyes of 15 patients were included(60% females). The median age(interquartile range) was 63(43)y and the median best corrected visual acuity(BCVA) was-0.08(0.08) log MAR. BODD were mostly located in zones A, E, and F. The minimal rim width(MRW) was globally preserved. The retinal nerve fiber layer(RNFL) was predominantly altered in zones D, E, and F. There was a significant correlation between BODD location and that of RNFL alterations in zones D(P=0.03) and E(P=0.025);Moreover, the presence of BODD in the E zone was significantly related to damaged RNFL in the neighbouring sectors D and F(P=0.012;P=0.02 respectively). Sixty-three percent(12/19) of visual fields were abnormal and there was a significant match(Phi=0.7, P=0.009) between drusen location and VFD only in zone D.CONCLUSION: BODD do not only affect young patients and can be more harmful than usually expected, as we found VFD in 63% of cases. There is a correspondence between BODD location, RNFL damage, and VFD distributions. The presence of BODD induces the overestimation of MRW,thereby disrupting its sensitivity as an early indicator of ganglion fibers damage.
文摘Optic disc drusen (ODD) are hyaline deposits in the optic nerve head, occurring in approximately 2% of the population. ODD may be superficial and visible, or buried and either invisible or seen only as elevation of the optic disc, mimicking optic disc edema. Advanced optic nerve imaging, including optical coherence tomography (OCT) can be used to diagnose and characterize ODD with very high resolution. Enhanced depth imaging (EDI-OCT) in particular has emerged as the optimal modality to directly visualize ODD. This modality has led to a greater ability to differentiate ODD from optic disc edema and prevent misdiagnosis or invasive testing. We review the characteristic findings of ODD on OCT, their distinguishing features, and the use of OCT as a biomarker in the neuro-ophthalmic assessment of ODD.
文摘Background:Age-related macular degeneration(AMD)is a common cause of severe vision impairment in populations over 50 years old.It is characterized by drusen;the accumulation of waste between the retinal pigment epithelium and Bruch’s membrane.Drusen have been identified in the eyes of Alzheimer’s patients,post-mortem.Further,beta-amyloid,best known as a pathological component of the senile plaques in Alzheimer’s disease,has been identified as a component of drusen in AMD.Researchers have also demonstrated an increased prevalence of cognitive impairment in individuals with AMD.The current study uses optical coherence tomography(OCT)and a cognitive assessment to investigate the potential use of drusen as a biomarker of cognitive impairment.The overall number of drusen detectable on the OCT scans of individuals who exhibit mild cognitive impairment is compared to the number of drusen detectable on the OCT scans of individuals who do not exhibit mild cognitive impairment.Methods:To date,10 participants(nine women)aged 74 to 95 years with a diagnosis of AMD and/or drusen have been recruited.The Optos®OCT/SLO imaging system was used to take cross-sectional images of the retina.The images were then manually graded by two trained graders to determine the number of drusen present along the retina.The Montreal Cognitive Assessment(MoCA)was used to assess overall cognitive status.Results:Of the 10 participants,three passed the full MoCA(i.e.scored at or above 26 out of 30 possible points)and seven did not pass,scoring positive for mild cognitive impairment(Mpass=27.33,SDpass=0.58;Mfail=21.86,SDfail=2.55).Preliminary analyses have demonstrated that individuals who pass the MoCA seem to have fewer drusen present overall(Mdn=35)compared to those who score positive for cognitive impairment(Mdn=63).However,a Mann-Whitney U test revealed that these findings are not significant;U=5,P=0.27.Conclusions:The results agree with previous literature demonstrating an increased prevalence of mild cognitive impairment in individuals with AMD.The larger average number of drusen found in individuals who score positive for cognitive impairment points to a difference in retinal abnormalities based on cognitive status.Beyond sample size,the insignificance of the difference between groups at this stage can be explained by the number of individuals who failed the MoCA who have wet AMD(n=5).The wet AMD makes grading of drusen on OCT scans more difficult due to scarring and warping of the retina.This could result in an under-representation of the number of drusen.Data collection is still underway,and an accurate depiction is expected with a larger sample size.Researchers have also suggested the importance of peripherally located drusen and its link to cognitive impairment,therefore,future analysis will consider this as well.
文摘Background:Soft drusen and basal linear deposit(BLinD)are two forms of the same extracellular lipid rich material that together make up an Oil Spill on Bruch’s membrane(BrM).Drusen are focal and can be recognized clinically.In contrast BLinD is thin and diffusely distributed,and invisible clinically,even on highest resolution OCT,but has been detected on en face hyperspectral autofluorescence(AF)imaging ex vivo.We sought to optimize histologic hyperspectral AF imaging and image analysis for recognition of drusen and sub-RPE deposits(including BLinD and basal laminar deposit),for potential clinical application.Methods:Twenty locations specifically with drusen and 12 additional locations specifically from fovea,perifovea and mid-periphery from RPE/BrM flatmounts from 4 AMD donors underwent hyperspectral AF imaging with 4 excitation wavelengths(λex 436,450,480 and 505 nm),and the resulting image cubes were simultaneously decomposed with our published non-negative matrix factorization(NMF).Rank 4 recovery of 4 emission spectra was chosen for each excitation wavelength.Results:A composite emission spectrum,sensitive and specific for drusen and presumed sub-RPE deposits(the SDr spectrum)was recovered with peak at 510-520 nm in all tissues with drusen,with greatest amplitudes at excitationsλ_(ex)436,450 and 480 nm.The RPE spectra of combined sources Lipofuscin(LF)/Melanolipofuscin(MLF)were of comparable amplitude and consistently recapitulated the spectra S1,S2 and S3 previously reported from all tissues:tissues with drusen,foveal and extra-foveal locations.Conclusions:A clinical hyperspectral AF camera,with properly chosen excitation wavelengths in the blue range and a hyperspectral AF detector,should be capable of detecting and quantifying drusen and sub-RPE deposits,the earliest known lesions of AMD,before any other currently available imaging modality.
文摘Background:With a large portion of older adults living longer,the number of individuals diagnosed with low vision is increasing.The use of optical coherence tomography/scanning laser ophthalmoscope(OCT/SLO)to diagnose retinal disease has become common place in the last 10 years,yet currently there are no OCT/SLO databases for pathological vision.Our aim is to develop a clinical database of individuals who have drusen(i.e.,lipid deposits found under the retina),or have been diagnosed with age-related macular degeneration(AMD),with information as to how the structure of the diseased retina changes over time,as well as measures of visual and cognitive functional performance.Methods:Fundus photographs and retinal scans will be taken using the same model of optos OCT/SLO located in three test sites(MAB-Mackay Rehabilitation Centre,School of Optometry Clinic at the University of Montreal,and the Lighthouse Institute,New York,USA).For each individual entry in the database,demographic and diagnosis information will be available.All OCT/SLO images will be graded according to the Age-related Eye Disease Study standard,in addition to number and size of drusen,severity of geographic atrophy,severity of pigment mottling and presence of choroidal neovascularization.Retinal topography and Raster scans from the OCT/SLO will provide a cross-sectional look at affected retinas.Fixation stability will be recorded using the SLO function,and present four different tasks that are designed to reproduce typical tasks of daily vision,with each task lasting for 10 seconds.The tasks are cross fixation,face recognition,visual search,and reading.These tasks in addition to the retinal scans will be used to determine the eccentricity of a preferred retinal locus from the anatomical fovea,and can be used as an outcome measure for clinical interventions in visually impaired patients.Results:The database will be available to professors training eye-care practitioners and rehabilitation specialists as a teaching tool.Students will be able to familiarize themselves with the retina and a variety of AMD-related pathologies before they start working with patients.The database will also be accessible by researchers interested in studying AMD from basic science to epidemiology,to investigate how drusen and AMD impact visual and cognitive functional performance.Conclusions:The common infrastructure is easily accessible to all VHRN members on request.The database will also be accessible online in 2018(see http://cvl.concordia.ca for more information).
文摘Background Large drusen is a known risk factor for the development of late complications of age-related macular degeneration （AMD） and drusen reduction has been found by our previous study. To prospectively evaluate the efficacy and safety of prophylactic laser treatment in Chinese patients with bilateral soft drusen, we examined the structure and function of the macula 8 years after treatment.Methods Ten patients with more than 10 soft drusen （〉125 mm） and best corrected visual acuity 〉20/25 in each eye participated in the study. One eye, with relatively more drusen, was exposed to an argon laser （514 nm） to achieve a barely visible retinal lesion. The contralateral eye was used as a control. Fluorescein angiography, Amsler tests,Fourier-domain optical coherence tomography and visual evoked potential tests were carried out 8 years later.Results No choroidal neovascularization was seen in the laser-treated eyes or control eyes. There were no significant differences in visual acuity or P100 latency and amplitude between the laser treated eyes and contralateral eyes （t=1.685,1.184; P〉0.05）. The thickness of the retinal pigment epithelium of the treated eyes was less than that of the contralateral eyes （t=-4.540; P 〈0.05）. The full retinal thickness in treated eyes was slightly, but insignificantly, reduced relative to contralateral eyes （t=-1.746; P 〉0.05）.Conclusions The treatment was associated with a reduction in retinal pigment epithelium thickness elevation compared with the contralateral eyes. Macular function was not impaired.
