Assessment of parafoveal cone density in patients taking hydroxychloroquine in the absence of clinically documented retinal toxicity

Debellemanière, Guillaume; Flores, Mathieu; Tumahai, Perle; mathieu, meillat; Garnier, M Bidaut; Delbosc, B.; Saleh, Maher

doi:10.1111/aos.12728

Cited by 19 publications

(13 citation statements)

References 19 publications

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“…As Stepien et al showed, there is some dropout in cone count as well as a simultaneous increase in cone spacing through the use of adaptive optics in HCQ retinopathy at a preclinical stage [13]. Similar results were confirmed by a following study [14].…”

Section: Discussionsupporting

confidence: 61%

Evaluation of photoreceptor outer segment length in hydroxychloroquine users

Çakir

Özturan

Yildiz

et al. 2019

Eye

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Objective This study aims to evaluate the photoreceptor outer segment (PROS) length in patients who use hydroxychloroquine (HCQ) prior to the development of retinopathy. Methods In this prospective, single-centre, comparative study, 44 patients using HCQ for ≥5 years, 30 patients using HCQ <5 years, and 45 age-and sex-matched healthy controls were enrolled. The participants underwent a detailed ophthalmologic examination, spectral-domain optical coherence tomography (SD-OCT) imaging, and 10-2 automated visual field testing. The PROS length was defined as the distance between the inner surface of the ellipsoid zone and the inner surface of the retina pigment epithelium. The measurements were performed subfoveally and at 500-1000-1500 µm temporally and nasally to the foveola. Results The mean PROS length of long-term users (≥5 years) was statistically greater than the controls at all measurement points (p < 0.001 at all points). Although the subfoveal PROS length was comparable between the long-term and short-term users (p = 0.148), the parafoveal PROS length measurements (nasal 1500 µm, nasal 1000 µm, nasal 500 µm, temporal 1000 µm, and temporal 1500 µm) of the long-term users were significantly greater than those of the short-term users (p < 0.001, p = 0.002, p = 0.027, p = 0.018, p = 0.001, respectively). No significant difference was found between the short-term users and the controls (p = 0.815, p = 0.395, p = 0.093, p = 0.079, p = 0.133, p = 0.686, p = 0.341, respectively). Conclusion The PROS length was greater in patients who used HCQ ≥5 years. Possible retinal pigment epithelium toxicity may have caused this finding.

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Section: Discussionsupporting

confidence: 61%

Evaluation of photoreceptor outer segment length in hydroxychloroquine users

Çakir

Özturan

Yildiz

et al. 2019

Eye

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“…For example, Chew et al have reported exclusion of approximately 40% of images due to image quality in their analyzed data set 16 . Debellemaniere et al had to exclude at least one eye from 46.9% of subjects due to poor AO image quality in their study of patients taking hydroxychloroquine without any evidence of maculopathy 34 . Furthermore, Feng et al reported that in their study of AO-FIO images of healthy subjects aged 14 to 69, the images from 52.7% were excluded due to image quality 35 .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of focus and deep learning methods for automated image grading and factors influencing image quality in adaptive optics ophthalmoscopy

Sampson

Alonso‐Caneiro

Chew

et al. 2021

Sci Rep

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Adaptive optics flood illumination ophthalmoscopy (AO-FIO) is an established imaging tool in the investigation of retinal diseases. However, the clinical interpretation of AO-FIO images can be challenging due to varied image quality. Therefore, image quality assessment is essential before interpretation. An image assessment tool will also assist further work on improving the image quality, either during acquisition or post processing. In this paper, we describe, validate and compare two automated image quality assessment methods; the energy of Laplacian focus operator (LAPE; not commonly used but easily implemented) and convolutional neural network (CNN; effective but more complex approach). We also evaluate the effects of subject age, axial length, refractive error, fixation stability, disease status and retinal location on AO-FIO image quality. Based on analysis of 10,250 images of 50 × 50 μm size, at 41 retinal locations, from 50 subjects we demonstrate that CNN slightly outperforms LAPE in image quality assessment. CNN achieves accuracy of 89%, whereas LAPE metric achieves 73% and 80% (for a linear regression and random forest multiclass classifier methods, respectively) compared to ground truth. Furthermore, the retinal location, age and disease are factors that can influence the likelihood of poor image quality.

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“…The proportions of sampling windows that were discarded before analysis due to poor image quality were 43% when taken from single AO image frames, and 40% when taken from the wide-field AO montages. Debellemanière et al 11 reported exclusion of at least one eye from 46.9% of subjects due to inadequate AO image quality in their study of patients taking hydroxychloroquine without any evidence of maculopathy. Further, in a separate study of AO images obtained from 72 eyes of healthy subjects aged 14 to 69 years, the images from 52.7% of subjects were excluded from analysis due to image quality that was insufficient to allow automatic montage and/or cone counting, including two patients who were aged under 30 with no apparent ocular pathology.…”

Section: Discussionmentioning

confidence: 99%

Agreement in Cone Density Derived from Gaze-Directed Single Images Versus Wide-Field Montage Using Adaptive Optics Flood Illumination Ophthalmoscopy

Chew

Sampson

Kashani

et al. 2017

Trans. Vis. Sci. Tech.

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PurposeWe compared cone density measurements derived from the center of gaze-directed single images with reconstructed wide-field montages using the rtx1 adaptive optics (AO) retinal camera.MethodsA total of 29 eyes from 29 healthy subjects were imaged with the rtx1 camera. Of 20 overlapping AO images acquired, 12 (at 3.2°, 5°, and 7°) were used for calculating gaze-directed cone densities. Wide-field AO montages were reconstructed and cone densities were measured at the corresponding 12 loci as determined by field projection relative to the foveal center aligned to the foveal dip on optical coherence tomography. Limits of agreement in cone density measurement between single AO images and wide-field AO montages were calculated.ResultsCone density measurements failed in 1 or more gaze directions or retinal loci in up to 58% and 33% of the subjects using single AO images or wide-field AO montage, respectively. Although there were no significant overall differences between cone densities derived from single AO images and wide-field AO montages at any of the 12 gazes and locations (P = 0.01–0.65), the limits of agreement between the two methods ranged from as narrow as −2200 to +2600, to as wide as −4200 to +3800 cones/mm2.ConclusionsCone density measurement using the rtx1 AO camera is feasible using both methods. Local variation in image quality and altered visibility of cones after generating montages may contribute to the discrepancies.Translational RelevanceCone densities from single AO images are not interchangeable with wide-field montage derived–measurements.

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Assessment of parafoveal cone density in patients taking hydroxychloroquine in the absence of clinically documented retinal toxicity

Cited by 19 publications

References 19 publications

Evaluation of photoreceptor outer segment length in hydroxychloroquine users

Evaluation of photoreceptor outer segment length in hydroxychloroquine users

Evaluation of focus and deep learning methods for automated image grading and factors influencing image quality in adaptive optics ophthalmoscopy

Agreement in Cone Density Derived from Gaze-Directed Single Images Versus Wide-Field Montage Using Adaptive Optics Flood Illumination Ophthalmoscopy

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