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Szilard Kiss - One of the best experts on this subject based on the ideXlab platform.
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ultra wide field Fluorescein Angiography in retinal disease
Current Opinion in Ophthalmology, 2014Co-Authors: Mrinali Patel, Szilard KissAbstract:PURPOSE OF REVIEW Ultra-wide-field Fluorescein Angiography (UWFA), which captures up to 200° of retina in a single image, now affords us the ability to angiographically examine the parts of the retina previously not photographable. Here, we review the role of UWFA in the management of retinal disease. RECENT FINDINGS UWFA effectively images the abnormality in a variety of retinal conditions, including diabetic retinopathy, retinal vein occlusion, sickle cell retinopathy, uveitis, and pediatric retinal disease, in turn guiding both diagnosis and management of these conditions. SUMMARY UWFA is a useful imaging modality that is expected to become increasingly incorporated into the practice of retina. This will likely fuel the studies to determine how to reconcile the findings from UWFA with practice guidelines based on the studies conducted prior to the development of UWFA.
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comparison of ultra widefield Fluorescein Angiography with the heidelberg spectralis noncontact ultra widefield module versus the optos optomap
Clinical Ophthalmology, 2013Co-Authors: Matthew T Witmer, George Parlitsis, Sarju Patel, Szilard KissAbstract:Purpose To compare ultra-widefield Fluorescein Angiography imaging using the Optos(®) Optomap(®) and the Heidelberg Spectralis(®) noncontact ultra-widefield module. Methods Five patients (ten eyes) underwent ultra-widefield Fluorescein Angiography using the Optos(®) panoramic P200Tx imaging system and the noncontact ultra-widefield module in the Heidelberg Spectralis(®) HRA+OCT system. The images were obtained as a single, nonsteered shot centered on the macula. The area of imaged retina was outlined and quantified using Adobe(®) Photoshop(®) C5 software. The total area and area within each of four visualized quadrants was calculated and compared between the two imaging modalities. Three masked reviewers also evaluated each quadrant per eye (40 total quadrants) to determine which modality imaged the retinal vasculature most peripherally. Results Optos(®) imaging captured a total retinal area averaging 151,362 pixels, ranging from 116,998 to 205,833 pixels, while the area captured using the Heidelberg Spectralis(®) was 101,786 pixels, ranging from 73,424 to 116,319 (P = 0.0002). The average area per individual quadrant imaged by Optos(®) versus the Heidelberg Spectralis(®) superiorly was 32,373 vs 32,789 pixels, respectively (P = 0.91), inferiorly was 24,665 vs 26,117 pixels, respectively (P = 0.71), temporally was 47,948 vs 20,645 pixels, respectively (P = 0.0001), and nasally was 46,374 vs 22,234 pixels, respectively (P = 0.0001). The Heidelberg Spectralis(®) was able to image the superior and inferior retinal vasculature to a more distal point than was the Optos(®), in nine of ten eyes (18 of 20 quadrants). The Optos(®) was able to image the nasal and temporal retinal vasculature to a more distal point than was the Heidelberg Spectralis(®), in ten of ten eyes (20 of 20 quadrants). Conclusion The ultra-widefield Fluorescein Angiography obtained with the Optos(®) and Heidelberg Spectralis(®) ultra-widefield imaging systems are both excellent modalities that provide views of the peripheral retina. On a single nonsteered image, the Optos(®) Optomap(®) covered a significantly larger total retinal surface area, with greater image variability, than did the Heidelberg Spectralis(®) ultra-widefield module. The Optos(®) captured an appreciably wider view of the retina temporally and nasally, albeit with peripheral distortion, while the ultra-widefield Heidelberg Spectralis(®) module was able to image the superior and inferior retinal vasculature more peripherally. The clinical significance of these findings as well as the area imaged on steered montaged images remains to be determined.
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peripheral retinal ischaemia as evaluated by ultra widefield Fluorescein Angiography is associated with diabetic macular oedema
British Journal of Ophthalmology, 2012Co-Authors: Matthew M Wessel, Nandini Nair, Grant D Aaker, Joshua R Ehrlich, Donald J Damico, Szilard KissAbstract:Purpose To determine the relationship between retinal ischaemia and the presence of macular oedema (DMO) in patients with diabetic retinopathy (DR) using ultra-widefield Fluorescein Angiography (UWFA) imaging. Methods A retrospective review of 122 eyes of 70 treatment-naive diabetic patients who underwent diagnostic UWFA using the Optos 200Tx imaging system. Two independent, masked graders quantified the area of retinal ischaemia. Based on clinical examination and optical coherence tomography (OCT), each patient was given a binary classification as either having DMO or no DMO. McNemar9s test (with Yates9 correction as indicated) and a two-sample test of proportions were used to determine the relationship between DMO and ischaemia for binary and proportional data, respectively. Linear and logistic models were constructed using generalised estimating equations to test relationships between independent variables, covariates and outcomes while controlling for inter-eye correlation, age, gender, haemoglobin A1c, mean arterial pressure and dependence on insulin. Results Seventy-six eyes (62%) exhibited areas of retinal ischaemia. There was a significant direct correlation between DMO and peripheral retinal ischaemia as seen on UWFA (p Conclusion Retinal ischaemia is significantly correlated with DMO in treatment-naive patients with DR. UWFA is a useful tool for detecting peripheral retinal ischaemia, which may have direct implications in the diagnosis, follow-up and treatment such as targeted peripheral photocoagulation.
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detection and monitoring of sickle cell retinopathy using ultra wide field color photography and Fluorescein Angiography
Retina-the Journal of Retinal and Vitreous Diseases, 2011Co-Authors: Minhee Cho, Szilard KissAbstract:Purpose:In this study, we demonstrate the use of wide-field photography and Fluorescein Angiography to visualize the peripheral vascular changes and to identify patients with risk factors for developing proliferative sickle cell retinopathy.Methods:This is a retrospective case series of 12 eyes of 6
Ronald C Gentile - One of the best experts on this subject based on the ideXlab platform.
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classification of human retinal microaneurysms using adaptive optics scanning light ophthalmoscope Fluorescein Angiography
Investigative Ophthalmology & Visual Science, 2014Co-Authors: Michael Dubow, Alexander Pinhas, Nishit Shah, Robert F Cooper, Alexander Gan, Ronald C GentileAbstract:PURPOSE Microaneurysms (MAs) are considered a hallmark of retinal vascular disease, yet what little is known about them is mostly based upon histology, not clinical observation. Here, we use the recently developed adaptive optics scanning light ophthalmoscope (AOSLO) Fluorescein Angiography (FA) to image human MAs in vivo and to expand on previously described MA morphologic classification schemes. METHODS Patients with vascular retinopathies (diabetic, hypertensive, and branch and central retinal vein occlusion) were imaged with reflectance AOSLO and AOSLO FA. Ninety-three MAs, from 14 eyes, were imaged and classified according to appearance into six morphologic groups: focal bulge, saccular, fusiform, mixed, pedunculated, and irregular. The MA perimeter, area, and feret maximum and minimum were correlated to morphology and retinal pathology. Select MAs were imaged longitudinally in two eyes. RESULTS Adaptive optics scanning light ophthalmoscope Fluorescein Angiography imaging revealed microscopic features of MAs not appreciated on conventional images. Saccular MAs were most prevalent (47%). No association was found between the type of retinal pathology and MA morphology (P = 0.44). Pedunculated and irregular MAs were among the largest MAs with average areas of 4188 and 4116 μm(2), respectively. Focal hypofluorescent regions were noted in 30% of MAs and were more likely to be associated with larger MAs (3086 vs. 1448 μm(2), P = 0.0001). CONCLUSIONS Retinal MAs can be classified in vivo into six different morphologic types, according to the geometry of their two-dimensional (2D) en face view. Adaptive optics scanning light ophthalmoscope Fluorescein Angiography imaging of MAs offers the possibility of studying microvascular change on a histologic scale, which may help our understanding of disease progression and treatment response.
Toco Yuen Ping Chui - One of the best experts on this subject based on the ideXlab platform.
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imaging foveal microvasculature optical coherence tomography Angiography versus adaptive optics scanning light ophthalmoscope Fluorescein Angiography
Investigative Ophthalmology & Visual Science, 2016Co-Authors: Brian D Krawitz, Eleni Efstathiadis, Lawrence S Geyman, Rishard Weitz, Toco Yuen Ping Chui, Joseph CarrollAbstract:PURPOSE To compare the use of optical coherence tomography Angiography (OCTA) and adaptive optics scanning light ophthalmoscope Fluorescein Angiography (AOSLO FA) for characterizing the foveal microvasculature in healthy and vasculopathic eyes. METHODS Four healthy controls and 11 vasculopathic patients (4 diabetic retinopathy, 4 retinal vein occlusion, and 3 sickle cell retinopathy) were imaged with OCTA and AOSLO FA. Foveal perfusion maps were semiautomatically skeletonized for quantitative analysis, which included foveal avascular zone (FAZ) metrics (area, perimeter, acircularity index) and vessel density in three concentric annular regions of interest. On each set of OCTA and AOSLO FA images, matching vessel segments were used for lumen diameter measurement. Qualitative image comparisons were performed by visual identification of microaneurysms, vessel loops, leakage, and vessel segments. RESULTS Adaptive optics scanning light ophthalmoscope FA and OCTA showed no statistically significant differences in FAZ perimeter, acircularity index, and vessel densities. Foveal avascular zone area, however, showed a small but statistically significant difference of 1.8% (P = 0.004). Lumen diameter was significantly larger on OCTA (mean difference 5.7 μm, P < 0.001). Microaneurysms, fine structure of vessel loops, leakage, and some vessel segments were visible on AOSLO FA but not OCTA, while blood vessels obscured by leakage were visible only on OCTA. CONCLUSIONS Optical coherence tomography Angiography is comparable to AOSLO FA at imaging the foveal microvasculature except for differences in FAZ area, lumen diameter, and some qualitative features. These results, together with its ease of use, short acquisition time, and avoidance of potentially phototoxic blue light, support OCTA as a tool for monitoring ocular pathology and detecting early disease.
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comparison of adaptive optics scanning light ophthalmoscopic Fluorescein Angiography and offset pinhole imaging
Biomedical Optics Express, 2014Co-Authors: Toco Yuen Ping Chui, Rishard Weitz, Michael Dubow, Alexander Pinhas, Nishit Shah, Yusufu N Sulai, Alfredo Dubra, Richard B RosenAbstract:Recent advances to the adaptive optics scanning light ophthalmoscope (AOSLO) have enabled finer in vivo assessment of the human retinal microvasculature. AOSLO confocal reflectance imaging has been coupled with oral Fluorescein Angiography (FA), enabling simultaneous acquisition of structural and perfusion images. AOSLO offset pinhole (OP) imaging combined with motion contrast post-processing techniques, are able to create a similar set of structural and perfusion images without the use of exogenous contrast agent. In this study, we evaluate the similarities and differences of the structural and perfusion images obtained by either method, in healthy control subjects and in patients with retinal vasculopathy including hypertensive retinopathy, diabetic retinopathy, and retinal vein occlusion. Our results show that AOSLO OP motion contrast provides perfusion maps comparable to those obtained with AOSLO FA, while AOSLO OP reflectance images provide additional information such as vessel wall fine structure not as readily visible in AOSLO confocal reflectance images. AOSLO OP offers a non-invasive alternative to AOSLO FA without the need for any exogenous contrast agent.
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in vivo imaging of human retinal microvasculature using adaptive optics scanning light ophthalmoscope Fluorescein Angiography
Biomedical Optics Express, 2013Co-Authors: Alexander Pinhas, Joseph Carroll, Rishard Weitz, Toco Yuen Ping Chui, Michael Dubow, Nishit Shah, Yusufu N Sulai, Drew Scoles, Joseph B Walsh, Alfredo DubraAbstract:The adaptive optics scanning light ophthalmoscope (AOSLO) allows visualization of microscopic structures of the human retina in vivo. In this work, we demonstrate its application in combination with oral and intravenous (IV) Fluorescein Angiography (FA) to the in vivo visualization of the human retinal microvasculature. Ten healthy subjects ages 20 to 38 years were imaged using oral (7 and/or 20 mg/kg) and/or IV (500 mg) Fluorescein. In agreement with current literature, there were no adverse effects among the patients receiving oral Fluorescein while one patient receiving IV Fluorescein experienced some nausea and heaving. We determined that all retinal capillary beds can be imaged using clinically accepted Fluorescein dosages and safe light levels according to the ANSI Z136.1-2000 maximum permissible exposure. As expected, the 20 mg/kg oral dose showed higher image intensity for a longer period of time than did the 7 mg/kg oral and the 500 mg IV doses. The increased resolution of AOSLO FA, compared to conventional FA, offers great opportunity for studying physiological and pathological vascular processes.
Koushik Tripathy - One of the best experts on this subject based on the ideXlab platform.
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widefield fundus Fluorescein Angiography features of uveitis associated with juvenile idiopathic arthritis
Ocular Immunology and Inflammation, 2020Co-Authors: Koushik Tripathy, Howard Ying, Anapatricia Maldonado Cerda, Artur Filipowicz, Mahmut Kaya, Zeynep Seymen, Stephen D Anesi, Peter Y Chang, C S FosterAbstract:To evaluate the wide-field fundus Fluorescein Angiography (WFA) characteristics of uveitis associated with juvenile idiopathic arthritis (JIA-uveitis). Retrospective review of records. WFA with Spe...
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evaluation of rhegmatogenous retinal detachments using optos ultrawide field fundus Fluorescein Angiography and comparison with etdrs 7 field overlay
journal of current ophthalmology, 2018Co-Authors: Koushik Tripathy, Rohan Chawla, Bhushan Ratansingh Wadekar, Pradeep Venkatesh, Yog Raj SharmaAbstract:Abstract Purpose To evaluate the ultrawide field fundus Fluorescein Angiography (UWFA) characteristics of rhegmatogenous retinal detachments (RRDs) and compare the findings with an early treatment diabetic retinopathy study (ETDRS) 7 field (ETDRS7F) overlay. Methods UWFA (Optos, PLC, Dunfermline, UK) was performed in 10 eyes with macula-off RRDs in 9 patients. The findings of UWFA were compared with that of an overlay of standard ETDRS7F. Results Vascular dilation, tortuosity of vessels, and blockage of choroidal fluorescence were noted in all eyes in both UWFA and ETDRS7F overlay. Other findings in UWFA and ETDRS7F included peripheral perivascular staining (10 versus 4 eyes), peripheral capillary nonperfusion (CNP) (9 eyes compared to none), vascular loop formation (7 eyes versus none), optic disc hyperfluorescence (5 eyes in both), petaloid leak at macula (2 eyes in both), and neovascularization elsewhere (3 eyes versus none). Conclusions Peripheral perivascular staining and leak, CNP, and vascular tortuosity are common UWFA features of RRDs. Standard ETDRS7F missed peripheral CNP, peripheral vascular loops, and peripheral retinal new vessels in all eyes compared to UWFA in the current study.
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Evaluation of rhegmatogenous retinal detachments using Optos ultrawide field fundus Fluorescein Angiography and comparison with ETDRS 7 field overlay
Elsevier, 2018Co-Authors: Koushik Tripathy, Rohan Chawla, Bhushan Ratansingh Wadekar, Pradeep Venkatesh, Yog Raj SharmaAbstract:Purpose: To evaluate the ultrawide field fundus Fluorescein Angiography (UWFA) characteristics of rhegmatogenous retinal detachments (RRDs) and compare the findings with an early treatment diabetic retinopathy study (ETDRS) 7 field (ETDRS7F) overlay. Methods: UWFA (Optos, PLC, Dunfermline, UK) was performed in 10 eyes with macula-off RRDs in 9 patients. The findings of UWFA were compared with that of an overlay of standard ETDRS7F. Results: Vascular dilation, tortuosity of vessels, and blockage of choroidal fluorescence were noted in all eyes in both UWFA and ETDRS7F overlay. Other findings in UWFA and ETDRS7F included peripheral perivascular staining (10 versus 4 eyes), peripheral capillary nonperfusion (CNP) (9 eyes compared to none), vascular loop formation (7 eyes versus none), optic disc hyperfluorescence (5 eyes in both), petaloid leak at macula (2 eyes in both), and neovascularization elsewhere (3 eyes versus none). Conclusions: Peripheral perivascular staining and leak, CNP, and vascular tortuosity are common UWFA features of RRDs. Standard ETDRS7F missed peripheral CNP, peripheral vascular loops, and peripheral retinal new vessels in all eyes compared to UWFA in the current study. Keywords: Capillary nonperfusion, Perivascular leak, Vascular loop, Arteriovenous shunt, Retinal neovascularization, Neovascularization of iri
Michael Dubow - One of the best experts on this subject based on the ideXlab platform.
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comparison of adaptive optics scanning light ophthalmoscopic Fluorescein Angiography and offset pinhole imaging
Biomedical Optics Express, 2014Co-Authors: Toco Yuen Ping Chui, Rishard Weitz, Michael Dubow, Alexander Pinhas, Nishit Shah, Yusufu N Sulai, Alfredo Dubra, Richard B RosenAbstract:Recent advances to the adaptive optics scanning light ophthalmoscope (AOSLO) have enabled finer in vivo assessment of the human retinal microvasculature. AOSLO confocal reflectance imaging has been coupled with oral Fluorescein Angiography (FA), enabling simultaneous acquisition of structural and perfusion images. AOSLO offset pinhole (OP) imaging combined with motion contrast post-processing techniques, are able to create a similar set of structural and perfusion images without the use of exogenous contrast agent. In this study, we evaluate the similarities and differences of the structural and perfusion images obtained by either method, in healthy control subjects and in patients with retinal vasculopathy including hypertensive retinopathy, diabetic retinopathy, and retinal vein occlusion. Our results show that AOSLO OP motion contrast provides perfusion maps comparable to those obtained with AOSLO FA, while AOSLO OP reflectance images provide additional information such as vessel wall fine structure not as readily visible in AOSLO confocal reflectance images. AOSLO OP offers a non-invasive alternative to AOSLO FA without the need for any exogenous contrast agent.
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classification of human retinal microaneurysms using adaptive optics scanning light ophthalmoscope Fluorescein Angiography
Investigative Ophthalmology & Visual Science, 2014Co-Authors: Michael Dubow, Alexander Pinhas, Nishit Shah, Robert F Cooper, Alexander Gan, Ronald C GentileAbstract:PURPOSE Microaneurysms (MAs) are considered a hallmark of retinal vascular disease, yet what little is known about them is mostly based upon histology, not clinical observation. Here, we use the recently developed adaptive optics scanning light ophthalmoscope (AOSLO) Fluorescein Angiography (FA) to image human MAs in vivo and to expand on previously described MA morphologic classification schemes. METHODS Patients with vascular retinopathies (diabetic, hypertensive, and branch and central retinal vein occlusion) were imaged with reflectance AOSLO and AOSLO FA. Ninety-three MAs, from 14 eyes, were imaged and classified according to appearance into six morphologic groups: focal bulge, saccular, fusiform, mixed, pedunculated, and irregular. The MA perimeter, area, and feret maximum and minimum were correlated to morphology and retinal pathology. Select MAs were imaged longitudinally in two eyes. RESULTS Adaptive optics scanning light ophthalmoscope Fluorescein Angiography imaging revealed microscopic features of MAs not appreciated on conventional images. Saccular MAs were most prevalent (47%). No association was found between the type of retinal pathology and MA morphology (P = 0.44). Pedunculated and irregular MAs were among the largest MAs with average areas of 4188 and 4116 μm(2), respectively. Focal hypofluorescent regions were noted in 30% of MAs and were more likely to be associated with larger MAs (3086 vs. 1448 μm(2), P = 0.0001). CONCLUSIONS Retinal MAs can be classified in vivo into six different morphologic types, according to the geometry of their two-dimensional (2D) en face view. Adaptive optics scanning light ophthalmoscope Fluorescein Angiography imaging of MAs offers the possibility of studying microvascular change on a histologic scale, which may help our understanding of disease progression and treatment response.
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in vivo imaging of human retinal microvasculature using adaptive optics scanning light ophthalmoscope Fluorescein Angiography
Biomedical Optics Express, 2013Co-Authors: Alexander Pinhas, Joseph Carroll, Rishard Weitz, Toco Yuen Ping Chui, Michael Dubow, Nishit Shah, Yusufu N Sulai, Drew Scoles, Joseph B Walsh, Alfredo DubraAbstract:The adaptive optics scanning light ophthalmoscope (AOSLO) allows visualization of microscopic structures of the human retina in vivo. In this work, we demonstrate its application in combination with oral and intravenous (IV) Fluorescein Angiography (FA) to the in vivo visualization of the human retinal microvasculature. Ten healthy subjects ages 20 to 38 years were imaged using oral (7 and/or 20 mg/kg) and/or IV (500 mg) Fluorescein. In agreement with current literature, there were no adverse effects among the patients receiving oral Fluorescein while one patient receiving IV Fluorescein experienced some nausea and heaving. We determined that all retinal capillary beds can be imaged using clinically accepted Fluorescein dosages and safe light levels according to the ANSI Z136.1-2000 maximum permissible exposure. As expected, the 20 mg/kg oral dose showed higher image intensity for a longer period of time than did the 7 mg/kg oral and the 500 mg IV doses. The increased resolution of AOSLO FA, compared to conventional FA, offers great opportunity for studying physiological and pathological vascular processes.