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Article ; Online: Is Central Retina Thickness the Most Relevant Parameter in the Management of Diabetic Macular Edema?

Vujosevic, Stela / Ting, Daniel S W

2023 Volume 43, Issue 10, Page(s) 1639–1643

MeSH term(s)	Humans ; Diabetic Retinopathy/diagnosis ; Macular Edema/diagnosis ; Macular Edema/drug therapy ; Retina/diagnostic imaging ; Diabetes Mellitus
Language	English
Publishing date	2023-08-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	603192-4
ISSN	1539-2864 ; 0275-004X
ISSN (online)	1539-2864
ISSN	0275-004X
DOI	10.1097/IAE.0000000000003914
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Article ; Online: Epidemiology of geographic atrophy and its precursor features of intermediate age-related macular degeneration.

Vujosevic, Stela / Alovisi, Camilla / Chakravarthy, Usha

Acta ophthalmologica

2023 Volume 101, Issue 8, Page(s) 839–856

Abstract: Globally age-related macular degeneration (AMD) is a leading cause of blindness with a significant impact on quality of life. Geographic atrophy (GA) is the atrophic late form of AMD and its prevalence increases markedly with age with around 1 in 5 ... ...

Abstract	Globally age-related macular degeneration (AMD) is a leading cause of blindness with a significant impact on quality of life. Geographic atrophy (GA) is the atrophic late form of AMD and its prevalence increases markedly with age with around 1 in 5 persons aged 85 and above having GA in at least one eye. Bilateral GA leads to severe visual impairment thus posing a significant burden on patients, careers and health providers. The incidence and prevalence of GA varies across different geographic regions, with the highest rates in those of European ancestry. Although heterogeneity in definitions of GA and reporting strategy can explain some of the discrepancies, the data overall are consistent in showing a lower prevalence in other ethnicities such as those of Asian heritage. This is at present unexplained but thought to be due to the existence of protective factors such as differences in eye pigmentation, diet, environmental exposures and genetic variability. This review covers key aspects of the prevalence and incidence of the ocular precursor features of GA (large drusen, pigmentary abnormalities and reticular pseudo-drusen), the late stage of GA and factors that have been known to be associated with modifying risk including systemic, demographic, environment, genetic and ocular. Understanding the global epidemiology scenario is crucial for the prevention of and management of patients with GA.
MeSH term(s)	Humans ; Geographic Atrophy ; Retinal Drusen/epidemiology ; Quality of Life ; Macular Degeneration/epidemiology ; Retina
Language	English
Publishing date	2023-11-07
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2408333-1
ISSN	1755-3768 ; 1755-375X
ISSN (online)	1755-3768
ISSN	1755-375X
DOI	10.1111/aos.15767
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Article ; Online: Measuring Quality of Life in Diabetic Retinal Disease: A Narrative Review of Available Patient-Reported Outcome Measures.

Vujosevic, Stela / Chew, Emily / Labriola, Leanne / Sivaprasad, Sobha / Lamoureux, Ecosse

Ophthalmology science

2023 Volume 4, Issue 2, Page(s) 100378

Abstract: Topic: Several patient-reported outcome measures (PROMs) are available to measure health-related quality of life (HRQoL) in patients with late-stage clinical diabetic retinal diseases (DRDs). However, an understanding of the psychometric properties of ... ...

Abstract	Topic: Several patient-reported outcome measures (PROMs) are available to measure health-related quality of life (HRQoL) in patients with late-stage clinical diabetic retinal diseases (DRDs). However, an understanding of the psychometric properties of PROMs is needed to assess how they could relate to severity levels of a revised DRD grading system. This narrative review assessed the available generic-, vision-, and DRD-related PROMs used in DRD research and highlights areas for improvement. Clinical relevance: Diabetic retinal disease is a common complication of diabetes and can lead to sight-threatening complications with a devastating effect on HRQoL. Methods: The Quality of Life working group is one of 6 working groups organized for the DRD Staging System Update Effort, a project of the Juvenile Diabetes Research Foundation Mary Tyler Moore Vision Initiative. PubMed, Cochrane Library, Embase, and Google Scholar databases were searched using core keywords to retrieve ophthalmology-related review articles, randomized clinical trials, and prospective, observational, and cross-sectional studies in the English language. A detailed review of 12 PROMs (4 QoL questionnaires and 8 utilities) that met a minimum level of evidence (LOE) was conducted. The relevance of each PROM to DRD disease stage and Biomarker Qualification guidelines ( Results: The National Eye Institute 25-item Visual Function Questionnaire (NEI VFQ-25), Impact of vision impairment-computerized adaptive testing, and Diabetic Retinopathy and Macular Edema Computerized Adaptive Testing System had a LOE of II in detecting change due to late-stage DRD (diabetic macular edema), although several areas for improvement (e.g., psychometrics and generalizability) were identified. Other PROMs, particularly the utilities, had a LOE of III due to cross-sectional evidence in late-stage clinical DRD. Although the NEI VFQ-25 has been the most widely used PROM in late-stage DRD, more work is required to improve its multidimensional structure and other psychometric limitations. No PROM was deemed relevant for subclinical or early/mid-DRD. Conclusion: This narrative review found that the most commonly used PROM is NEI VFQ-25, but none meets the ideal psychometric, responsiveness, and clinical setting digital administration requirements that could be included in an updated DRD staging system for diagnosis and monitoring of DRD progression. Financial disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Language	English
Publishing date	2023-08-09
Publishing country	Netherlands
Document type	Journal Article ; Review
ISSN	2666-9145
ISSN (online)	2666-9145
DOI	10.1016/j.xops.2023.100378
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Article ; Online: Digital innovations for retinal care in diabetic retinopathy.

Vujosevic, Stela / Limoli, Celeste / Luzi, Livio / Nucci, Paolo

Acta diabetologica

2022 Volume 59, Issue 12, Page(s) 1521–1530

Abstract: Aim: The purpose of this review is to examine the applications of novel digital technology domains for the screening and management of patients with diabetic retinopathy (DR).: Methods: A PubMed engine search was performed, using the terms " ... ...

Abstract	Aim: The purpose of this review is to examine the applications of novel digital technology domains for the screening and management of patients with diabetic retinopathy (DR). Methods: A PubMed engine search was performed, using the terms "Telemedicine", "Digital health", "Telehealth", "Telescreening", "Artificial intelligence", "Deep learning", "Smartphone", "Triage", "Screening", "Home-based", "Monitoring", "Ophthalmology", "Diabetes", "Diabetic Retinopathy", "Retinal imaging". Full-text English language studies from January 1, 2010, to February 1, 2022, and reference lists were considered for the conceptual framework of this review. Results: Diabetes mellitus and its eye complications, including DR, are particularly well suited to digital technologies, providing an ideal model for telehealth initiatives and real-world applications. The current development in the adoption of telemedicine, artificial intelligence and remote monitoring as an alternative to or in addition to traditional forms of care will be discussed. Conclusions: Advances in digital health have created an ecosystem ripe for telemedicine in the field of DR to thrive. Stakeholders and policymakers should adopt a participatory approach to ensure sustained implementation of these technologies after the COVID-19 pandemic. This article belongs to the Topical Collection "Diabetic Eye Disease", managed by Giuseppe Querques.
MeSH term(s)	Humans ; Pandemics ; Ecosystem ; COVID-19/complications ; COVID-19/epidemiology ; Diabetic Retinopathy/diagnosis ; Diabetic Retinopathy/therapy ; Diabetic Retinopathy/epidemiology ; Telemedicine ; Mass Screening ; Diabetes Mellitus
Language	English
Publishing date	2022-08-12
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	1097676-0
ISSN	1432-5233 ; 0940-5429
ISSN (online)	1432-5233
ISSN	0940-5429
DOI	10.1007/s00592-022-01941-9
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Article: Update on Current and Future Management for Diabetic Maculopathy.

Udaondo, Patricia / Parravano, Mariacristina / Vujosevic, Stela / Zur, Dinah / Chakravarthy, Usha

Ophthalmology and therapy

2022 Volume 11, Issue 2, Page(s) 489–502

Abstract: Diabetic macular edema (DME) remains the major cause of preventable blindness in the working-age population in developed countries, and screening programs are extremely important in the management of this complication of diabetic retinopathy. The ... ...

Abstract	Diabetic macular edema (DME) remains the major cause of preventable blindness in the working-age population in developed countries, and screening programs are extremely important in the management of this complication of diabetic retinopathy. The introduction of modern imaging modalities and technological advances have facilitated both the early detection and the follow-up of patients with DME, particularly optical coherence tomography angiography and artificial intelligence. Intravitreal therapy is the gold standard treatment for DME, but not all patients respond equally to this therapy, and sometimes it is not easy to apply treatment protocols correctly; for these reasons, clinical practice results may differ from those of clinical trials in terms of vision gain. One approach has been to implement new treatment regimens, such as treat and extend, and new molecules and therapeutic targets are constantly being developed. The main goal of this review paper is to describe the current treatment options and management strategies for DME in Europe and to provide a brief oversight of the novel therapeutic options on the horizon.
Language	English
Publishing date	2022-01-31
Publishing country	England
Document type	Journal Article ; Review
ISSN	2193-8245
ISSN	2193-8245
DOI	10.1007/s40123-022-00460-8
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Article ; Online: Imaging geographic atrophy: integrating structure and function to better understand the effects of new treatments.

Vujosevic, Stela / Loewenstein, Anat / O'Toole, Louise / Schmidt-Erfurth, Ursula Margarethe / Zur, Dinah / Chakravarthy, Usha

The British journal of ophthalmology

2024

Abstract: Geographic atrophy (GA) is an advanced and irreversible form of age-related macular degeneration (AMD). Chronic low grade inflammation is thought to act as an initiator of this degenerative process, resulting in loss of photoreceptors (PRs), retinal ... ...

Abstract	Geographic atrophy (GA) is an advanced and irreversible form of age-related macular degeneration (AMD). Chronic low grade inflammation is thought to act as an initiator of this degenerative process, resulting in loss of photoreceptors (PRs), retinal pigment epithelium (RPE) and the underlying choriocapillaris. This review examined the challenges of clinical trials to date which have sought to treat GA, with particular reference to the successful outcome of C3 complement inhibition. Currently, optical coherence tomography (OCT) seems to be the most suitable method to detect GA and monitor the effect of treatment. In addition, the merits of using novel anatomical endpoints in detecting GA expansion are discussed. Although best-corrected visual acuity is commonly used to monitor disease in GA, other tests to determine visual function are explored. Although not widely available, microperimetry enables quantification of retinal sensitivity (RS) and macular fixation behaviour related to fundus characteristics. There is a spatial correlation between OCT/fundus autofluorescence evaluation of PR damage outside the area of RPE loss and RS on microperimetry, showing important associations with visual function. Standardisation of testing by microperimetry is necessary to enable this modality to detect AMD progression. Artificial intelligence (AI) analysis has shown PR layers integrity precedes and exceeds GA loss. Loss of the ellipsoid zone has been recognised as a primary outcome parameter in therapeutic trials for GA. The integrity of the PR layers imaged by OCT at baseline has been shown to be an important prognostic indicator. AI has the potential to be invaluable in personalising care and justifying treatment intervention.
Language	English
Publishing date	2024-01-30
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	80078-8
ISSN	1468-2079 ; 0007-1161
ISSN (online)	1468-2079
ISSN	0007-1161
DOI	10.1136/bjo-2023-324246
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Article ; Online: Macula vs periphery in diabetic retinopathy: OCT-angiography and ultrawide field fluorescein angiography imaging of retinal non perfusion.

Vujosevic, Stela / Fantaguzzi, Francesca / Silva, Paolo S / Salongcay, Recivall / Brambilla, Marco / Torti, Emanuele / Nucci, Paolo / Peto, Tunde

Eye (London, England)

2024

Abstract: Objectives: To investigate the association between peripheral non-perfusion index (NPI) on ultrawide-field fluorescein angiography (UWF-FA) and quantitative OCT-Angiography (OCT-A) metrics in the macula.: Methods: In total, 48 eyes with UWF-colour ... ...

Abstract	Objectives: To investigate the association between peripheral non-perfusion index (NPI) on ultrawide-field fluorescein angiography (UWF-FA) and quantitative OCT-Angiography (OCT-A) metrics in the macula. Methods: In total, 48 eyes with UWF-colour fundus photos (CFP), UWF-FA (California, Optos) and OCT-A (Spectralis, Heidelberg) were included. OCT-A (3 × 3 mm) was used to determine foveal avascular zone (FAZ) parameters and vessel density (VD), perfusion density (PD), fractal dimension (FD) on superficial capillary plexus (SCP). NPI's extent and distribution was determined on UWF-FA within fovea centred concentric rings corresponding to posterior pole (<10 mm), mid-periphery (10-15 mm), and far-periphery (>15 mm) and within the total retinal area, the central macular field (6×6 mm), ETDRS fields and within each extended ETDRS field (P3-P7). Results: Macular PD was correlated to NPI in total area of retina (Spearman ρ = 0.69, p < 0.05), posterior pole (ρ = 0.48, p < 0.05), mid-periphery (ρ = 0.65, p < 0.05), far-periphery (ρ = 0.59, p < 0.05), P3-P7 (ρ = 0,55 at least, p < 0.05 for each), central macula (ρ = 0.47, p < 0.05), total area in ETDRS (ρ = 0.55, p < 0.05). Macular VD and FD were correlated to NPI of total area of the retina (ρ = 0.60 and 0.61, p < 0.05), the mid-periphery (ρ = 0.56, p < 0.05) and far-periphery (ρ = 0.60 and ρ = 0.61, p < 0.05), and in P3-P7 (p < 0.05). FAZ perimeter was significantly corelated to NPI at posterior pole and central macular area (ρ = 0.37 and 0.36, p < 0.05), and FAZ area to NPI in central macular area (ρ = 0.36, p < 0.05). Conclusions: Perfusion macular metrics on OCT-A correlated with UWF-FA's non-perfusion (NP), particularly in the retina's mid and far periphery, suggesting that OCT-A might be a useful non-invasive method to estimate peripheral retinal NP.
Language	English
Publishing date	2024-02-24
Publishing country	England
Document type	Journal Article
ZDB-ID	91001-6
ISSN	1476-5454 ; 0950-222X
ISSN (online)	1476-5454
ISSN	0950-222X
DOI	10.1038/s41433-024-02989-3
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Article ; Online: Severity of Disorganization of Retinal Layers and Visual Function Impairment in Diabetic Retinopathy.

Vujosevic, Stela / Alovisi, Camilla / Piccoli, Gabriele / Brambilla, Marco / Torti, Emanuele / Marenzi, Elisa / Leporati, Francesco / Luzi, Livio / Nucci, Paolo

Ophthalmology. Retina

2024

Abstract: Purpose: To evaluate best corrected visual acuity (BCVA), retina sensitivity (RS) and fixation impairment by microperimetry (MP) due to the presence and severity of disorganization of inner and outer retinal layers (DRIL/DROL) and ischemia in OCT/OCT- ... ...

Abstract	Purpose: To evaluate best corrected visual acuity (BCVA), retina sensitivity (RS) and fixation impairment by microperimetry (MP) due to the presence and severity of disorganization of inner and outer retinal layers (DRIL/DROL) and ischemia in OCT/OCT-Angiography(OCT-A) in diabetic retinopathy (DR). Design: Retrospective case-control study. Subjects: Seventy-six eyes (65 patients) with DR were analyzed. Major exclusion criteria were: center-involving diabetic macular edema (DME), significant media opacity, nondiabetic macular pathology, active proliferative DR. Patients with DRIL and DROL within central 3 mm were enrolled as cases. Patients with DR and no retina disorganization were considered as controls. Methods: A detailed grading of microperimetry and OCT/OCT-A images using Image J software, and specific Image Manipulation Program was applied to co-localize the presence of retina disorganization and RS. BCVA and RS were correlated with the disorganization of retina layers' characteristics and grading (Grade 1-DRIL; Grade 2-DROL; Grade 3-DROL plus, with involvement of the ellipsoid zone). The same procedure of co-localization was applied to the vascular layers on OCT-A using Matlab. Main outcome: Correlation between BCVA and microperimetry parameters with disorganization of retina layers grading and OCT-A parameters. Results: BCVA, mean RS within 1mm and central 3mm (overall RS-oRS), perfusion density, vessel density and geometric perfusion deficit in intermediate and deep capillary plexuses were lower in cases versus controls (p<.001). Mean RS within 1mm (21.4dB±2.4 vs 13.8dB±5.4, p=.002), oRS (22.0dB±2.1 vs 14.4dB ±4.6, p<.001), and BCVA (76.1±7.4 vs 61.2±20.4 ETDRS letters; p=.02), had a significant decrease from grade 1 to grade 3 retina disorganization.Choriocapillaris flow-voids (CC-FV) increased from grade 1 to grade 3 (DROL plus) (p=.004). oRS and CC-FV were identified as significant predictors of retina disorganization grade with an adjusted coefficient of determination, R Conclusion: MP and BCVA documented a reduction in visual function in patients with DR and disorganization of retina layers at different grades, with greater functional impairment when outer retina layers and photoreceptors are involved. The severity of retina disorganization and the presence of ischemia could serve as a potential biomarker of functional impairment.
Language	English
Publishing date	2024-04-09
Publishing country	United States
Document type	Journal Article
ISSN	2468-6530
ISSN (online)	2468-6530
DOI	10.1016/j.oret.2024.04.005
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Article ; Online: TREND database: Retinal images of healthy young subjects visualized by a portable digital non-mydriatic fundus camera.

Popovic, Natasa / Vujosevic, Stela / Radunović, Miroslav / Radunović, Miodrag / Popovic, Tomo

PloS one

2021 Volume 16, Issue 7, Page(s) e0254918

Abstract: Topological characterization of the Retinal microvascular nEtwork visualized by portable fuNDus camera (TREND) is a database comprising of 72 color digital retinal images collected from the students of the Faculty of Medicine at the University of ... ...

Abstract	Topological characterization of the Retinal microvascular nEtwork visualized by portable fuNDus camera (TREND) is a database comprising of 72 color digital retinal images collected from the students of the Faculty of Medicine at the University of Montenegro, in the period from February 18th to March 11th 2020. The database also includes binarized images of manually segmented microvascular networks associated with each raw image. The participant demographic characteristics, health status, and social habits information such as age, sex, body mass index, smoking history, alcohol use, as well as previous medical history was collected. As proof of the concept, a smaller set of 10 color digital fundus images from healthy older participants is also included. Comparison of the microvascular parameters of these two sets of images demonstrate that digital fundus images recorded with a hand-held portable camera are able to capture the changes in patterns of microvascular network associated with aging. The raw images from the TREND database provide a standard that defines normal retinal anatomy and microvascular network geometry in young healthy people in Montenegro as it is seen with the digital hand-held portable non-mydriatic MiiS HORUS Scope DEC 200.This knowledge could facilitate the application of this technology at the primary level of health care for large scale telematic screening for complications of chronic diseases, such as hypertensive and diabetic retinopathy. In addition, it could aid in the development of new methods for early detection of age-related changes in the retina, systemic chronic diseases, as well as eye-specific diseases. The associated manually segmented images of the microvascular networks provide the standard that can be used for development of automatic software for image quality assessment, segmentation of microvascular network, and for computer-aided detection of pathological changes in retina. The TREND database is freely available at https://doi.org/10.5281/zenodo.4521043.
MeSH term(s)	Databases, Factual ; Female ; Humans ; Male ; Optical Imaging/instrumentation ; Optical Imaging/methods ; Retina/diagnostic imaging ; Retinal Vessels/diagnostic imaging ; Software ; Young Adult
Language	English
Publishing date	2021-07-23
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0254918
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Article ; Online: Retinal vascular occlusion and SARS-CoV-2 vaccination.

Vujosevic, Stela / Limoli, Celeste / Romano, Simona / Vitale, Lucia / Villani, Edoardo / Nucci, Paolo

Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie

2022 Volume 260, Issue 11, Page(s) 3455–3464

Abstract: Purpose: To assess the clinical and retinal imaging features of patients in whom retinal vascular occlusion (VO) had developed in temporal associations with COVID-19 vaccination.: Methods: In this retrospective case series, all consecutive adult ... ...

Abstract	Purpose: To assess the clinical and retinal imaging features of patients in whom retinal vascular occlusion (VO) had developed in temporal associations with COVID-19 vaccination. Methods: In this retrospective case series, all consecutive adult patients with new onset VO within 6 weeks of vaccination against COVID-19 were included in the study between May 1 and October 31, 2021. All patients had a systemic medical health assessment, full ophthalmic evaluation, and complete fundus imaging. Results: Fifteen eyes of VO (14 patients) after COVID-19 vaccinations were identified. The median time between vaccination and symptoms onset was 14 days (range 7-42 days). The mean best-corrected visual acuity (BCVA) was 20/55 with a range of 20/20 to 20/200. Eleven of 15 eyes (73.3%) had visual acuity improvement after intravitreal treatment at 60-90 days (range, 45-105 days) from the presentation. Four of 5 cases without systemic risk factors for VO had a mean BCVA > 20/32 at presentation and > 20/25 at the latest evaluation. Between May 1 and October 31, 2021, a temporal association was found between the 15 reported cases and COVID-19 vaccination out of a total of 29 VO (p = 0.05). The incidence of VO was higher in the considered period compared to the equivalent 6-month period in 2019 (1.17% vs 0.52%, respectively; p = 0.0134). Conclusions: Retinal vascular occlusion with different grades of severity are reported in temporal association with COVID-19 vaccination. The exact pathogenic mechanism needs to be further studied. No certain causal relationship can be established from this case series.
MeSH term(s)	Adult ; Humans ; Angiogenesis Inhibitors ; COVID-19/epidemiology ; COVID-19/prevention & control ; COVID-19 Vaccines/adverse effects ; Fluorescein Angiography ; Intravitreal Injections ; Retinal Diseases/drug therapy ; Retinal Vein Occlusion/etiology ; Retinal Vein Occlusion/complications ; Retrospective Studies ; SARS-CoV-2 ; Tomography, Optical Coherence ; Treatment Outcome ; Vaccination
Chemical Substances	Angiogenesis Inhibitors ; COVID-19 Vaccines
Language	English
Publishing date	2022-05-25
Publishing country	Germany
Document type	Journal Article
ZDB-ID	8435-9
ISSN	1435-702X ; 0721-832X
ISSN (online)	1435-702X
ISSN	0721-832X
DOI	10.1007/s00417-022-05707-5
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