Association of Kidney Function Measures With Signs of Neurodegeneration and Small Vessel Disease on Brain Magnetic Resonance Imaging: The Atherosclerosis Risk in Communities (ARIC) Study.

RATIONALE & OBJECTIVE: Chronic kidney disease (CKD) is a risk factor for cognitive decline, but evidence is limited on its etiology and morphological manifestation in the brain. We evaluated the association of estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (UACR) with structural brain abnormalities visible on magnetic resonance imaging (MRI). We also assessed whether this association was altered when different filtration markers were used to estimate GFR. STUDY DESIGN: Cross-sectional study nested in a cohort study. SETTING & PARTICIPANTS: 1,527 participants in the Atherosclerosis Risk in Communities (ARIC) Study. PREDICTORS: Log(UACR) and eGFR based on cystatin C, creatinine, cystatin C and creatinine in combination, or ß2-microglobulin (B2M). OUTCOMES: Brain volume reduction, infarcts, microhemorrhages, white matter lesions. ANALYTICAL APPROACH: Multivariable linear and logistic regression models fit separately for each predictor based on a 1-IQR difference in the predictor value. RESULTS: Each 1-IQR lower eGFR was associated with reduced cortex volume (regression coefficient: -0.07 [95% CI, -0.12 to-0.02]), greater white matter hyperintensity volume (logarithmically transformed; regression coefficient: 0.07 [95% CI, 0.01-0.15]), and lower white matter fractional anisotropy (regression coefficient: -0.08 [95% CI, -0.17 to-0.01]). The results were similar when eGFR was estimated with different equations based on cystatin C, creatinine, a combination of cystatin C and creatinine, or B2M. Higher log(UACR) was similarly associated with these outcomes as well as brain infarcts and microhemorrhages (odds ratios per 1-IQR-fold greater UACR of 1.31 [95% CI, 1.13-1.52] and 1.30 [95% CI, 1.12-1.51], respectively). The degree to which brain volume was lower in regions usually susceptible to Alzheimer disease and LATE (limbic-predominant age-related TDP-43 [Tar DNA binding protein 43] encephalopathy) was similar to that seen in the rest of the cortex. LIMITATIONS: No inference about longitudinal effects due to cross-sectional design. CONCLUSIONS: We found eGFR and UACR are associated with structural brain damage across different domains of etiology, and eGFR- and UACR-related brain atrophy is not selective for regions typically affected by Alzheimer disease and LATE. Hence, Alzheimer disease or LATE may not be leading contributors to neurodegeneration associated with CKD.

Patient Utilization of Premium Intraocular Lenses Before and During the COVID-19 Pandemic.

PURPOSE: To compare the choice of intraocular lens (IOL) and sociodemographic characteristics between patients who underwent elective cataract surgery before the COVID-19 pandemic and during the pandemic at the Wilmer Eye Institute. METHODS: A retrospective chart review of patients who underwent cataract surgery before the COVID-19 pandemic (June 1 to November 30, 2019) and during the pandemic (June 1 to November 30, 2020) was conducted. Sociodemographic information, including age, sex, race, and insurance, and choice of IOL (premium or standard) were analyzed. The association between timing of surgery and choice of IOL was analyzed using multivariable logistic regression. RESULTS: The study included 2,877 patients (3,946 eyes) before COVID-19 and 2,564 patients (3,605 eyes) during COVID-19. However, 9.0% (357/3,946) of surgeries before COVID-19 used premium IOLs compared with 11.1% (399/3,605) during COVID-19 ( P =0.004). There was no difference in the racial characteristics of patients between before and during COVID-19. After adjusting for time of surgery and demographics, the odds of choosing premium IOLs for black patients was 0.32 times the odds for white patients ( P <0.001). There was an increase in private-insured patients but a decrease in Medicare-insured patients during COVID-19. After adjusting for time of surgery and demographics, private-insured patients had higher odds of choosing premium IOLs ( P <0.001), whereas Medicaid-insured patients had lower odds ( P =0.007) when compared with Medicare-insured patients. CONCLUSION: More patients chose premium IOLs during COVID-19 than before COVID-19, concurrent with change in insurance status. White patients were more likely to choose premium IOLs than black patients, as were private-insured patients compared with Medicare-insured patients.

Augmented Vision for Dental Students' Education in Detecting Proximal Carious Lesions on Bitewing Radiographs: A Randomized Controlled Trial.

This two-arm, parallel, randomized controlled trial aimed to assess the effect of augmented vision (AV, using interactive color overlays) on the education of dental students in detecting proximal carious lesions on bitewing radiographs compared to black-and-white textbook-like illustrations. Forty-eight preclinical third-year dental students were randomized using a random number generator into two learning groups: test (AV, allowing interaction with color-highlighted carious lesions, n = 24) and control (showing the native radiograph and a black-and-white illustration displaying the carious lesion, n = 24). First, students had 2 weeks to assess 50 bitewings (lesion prevalence on the tooth level: 54.5%) in the test or control. Due to the nature of the intervention, participants could not be blinded toward the intervention. After that, they were asked to detect lesions on 10 independent bitewings and to assess lesion extent (outer/inner enamel; outer/middle/inner dentin). The reference test was constituted by two experienced dentists. No significant differences in accuracy (test 0.84 [95% CI: 0.79, 0.88]; control 0.83 [0.78, 0.87]), AUC (test 0.82 [0.81, 0.84]; control 0.81 [0.80, 0.83]) and F1 score (test 0.79 [0.75, 0.82]; control 0.77 [0.72, 0.81]) were observed between groups. Students of both groups showed difficulties in differentiating enamel from dentin carious lesions. While AV was reported to be motivating by students, it did not increase their accuracy.

Impact of artificial intelligence on dentists' gaze during caries detection: A randomized controlled trial.

OBJECTIVES: We aimed to understand how artificial intelligence (AI) influences dentists by comparing their gaze behavior when using versus not using an AI software to detect primary proximal carious lesions on bitewing radiographs. METHODS: 22 dentists assessed a median of 18 bitewing images resulting in 170 datasets from dentists without AI and 179 datasets from dentists with AI, after excluding data with poor gaze recording quality. We compared time to first fixation, fixation count, average fixation duration, and fixation frequency between both trial groups. Analyses were performed for the entire image and stratified by (1) presence of carious lesions and/or restorations and (2) lesion depth (E1/2: outer/inner enamel; D1-3 outer-inner third of dentin). We also compared the transitional pattern of the dentists' gaze between the trial groups. RESULTS: Median time to first fixation was shorter in all groups of teeth for dentists with AI versus without AI, although p>0.05. Dentists with AI had more fixations (median=68, IQR=31, 116) on teeth with restorations compared to dentists without AI (median=47, IQR=19, 100), p = 0.01. In turn, average fixation duration was longer on teeth with caries for the dentists with AI than those without AI; although p>0.05. The visual search strategy employed by dentists with AI was less systematic with a lower proportion of lateral tooth-wise transitions compared to dentists without AI. CONCLUSIONS: Dentists with AI exhibited more efficient viewing behavior compared to dentists without AI, e.g., lesser time taken to notice caries and/or restorations, more fixations on teeth with restorations, and fixating for shorter durations on teeth without carious lesions and/or restorations. CLINICAL SIGNIFICANCE: Analysis of dentists' gaze patterns while using AI-generated annotations of carious lesions demonstrates how AI influences their data extraction methods for dental images. Such insights can be exploited to improve, and even customize, AI-based diagnostic tools, thus reducing the dentists' extraneous attentional processing and allowing for more thorough examination of other image areas.

Machine Learning in Dentistry: A Scoping Review.

Machine learning (ML) is being increasingly employed in dental research and application. We aimed to systematically compile studies using ML in dentistry and assess their methodological quality, including the risk of bias and reporting standards. We evaluated studies employing ML in dentistry published from 1 January 2015 to 31 May 2021 on MEDLINE, IEEE Xplore, and arXiv. We assessed publication trends and the distribution of ML tasks (classification, object detection, semantic segmentation, instance segmentation, and generation) in different clinical fields. We appraised the risk of bias and adherence to reporting standards, using the QUADAS-2 and TRIPOD checklists, respectively. Out of 183 identified studies, 168 were included, focusing on various ML tasks and employing a broad range of ML models, input data, data sources, strategies to generate reference tests, and performance metrics. Classification tasks were most common. Forty-two different metrics were used to evaluate model performances, with accuracy, sensitivity, precision, and intersection-over-union being the most common. We observed considerable risk of bias and moderate adherence to reporting standards which hampers replication of results. A minimum (core) set of outcome and outcome metrics is necessary to facilitate comparisons across studies.

Associations of Midlife and Late-Life Blood Pressure Status With Late-Life Retinal OCT Measures.

Purpose: To explore the relationship of long-term blood pressure (BP) patterns with late-life optical coherence tomography (OCT) structural measures reflecting optic nerve health. Methods: Participants in this community-based cohort study of black and white individuals were part of the Atherosclerosis Risk in Communities study and the nested Eye Determinants of Cognition (EyeDOC) study. Participants had BP measured six times from 1987 to 2017 and were categorized into five BP patterns: sustained normotension; midlife normotension, late-life hypertension (systolic BP [SBP] >140 mmHg or diastolic BP [DBP] >90 mmHg or antihypertensive medication use); sustained hypertension; midlife normotension, late-life hypotension (SBP <90 mmHg or DBP <60 mmHg); and midlife hypertension, late-life hypotension. Multivariable linear regression modeling was used to evaluate associations between BP patterns and late-life OCT ganglion cell complex (GCC) and peripapillary retinal nerve fiber layer (RNFL) thickness. Results: In total, 931 eyes of 931 participants (mean age at EyeDOC visit = 80 years; 63% female; 45% black) were included. Mean GCC and RNFL thicknesses in the sustained normotension pattern were 90.8 ± 10.3 µm and 89.9 ± 11.2 µm versus 89.4 ± 11.9 µm and 90.1 ± 12.2 µm in the sustained hypertension pattern (P > 0.05). Compared to the sustained normotension pattern, no significant differences in GCC or RNFL thickness were found for any anomalous BP pattern. Conclusions: Assessment of long-term BP status showed no significant associations with late-life OCT structural measures. Translational Relevance: OCT imaging results in our population-based sample suggest that neither hypertension, even when present in midlife, nor late-life hypotension are significant risk factors for late-life optic nerve damage.

Gaze patterns of dentists while evaluating bitewing radiographs.

OBJECTIVES: Understanding dentists' gaze patterns on radiographs may allow to unravel sources of their limited accuracy and develop strategies to mitigate them. We conducted an eye tracking experiment to characterize dentists' scanpaths and thus their gaze patterns when assessing bitewing radiographs to detect primary proximal carious lesions. METHODS: 22 dentists assessed a median of nine bitewing images each, resulting in 170 datasets after excluding data with poor quality of gaze recording. Fixation was defined as an area of attentional focus related to visual stimuli. We calculated time to first fixation, fixation count, average fixation duration, and fixation frequency. Analyses were performed for the entire image and stratified by (1) presence of carious lesions and/or restorations and (2) lesion depth (E1/2: outer/inner enamel; D1-3: outer-inner third of dentin). We also examined the transitional nature of the dentists' gaze. RESULTS: Dentists had more fixations on teeth with lesions and/or restorations (median=138 [interquartile range=87, 204]) than teeth without them (32 [15, 66]), p<0.001. Notably, teeth with lesions had longer fixation durations (407 milliseconds [242, 591]) than those with restorations (289 milliseconds [216, 337]), p<0.001. Time to first fixation was longer for teeth with E1 lesions (17,128 milliseconds [8813, 21,540]) than lesions of other depths (p = 0.049). The highest number of fixations were on teeth with D2 lesions (43 [20, 51]) and lowest on teeth with E1 lesions (5 [1, 37]), p<0.001. Generally, a systematic tooth-by-tooth gaze pattern was observed. CONCLUSIONS: As hypothesized, while visually inspecting bitewing radiographic images, dentists employed a heightened focus on certain image features/areas, relevant to the assigned task. Also, they generally examined the entire image in a systematic tooth-by-tooth pattern.

Risk Factors Associated with Cystoid Macular Edema among Patients Undergoing Primary Repair of Rhegmatogenous Retinal Detachment.

PURPOSE: To investigate predictors of the development and resolution of cystoid macular edema (CME) after rhegmatogenous retinal detachment (RRD) repair. DESIGN: Retrospective cross sectional study. SUBJECTS: Patients who underwent primary repair of uncomplicated RRD. METHODS: Demographics, ophthalmic history, visual acuity, RRD features, time to development/resolution of CME, OCT characteristics of CME/epiretinal membrane (ERM), type of surgery, and treatments were collected. Logistic regressions were used to identify predictors of CME development and resolution. MAIN OUTCOME MEASURES: Predictors of CME development and resolution. RESULTS: A total of 708 eyes were included, of which 55 (7.8%) developed CME. Factors associated with an increased risk of CME development included total number of retinal detachment surgeries (odds ratio [OR] 1.66 [1.24-2.23], P < 0.001), prior intraocular surgery (OR 4.43 [1.19-16.51], P = 0.03), and presence of ERM after surgery (OR 4.49 [2.30-8.74], P < 0.001). Patients undergoing pars plana vitrectomy (PPV) were more likely to develop CME compared with patients undergoing scleral buckling (SB; OR 3.09 [1.18-8.10], P = 0.02). A longer average time to CME detection was associated with lower CME resolution (OR 0.94 [0.89-0.998], P = 0.04). In patients who developed an ERM postsurgically, those who developed CME after ERM had a lower rate of resolution compared with those who developed CME before ERM (P = 0.03). CONCLUSIONS: Cystoid macular edema may be more likely to develop in patients undergoing PPV than SB, those who underwent more surgeries for RRD repair, those who had prior intraocular surgery, or those who developed an ERM after RRD repair. Resolution of CME may be affected by the time to detection of CME and ERM development. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Associations among Visual, Auditory, and Olfactory Functions in Community-Based Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study.

Purpose: Objective examination of relationships among visual, hearing, and olfactory function may yield mechanistic insights and inform our understanding of the burden of multiple-sensory impairments. Methods: This cross-sectional study capitalized on continuous measures of visual acuity (VA), contrast sensitivity, pure tone audiometry, Quick Speech-in-Noise (QuickSIN), and Sniffin' Sticks from a subset of ARIC participants at two community sites (EyeDOC Study, 2017-2019). Scales of all measures were aligned such that higher values indicated greater impairment. Intersensory bivariate associations were assessed graphically, and correlations assessed using Kendall's tau. Intersensory associations, independent of age, education, smoking, diabetes, and hypertension, were examined using linear regression. Analyses were stratified by community/race (Washington County/White vs Jackson/Black) and sex (men vs women) to explore community-sex heterogeneity. Results: We included 834 participants (mean age, 79 years); 39% were from Jackson and 63% females. We found weak intersensory correlations (tau generally ≤0.15). In the demographics-adjusted regression models, results were heterogeneous across communities and sex. Worse near VA, contrast sensitivity, and olfaction were associated with worse QuickSIN and worse near VA was associated with worse olfaction in some but not all community/race-sex groups (e.g., Jackson/Black women, 0.1 logMAR worse near VA was associated with 0.27 units increase in QuickSIN [95% confidence interval, 0.10-0.45]). Associations were modestly attenuated by adjustment for the shared risk factors of smoking, diabetes, and hypertension. Conclusions: Visual dysfunction showed little or no association with hearing or olfaction impairments, suggesting a modest role for shared risk factors. Translational Relevance: Visually impaired individuals have only a modestly higher risk of other sensory impairment.

Association of Optical Coherence Tomography and Optical Coherence Tomography Angiography Retinal Features With Visual Function in Older Adults.

Importance: Although there is abundant evidence relating neuronal and vascular optical coherence tomography (OCT) and OCT angiography (OCTA) measures to retinal disease, data on the normative distribution of retinal features and their associations with visual function in a healthy, older, community-based population are sparse. Objectives: To characterize the normative OCT and OCTA measures in older adults and describe their associations with visual function. Design, Setting, and Participants: This was a cross-sectional, observational study conducted from May 17, 2017, to May 31, 2019. The study included a community-based sample. Participants in the Atherosclerosis Risk in Communities study from Jackson, Mississippi (all self-reported Black participants), and Washington County, Maryland (all self-reported White participants), were recruited in the Eye Determinants of Cognition study (EyeDOC). Data analyses were conducted from June 14, 2020, to May 31, 2021. Main Outcomes and Measures: Retinal measurements, including retinal nerve fiber layer (RNFL) thickness, macular ganglion cell complex (GCC) thickness, macular vessel density (VD) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP), and foveal avascular zone (FAZ) area, were captured with spectral-domain OCT and OCTA. Visual function, including presenting distance vision, corrected distance vision, near visual acuity (VA), and contrast sensitivity (CS), was assessed. Results: A total of 759 participants (mean [SD] age, 80 [4.2] years; 480 female participants [63%]; 352 Black participants [46%]) were included in the study. Mean (SD) GCC thickness (89.2 [9.3] µm vs 92.3 [8.5] µm) and mean (SD) FAZ (0.36 [0.16] mm2 vs 0.26 [0.12] mm2) differed between Jackson and Washington County participants, respectively. Mean (SD) RNFL thickness and mean (SD) VD in SCP and DCP were greater for participants 80 years or younger than for participants older than 80 years (RNFL: ≤80 years, 93.2 [10.5] µm; >80 years, 91.1 [11.6] µm; VD SCP, ≤80 years, 44.3% [3.5%]; >80 years, 43.5% [3.8%]; VD DCP, ≤80 years, 44.7% [4.9%]; >80 years, 43.7% [4.8%]). Linear regression showed each 10-µm increment in RNFL thickness and GCC thickness was positively associated with 0.016 higher logCS among all participants (RNFL: 95% CI, 0.005-0.027; P = .004; GCC: 95% CI, 0.003-0.029; P = .02), with stronger associations among Jackson participants. The associations of VA and structural measures were found only in Jackson participants, with coefficients per 10-µm increment of 0.012 logMAR VA (RNFL: 95% CI, 0.000-0.023; P = .049) and 0.020 logMAR VA (GCC: 95% CI, 0.004-0.034; P = .04). Conclusions and Relevance: In this cross-sectional study, better CS was associated with greater RNFL thickness and GCC thickness, but no visual measures were associated with angiographic features overall. These findings suggest that clinical application of normative references for OCT- and OCTA-based measures should consider demographic and community features.