Optical Coherence Tomography Measurements in Type 1 Diabetic Subjects with Low and Moderate Daily Physical Activity.

Background: Physical activity is nowadays recognized as a protective factor against cardiovascular conditions, being cost-effective and easy to implement. Through its positive effects on hemodynamic and oxidative stress, different intensities in daily physical activity could influence diabetic macular edema (DME) in type 1 Diabetes Mellitus (DM). Methods: With the help of a spectral domain optical coherence tomography (OCT) device, we studied the macular thickness and ETDRS map parameters in type 1 DM patients who were classified into two groups: low and moderate intensity routine physical activity status, using the international physical activity questionnaire (IPAQ). All subjects received comparable anti-VEGF treatment. Results: Having a long disease evolution, patients with type 1 DM (T1DM) with moderate physical activity displayed better OCT measurements in specific retinal sectors than their counterparts with low physical activity. Variables such as age and body mass index (BMI) can influence the level of physical activity in T1DM patients. Conclusions: This study showed a lower prevalence of DME in T1DM subjects with moderate physical activity levels, revealing lower values for ETDRS OCT parameters in specific retinal sectors. The macular volumes (mm3) were significantly lower in the right eye for this group of subjects. Abbreviations: BMI = body mass index, CMT = central macular thickness, DM = diabetes mellitus, DME = diabetic macular edema, DR = diabetic retinopathy, FT = foveal thickness, II = inferior inner thickness, IO = inferior outer thickness, IPAQ = international physical activity questionnaire, LE = left eye, OCT = optical coherence tomography, MMT = maximal macular thickness, mMT = minimal macular thickness, MV = macular volume, NI = nasal inner thickness, NO = nasal outer thickness, QoL = quality of life, RE = right eye, SI = superior inner thickness, SO = superior outer thickness, T1DM = type 1 diabetes mellitus, T2DM = type 2 diabetes mellitus, TI = temporal inner thickness, TO = temporal outer thickness.

Diabetic Macular Edema Optical Coherence Tomography Biomarkers Detected with EfficientNetV2B1 and ConvNeXt.

(1) Background: Diabetes mellitus (DM) is a growing challenge, both for patients and physicians, in order to control the impact on health and prevent complications. Millions of patients with diabetes require medical attention, which generates problems regarding the limited time for screening but also addressability difficulties for consultation and management. As a result, screening programs for vision-threatening complications due to DM have to be more efficient in the future in order to cope with such a great healthcare burden. Diabetic macular edema (DME) is a severe complication of DM that can be prevented if it is timely screened with the help of optical coherence tomography (OCT) devices. Newly developing state-of-the-art artificial intelligence (AI) algorithms can assist physicians in analyzing large datasets and flag potential risks. By using AI algorithms in order to process OCT images of large populations, the screening capacity and speed can be increased so that patients can be timely treated. This quick response gives the physicians a chance to intervene and prevent disability. (2) Methods: This study evaluated ConvNeXt and EfficientNet architectures in correctly identifying DME patterns on real-life OCT images for screening purposes. (3) Results: Firstly, we obtained models that differentiate between diabetic retinopathy (DR) and healthy scans with an accuracy of 0.98. Secondly, we obtained a model that can indicate the presence of edema, detachment of the subfoveolar neurosensory retina, and hyperreflective foci (HF) without using pixel level annotation. Lastly, we analyzed the extent to which the pretrained weights on natural images "understand" OCT scans. (4) Conclusions: Pretrained networks such as ConvNeXt or EfficientNet correctly identify features relevant to the differentiation between healthy retinas and DR, even though they were pretrained on natural images. Another important aspect of our research is that the differentiation between biomarkers and their localization can be obtained even without pixel-level annotation. The "three biomarkers model" is able to identify obvious subfoveal neurosensory detachments, retinal edema, and hyperreflective foci, as well as very small subfoveal detachments. In conclusion, our study points out the possible usefulness of AI-assisted diagnosis of DME for lowering healthcare costs, increasing the quality of life of patients with diabetes, and reducing the waiting time until an appropriate ophthalmological consultation and treatment can be performed.

An overview of the visual dysfunctions in Parkinson's disease - Update from a prospective study in Transylvania.

Being a highly prevalent neurodegenerative disorder worldwide, Parkinson's disease (PD) shows its complexity not only in the variability of its pathology, but also in the complex constellation of its clinical picture. PD does not affect only the nervous system; instead, it is today recognized as having both motor and non-motor features. The purpose of this article is to report up-to-date information of an ongoing study, which correlates the motor features of Parkinson's disease (PD) with the visual disturbances (non-motor features) related to this disease. Abbreviations: PD = Parkinson's disease, HY = Hoehn-Yahr scale, MMSE = Mini-Mental state exam, UPDRS = Unified Parkinson's disease rating scale, RE = right eye, LE = left eye.

Interleaved Optical Coherence Tomography: Clinical and Laboratory Biomarkers in Patients with Diabetic Macular Edema.

(1) Background: The global burden of diabetes mellitus (DM) has been estimated to reach 600 million patients worldwide by 2040. Approximately 200 million people will develop diabetic retinopathy within this time frame. Diabetic macular edema (DME) is a severe, vision-threatening complication that can develop at any stage of diabetic retinopathy, and it represents the main cause of vision loss in patients with DM. Its harmful consequences on visual function could be prevented with timely recognition and treatment. (2) Methods: This study assessed the clinical (demographic characteristics, diabetic evolution, and systemic vascular complications); laboratory (glycated hemoglobin, metabolic parameters, capillary oxygen saturation, and renal function); ophthalmologic exam; and spectral-domain optical coherence tomography (SD-OCT) (macular volume, central macular thickness, maximal central thickness, minimal central thickness, foveal thickness, superior inner, inferior inner, nasal inner, temporal inner, inferior outer, superior outer, nasal outer, and temporal outer thicknesses, disruption of the ellipsoid zone, and disruption of the inner retinal layers (DRIL) parameters in three groups of individuals: healthy controls (HC), patients with DME and type 1 DM (T1DM-group A), and patients with DME and type 2 DM (T2DM-group B) to identify novel correlations between them that would open a path to new pathogenetic hypotheses and, implicitly, to the identification of new therapeutic methods, as part of a tailored treatment within the concept of precision medicine. (3) Results: The duration of DM was significantly longer in group A as compared with group B, as were the prevalence of smoking and systemic vascular complications. Capillary oxygen saturation and estimated glomerular filtration rates were significantly lower, and serum creatinine levels were significantly higher in group A as compared to group B. Regarding the OCT findings, DME had a predominantly eccentric pattern, and the right eye was more severely affected in both groups of patients. Significantly higher values were obtained in group B as compared to group A for the following OCT biomarkers: macular volume, central macular thickness, maximal central thickness, minimal central thickness, foveal thickness, superior inner, inferior inner, nasal inner, inferior outer and nasal outer thickness. The disruption of the ellipsoid zone was significantly more prevalent within group A, whereas the overall disruption of the retinal inner layers (DRIL) was identified significantly more frequently in group B. (4) Conclusions: Whereas systemic and laboratory biomarkers were more severely affected in patients with DME and T1DM, the OCT quantitative biomarkers revealed significantly higher values in patients with DME and T2DM.

Circumpapillary Retinal Nerve Fiber Layer OCT Imaging in a Parkinson's Disease Cohort-A Multidisciplinary Approach in a Clinical Research Hospital.

(1) Background: The purpose of this paper is to report the data of the first study in a Clinical Research Hospital, in the Transylvania region, focusing on the Spectral Domain Optical Coherence Tomography (SD-OCT) measurements in the early stages of Parkinson's disease (PD), and to compare the results with age-matched healthy controls. (2) Methods: This study assessed the circumpapillary retinal nerve fiber layer (cpRNFL) SD-OCT measurements (Heidelberg Spectralis, Heidelberg Engineering, Germany) of two study groups: patients suffering from PD (Hoehn-Yahr stages 1-3) and healthy controls. Secondary objectives were to investigate the reported visual symptoms by evaluating the color vision, contrast sensitivity, and the central visual defects for macular disease using standardized charts. Subjects with prior history of ophthalmologic diseases, advanced stages of PD (Hoehn-Yahr stages 4-5), or with psychiatric conditions were not included in this study. The same team of neurologists and ophthalmologists evaluated all individuals in order to have comparable data and to eliminate inter-examiner differences. All subjects were recruited from the same Clinical Research Hospital in the Transylvania region, Romania. (3) Results: 72% of the PD patients (n = 17) in this study reported visual symptoms. In respect to the ophthalmologic chart evaluation for PD patients, the most frequent disturbances were identified in the Ishihara color perception testing (33%). The regression analysis showed significant results for the Ishihara testing in relation to the cpRNFL thinning in the temporal retinal sectors for both eyes. cpRNFL thinning was predominantly contralateral to the parkinsonism (p = 0.001). The temporal and global values of the cpRNFL were significantly lower in all PD patients < 70 years old, compared to the age-matched healthy controls. (4) Conclusions: Specific patterns of cpRNFL thinning were found in the PD subjects younger than 70 years. A multidisciplinary approach is essential for a complete evaluation of PD patients.

Visual function changes in a Parkinson's Disease cohort - preliminary data.

The prevalence of Parkinson's disease (PD), the second most common neurodegenerative disorder, has dramatically increased worldwide from 2,5 million in 1990, to 6,1 million in 2016. This condition continues to unfold its complexity, being nowadays recognized more as a syndrome rather than a disease. Beside the motor symptoms, the non-motor features, which can appear as early as twenty years before the classic onset, are now included in the diagnostic criteria. Increased public awareness, early recognition, and intervention (mostly neuroprotective) could highly increase the quality of life of people suffering from PD. We believe that these measures must be taken without delay, in order to counteract the increasing prevalence of PD worldwide. Abbreviations: PD = Parkinson's disease, GBD = Global Burden of Diseases, HY = Hoehn-Yahr scale, SD = standard deviation.

Optical Coherence Tomography (Angiography) Biomarkers in the Assessment and Monitoring of Diabetic Macular Edema.

Retinopathy is one of the most severe diabetes-related complications, and macular edema is the major cause of central vision loss in patients with diabetes mellitus. Significant progress has been made in recent years in optical coherence tomography and angiography technology. At the same time, various parameters have been attributed the role of biomarkers creating the frame for new monitoring and treatment strategies and offering new insights into the pathogenesis of diabetic retinopathy and diabetic macular edema. In this review, we gathered the results of studies that investigated various specific OCT (angiography) parameters in diabetic macular edema, such as central subfoveal thickness (CST), cube average thickness (CAT), cube volume (CV), choroidal thickness (CT), retinal nerve fiber layer (RNFL), retinal thickness at the fovea (RTF), subfoveal choroidal thickness (SFCT), central macular thickness (CMT), choroidal vascularity index (CVI), total macular volume (TMV), central choroid thickness (CCT), photoreceptor outer segment (PROS), perfused capillary density (PCD), foveal avascular zone (FAZ), subfoveal neuroretinal detachment (SND), hyperreflective foci (HF), disorganization of the inner retinal layers (DRIL), ellipsoid zone (EZ), inner segment/outer segment (IS/OS) junctions, vascular density (VD), deep capillary plexus (DCP), and superficial capillary plexus (SCP), in order to provide a synthesis of biomarkers that are currently used for the early diagnosis, assessment, monitoring, and outlining of prognosis.