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Glaucoma: HELP
Articles from Singapore Republic
Based on 465 articles published since 2010
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These are the 465 published articles about Glaucoma that originated from Singapore Republic during 2010-2020.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13 · 14 · 15 · 16 · 17 · 18 · 19
1 Editorial Minimally invasive glaucoma surgery - coming of age. 2018

Sng, Chelvin C A / Barton, Keith. ·National University Hospital, Singapore, Singapore. · Singapore Eye Research Institute, Singapore, Singapore. · Moorfields Eye Hospital, London, UK. · Moorfields Eye Hospital, London, UK BJO@keithbarton.co.uk. ·Br J Ophthalmol · Pubmed #30249721.

ABSTRACT: -- No abstract --

2 Editorial Mechanisms underlying acute angle closure. 2017

Nongpiur, Monisha E / Aung, Tin. ·Singapore Eye Research Institute, Singapore National Eye Centre, Singapore. · Duke-NUS Medical School, Singapore. · Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. ·Clin Exp Ophthalmol · Pubmed #28618456.

ABSTRACT: -- No abstract --

3 Editorial Stopping antithrombotics during regional anaesthesia and eye surgery: crying wolf? 2017

Kumar, C M / Seet, E. ·Department of Anaesthesia, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828 chandra.kumar2406@gmail.com. · Department of Anaesthesia, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828. ·Br J Anaesth · Pubmed #28100518.

ABSTRACT: -- No abstract --

4 Editorial Optical coherence tomography angiography: a non-invasive tool to image end-arterial system. 2016

Agrawal, Rupesh / Xin, Wei / Keane, Pearse A / Chhablani, Jay / Agarwal, Aniruddha. ·a National Healthcare Group Eye Institute , Tan Tock Seng Hospital , Singapore. · b Department of Medical Retina , Moorfields Eye Hospital NHS Foundation Trust , London , UK. · c Institute of Ophthalmology , University College London , London , UK. · d Department of Vitreoretina , L V Prasad Eye Institute , Hyderabad , India. · e Stanley M. Truhlsen Eye Institute , University of Nebraska Medical Center , Omaha , Nebraska , USA. ·Expert Rev Med Devices · Pubmed #27176114.

ABSTRACT: -- No abstract --

5 Editorial Flavonoids and glaucoma: revisiting therapies from the past. 2015

Milea, Dan / Aung, Tin. ·Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore. · Neuroscience and Behavioural Disorders Group, Duke-NUS, Singapore, Singapore. · Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore. aung.tin@snec.com.sg. · Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. aung.tin@snec.com.sg. ·Graefes Arch Clin Exp Ophthalmol · Pubmed #26344732.

ABSTRACT: -- No abstract --

6 Editorial Glaucoma and allergies: 'should I get rid of my cat?'. 2015

Sng, Chelvin C A / Barton, Keith. ·Glaucoma Service, Moorfields Eye Hospital, London, United Kingdom Department of Ophthalmology, National University Health System, Singapore Singapore Eye Research Institute, Singapore. · Glaucoma Service, Moorfields Eye Hospital, London, United Kingdom Department of Ophthalmology, National University Health System, Singapore National Institute for Health Research, Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, London Department of Epidemiology and Genetics, Institute of Ophthalmology, University College, London. ·Br J Ophthalmol · Pubmed #26130672.

ABSTRACT: -- No abstract --

7 Editorial How can nanoparticles be used to overcome the challenges of glaucoma treatment? 2014

Venkatraman, Subbu / Wong, Tina. ·School of Materials Science & Engineering, NTU & Ocular Therapeutic Engineering Centre, NTU, 50 Nanyang Avenue, 639798 Singapore  ·Nanomedicine (Lond) · Pubmed #25204817.

ABSTRACT: -- No abstract --

8 Review Beyond intraocular pressure: Optimizing patient-reported outcomes in glaucoma. 2019

Fenwick, Eva K / Man, Ryan Ek / Aung, Tin / Ramulu, Pradeep / Lamoureux, Ecosse L. ·Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore. · Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore. · Glaucoma Centre of Excellence, Wilmer Eye Institute, Johns Hopkins University, USA. · Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore. Electronic address: ecosse.lamoureux@seri.com.sg. ·Prog Retin Eye Res · Pubmed #31676347.

ABSTRACT: Glaucoma, an irreversible blinding condition affecting 3-4% adults aged above 40 years worldwide, is set to increase with a rapidly aging global population. Raised intraocular pressure (IOP) is a major risk factor for glaucoma where the treatment paradigm is focused on managing IOP using medications, laser, or surgery regimens. However, notwithstanding IOP and other clinical parameters, patient-reported outcomes, including daily functioning, emotional well-being, symptoms, mobility, and social life, remain the foremost concerns for people being treated for glaucoma. These outcomes are measured using objective patient-centered outcome measures (PCOMs) and subjective patient-reported outcome measures (PROMs). Studies using PCOMs have shown that people with glaucoma have several mobility, navigational and coordination challenges; reading and face recognition deficits; and are slower in adapting to multiple real-world situations when compared to healthy controls. Similarly, studies have consistently demonstrated, using PROMs, that glaucoma substantially and negatively impacts on peoples' self-reported visual functioning, mobility, independence, emotional well-being, self-image, and confidence in healthcare, compared to healthy individuals, particularly in those with late-stage disease undergoing a heavy treatment regimen. The patient-centred effectiveness of current glaucoma treatment paradigms is equivocal due to a lack of well-designed randomized controlled trials; short post-treatment follow-up periods; an inappropriate selection or availability of PROMs; and/or an insensitivity of currently available PROMs to monitor changes especially in patients with newly diagnosed early-stage glaucoma. We provide a comprehensive, albeit non-systematic, critique of the psychometric properties, limitations, and recent advances of currently available glaucoma-specific PCOMs and PROMs. Finally, we propose that item banking and computerized adaptive testing methods can address the multiple limitations of paper-pencil PROMs; customize their administration; and have the potential to improve healthcare outcomes for people with glaucoma.

9 Review Glaucoma management in the era of artificial intelligence. 2019

Devalla, Sripad Krishna / Liang, Zhang / Pham, Tan Hung / Boote, Craig / Strouthidis, Nicholas G / Thiery, Alexandre H / Girard, Michael J A. ·Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore. · Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore. · School of Optometry & Vision Sciences, Cardiff University, Cardiff, UK. · Newcastle Research & Innovation Institute, Singapore, Singapore. · NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK. · Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, New South Wales, Australia. · Department of Statistics and Applied Probability, National University of Singapore, Singapore, Singapore. · Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore mgirard@nus.edu.sg. ·Br J Ophthalmol · Pubmed #31640973.

ABSTRACT: Glaucoma is a result of irreversible damage to the retinal ganglion cells. While an early intervention could minimise the risk of vision loss in glaucoma, its asymptomatic nature makes it difficult to diagnose until a late stage. The diagnosis of glaucoma is a complicated and expensive effort that is heavily dependent on the experience and expertise of a clinician. The application of artificial intelligence (AI) algorithms in ophthalmology has improved our understanding of many retinal, macular, choroidal and corneal pathologies. With the advent of deep learning, a number of tools for the classification, segmentation and enhancement of ocular images have been developed. Over the years, several AI techniques have been proposed to help detect glaucoma by analysis of functional and/or structural evaluations of the eye. Moreover, the use of AI has also been explored to improve the reliability of ascribing disease prognosis. This review summarises the role of AI in the diagnosis and prognosis of glaucoma, discusses the advantages and challenges of using AI systems in clinics and predicts likely areas of future progress.

10 Review The genetics of angle closure glaucoma. 2019

Wang, Jin / Yusufu, Mayinuer / Khor, Chiea Chuen / Aung, Tin / Wang, Ningli. ·Beijing Tongren Hospital, Capital Medical University, Beijing, China. · Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, China. · Singapore Eye Research Institute, Singapore; Genome Institute of Singapore, Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. · Singapore Eye Research Institute, Singapore; Singapore National Eye Center, Singapore, Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. · Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, China. Electronic address: wningli@vip.163.com. ·Exp Eye Res · Pubmed #31634478.

ABSTRACT: Glaucoma, the leading cause of irreversible blindness worldwide, can be divided into two major types: primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG). PACG could lead to severe vision loss and has a high prevalence among Asian populations. The worldwide population affected by PACG is estimated to exceed 20 million by 2020. Recent studies have shown that there are at least eight genetic loci significantly associated with risk of PACG, possibly contributing to the phenotype by interacting with environmental factors. This review presents the progress that has been achieved in the genetics of PACG and its future perspectives. This article should be considered as a memorial article to honor Dr. R. Rand Allingham's remarkable contribution to genetic association studies in glaucoma. We are deeply saddened by the loss of Dr. Allingham, not only a huge loss for ophthalmology, but also loss of a dear friend. Looking back to his extraordinary career, Dr. Allingham devoted his whole life and passion into establishing the genetic basis of different forms of glaucoma such as open angle, angle closure, and exfoliation glaucoma. He had a special interest in analyses of populations from African ancestry, which greatly boosted the understanding of glaucoma genetics.

11 Review Scleral structure and biomechanics. 2019

Boote, Craig / Sigal, Ian A / Grytz, Rafael / Hua, Yi / Nguyen, Thao D / Girard, Michael J A. ·Structural Biophysics Research Group, School of Optometry & Vision Sciences, Cardiff University, UK; Ophthalmic Engineering & Innovation Laboratory (OEIL), Department of Biomedical Engineering, National University of Singapore, Singapore; Newcastle Research & Innovation Institute Singapore (NewRIIS), Singapore. Electronic address: bootec@cardiff.ac.uk. · Laboratory of Ocular Biomechanics, Department of Ophthalmology, University of Pittsburgh, USA. · Department of Ophthalmology & Visual Sciences, University of Alabama at Birmingham, USA. · Department of Mechanical Engineering, Johns Hopkins University, USA. · Ophthalmic Engineering & Innovation Laboratory (OEIL), Department of Biomedical Engineering, National University of Singapore, Singapore; Singapore Eye Research Institute (SERI), Singapore National Eye Centre, Singapore. ·Prog Retin Eye Res · Pubmed #31412277.

ABSTRACT: As the eye's main load-bearing connective tissue, the sclera is centrally important to vision. In addition to cooperatively maintaining refractive status with the cornea, the sclera must also provide stable mechanical support to vulnerable internal ocular structures such as the retina and optic nerve head. Moreover, it must achieve this under complex, dynamic loading conditions imposed by eye movements and fluid pressures. Recent years have seen significant advances in our knowledge of scleral biomechanics, its modulation with ageing and disease, and their relationship to the hierarchical structure of the collagen-rich scleral extracellular matrix (ECM) and its resident cells. This review focuses on notable recent structural and biomechanical studies, setting their findings in the context of the wider scleral literature. It reviews recent progress in the development of scattering and bioimaging methods to resolve scleral ECM structure at multiple scales. In vivo and ex vivo experimental methods to characterise scleral biomechanics are explored, along with computational techniques that combine structural and biomechanical data to simulate ocular behaviour and extract tissue material properties. Studies into alterations of scleral structure and biomechanics in myopia and glaucoma are presented, and their results reconciled with associated findings on changes in the ageing eye. Finally, new developments in scleral surgery and emerging minimally invasive therapies are highlighted that could offer new hope in the fight against escalating scleral-related vision disorder worldwide.

12 Review Glaucoma in myopia: diagnostic dilemmas. 2019

Tan, Nicholas Y Q / Sng, Chelvin C A / Jonas, Jost B / Wong, Tien Yin / Jansonius, Nomdo M / Ang, Marcus. ·Singapore Eye Research Institute, Singapore, Singapore. · Singapore National Eye Centre, Singapore, Singapore. · Singapore Eye Research Institute, Singapore, Singapore chelvin@gmail.com. · Department of Ophthalmology, National University Hospital, Singapore, Singapore. · Moorfields Eye Hospital, London, UK. · Department of Ophthalmology, Ruprecht-Karls-University Heidelberg, Seegartenklinik Heidelberg, Mannheim, Germany. · Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore. · Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands. ·Br J Ophthalmol · Pubmed #31040131.

ABSTRACT: Myopic eyes have an increased risk of glaucoma. However, glaucomatous changes in a myopic eye are often difficult to detect. Classic structural and functional investigations to diagnose glaucoma may be confounded by myopia. Here, we identify some of the common pitfalls in interpreting these structural parameters, and the possible solutions that could be taken to overcome them. For instance, in myopic eyes, we discuss the limitations and potential sources of error when using neuroretinal rim parameters, and retinal nerve fibre layer and ganglion cell-inner plexiform layer thickness measurements. In addition, we also review new developments and potential adjuncts in structural imaging such as the assessment of the retinal nerve fibre layer texture, and the examination of the microcirculation of the optic nerve head using optical coherence tomography angiography. For the functional assessment of glaucoma, we discuss perimetric strategies that may aid in detecting characteristic visual field defects in myopic glaucoma. Ultimately, the evaluation of glaucoma in myopia requires a multimodal approach, to allow correlation between structural and functional assessments. This review provides overview on how to navigate this diagnostic dilemma.

13 Review Retinal oximetry: Metabolic imaging for diseases of the retina and brain. 2019

Stefánsson, Einar / Olafsdottir, Olof Birna / Eliasdottir, Thorunn S / Vehmeijer, Wouter / Einarsdottir, Anna Bryndis / Bek, Toke / Torp, Thomas Lee / Grauslund, Jakob / Eysteinsson, Thor / Karlsson, Robert Arnar / Van Keer, Karel / Stalmans, Ingeborg / Vandewalle, Evelien / Todorova, Margarita G / Hammer, Martin / Garhöfer, Gerhard / Schmetterer, Leopold / Šín, Martin / Hardarson, Sveinn Hakon. ·University of Iceland, Reykjavik, Iceland; Landspitali, University Hospital, Reykjavik, Iceland; Oxymap ehf, Reykjavik, Iceland. Electronic address: einarste@landspitali.is. · University of Iceland, Reykjavik, Iceland; Landspitali, University Hospital, Reykjavik, Iceland. · Leiden University, Leiden, the Netherlands. · University of Iceland, Reykjavik, Iceland; Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark. · Aarhus University Hospital, Aarhus, Denmark. · Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark. · University of Iceland, Reykjavik, Iceland; Oxymap ehf, Reykjavik, Iceland. · University of Leuven, Leuven, Belgium. · University of Basel, Department of Ophthalmology, Basel, Switzerland; Cantonal Hospital St.Gallen, Department of Ophthalmology, St. Gallen, Switzerland. · Universitätsklinikum Jena, Germany. · Department of Clinical Pharmacology, Medical University of Vienna, Austria. · Singapore Eye Research Institute, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria. · Department of Ophthalmology, University Hospital and Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic. · University of Iceland, Reykjavik, Iceland. ·Prog Retin Eye Res · Pubmed #30999027.

ABSTRACT: Retinal oximetry imaging of retinal blood vessels measures oxygen saturation of hemoglobin. The imaging technology is non-invasive and reproducible with remarkably low variability on test-retest studies and in healthy cohorts. Pathophysiological principles and novel biomarkers in several retinal diseases have been discovered, as well as possible applications for systemic and brain disease. In diabetic retinopathy, retinal venous oxygen saturation is elevated and arteriovenous difference progressively reduced in advanced stages of retinopathy compared with healthy persons. This correlates with pathophysiology of diabetic retinopathy where hypoxia stimulates VEGF production. Laser treatment and vitrectomy both improve retinal oximetry values, which correlate with clinical outcome. The oximetry biomarker may allow automatic measurement of severity of diabetic retinopathy and predict its response to treatment. Central retinal vein occlusion is characterized by retinal hypoxia, which is evident in retinal oximetry. The retinal hypoxia seen on oximetry correlates with the extent of peripheral ischemia, visual acuity and thickness of macular edema. This biomarker may help diagnose and measure severity of vein occlusion and degree of retinal ischemia. Glaucomatous retinal atrophy is associated with reduced oxygen consumption resulting in reduced arteriovenous difference and higher retinal venous saturation. The oximetry findings correlate with worse visual field, thinner nerve fiber layer and smaller optic disc rim. This provides an objective biomarker for glaucomatous damage. In retinitis pigmentosa, an association exists between advanced atrophy, worse visual field and higher retinal venous oxygen saturation, lower arteriovenous difference. This biomarker may allow measurement of severity and progression of retinitis pigmentosa and other atrophic retinal diseases. Retinal oximetry offers visible light imaging of systemic and central nervous system vessels. It senses hypoxia in cardiac and pulmonary diseases. Oximetry biomarkers have been discovered in Alzheimer's disease and multiple sclerosis and oxygen levels in the retina correspond well with brain.

14 Review Vision Impairment in CKD Patients: Epidemiology, Mechanisms, Differential Diagnoses, and Prevention. 2019

Nusinovici, Simon / Sabanayagam, Charumathi / Teo, Boon Wee / Tan, Gavin Siew Wei / Wong, Tien Yin. ·Singapore Eye Research Institute, Singapore National Eye Centre, Singapore. · Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore. · Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. · Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore. Electronic address: ophwty@nus.edu.sg. ·Am J Kidney Dis · Pubmed #30929852.

ABSTRACT: Eyes and kidneys have numerous structural, developmental, physiologic, and pathogenic pathways in common, suggesting that many kidney and eye diseases may be interlinked. Studies suggest that the prevalence of eye diseases and vision impairment are higher among persons with end-stage kidney disease and earlier stages of chronic kidney disease (CKD) than in those without. Ocular morbidity in persons with CKD and end-stage kidney disease may be due to the following risk factors: (1) underlying conditions and risk factors for CKD such as diabetes or hypertension, (2) metabolic disorders associated with CKD, (3) uremia and anemia, and (4) CKD treatment. Among the chief eye diseases, diabetic retinopathy and age-related macular degeneration are most consistently associated with CKD. Further research for eye diseases such as glaucoma and cataract is needed to determine their relationships with CKD. Despite the high prevalence and burden of vision impairment among persons with CKD, eye screening in patients with CKD is not currently recommended as standard practice. This review suggests that patients with CKD should be encouraged to undergo a complete eye examination. Furthermore, physicians should be aware that patients undergoing dialysis may develop acute eye problems such as acute glaucoma, and appropriate referral to ophthalmologists should be considered in those with a history of glaucoma or recent ocular surgery. Interdisciplinary collaboration between nephrologists and ophthalmologists will ensure enhanced and appropriate management of patients with CKD.

15 Review Chromatic Pupillometry Methods for Assessing Photoreceptor Health in Retinal and Optic Nerve Diseases. 2019

Rukmini, A V / Milea, Dan / Gooley, Joshua J. ·Programme in Neuroscience and Behavioural Disorders, Centre for Cognitive Neuroscience, Duke-NUS Medical School, Singapore, Singapore. · Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore. · The Ophthalmology and Visual Sciences Academic Clinical Programme (EYE-ACP), SingHealth and Duke-NUS, Singapore, Singapore. ·Front Neurol · Pubmed #30809186.

ABSTRACT: The pupillary light reflex is mediated by melanopsin-containing intrinsically-photosensitive retinal ganglion cells (ipRGCs), which also receive input from rods and cones. Melanopsin-dependent pupillary light responses are short-wavelength sensitive, have a higher threshold of activation, and are much slower to activate and de-activate compared with rod/cone-mediated responses. Given that rod/cone photoreceptors and melanopsin differ in their response properties, light stimuli can be designed to stimulate preferentially each of the different photoreceptor types, providing a read-out of their function. This has given rise to chromatic pupillometry methods that aim to assess the health of outer retinal photoreceptors and ipRGCs by measuring pupillary responses to blue or red light stimuli. Here, we review different types of chromatic pupillometry protocols that have been tested in patients with retinal or optic nerve disease, including approaches that use short-duration light exposures or continuous exposure to light. Across different protocols, patients with outer retinal disease (e.g., retinitis pigmentosa or Leber congenital amaurosis) show reduced or absent pupillary responses to dim blue-light stimuli used to assess rod function, and reduced responses to moderately-bright red-light stimuli used to assess cone function. By comparison, patients with optic nerve disease (e.g., glaucoma or ischemic optic neuropathy, but not mitochondrial disease) show impaired pupillary responses during continuous exposure to bright blue-light stimuli, and a reduced post-illumination pupillary response after light offset, used to assess melanopsin function. These proof-of-concept studies demonstrate that chromatic pupillometry methods can be used to assess damage to rod/cone photoreceptors and ipRGCs. In future studies, it will be important to determine whether chromatic pupillometry methods can be used for screening and early detection of retinal and optic nerve diseases. Such methods may also prove useful for objectively evaluating the degree of recovery to ipRGC function in blind patients who undergo gene therapy or other treatments to restore vision.

16 Review Myopic optic disc changes and its role in glaucoma. 2019

Tan, Nicholas Y Q / Sng, Chelvin C A / Ang, Marcus. ·Singapore Eye Research Institute. · Singapore National Eye Centre. · Ophthalmology Department, National University Hospital, Singapore. · Moorfields Eye Hospital, London, UK. · Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore. ·Curr Opin Ophthalmol · Pubmed #30562243.

ABSTRACT: PURPOSE OF REVIEW: Optic nerve head (ONH) changes such as tilt and torsion are associated with the progression of myopia, and may in turn predispose toward glaucoma. At the same time, these ONH deformations also make the structural assessment for glaucoma difficult. Here, we review the mechanisms and changes to the myopic optic disc, and the advances in structural imaging to better evaluate the ONH in myopia. RECENT FINDINGS: The distance, depth, and angle between the optic disc and the deepest point of the elongated eyeball may be related to the degree and direction of optic disc tilt and torsion. It is hypothesized that as the eyeball grows axially, the disc is pulled toward its most protruded point. These ONH deformations in myopia are thought to induce strain on the lamina cribrosa and the axons passing through it. Recent studies have shown unique characteristics of the lamina cribrosa in myopia that may account for susceptibility toward glaucoma. New developments in imaging the ONH in myopia, including the use of optical coherence tomography-angiography may also further our understanding of the relationship between myopia and glaucoma. SUMMARY: Optic disc changes in myopia are secondary to the configuration of the posterior globe. These ONH deformations may predispose toward glaucoma, although the causative relationship between myopia and glaucoma remains to be further clarified.

17 Review Artificial intelligence and deep learning in ophthalmology. 2019

Ting, Daniel Shu Wei / Pasquale, Louis R / Peng, Lily / Campbell, John Peter / Lee, Aaron Y / Raman, Rajiv / Tan, Gavin Siew Wei / Schmetterer, Leopold / Keane, Pearse A / Wong, Tien Yin. ·Singapore Eye Research Institute, Singapore National Eye Center, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore daniel.ting.s.w@singhealth.com.sg. · Department of Ophthalmology, Mt Sinai Hospital, New York City, New York, USA. · Google AI Healthcare, Mountain View, California, USA. · Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA. · Department of Ophthalmology, University of Washington, School of Medicine, Seattle, Washington, USA. · Vitreo-retinal Department, Sankara Nethralaya, Chennai, Tamil Nadu, India. · Singapore Eye Research Institute, Singapore National Eye Center, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore. · Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. · Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria. · Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria. · Vitreo-retinal Service, Moorfields Eye Hospital, London, UK. ·Br J Ophthalmol · Pubmed #30361278.

ABSTRACT: Artificial intelligence (AI) based on deep learning (DL) has sparked tremendous global interest in recent years. DL has been widely adopted in image recognition, speech recognition and natural language processing, but is only beginning to impact on healthcare. In ophthalmology, DL has been applied to fundus photographs, optical coherence tomography and visual fields, achieving robust classification performance in the detection of diabetic retinopathy and retinopathy of prematurity, the glaucoma-like disc, macular oedema and age-related macular degeneration. DL in ocular imaging may be used in conjunction with telemedicine as a possible solution to screen, diagnose and monitor major eye diseases for patients in primary care and community settings. Nonetheless, there are also potential challenges with DL application in ophthalmology, including clinical and technical challenges, explainability of the algorithm results, medicolegal issues, and physician and patient acceptance of the AI 'black-box' algorithms. DL could potentially revolutionise how ophthalmology is practised in the future. This review provides a summary of the state-of-the-art DL systems described for ophthalmic applications, potential challenges in clinical deployment and the path forward.

18 Review [Structural endpoints for glaucoma studies]. 2019

Popa-Cherechenau, A / Schmidl, D / Garhöfer, G / Schmetterer, L. ·Universitätsklinik für Klinische Pharmakologie, Medizinische Universität Wien, Wien, Österreich. · Medizinische und Pharmazeutische Universität Carol Davila, Bukarest, Rumänien. · Abteilung für Ophthalmologie, Notfallzentrum der Universitätsklinik Bukarest, Bukarest, Rumänien. · Universitätsklinik für Klinische Pharmakologie, Medizinische Universität Wien, Wien, Österreich. leopold.schmetterer@seri.com.sg. · Singapore Eye Research Institute, SERI (Augenforschungszentrum Singapur), College Str. 20, Discovery Tower Ebene 6, 169856, Singapur, Singapur. leopold.schmetterer@seri.com.sg. · Lee Kong Chian Medical Schools, Nanyang Technological University (NTU), Singapur, Singapur. leopold.schmetterer@seri.com.sg. · Klinisches Fortbildungszentrum Ophthalmologie und Visual Sciences, Duke-NUS Medical School, Singapur, Singapur. leopold.schmetterer@seri.com.sg. · Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapur, Singapur. leopold.schmetterer@seri.com.sg. ·Ophthalmologe · Pubmed #29511811.

ABSTRACT: BACKGROUND: Structural endpoints have been discussed as surrogate endpoints for the approval of neuroprotective drugs in glaucoma. OBJECTIVE: Is the evidence strong enough to establish structural endpoints as surrogate endpoints? MATERIAL AND METHODS: Review of current understanding between structure and function in glaucoma. RESULTS: The introduction of optical coherence tomography has revolutionized imaging in glaucoma patients. Clinically either the nerve fiber layer thickness can be measured along a circle centered in the optic nerve head or the ganglion cell layer thickness can be assessed in the macular region, the latter being quantified in combination with other inner retinal layers. On a microscopic level there is a strong correlation between structural and functional loss but this relation can only partially be described with currently available clinical methods. This is particularly true for longitudinal course of the disease in glaucoma patients. Novel imaging techniques that are not yet used clinically may have the potential to increase our understanding between structure and function in glaucoma but further research in this field is required. CONCLUSION: The current evidence does not allow the establishment of structural endpoints as surrogate endpoints for phase 3 studies in glaucoma. Neuroprotective drugs have to be approved on the basis of visual field data because this is the patient-relevant endpoint. Structural endpoints can, however, play an important role in phase 2 and proof of concept studies.

19 Review Computer-aided diagnosis of glaucoma using fundus images: A review. 2018

Hagiwara, Yuki / Koh, Joel En Wei / Tan, Jen Hong / Bhandary, Sulatha V / Laude, Augustinus / Ciaccio, Edward J / Tong, Louis / Acharya, U Rajendra. ·Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, 599489, Singapore. · National University of Singapore, Institute of System Science. · Department of Ophthalmology, Kasturba Medical College, Manipal, India. · National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore. · Department of Medicine, Columbia University, New York, USA. · Ocular Surface Research Group, Singapore Eye Research Institute, Singapore; Cornea and External Eye Disease Service, Singapore National Eye Center, Singapore; Eye Academic Clinical Program, Duke-NUS Medical School, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. · Department of Electronics and Computer Engineering, Ngee Ann Polytechnic, 599489, Singapore; Department of Biomedical Engineering, School of Science and Technology, Singapore School of Social Sciences, Singapore; School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia. Electronic address: aru@np.edu.sg. ·Comput Methods Programs Biomed · Pubmed #30337064.

ABSTRACT: BACKGROUND AND OBJECTIVES: Glaucoma is an eye condition which leads to permanent blindness when the disease progresses to an advanced stage. It occurs due to inappropriate intraocular pressure within the eye, resulting in damage to the optic nerve. Glaucoma does not exhibit any symptoms in its nascent stage and thus, it is important to diagnose early to prevent blindness. Fundus photography is widely used by ophthalmologists to assist in diagnosis of glaucoma and is cost-effective. METHODS: The morphological features of the disc that is characteristic of glaucoma are clearly seen in the fundus images. However, manual inspection of the acquired fundus images may be prone to inter-observer variation. Therefore, a computer-aided detection (CAD) system is proposed to make an accurate, reliable and fast diagnosis of glaucoma based on the optic nerve features of fundus imaging. In this paper, we reviewed existing techniques to automatically diagnose glaucoma. RESULTS: The use of CAD is very effective in the diagnosis of glaucoma and can assist the clinicians to alleviate their workload significantly. We have also discussed the advantages of employing state-of-art techniques, including deep learning (DL), when developing the automated system. The DL methods are effective in glaucoma diagnosis. CONCLUSIONS: Novel DL algorithms with big data availability are required to develop a reliable CAD system. Such techniques can be employed to diagnose other eye diseases accurately.

20 Review Functional role of peroxiredoxin 6 in the eye. 2018

Wahlig, Stephen / Lovatt, Matthew / Mehta, Jodhbir S. ·Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute (SERI), Singapore; Duke University School of Medicine, Durham, NC, USA. · Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute (SERI), Singapore. · Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute (SERI), Singapore; Singapore National Eye Center (SNEC), Singapore; Eye-ACP, Duke-NUS Graduate Medical School, Singapore. Electronic address: jodhbir.s.mehta@singhealth.com.sg. ·Free Radic Biol Med · Pubmed #30120980.

ABSTRACT: Peroxiredoxin 6 (Prdx6) is the only mammalian 1-Cys member of the Prdx family, a group of enzymes which share the ability to reduce peroxides. In addition to its peroxidase function, Prdx6 also demonstrates phospholipase A

21 Review Genetics of Exfoliation Syndrome. 2018

Aung, Tin / Chan, Anita S / Khor, Chiea-Chuen. ·Singapore Eye Research Institute. · Singapore National Eye Center. · Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore. · Genome Institute of Singapore, Singapore, Singapore. ·J Glaucoma · Pubmed #29965897.

ABSTRACT: Exfoliation syndrome (XFS) is an age-related systemic disorder of the extracellular matrix with important ocular manifestations. In this disorder, exfoliation material (XFM) is deposited in the anterior chamber of the eye on the lens, iris, ciliary body, as well as other intraocular structures. This accumulation of XFM can obstruct the trabecular meshwork, resulting in elevated intraocular pressure and eventually causing glaucomatous optic neuropathy. In itself a highly hereditable condition, XFS is also the commonest recognizable cause of open-angle glaucoma worldwide, accounting for a majority of cases in some countries. Outside the eye, XFM deposits around blood vessels, particularly in association with elastic connective tissue, are found in numerous organs, including the skin, heart, and lungs. Long suspected to be a genetic disorder on the basis of familial aggregation studies, recent genome-wide association studies uncovered strong association between 7 genetic loci (LOXL1, CACNA1A, FLT1-POMP, TMEM136-ARHGEF12, AGPAT1, RBMS3, and SEMA6A) and increased risk of XFS. At the same time, a lower than usual sibling relative risk for XFS compared with other inherited conditions suggests XFS to be a complex disorder. The evidence to date suggests that additional genetic loci and biological insights for XFS remain to be identified through larger studies.

22 Review Anterior segment optical coherence tomography. 2018

Ang, Marcus / Baskaran, Mani / Werkmeister, René M / Chua, Jacqueline / Schmidl, Doreen / Aranha Dos Santos, Valentin / Garhöfer, Gerhard / Mehta, Jodhbir S / Schmetterer, Leopold. ·Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore; Moorfields Eye Hospital, London, United Kingdom. · Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore. · Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria; Christian Doppler Laboratory for Ocular and Dermal Effects of Thiomers, Medical University of Vienna, Austria. · Department of Clinical Pharmacology, Medical University of Vienna, Austria. · Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria; Christian Doppler Laboratory for Ocular and Dermal Effects of Thiomers, Medical University of Vienna, Austria; Department of Clinical Pharmacology, Medical University of Vienna, Austria; Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore. Electronic address: leopold.schmetterer@seri.com.sg. ·Prog Retin Eye Res · Pubmed #29635068.

ABSTRACT: Optical coherence tomography (OCT) provides non-contact, rapid in vivo imaging of ocular structures, and has become a key part of evaluating the anterior segment of the eye. Over the years, improvements to technology have increased the speed of capture and resolution of images, leading to the increasing impact of anterior segment OCT imaging on clinical practice. In this review, we summarize the historical development of anterior segment OCT, and provide an update on the research and clinical applications of imaging the ocular surface, cornea, anterior chamber structures, aqueous outflow system, and most recently anterior segment vessels. We also describe advancements in anterior segment OCT technology that have improved understanding with greater detail, such as tear film in dry eye disease evaluation, intra-operative real-time imaging for anterior segment surgery, and aqueous outflow with angle assessment for glaucoma. Improvements to image processing and software have also improved the ease and utility of interpreting anterior segment OCT images in everyday clinical practice. Future developments include refinement of assessing vascular networks for the anterior segment, in vivo ultra-high resolution anterior segment optical coherence tomography with histology-like detail, en-face image with 3-dimensional reconstruction as well as functional extensions of the technique.

23 Review Assessment of flow dynamics in retinal and choroidal microcirculation. 2018

Wei, Xin / Balne, Praveen Kumar / Meissner, Kenith E / Barathi, Veluchamy A / Schmetterer, Leopold / Agrawal, Rupesh. ·National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore. · Singapore Eye Research Institute, Singapore. · Department of Physics, Swansea University, Swansea, UK. · Singapore Eye Research Institute, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria; Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria. · National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore; Singapore Eye Research Institute, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore. Electronic address: rupesh_agrawal@ttsh.com.sg. ·Surv Ophthalmol · Pubmed #29577954.

ABSTRACT: Alterations in ocular blood flow have been implicated in mechanisms that lead to vision loss in patients with various ocular disorders such as diabetic retinopathy, glaucoma, and age-related macular degeneration. Assessment of retinal and choroidal blood flow is also a window to evaluate systemic diseases that affect microvasculature. Quantification and qualification of the blood flow in the retina and choroid help us understand pathophysiology, stratify disease risk, and monitor disease progression in these disorders. Multiple methods are used by researchers for assessment of blood flow, but a gold standard is lacking. We review commonly used methods, both invasive and noninvasive, for evaluation of blood flow, including intravital microscopy, laser Doppler velocimetry, laser Doppler flowmetry, laser interferometry, confocal scanning laser Doppler flowmetry, laser speckle flowgraphy, Doppler optical coherence tomography, blue-field entoptic simulation, retinal vessel caliber assessment, optical coherence tomography angiography, retinal function imaging, color Doppler imaging, and scanning laser ophthalmoscope angiogram. As technology evolves, better evaluation of blood flow in various ocular and systemic diseases will likely bring new perspectives into clinical practice and translate to better diagnosis and treatment.

24 Review Glaucoma related retinal oximetry: a technology update. 2018

Yap, Zhu Li / Verma, Sushma / Lee, Yi Fang / Ong, Charles / Mohla, Aditi / Perera, Shamira A. ·Singapore National Eye Center. · Singapore Eye Research Institute, Singapore. ·Clin Ophthalmol · Pubmed #29379268.

ABSTRACT: There are two long-standing theories about the pathogenesis of glaucoma - barotrauma and the effect of vascular hypoxia. Currently, it is still unknown whether diminished blood flow is the cause or result of glaucomatous atrophy of ganglion cells and the optic nerve. Though many other imaging techniques used to directly assess ocular blood flow have been well studied, they are limited by their inability to directly assess metabolism in the ocular tissues or measure the oxygen carrying capacity in the vessels. Retinal oximetry is a relatively novel, noninvasive imaging technique that reliably measures oxygen saturation levels in the retinal vessels, offering surrogate markers for the metabolic demands of the eye. The clinical significance of these measurements has not been well established. Thus, this review gives an overview of ocular imaging and current retinal oximetry techniques, while contextualizing the important oximetry studies that have investigated the vascular theory behind glaucoma.

25 Review Optical coherence tomography angiography: a review of current and future clinical applications. 2018

Ang, Marcus / Tan, Anna C S / Cheung, Chui Ming Gemmy / Keane, Pearse A / Dolz-Marco, Rosa / Sng, Chelvin C A / Schmetterer, Leopold. ·Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore. marcus.ang@snec.com.sg. · Duke-NUS Medical School, Singapore, Singapore. marcus.ang@snec.com.sg. · Singapore Eye Research Institute, Singapore, Singapore. marcus.ang@snec.com.sg. · Moorfields Eye Hospital, London, UK. marcus.ang@snec.com.sg. · Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore. · Duke-NUS Medical School, Singapore, Singapore. · Singapore Eye Research Institute, Singapore, Singapore. · Moorfields Eye Hospital, London, UK. · Institute of Ophthalmology, University College London, London, UK. · FISABIO Ophthalmic Medicine, Valencia, Spain. · National University Health System, Singapore, Singapore. · Lee Kong Medical School, Nanyang Technological University, Singapore, Singapore. · Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria. · Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria. ·Graefes Arch Clin Exp Ophthalmol · Pubmed #29318383.

ABSTRACT: Optical coherence tomography angiography is a non-invasive imaging technique that now allows for simultaneous in vivo imaging of the morphology as well as the vasculature in the eye. In this review, we provide an update on the existing clinical applications of optical coherence tomography angiography technology from the anterior to posterior segment of the eye. We also discuss the limitations of optical coherence tomography angiography technology, as well as the caveats to the interpretation of images. As current optical coherence tomography angiography systems are optimized for the retina, most studies have focused on interpreting images from conditions such as age related macular degeneration and retinal vascular diseases. However, the interpretation of these optical coherence tomography angiography images should be taken in consideration with other multi-modal imaging to overcome the limitations of each technique. In addition, there are a growing variety of clinical applications for optical coherence tomography angiography imaging in optic nerve head evaluation for glaucoma and optic neuropathies. Further developments in anterior optical coherence tomography angiography have now allowed for evaluation of anterior segment pathology such as glaucoma, ocular surface diseases, corneal vascularisation, and abnormal iris vasculature. Future developments in software could allow for improved segmentation and image resolution with automated measurements and analysis.

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