Browsing by Author "Masoud Aghsaei Fard"

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    Artificial intelligence to detect papilledema from ocular fundus photographs
    (2020-04-30) Dan Milea; Raymond P. Najjar; Jiang Zhubo; Daniel Ting; Caroline Vasseneix; Xinxing Xu; Masoud Aghsaei Fard; Pedro Fonseca; Kavin Vanikieti; Wolf A. Lagrèze; Chiara La Morgia; Carol Y. Cheung; Steffen Hamann; Christophe Chiquet; Nicolae Sanda; Hui Yang; Luis J. Mejico; Marie Bénédicte Rougier; Richard Kho; Tran Thi Ha Chau; Shweta Singhal; Philippe Gohier; Catherine Clermont-Vignal; Ching Yu Cheng; Jost B. Jonas; Patrick Yu-Wai-Man; Clare L. Fraser; John J. Chen; Selvakumar Ambika; Neil R. Miller; Yong Liu; Nancy J. Newman; Tien Y. Wong; Valérie Biousse; Farabi Eye Hospital; John van Geest Centre for Brain Repair; Istituto delle Scienze Neurologiche di Bologna; Universite Grenoble Alpes; Duke-NUS Medical School Singapore; Fondation Adolphe de Rothschild; University of Cambridge; Københavns Universitet; Alma Mater Studiorum Università di Bologna; Yong Loo Lin School of Medicine; Medical Research Foundation, Chennai; Universität Freiburg im Breisgau; Singapore Eye Research Institute; Universite Catholique de Lille; Sun Yat-Sen University; Universidade de Coimbra; Centro Hospitalar e Universitário de Coimbra; State University of New York Upstate Medical University; Universität Heidelberg; Moorfields Eye Hospital NHS Foundation Trust; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Save Sight Institute; Hôpitaux universitaires de Genève; CHU Angers; Singapore National Eye Centre; Centre Hospitalier Universitaire de Grenoble; Mayo Clinic; A-Star, Institute of High Performance Computing; Groupe Hospitalier Pellegrin; Chinese University of Hong Kong; Emory University School of Medicine; Johns Hopkins School of Medicine; American Eye Center
    Copyright © 2020 Massachusetts Medical Society. BACKGROUND Nonophthalmologist physicians do not confidently perform direct ophthalmoscopy. The use of artificial intelligence to detect papilledema and other optic-disk abnormalities from fundus photographs has not been well studied. METHODS We trained, validated, and externally tested a deep-learning system to classify optic disks as being normal or having papilledema or other abnormalities from 15,846 retrospectively collected ocular fundus photographs that had been obtained with pharmacologic pupillary dilation and various digital cameras in persons from multiple ethnic populations. Of these photographs, 14,341 from 19 sites in 11 countries were used for training and validation, and 1505 photographs from 5 other sites were used for external testing. Performance at classifying the optic-disk appearance was evaluated by calculating the area under the receiver-operating-characteristic curve (AUC), sensitivity, and specificity, as compared with a reference standard of clinical diagnoses by neuro-ophthalmologists. RESULTS The training and validation data sets from 6779 patients included 14,341 photographs: 9156 of normal disks, 2148 of disks with papilledema, and 3037 of disks with other abnormalities. The percentage classified as being normal ranged across sites from 9.8 to 100%; the percentage classified as having papilledema ranged across sites from zero to 59.5%. In the validation set, the system discriminated disks with papilledema from normal disks and disks with nonpapilledema abnormalities with an AUC of 0.99 (95% confidence interval [CI], 0.98 to 0.99) and normal from abnormal disks with an AUC of 0.99 (95% CI, 0.99 to 0.99). In the external-testing data set of 1505 photographs, the system had an AUC for the detection of papilledema of 0.96 (95% CI, 0.95 to 0.97), a sensitivity of 96.4% (95% CI, 93.9 to 98.3), and a specificity of 84.7% (95% CI, 82.3 to 87.1). CONCLUSIONS A deep-learning system using fundus photographs with pharmacologically dilated pupils differentiated among optic disks with papilledema, normal disks, and disks with nonpapilledema abnormalities.
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    Association of myopia with peripapillary perfused capillary density in patients with glaucoma an optical coherence tomography angiography study
    (2018-05-01) Yanin Suwan; Masoud Aghsaei Fard; Lawrence S. Geyman; Apichat Tantraworasin; Toco Y. Chui; Richard B. Rosen; Robert Ritch; Tehran University of Medical Sciences; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Icahn School of Medicine at Mount Sinai; New York Eye and Ear Infirmary; Chiang Mai University
    © 2018 American Medical Association. All rights reserved. IMPORTANCE This study used optical coherence tomographic angiography to assess for impaired blood flow in myopic eyes with or without open-angle glaucoma. OBJECTIVE To compare the peripapillary perfused capillary density (PCD) between eyes with and without glaucoma. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study at a tertiary glaucoma referral practice, we recruited patients with myopic eyes of spherical equivalent of more than -3.0 diopters with and without open-angle glaucoma, patients with nonmyopic eyes with glaucoma, and patients with no disease from February 2016 to October 2016. We obtained 4.5 × 4.5-mm optical coherence tomographic angiography images of the optic nerve head and calculated PCD as the ratio of pixels associated with capillaries to the number of pixels in the region of interest after large blood vessel removal. Both eyes of each patient were used in the analysis. Continuous variables were assessed by analysis of variance and Tukey tests. A marginal model of generalized estimating equations was performed to adjust for confounding factors and intraclass correlations. MAIN OUTCOMES AND MEASURES Mean PCD. RESULTS We matched 87 patients with myopic eyes with glaucoma (of whom 39 [45%] were women), 17 with myopic eyes without glaucoma (of whom 10 [59%] were women), and 93 with non-myopic eyes with glaucoma (of whom 55 [59%] were women) for visual field defects and included 51 control participants (or whom 38 [75%] were women). Mean (SD) ages were 67.5 (12.0) years for patients with myopia and glaucoma, 48.2 (19.0) years for those with myopia without glaucoma, 67.3 (11.0) years for those with glaucoma without myopia, and 64.7 (8.9) years in control participants. Global PCD demonstrated a progressive decrease from the control group (mean [SD], 41.0 [4.2]) to those with myopia without glaucoma (38.4 [5.8]) to those with glaucoma without myopia (31.9 [7.5]) to those with both (28.2 [6.0]; all P < .001). The mean difference in global PCD between the 3 groups and control group, adjusted for age and axial length, was greatest in those with myopia and glaucoma (-11.1; 95% CI, -14.0 to -8.1; P < .001), followed by those with glaucoma without myopia (-8.6; 95% CI, -10.9 to -6.3; P < .001) and those with myopia without glaucoma (-2.8; 95% CI, -6.9 to 1.2; P = .17). No interaction was found between glaucoma and myopia. CONCLUSIONS AND RELEVANCE These findings demonstrate peripapillary microvascular attenuation to a greater extent in open-angle glaucoma than myopia. The cross-sectional design means we cannot determine if this association is a cause and/or is associated with other confounding factors.
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    Automated Evaluation of Parapapillary Choroidal Microvasculature in Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma
    (2021-04-01) Masoud Aghsaei Fard; Mona Safizadeh; Amirreza Shaabani; Rahele Kafieh; Sahar Hojati; Marjan Afzali; Yanin Suwan; Robert Ritch; Sasan Moghimi; Ramathibodi Hospital; Medical Image and Signal Processing Research Center, Isfahan UMS; Farabi Eye Hospital; New York Eye and Ear Infirmary; Shiley Eye Institute
    Objective: To determine whether parapapillary choroidal microvasculature (PPCMv) density as measured by optical coherence tomography angiography differs between pseudoexfoliation syndrome (PXS) and pseudoexfoliation glaucoma (PXG). Design: Cross-sectional study. Methods: One hundred ninety-two eyes of 120 subjects from 2 academic referral institutions were enrolled. Automated PPCMv density was calculated using custom Matlab software in inner and outer annuli around the optic nerve region in addition to peripapillary superficial vasculature. Linear modeling was used to compare vessel densities among groups. Results: Data from 64 eyes with PXS, 84 eyes with PXG, and 44 eyes healthy control subjects were analyzed. The differences of visual field mean deviation and peripapillary retinal nerve fiber layer thickness among study groups were statistically significant with lower values in PXG eyes compared with the PXS and control groups. Peripapillary superficial retinal vessel densities were significantly reduced in patients with PXG compared with patients with PXS and normal control subjects (all P < .001) without a difference between PXS and control eyes. Customized outer annular PPCMv density in the PXG group with a value of 11.1% (SD 5.1%) was lower than that in PXS with a value of 13.2% (SD 5.3%; P = .001). Similarly, PXS values were lower than those of control eyes with a value of 18.6% (SD 5.1%; P < .001). Conclusion: A progressive decrease in outer PPCMv from the control group to those with PXS without glaucoma to those with PXS and glaucoma (PXG) showed deep peripapillary vasculopathy in pseudoexfoliation syndrome. Choroidal vessel density may be affected early in the course of pseudoexfoliation before glaucoma develops.
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    Optical coherence tomography angiography in papilledema compared with pseudopapilledema
    (2019-01-01) Masoud Aghsaei Fard; Alireza Sahraiyan; Jalil Jalili; Marjane Hejazi; Yanin Suwan; Robert Ritch; Prem S. Subramanian; Tehran University of Medical Sciences; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; University of Colorado Health Sciences Center; New York Eye and Ear Infirmary
    © 2019 The Authors. PURPOSE. The purpose of this study is to evaluate differences in optical coherence tomography angiography (OCT-A) findings between patients with papilledema and pseudopapilledema. METHODS. In this prospective, comparative study, 41 eyes of 21 subjects with papilledema, 27 eyes of 15 subjects with pseudopapilledema, and 44 eyes of 44 healthy normal subjects were included and were imaged using OCT-A. In addition to peripapillary total vasculature maps obtained with commercial vessel density mapping, major vessel removal using customized image analysis software was also used to measure whole image capillary density and peripapillary capillary density (PCD). Peripapiilary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) were recorded. RESULTS. Average RNFL thicknesses were greater in papilledema eyes than in pseudopapilledema and control subjects. GCC thickness was not different among three groups. Peripapillary vasculature values were significantly lower in papilledema (58.5 ± 6.1%) and pseudopapilledema (58.9 ± 4.7%) eyes compared with healthy eyes (63.2 ± 3.1%) using commercial machine software, without a difference between papilledema and pseudopapilledema eyes. However, using our customized software, peripapillary ‘‘capillary’’ density of papilledema eyes was 29.8 ± 9.4%, which was not significantly different from healthy subjects (31.8 ± 7.4%; P = 0.94). Pseudopapilledema eyes with peripapillary density of 25.5 ± 8.3% had significantly lower capillary values compared with control eyes (P = 0.01). There was a significantly lower whole image and nasal sector peripapillary capillary density of inner retina in pseudopapilledema eyes than papilledema eyes (P = 0.03 and P = 0.02, respectively). CONCLUSIONS. Whole image and nasal peripapillary sector capillary densities using OCT-A had diagnostic accuracy for differentiating true and pseudo-disc swelling.
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    Pattern of peripapillary capillary density loss in ischemic optic neuropathy compared to that in primary open-angle glaucoma
    (2018-01-01) Masoud Aghsaei Fard; Yanin Suwan; Sasan Moghimi; Lawrence S. Geyman; Toco Y. Chui; Richard B. Rosen; Robert Ritch; Tehran University of Medical Sciences; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Icahn School of Medicine at Mount Sinai; New York Eye and Ear Infirmary
    © This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication. Purpose Both non-arteritic anterior ischemic optic neuropathy (NAION) and primary open-angle glaucoma (POAG) damage retinal ganglion cell axons, which are perfused by the radial peripapillary capillaries. To evaluate the pattern of ischemia, we compared peripapillary capillary density (PCD) in NAION eyes to POAG eyes matched for visual field mean deviation and retinal nerve fiber layer thickness. Methods 31 chronic NAION (>6 months after the acute event) and unaffected fellow eyes (31 subjects), 42 moderate and severe POAG eyes (27 subjects), and 77 control eyes (46 healthy subjects) were imaged with a commercial optical coherence tomography angiography system (AngioVue, Avanti RTVue-XR, Optovue, CA) at two academic institutions. Two concentric circles of diameters 1.95mm (inner) and 3.45mm (outer) were manually placed on images centered on the optic nerve head, producing an annular region-of-interest. Image analysis with major vessel removal was performed using a custom program. Whole-image, whole-annulus, and sectoral PCDs were measured. Results Whole-image and whole-annulus PCDs in NAION and moderate and severe POAG eyes were significantly decreased compared to unaffected fellow eyes and control eyes (all P<0.001). Superior and temporal PCD values were affected more than other sectors in both NAION and POAG groups compared to control group. Whole-image and whole-annulus PCDs were not statistically different between NAION and POAG eyes (both P = 0.99). However, of all peripapillary sectors, the inferior sector PCD value was less affected in POAG eyes compared to NAION eyes (P = 0.001). Univariate analysis results also revealed a significant positive correlation between superior and inferior PCDs and corresponding RNFL thicknesses. The inferior sector correlation was greater in POAG than NAION eyes. Conclusion While the whole PCD values were not different in chronic NAION and POAG, the greater correlation of inferior PCD with corresponding RNFL sectors in POAG compared to NAION suggests greater susceptibility of the inferior radial peripapillary capillary in the pathogenesis of POAG.
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    Peripapillary Perfused Capillary Density in Acute Angle-Closure Glaucoma: An Optical Coherence Tomography Angiography Study
    (2021-01-19) Yanin Suwan; Masoud Aghsaei Fard; Purit Petpiroon; Wasu Supakontanasan; Rotjaporn Pruksacholavit; Apichat Tantraworasin; Chaiwat Teekhasaenee; Robert Ritch; Ramathibodi Hospital; Farabi Eye Hospital; New York Eye and Ear Infirmary; Chiang Mai University
    PURPOSE: To compare peripapillary perfused capillary density (PCD) on optical coherence tomography angiography among resolved acute angle-closure (AAC), primary open-angle glaucoma (POAG), and control eyes. DESIGN: Prospective, cross-sectional, observational study. METHODS: All patients with resolved AAC or POAG of varying severity and controls were enrolled. We obtained 4.5 × 4.5 mm2 optical coherence tomography angiography images of the optic nerve head. PCD was analyzed using customized software with major vessel removal. Continuous variables were assessed using the analysis of variance and Bonferroni correction test. A marginal model of generalized estimating equations was used to adjust for confounding factors and interocular correlation. RESULTS: The study included 44 eyes with resolved AAC (mean duration of elevated intraocular pressure, 8.1 ± 10.9 days), 69 eyes with POAG, and 49 control eyes. PCD showed a similar decrease between AAC and POAG eyes (P > 0.99). After adjusting for age and sex, the mean difference in global PCD between each of the POAG stage groups and the AAC group was the highest in the severe POAG group (-3.43; 95% confidence interval [CI], -11.38 to 2.52; P = 0.211), followed by the mild POAG (0.68; 95% CI, -3.26 to 4.62; P = 0.735) and moderate POAG (0.20; 95% CI, -5.21 to 5.61; P = 0.942) groups. The duration of increased intraocular pressure did not affect PCD (P = 0.258 and 0.168 for global and annular PCDs, respectively). CONCLUSIONS: The degree of microvascular attenuation in AAC eyes was not different from that in POAG eyes.
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    Peripapillary perfused capillary density in exfoliation syndrome and exfoliation glaucoma versus POAG and healthy controls: An OCTA study
    (2018-03-01) Yanin Suwan; Lawrence S. Geyman; Masoud Aghsaei Fard; Apichat Tantraworasin; Toco Y. Chui; Richard B. Rosen; Robert Ritch; Tehran University of Medical Sciences; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Icahn School of Medicine at Mount Sinai; New York Eye and Ear Infirmary; Chiang Mai University
    Copyright © 2017 Asia-Pacific Academy of Ophthalmology. Unauthorized reproduction of this article is prohibited. Purpose: To compare the peripapillary perfused capillary density (PCD) among eyes with exfoliation syndrome (XFS), exfoliation glaucoma (XFG), primary open-angle glaucoma (POAG), and controls. Design: Observational, cross-sectional study. Methods: Optical coherence tomography angiography (OCTA) images (4.5 × 4.5 mm) of the optic nerve head were obtained using a commercial spectral domain OCTA system (AngioVue Avanti RTVue-XR, OptoVue, Fremont, CA). Two concentric circles with 1.95-mm (inner) and 3.45-mm (outer) diameters were placed manually, producing an annulus of width 0.75 mm centered at the optic disc. PCD was calculated as the ratio of pixels associated with capillaries to the pixels in the annulus after large blood vessel removal. Continuous variables were assessed by analysis of variance and Tukey honest significant difference (HSD) test. Multiple linear regression analysis was performed to adjust for confounding factors. Results: Forty-three XFG eyes, 31 POAG eyes matched for visual field mean deviation, 33 XFS eyes, and 45 control eyes were analyzed. PCD demonstrated a progressive decrease from controls to XFS to POAG to XFG. Pairwise comparisons revealed significant differences in PCD between each pair of groups (all P < 0.01) except for PCD between XFS and POAG (P = 0.08). A multivariable model adjusting for age and stage showed a more significant decrease in PCD in XFG compared with POAG (P = 0.001). Conclusions: PCD was more significantly decreased in XFG compared with POAG eyes and in XFS compared with control eyes. OCTA provides the first quantitative evidence of the microvascular disturbance that accompanies XFS.