Combining vascular and nerve fiber layer thickness measurements to model glaucomatous focal visual field loss.

We compare the focal structure-function correlation of structural measurements of peripapillary retinal nerve fiber layer thickness (RNFL-T) using optical coherence tomography (OCT), capillary density (CD) measurements using OCT-angiography (OCT-A), or a combination of both, with visual field deviation (VFD) in early to advanced glaucoma. Primary open angle glaucoma patients (n = 46, mean ± SD age: 67 ± 10 years; VF mean deviation: -10.41 ± 6.76 dB) were included in this cross-sectional study. We performed 30-2 standard automated perimetry OCT (3.5-mm diameter ring scan) and 15°×15° OCT-A (superficial vascular complex slab). Based on a nerve fiber trajectory model, each VF test spot was assigned to an OCT-A wedge and an OCT ring-sector. Two univariate linear models (Mv and Mt ) using either CD-based vascular (Mv ) or RNFL-T-based thickness information (Mt ) and one multivariate model using both (Mv:t ) were compared in their associations with measured focal VFD, which were higher for the multivariate model Mv:t (mean ± SD correlation coefficient: 0.710 ± 0.086) than for either nested model (0.627 ± 0.078 for Mv and 0.578 ± 0.095 for Mt ). Using a focal visual field approach, the combination of RNFL-T and CD showed better structure-function correlations than thickness or vascular information only.

Remodelling intravitreal therapy pathways for macular disease during the COVID-19 pandemic and an Austrian national lockdown.

OBJECTIVE: To analyse the remodelling and recovery of a relocated intravitreal injection (IVI) service with an adapted treatment regimen in a tertiary referral centre during a nationwide lockdown with initial cancellation of all non-emergency treatments caused by the COVID-19 pandemic. METHODS AND ANALYSIS: For this retrospective observational study at Hanusch Hospital, Vienna, between 16 March 2020 and 5 May 2020, we conducted an analysis of an appointment booking system based on prioritisation incorporating disease class, severity and fellow eye status by evidence-based impact on irreversible structural impairment and survey data from telephone interviews. Recapture time was defined as the time-to-discard the backlog of patients in need for treatment. Non-attendance was stratified as treatment refusal for personal reasons and non-attendance due to lockdown-related restrictions. RESULTS: Of the 1109 patients, 241 (21.7%) were considered as highly urgent, 269 (24.3%) as urgent, 402 (36.2%) as semiurgent and 197 (17.8%) as non-urgent. Recapture time was 15 days for highly urgent patients, 22 days for urgent patients, 43 days for semiurgent patients and 46 days for non-urgent patients. The proportion of patients who refused treatment due to personal reasons was 5.2%, with a mean age of 82.4 years; 29 patients (2.6%) could not attend due to lockdown-related restrictions. CONCLUSION: By streamlining treatment based on urgency as well as increasing the number of bilateral IVI, recapture time was fast. We could provide a safe treatment environment for healthcare professionals and patients after resetting the injection service outside of the hospital with increased levels of protection.

Analysis of the origin of atypical scanning laser polarimetry patterns by polarization-sensitive optical coherence tomography.

PURPOSE: To analyze the physical origin of atypical scanning laser polarimetry (SLP) patterns. To compare polarization-sensitive optical coherence tomography (PS-OCT) scans to SLP images. To present a method to obtain pseudo-SLP images by PS-OCT that are free of atypical artifacts. METHODS: Forty-one eyes of healthy subjects, subjects with suspected glaucoma, and patients with glaucoma were imaged by SLP (GDx VCC) and a prototype spectral domain PS-OCT system. The PS-OCT system acquires three-dimensional (3D) datasets of intensity, retardation, and optic axis orientation simultaneously within 3 seconds. B-scans of intensity and retardation and en face maps of retinal nerve fiber layer (RNFL) retardation were derived from the 3D PS-OCT datasets. Results were compared with those obtained by SLP. RESULTS: Twenty-two eyes showed atypical retardation patterns, and 19 eyes showed normal patterns. From the 22 atypical eyes, 15 showed atypical patterns in both imaging modalities, five were atypical only in SLP images, and two were atypical only in PS-OCT images. In most (15 of 22) atypical cases, an increased penetration of the probing beam into the birefringent sclera was identified as the source of atypical patterns. In such cases, the artifacts could be eliminated in PS-OCT images by depth segmentation and exclusion of scleral signals. CONCLUSIONS: PS-OCT provides deeper insight into the contribution of different fundus layers to SLP images. Increased light penetration into the sclera can distort SLP retardation patterns of the RNFL.

Intravitreal bevacizumab therapy for neovascular age-related macular degeneration with large submacular hemorrhage.

PURPOSE: To evaluate functional and anatomic effects of intravitreal bevacizumab (Avastin; Roche Pharma, Vienna, Austria) in patients with neovascular age-related macular degeneration (AMD) with large submacular hemorrhages. DESIGN: Retrospective, clinical study. METHODS: Twenty-one eyes of 19 AMD patients with choroidal neovascularization and large submacular hemorrhage involving the fovea comprising more than 50% of the total lesion area were evaluated. All patients completed at least four months of follow-up; 12 patients fulfilled 12 months or more of follow-up. Patients were treated with up to six intravitreal bevacizumab injections (1 mg/0.04 ml) at a minimum of four-week intervals. Changes from baseline visual acuity (VA) scores, retinal measurements by optical coherence tomography (OCT), angiographic lesion characteristics, and hemorrhage size were analyzed. A safety assessment was performed at all visits. RESULTS: Intravitreal bevacizumab injections were well tolerated in all patients. At month 4, VA was stable or improved (visual loss of 3 acuity lines or fewer) in 100% and improved by at least 3 lines in 9.5%. Comparable results were found at month 12. On average, the central foveal thickness decreased significantly by 55 microm four weeks after the first injection (P < .001) and by 52 microm at month 4 (P = .002). A significant anatomic improvement also was found for maximum retinal thickness, minimum retinal thickness, and foveal volume (P < .05) and was maintained during four months of follow-up. Mean size of hemorrhage was significantly reduced from 19.7 mm(2) at baseline to 2.5 mm(2) at the four-month follow-up (P < .001). CONCLUSIONS: Intravitreal bevacizumab seems to be a promising therapeutic option in eyes with neovascular AMD and large submacular hemorrhages, with a stabilization in VA and anatomic improvement.