17th International · 2019. 10. 29. · 17th International Symposium (ISS) October 18-19, 2019 SIGNIEL Lotte World Tower · Seoul · South Korea ® Abstract Book Course Directors

17th International Symposium (ISS)

October 18-19, 2019 SIGNIEL Lotte World Tower · Seoul · South Korea

®

Abstract Book

Course DirectorsHakyoung Kim (South Korea) Seung-Young Yu (South Korea)

FacultyBalwantray Chauhan (Canada)K. Bailey Freund (USA)Damien Gatinel (France)Don-Il Ham (South Korea)Wilson Heriot (Australia)Frank G. Holz (Germany)Alex Huang (USA)Adrian Koh (Singapore)Hideki Koizumi (Japan)Ji Eun Lee (South Korea)

Tock Han Lim (Singapore)Kyu Hyung Park (South Korea)Cynthia Roberts (USA)SriniVas R. Sadda (USA)Giovanni Staurenghi (Italy)Kyung Rim Sung (South Korea)Sebastian Wolf (Switzerland)Hyeong Gon Yu (South Korea)Suqin Yu (China)Linda Zangwill (USA)

Honorary LectureWon Ki Lee (South Korea)

17th International SPECTRALIS® Symposium (ISS) October 18-19, 2019 SIGNIEL Lotte World Tower Seoul · South Korea

Scientific Program

Course Directors Hakyoung Kim (South Korea) Seung-Young Yu (South Korea)

Faculty Balwantray Chauhan (Canada), K. Bailey Freund (USA), Damien Gatinel (France), Don-Il Ham (South Korea), Wilson Heriot (Australia), Frank G. Holz (Germany), Alex Huang (USA), Adrian Koh (Singapore), Hideki Koizumi (Japan), Ji Eun Lee (South Korea), Won Ki Lee (South Korea), Tock Han Lim (Singapore), Kyu Hyung Park (South Korea), Cynthia Roberts (USA), SriniVas R. Sadda (USA), Giovanni Staurenghi (Italy), Kyung Rim Sung (South Korea), Sebastian Wolf (Switzerland), Hyeong Gon Yu (South Korea), Suqin Yu (China), Linda Zangwill (USA)

Friday, October 18, 2019

08:30 Registration and Welcome Coffee

New Imaging Modalities & more – Update! Moderators: Seung-Young Yu, Giovanni Staurenghi

09:20 Welcome Note (Hakyoung Kim)

09:30 Are the OCTAs all the Same? (Giovanni Staurenghi)

09:50 Choroidal Change in Posterior Uveitis (Hyeong Gon Yu) – page 15

10:10 Novel Microperimetry Import Feature (K. Bailey Freund) – page 17

10:30 Novel Approaches to High Magnification Imaging (Frank G. Holz) – page 19

10:40 Fluorescence Lifetime Imaging (Sebastian Wolf) – page 21

10:50 Panel Discussion – Moderators: Seung-Young Yu, Giovanni Staurenghi

11:00 Coffee Break

Multimodal Imaging – One is Not Enough! Moderators: Ji Eun Lee, Sebastian Wolf

11:30 Why a Multimodal Imaging Approach for the CNV Classification is Important (Giovanni Staurenghi) – page 23

11:50 Management of Myopic CNV (Tock Han Lim) – page 25

12:10 Needs of Multimodal Imaging for CSC (Seung-Young Yu) – page 27

12:30 MacTel: Novel Insights (Frank G. Holz) – page 29

12:50 Panel Discussion – Moderators: Ji Eun Lee, Sebastian Wolf

13:00 Group Photo Slot 1 & Lunch

13:45 Poster Session starts

PCV Imaging – Asia only? Moderators: Kyu Hyung Park, Frank G. Holz

14:30 Management of PCV (Tock Han Lim) – page 31

14:50 Early Choroidal Hypofluorescence in ICGA in PCV (Ji Eun Lee) – page 33

15:10 Is ICGA Still Needed for the Diagnosis and Management of PCV? (Adrian Koh) – page 35

15:30 Multicolor Imaging and Color Fundus Photography in PCV Detection (Anna Tan) – page 37

15:40 Panel Discussion – Moderators: Kyu Hyung Park, Frank G. Holz

16:00 Coffee Break & Posters

OCT Imaging & More – Retina! Moderators: Suqin Yu, Tock Han Lim

16:30 Longitudinal Changes of Retina in Reticular Pseudodrusen (Don-Il Ham) – page 39

16:50 Biometric Analysis in Central Serous Chorioretinopathy (Hideki Koizumi) – page 41

17:10 More Effective Screening for Epiretinal Membranes (Hiroto Terasaki) – page 43

Ophthalmology and the International Space Station! Moderator: Alex Huang

17:20 Multicolor Imaging for Assessment of the Optic Nerve and Macula (SriniVas R. Sadda) – page 45

17:40 Panel Discussion – Moderators: Suqin Yu, Tock Han Lim, Alex Huang

18:00 END / Welcome Reception


Scientific Program

Course Directors Hakyoung Kim (South Korea) Seung-Young Yu (South Korea)

Faculty Balwantray Chauhan (Canada), K. Bailey Freund (USA), Damien Gatinel (France), Don-Il Ham (South Korea), Wilson Heriot (Australia), Frank G. Holz (Germany), Alex Huang (USA), Adrian Koh (Singapore), Hideki Koizumi (Japan), Ji Eun Lee (South Korea), Won Ki Lee (South Korea), Tock Han Lim (Singapore), Kyu Hyung Park (South Korea), Cynthia Roberts (USA), SriniVas R. Sadda (USA), Giovanni Staurenghi (Italy), Kyung Rim Sung (South Korea), Sebastian Wolf (Switzerland), Hyeong Gon Yu (South Korea), Suqin Yu (China), Linda Zangwill (USA)

Saturday, October 19, 2019

08:30 Welcome Coffee

Honorary Lecture – Moderators: K. Bailey Freund, Hakyoung Kim

09:30 Unravelling the Pachychoroid Spectrum (Won Ki Lee) – page 47

Artificial Intelligence & More – No Doctors Please? Moderators: Don-Il Ham, SriniVas R. Sadda

09:50 Automate Biomarker Detection from OCT Scans (Sebastian Wolf) – page 49

10:10 Function Follows Form: Morphology-Based Functions Prediction (Frank G. Holz) – page 51

10:20 Deep Transfer Learning Classification Algorithms (John Miller) – page 53

10:30 Identifying the Intra-Retinal Fluid and Sub-Retinal Fluid Using OCT 3D-Analytics and Multicolor Imaging (Suqin Yu) – page 55

10:50 Panel Discussion – Moderators: Don-Il Ham, SriniVas R. Sadda

11:00 Coffee Break

Glaucoma Imaging & More! Moderators: Kyung Rim Sung, Balwantray Chauhan

11:30 Two-Photon Imaging of Retinal Ganglion Cells (Balwantray Chauhan) – page 57

11:50 Effect of Glaucoma Surgery on Optic Disc and Peripapillary Retinal Circulation (Kyung Rim Sung) – page 59

12:10 Bleb Biology and Outflow (Alex Huang) – page 61

12:30 Artificial Intelligence/Deep Learning for Detection of Glaucoma and Prediction of Visual Field Damage (Linda Zangwill)

12:50 Deep-Layer Microvasculature Dropout in Pre-perimetric Glaucoma Patients (Min Hee Suh) – page 63

13:00 Panel Discussion – Moderators: Kyung Rim Sung, Balwantray Chauhan

13:10 Group Photo Slot 2 & Lunch

13:45 Poster Session starts

ANTERION Anterior Segment Imaging – 4 in 1! Moderators: Cynthia Roberts, Damien Gatinel

14:30 What I Like in Anterior Segment Imaging – An Introduction to ANTERION (Cynthia Roberts) – page 65

14:50 Preliminary Experience with the ANTERION (Damien Gatinel) – page 67

15:10 Anterior Segment Imaging in Glaucoma (Alex Huang) – page 69

15:30 ANTERION Applications (Cynthia Roberts) – page 71

15:50 Panel Discussion – Moderators: Cynthia Roberts, Damien Gatinel

16:00 Coffee Break & Posters

Optical Coherence Tomography Angiography – Update! Moderators: Hyeong Gon Yu, Adrian Koh

16:30 Dense B-Scan OCTA (K. Bailey Freund) – page 73

16:50 Retinal Biomarkers for Disease Prognostication (Adrian Koh) – page 75

17:10 OCTA in Diabetics (Wilson Heriot) – page 77

17:30 Friend or Foe: OCT Angiography based Type 1 CNV Detection and Progression of Geographic Atrophy (Frank G. Holz) – page 79

17:40 Stress/Rest Optical Coherence Tomography Angiography Study (Marco Lupidi) – page 81

17:50 OCTA in Epiretinal Membrane (Kyu Hyung Park) – page 83

18:10 Panel Discussion – Moderators: Hyeong Gon Yu, Adrian Koh

18:15 END


Scientific Program

Poster Presentations

A Case of Acute Optic Neuritis in a Physician

(Manish Jain) – page 85

Automated Identification of Spontaneous Venous Pulsation from Infrared Video of the Optic Nerve Head

(Scott Stainton) – page 87

Detection of Retinal Microvascular Changes in von Hippel-Lindau Disease using Optical Coherence Tomography Angiography

(Raviv Katz) – page 89

Multimodal Imaging Analysis of Abilateral Multiplies Serous Retinal Detachments Following Caffeine-Based Thermogenic Supplements

(Clovis Arcoverde Freitas Neto) – page 91

The Periarterial Capillary-Free Zone and the “Fern-Like” Retinal Vascullitis Appearance: A Fluorescein Angiography and Optical Coherence Tomography Angiography Evaluation in a Patient with Intermediate Uveitis

(Clovis Arcoverde Freitas Neto) – page 93

Optical Coherence Tomography Characteristics of Taxane-Induced Macular Edema and Other Multi-Modal Imaging Findings

(Anna Tan) – page 95

How Does OCT-A Scan Type Affect Discovery of Different Diabetic Retinopathy (DR) Lesions?

(John Miller) – page 97

17th International SPECTRALIS® Symposium (ISS) Faculty Members & Guest Speakers Oct 18-19, 2019 · SIGNIEL Lotte World Tower Seoul · South Korea

Course Directors:

Hakyoung Kim, MD, PhD Department of Ophthalmology, Hallym University Medical Center, Seoul, South Korea Hakyoung Kim, MD is a Professor of the Department of Ophthalmology at the Hallym University. His major clinical interest is vitreoretinal and uveal diseases. His main research interests were electrophysiology and pharmacology.

He graduated Seoul National University and trained at the Seoul National University Hospital and the Chungang University Hospital. He passed a fellowship at the Seoul National University and the Iwate medical University, Morioka, Japan. He is a member of Healthcare Review and Assessment Committee.

Seung-Young Yu, MD, PhD Kyung-Hee University Hospital, Kyung-Hee University Medical Center, Seoul, South Korea Seung-Young Yu, MD, PhD is a committed academic physician, with a passion for clinical work, teaching and research. She graduated from KyungHee University School of Medicine and served as a research fellow at Massachusettes Eye and Ear Infirmary during 2002-2004 and visiting scholar at Beyer Eye Institute during 2012-2013. She is a current professor at the KyungHee University School of Medicine. She has depth understanding of the latest systems in retinal imaging which she vigorously utilizes in clinical research. She published majority of articles in retinal imaging including various OCT technologies and fundus autofluorescence systems.

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Faculty Members:

Balwantray C. Chauhan, PhD Dalhousie University, Halifax NS, Canada

Balwantray Chauhan, PhD, is Mathers Professor and Research Director of Ophthalmology and Visual Sciences, Professor of Physiology and Biophysics and Professor of Medical Neurosciences at Dalhousie University. He obtained his Ph.D. at the University of Wales, Cardiff, UK, and his postdoctoral training at the University of British Columbia, Vancouver, Canada, under Dr. Stephen Drance. Dr. Chauhan’s clinical research interests centre on changes in the visual field and optic nerve head in glaucoma. He has devised new methods for detecting glaucoma progression and conducted research leading to their translation to clinical practice. Key contributions in imaging include the Topographical Change Analysis (TCA), used for identifying changes in the optic nerve and on the acquisition and analysis of anatomically and geometrically accurate data from the optic nerve. Dr. Chauhan is Principal Investigator of the Canadian Glaucoma Study, a multi-centre study on the risk factors for the progression of open-angle glaucoma. He also conducts research with experimental models of optic nerve damage. Areas of activity include studies of neuron-glia interaction in the retina and optic nerve, in vivo structural and functional imaging of retinal ganglion cells and neuroprotection. This research is conducted in the Retina and Optic Nerve Research Laboratory, a multidisciplinary facility he was instrumental in establishing. Dr. Chauhan has received numerous awards and recognitions including the senior Alcon Research Institute Award, the Gold Fellow of the Association for Research in Vision and Ophthalmology, and the Secretariat Award of the American Academy of Ophthalmology. He is President of the Glaucoma Research Society. His research is funded by the Canadian Institutes of Health Research, National Sciences and Engineering Research Council, the Atlantic Innovation Fund and other public and private sector agencies.

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K. Bailey Freund, MD Vitreous Retina Macula Consultants of New York Clinical Professor of Ophthalmology, NYU School of Medicine, USA

K. Bailey Freund, MD specializes in all retinal disorders including macular degeneration, diabetic retinopathy, and retinal vascular diseases. He is an expert in retinal imaging and diagnostically challenging and rare conditions. For those reasons, he routinely evaluates patients and images from around the world. Dr. Freund has initiated and conducted many clinical trials for treatments for retinal diseases. He is a Clinical Professor of Ophthalmology at New York University School of Medicine. He is a senior partner at Vitreous Retina Macula Consultants of New York, a single-specialty group with eleven retinal physicians. He is an attending surgeon at Manhattan Eye, Ear and Throat Hospital and New York Presbyterian Hospital. Dr. Freund is a founding member and trustee of the International Retinal Imaging Society. He is also a member of the Retina Society, Macula Society, and the American Society of Retina Specialists.

He is on the Editorial Board of the journal Retina and is an Associate Editor for Retinal Cases & Brief Reports. He has authored over 400 peer-reviewed scientific manuscripts and has written numerous books and book chapters, most notably the second edition of The Retinal Atlas. He recently joined the editorial team for Ryan’s Retina 7th edition. Dr., Freund has received numerous awards including the prestigious Young Investigator Award from the Macula Society and the Senior Achievement Award from the American Academy of Ophthalmology. He is a graduate of Williams College and the New York University School of Medicine and completed his residency training in general ophthalmology and fellowship in medical and surgical retina at the Manhattan Eye, Ear, and Throat Hospital. Dr. Freund is also a prominent collector of vintage magic apparatus and a proud husband and father of two.

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17th International SPECTRALIS® Symposium (ISS) Faculty Members & Guest Speakers Oct 18-19, 2019 · SIGNIEL Lotte World Tower Seoul · South Korea Damien Gatinel, MD Rothschild Foundation, Paris, France Damien Gatinel, MD, PhD leads one of the most advanced departments in cataract, cornea and refractive surgery in Europe at the Rothschild Foundation in Paris. He teaches and trains around 14 residents and fellows per year, has published more than 100 manuscripts in the peer-reviewed literature and has given more than 200 invited oral presentations all over the world. His research is mainly focused on IOL optical design, the mathematical modeling of laser refractive surgical procedures, astigmatism correction, and the detection of subclinical keratoconus. He owns a PhD in applied mathematics, and several patents, among which for the first diffractive trifocal IOL design resulting in him being given the title of Knight of the Order of the Crown from the Kingdom of Belgium. Dr. Gatinel is a board member of the Executive Committee of the ISRS and of the Research Committee of the ESCRS. He serves on the Editorial Board of the Journal of Refractive Surgery, and has received more than 20 international awards, including 14 Best Paper of Session won during ASCRS meetings, the Lans Distinguished Award and the Senior Achievement Award of the AAO.

Don-Il Ham, MD Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea Don-Il Ham, MD, is Professor and Chairman of the Department of Ophthalmology at the Samsung Medical Center, Sungkyunkwan University, South Korea. His main clinical interests are retina and uveitis. His main research interests include pathogenesis, imaging, and treatment of retinal degeneration, vascular retinopathy, chorioretinopathy and uveitis. He graduated from Seoul National University and had residency and fellowship training at Seoul National University Hospital. He also had a research fellowship at NEI, NIH. He is a member of Korean Retina Society, Korean Uveitis Society, ARVO, AAO, ASRS, and IOIS.

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17th International SPECTRALIS® Symposium (ISS) Faculty Members & Guest Speakers Oct 18-19, 2019 · SIGNIEL Lotte World Tower Seoul · South Korea Wilson Heriot, MBBS FRANZCO University of Melbourne, Department of Ophthalmology, and the Department of Optometry and Vision Sciences, Melbourne, Australia Wilson Heriot, MBBS FRANZCO, is a Melbourne, Australia based retinal specialist. After completing his general ophthalmic training in Melbourne, he investigated phototoxic retinal injury and choroidal neovascularization during a 2-year Medical retinal research fellowship with Paul Henkind in New York. This was followed by a vitreoretinal surgical fellowship with Robert Machemer at Duke University investigating RPE repair processes. His current research projects include a translation to clinical care program for a new method of retinal detachment repair called Retinal Thermofusion funded by a USA Department of Defense Congressionally Direct Grant, and the identification and characterization of the patterns of neurovascular degenerative changes in diabetic retinopathy. He was an investigator in the LEAD 3ns randomized trial for early AMD risk reduction. He holds an Associate Professorship in both the Department of Surgery, Ophthalmology, University of Melbourne and the Department of Optometry and Vision Sciences, University of Melbourne and is in private practice at Retinology Institute, Glen Iris, Australia.

Frank G. Holz, MD, FEBO, FARVO Department of Ophthalmology, University of Bonn, Germany Frank G. Holz, MD, FEBO, is Professor and Chairman of the Department of Ophthalmology at the University of Bonn, Germany. His major clinical interest is medical and surgical retina. His main research interests include the pathogenesis, biomarkers and new therapies for macular and retinal diseases including age-related macular degeneration. He has a keen interest in innovative retinal imaging technologies and image analysis strategies. He was a scholar of the German National Academic Foundation (Studienstiftung des deutschen Volkes), trained at the University of Heidelberg, Germany and the University of Chicago/Pritzker School of Medicine, and passed a fellowship at Moorfields Eye Hospital, London. Professor Holz has been a cofounder of the Priority Program AMD of the German Research Council (DFG) and founded the GRADE Reading Center Bonn to perform digital image analysis in clinical natural history and interventional trials. He is a Board Member of the German Ophthalmological Society (DOG), President of EURETINA, Member of the Club Jules Gonin, the European Academy of Ophthalmology (EAO), the Macula Society, the Gass Club; Editor-in-Chief of Der Ophthalmologe; and serves a reviewer for various peer reviewed journals.

He has received numerous awards including the Pro Retina Macular Degeneration Research Award, the Leonhard-Klein Award for Ocular Surgery, the Alcon Research Institute (ARI) Award, and the Senior Achievement Award of the AAO. He published more than 400 articles in peer-reviewed journals and is editor of several books on retinal diseases.

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17th International SPECTRALIS® Symposium (ISS) Faculty Members & Guest Speakers Oct 18-19, 2019 · SIGNIEL Lotte World Tower Seoul · South Korea Alex Huang, MD, PhD Doheny Eye Center of Pasadena, USA Alex Huang, MD, PhD, graduated from Pomona College and completed his MSTP (Medical Scientist Training Program) M.D./PhD program at The Johns Hopkins University School of Medicine with Lasker Award winning Dr. Solomon Snyder in the Solomon H. Snyder Department of Neuroscience. After completing his residency at then USC/Doheny Eye Institute, Dr. Huang left USC to complete his glaucoma fellowship with Dr. Robert Weinreb at Shiley Eye Institute. Today he is one of the founding faculty members of the Doheny Eye Institute/Stein Eye Institute/UCLA affiliation.

Dr. Huang is a clinician-scientist who is supported by the National Institutes of Health/National Eye Institute on a K08 award and the National Aeronautics and Space Administration (NASA). Clinically, Dr. Huang is recognized as a thought leader in new angle-based minimally invasive glaucoma surgeries (MIGS) that he offers to his patients. He has directed his clinical acumen in MIGS into a research program dedicated to developing a combined Structure/Function understanding of aqueous humor outflow using OCT and aqueous angiography. In his NASA work, his research focuses on the cause and development of countermeasures for Space Flight-Associated Neuro-ocular Syndrome (SANS), a condition characterized by ocular changes due to persistent microgravity exposure.

Dr. Huang has also been awarded the American Glaucoma Society Mentoring for Advancement of Physician-Scientists award (MAPS) two times (2013 and 2014) and was given the American Glaucoma Society Young-Clinician Scientist Award in 2015. Fight for Sight recognized Dr. Huang as an Undergraduate Research Award Mentor in 2015. Dr. Huang was honored with the Research to Prevent Blindness Career Development Award (1/2016) and the Heidelberg Engineering Xtreme Research award (6/2016). He was named the #1 Rising Star by The Ophthalmologist magazine in 2017.

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17th International SPECTRALIS® Symposium (ISS) Faculty Members & Guest Speakers Oct 18-19, 2019 · SIGNIEL Lotte World Tower Seoul · South Korea Adrian Koh, MD The Balmoral Clinic, Singapore

Adrian Koh, MD, is Professor and Founding Partner / Senior Consultant at the Eye & Retina Surgeons, Camden Medical Centre and Associate Professor at the National University of Singapore. He is visiting consultant to Singapore National Eye Centre and Tan Tock Seng Hospital. He is past President of the Singapore Society of Ophthalmology, and member of the Executive Council of the College of Ophthalmologists. He is Executive Director of ESASO (European School of Advanced Studies in Ophthalmology) Asia. He was the Secretary General and Vice President of the 2006 APAO Congress in Singapore and Congress President of the 5th APVRS in 2010. He is an active member of the Macula Society and Club Jules Gonin. He serves on the Executive Council of the Asia Pacific Vitreo Retina Society (APVRS) and was Regional Secretary of the Asia Pacific Academy of Ophthalmology (APAO). He is an active member of EURETINA, American Academy of Ophthalmology, Asia Pacific Academy of Ophthalmology, Vision Academy and Asia Pacific Vitreoretina Society. Prof Koh completed Fellowships in Medical Retina at Moorfields Eye Hospital & the Jules Stein Eye Institute. He trained under Professors Alan Bird, Susan Downer, Graham Holder, Bradley Straatsma and John Heckenlively. His areas of expertise include degenerative macular disease such as polypoidal choroidal vasculopathy (PCV), choroidal neovascularisation, retinal dystrophy, visual electrophysiology and retinal vascular disease. He is one of the key international opinion leaders in Retina. He was principal investigator of the EVEREST-1 and EVEREST-2 trials and Chairman of the PCV Roundtable of Experts. He sits on several international advisory boards and steering committees, including Vision Academy Steering Committee and Brolucizumab Global Steering Committee. Prof Koh has published extensively in peer reviewed journals and ophthalmology textbooks, and lectures in numerous national and international meetings each year.

Hideki Koizumi, MD, PhD Department of Ophthalmology, University of the Ryukyus, Okinawa, Japan

Hideki Koizumi, MD, PhD, is a Professor and Chairman of the Department of Ophthalmology at the University of the Ryukyus, Okinawa, Japan. He is an internationally recognized expert in the diagnosis and treatment of retinal and macular diseases and retinal imaging. Currently, he is the youngest chairman of ophthalmology department in Japan.

Prof. Koizumi is the author of more than 80 peer-reviewed articles and book chapters. He also serves on the Editorial Board of the Current Eye Research and an active reviewer for many ophthalmologic publications.

Prof. Koizumi is a member of The Macula Society and The American Academy of Ophthalmology (AAO). He is the recipient of the 2019 Achievement Award from the AAO.

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17th International SPECTRALIS® Symposium (ISS) Faculty Members & Guest Speakers Oct 18-19, 2019 · SIGNIEL Lotte World Tower Seoul · South Korea Ji Eun Lee, MD Pusan National University Hospital, South Korea Ji Eun Lee, MD, is Professor and Chairman of the Department of Ophthalmology at College of Medicine, Pusan National University, Korea. He finished his retinal fellowship in Pusan National University Hospital and Bascom Palmer Eye Institute. His main interests include both medical and surgical retina. He participated many clinical researches as well as organized several multicenter studies.

He wrote the first textbook for vitreoretinal surgery written in Korean and was the first reported a single-layered internal limiting membrane flap technique for macular hole surgery. The video selected as Best Show of AAO 2014. He has received academic awards of Korea Retina Society twice. He is a member of American Academy of Ophthalmology and The Retina Society. He published more than 130 articles in peer-reviewed journals.

Tock Han Lim, MBBS, FRCSEd, MMed (Ophth), FAMS NHG Eye Institute, Tan Tock Seng Hospital, Singapore Tock Han Lim, MBBS, FRCSEd, MMed (Ophth), FAMS, is Professor and currently the Assistant CEO (Education and Research) of National Healthcare Group, Singapore. He was fellowship trained in Mayo Clinic, Rochester, Mn, USA. Among his clinical and research interests are Age-Related Macular Degeneration (AMD) and Polypoidal Choroidal Vasculopathy (PCV). He has pioneered the use of Confocal Scanning Laser Indocyanine Angiography (CSLO-ICGA) in the region for the diagnosis and treatment of PCV, culminating in the setting up of the region’s first reading center for PCV imaging (Fundus Imaging Reading Centre, FIRC) and the EVEREST Trial (by Novartis), the first prospective randomized controlled trial of PCV. He was the founding Designated Institutional Official for the NHG-AHPL Residency Programme, one of first institution worldwide accredited by Accreditation Council for Graduate Medical Education International (ACGME-I). He is a Clinical Associate Professor in Ophthalmology at the National University of Singapore, Division of Graduate Medical Studies; as well as Adjunct Associate Professor at the School of Materials Science and Engineering at Nanyang Technological University and an Adjunct Professor at the Universiti Kebangsaan, Malaysia. He is also the immediate past and the founding President of the College of Ophthalmologists Academy of medicine Singapore.

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17th International SPECTRALIS® Symposium (ISS) Faculty Members & Guest Speakers Oct 18-19, 2019 · SIGNIEL Lotte World Tower Seoul · South Korea Kyu Hyung Park, MD Department of Ophthalmology, College of Medicine, Seoul National University, Seoul, South Korea

Kyu Hyung Park, MD, is a Professor of the Department of Ophthalmology at the Seoul National University, Korea. He is one of the leading scientists in medical and surgical retina, ocular genetic epidemiology in Korea. He published over 200 papers in peer-reviewed journals. He serves as principal investigator on many clinical trials for age related macular degeneration, diabetic macular edema and retinal vein occlusion. He was a secretary general of Korean Ophthalmology Society and is current secretary general of Korean Retina Society.

His main research interests include pathogenesis, new diagnostic and new therapeutic tools for retinal diseases including age-related macular degeneration, diabetic retinopathy, and rare retinal diseases. He has been collecting genetic, proteomic and epidemiologic data on age-related macular degeneration and diabetic retinopathy and rare genetic diseases and analyze genetic and proteomic profiles of Korean to elucidate the genetic marker and potential biomarker of the diseases. Currently, he also takes in charge of ophthalmological investigation of Korean National Health and Nutritional Survey to establish valuable epidemiologic data of ocular diseases including age-related macular degeneration, diabetic retinopathy and glaucoma. He has received numerous awards including the Scientific achievement Award of Korean Retina Society, Service award of APAO and Minister Award of Health and Welfare Department of Korean Government.

Cynthia J. Roberts, PhD Ophthalmology & Visual Science; and Biomedical Engineering The Ohio State University, Columbus, OH, USA Cynthia J. Roberts, PhD, is Professor of Ophthalmology and Biomedical Engineering at The Ohio State University in Columbus, Ohio, United States. She serves as Director of Research and holds Martha G. and Milton Staub Chair for Research in Ophthalmology. Her research interests include corneal and ocular biomechanics, clinical measurement of corneal biomechanical response, intraocular pressure (IOP) measurement error, corneal tomography, OCT, and other ophthalmic imaging applications. She made significant contributions to the basic science of corneal topography in the 1990’s, especially related to optimal algorithms for interpretation of response to refractive surgery. She received a Master of Science Degree in Electrical Engineering and a Doctoral Degree in Biomedical Engineering, both from The Ohio State University. She has given over 200 international invited lectures, published over 130 papers in peer-reviewed journals, contributed to more than 20 book chapters and co-edited three books on Corneal Topography, Corneal Biomechanics, and Biomechanics of the Eye. She serves on the Editorial Boards of two journals, as well as a reviewer for various additional journals.

She has received numerous awards, including the Achievement Award from the AAO, the Lumley Interdisciplinary Research Award, and the Lans Distinguished Award from the ISRS. She was also named to the 2014 and 2018 Power Lists of the Top 100 Most Influential People in Ophthalmology.

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17th International SPECTRALIS® Symposium (ISS) Faculty Members & Guest Speakers Oct 18-19, 2019 · SIGNIEL Lotte World Tower Seoul · South Korea SriniVas R. Sadda, MD Doheny Eye Institute, University of California, Los Angeles, CA, USA SriniVas R. Sadda, MD, is the President and Chief Scientific Officer of the Doheny Eye Institute, the Stephen J. Ryan – Arnold and Mabel Beckman Endowed Chair, and Professor of Ophthalmology at the University of California – Los Angeles (UCLA), David Geffen School of Medicine. He received his medical degree from The Johns Hopkins University in Baltimore, Maryland. After an internship at the William Beaumont Hospital in Royal Oak, Michigan, he returned to Johns Hopkins University and the Wilmer Eye Institute in Baltimore for an ophthalmology residency as well as neuro-ophthalmology and medical retina fellowships. Dr Sadda’s major research interests include automated retinal image analysis, retinal substructure assessment, advanced retinal imaging technologies, and vision restoration approaches. His research has been consistently funded by the National Institutes of Health (NIH) and multiple private organizations including the Foundation Fighting Blindness, Research to Prevent Blindness, Foundation for Retinal Research, and the Macula Vision Research Foundation. He has organized multiple consensus efforts for the classification of various retinal disorders. Dr. Sadda has served as Principal Investigator for over 30 major clinical trials and has led several international collaborative research programs. He is the founder and Emeritus Director of the Doheny Image Reading Center, one of the largest centralized reading centers in the world. He has more than 450 publications in peer-reviewed journals and over 300 published abstracts. He authored the first edition of the textbook Emerging Technologies in Retinal Disease, as well as 20 other book chapters. As an invited lecturer, he has given more than 400 presentations around the country and the world, including multiple named lectures. Dr. Sadda also serves as an editorial board member of Ophthalmic Surgery, Lasers & Imaging, Retina, Graefe’s Archive for Clinical and Experimental Ophthalmology, Ophthalmology Retina, and Ophthalmology. He is also an editor of the 5th edition of the Ryan’s Retina textbook. He regularly serves the NIH Center for Scientific Review on study section. Among Dr. Sadda’s awards and honors are a Research to Prevent Blindness Physician-Scientist Award, a Senior Honor Award from the American Society of Retina Specialists, a Senior Achievement Award and Secretariat Award from the American Academy of Ophthalmology, John H. Zumberge Research and Innovation Award, the Macula Society Young Investigator Award, Asia-Pacific Academy of Ophthalmology (APAO) Achievement Award, The Macula Society Paul Henkind Lecture and Award, and American Society of Retina Specialists Young Investigator Award. He has also received the Silver Fellow designation from the Association for Research in Vision and Ophthalmology. He has been named to the Best Doctors of America list for several consecutive years.

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17th International SPECTRALIS® Symposium (ISS) Faculty Members & Guest Speakers Oct 18-19, 2019 · SIGNIEL Lotte World Tower Seoul · South Korea Giovanni Staurenghi, MD Sacco Hospital, University of Milano, Italy Giovanni Staurenghi, MD, presently Professor of Ophthalmology, is Chairman of the University Eye Clinic at Department of Biomedical and Clinical Science “Luigi Sacco” University of Milan, Italy. He got his degree at the University of Pavia (Italy) in 1986 and his residency at the University of Milan (Italy) in 1990. He was research fellow at the Schepens Eye Research institute from 1991 to 1992 and Visiting Scientist at the same Institute from 1992 to 1993. He became associate professor in 1999 and full professor in 2007. His research, publications and lectures have an important bearing on retinal degeneration; in particular his work is oriented on different types of imaging and treatment. He has been a member of ARVO since 1988, Macula Society since 2004, Ophthalmic Photographer Society since 2006 and American Accademy of Ophthalmology since 2007. He is also a Silver Medal Fellow of ARVO and a member of the Gass Club. He serves as Editorial Board Member for Retina and American Journal of Retinal Cases.

Kyung Rim Sung, MD Asan Medical Center, Seoul, South Korea

Kyung Rim Sung, MD, is Professor and Chair of Deparment of Ophthalmology at the Asan Medical Center, University of Ulsan College of medicine, Seoul, Korea. Dr. Sung graduated Seoul National University, medical school. She completed residency and clinical fellowship at Asan Medical Center and research fellowship at University of Pittsburgh Medical Center. Her current research interests include pathogenesis of angle-closure glaucoma, ocular blood flow in glaucoma, myopia and glaucoma, glaucoma imaging, and basic research related to optic nerve head astrocyte. She received several worldwide renowned awards including the AAO achievement award and published 127 peer reviewed article in international journals.

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17th International SPECTRALIS® Symposium (ISS) Faculty Members & Guest Speakers Oct 18-19, 2019 · SIGNIEL Lotte World Tower Seoul · South Korea Sebastian Wolf, MD, PhD Inselspital University of Bern, Switzerland

Sebastian Wolf, MD, PhD is Professor of Ophthalmology and Director of the Department of Ophthalmology at the Inselspital, University of Bern, Switzerland.

His main areas of scientific interest are age-related macular His main areas of scientific interest are medical retina, retinal imaging, and vitreo-retinal surgery. Dr Wolf has authored over 300 publications in peer-reviewed journals, including Archives of Ophthalmology, AJO, BJO, Diabetes Care, IOVS, Ophthalmology, Retina, and Scientific reports. He serves on the editorial board of various scientific journals including IOVS, European Journal of Ophthalmology, and Graefes Archives, and he is Editor-in-Chief for Ophthalmologica.

He is a member of many professional organisations, including Deutsche and Schweizer Ophthalmologische Gesellschaft, ARVO, the Retina Society, ASRS, EURETINA, Club Jules Gonin, and the AAO. He has been appointed as ARVO Gold Fellow. He has served as General Secretary and president of the EURETINA.

Hyeong Gon Yu, MD, PhD Seoul National University Hospital, Seoul, South Korea Hyeong Gon Yu, MD, PhD is Professor of Seoul National University (SNU) College of Medicine and in charge of the Retina and Uveitis service in Seoul National University Hospital (SNUH). He has set up two special clinics in the SNUH, the uveitis clinic and the hereditary retinal disease clinic. He serves as a prinicipal investigator or co-investigator in many clinical trials.

As an ophthalmogist with subspecialty expertise in the retina, he is committed to studying pathogenic mechanisms of retinal disease and deveoping novel therapeutic intervention. His research interests focus on clinical and translation research on retinal degeneration associated with age-related and hereditary retinal degeneration, vascular retinopathy and ocular inflammatory diseases. He is a recipient of SNUH Academic Award from Seoul National Univesity Hospital, Korean Ophthalmology Society and Korean Retina Society. He is also Chair of the Department of Experimental Animal Research of SNUH Bioresearch Institute and the founding president of the Korean Association of Retinal Degeneration. He has been actively participating in many international academic societies as a council member or a faculty including MS(Macula Society), IUSG(International Uveitis Society Group), ISBD (international society of Behcet disease), APAO(Asia Pacific Academy of Ophthalmology) and APVRS (Asia Pacific Vitreo-Retinal Society) and contributed to the development of ophthalmic researches in Asia-pacific region.

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17th International SPECTRALIS® Symposium (ISS) Faculty Members & Guest Speakers Oct 18-19, 2019 · SIGNIEL Lotte World Tower Seoul · South Korea Suqin Yu, MD Shanghai General Hospital, Shanghai Jiaotong University, China Suqin Yu, MD, is an Associate Professor of the Department of Ophthalmology, Shanghai Jiaotong University Shanghai General Hospital, China. She received her medical degree from Shanghai Medical University and master degree from Shanghai Medical College of Fudan University. She also received international fellowship at the Vitreous Retina Macula Consultants of New York, Manhattan Eye, Ear and Throat Hospital.

Dr. Yu has about 25 years of extensive experience in eye care, diagnosis and treatment of various eye diseases. Her subspecialty is vitreoretinal diseases; interests are in retinal imaging, fundus morphological and functional examinations, and laser treatments for retinal diseases. She has published about 50 popular science articles and peer-reviewed journal articles and have co-authored 6 books.

Linda Zangwill, PhD University of California, San Diego, USA Linda Zangwill, PhD, is Professor of Ophthalmology at the University of California San Diego serves as Director of Clinical Research of the Hamilton Glaucoma Center, and Director of the Imaging Data Evaluation and Analysis (IDEA) Reading Center. Dr. Zangwill completed her BS from UC Berkeley, MS from the Harvard School of Public Health, and PhD in Epidemiology from Ben-Gurion University of the Negev, Beer-Sheva, Israel. Dr. Zangwill has published over 300 manuscripts in peer-reviewed journals. She is an elected executive committee member of the Glaucoma Research Society and the Imaging and Perimetry Society. Dr. Zangwill is an Association for Research in Vision and Ophthalmology Gold Fellow. Dr. Zangwill has been continuously funded by the National Eye Institute for 25 years as Principal Investigator for the Diagnostic Innovations in Glaucoma Study (DIGS) and more recently, the African Descent and Glaucoma Evaluation Study (ADAGES). Dr. Zangwill’s clinical research focuses on improving our understanding of the complex relationship between structural and functional change over time in the aging and glaucoma eye, developing computational, machine learning and statistical techniques to improve glaucoma detection, and identifying risk factors that can predict rapidly progressing glaucoma.

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Honorary Lecture: Won Ki Lee, MD Nune Eye Hospital, Seoul, South Korea

Won Ki Lee, MD, is now working in Nune Eye Hospital. Previously, he was Professor of the Department of Ophthalmology at the Catholic University in Seoul. His major clinical interest is medical and surgical retina. His main research interests include the pathogenesis and treatment for macular and retinal diseases including age-related macular degeneration and polypoidal choroidal vasculopthy. He received his medical education at Seoul National University, trained at the National Medical Center (Seoul), and had a fellowship at Osaka City University (Japan). He is the President of the Korean Retina Society. He is an Executive Committee Member of the International Retina Imaging Society (INTRIS) and Asia-Pacific Vitreoretina Society (APVRS), and a Member of the Macula Society. He published more than 100 articles in peer-reviewed journals.

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Choroidal Change in Posterior Uveitis

Hyeong Gon Yu

Seoul National University Hospital, Seoul, Korea

Purpose: To evaluate long-term changes of subfoveal choroidal thickness (SCT) in Behçet's disease (BD) and Vogt Koyanagi Harada disease (VKH) with posterior uveitis.

Methods: Changes in SCT measured with enhanced depth imaging optical coherence tomography during quiescent phase were assessed during >24 months in uveitis patients and control group. In VKH patients with the interval between diagnosis and final follow-up of ≥ 24 months were divided into two groups according to route of systemic corticosteroid; intravenous pulse therapy (IV pulse group) and oral administration (oral group). Sunset glow fundus (SGF) scores determined by ultra-wide field retinal imaging and SCT determined by enhanced depth imaging optical coherence tomography were compared.

Results: Baseline characteristics showed no difference. Mean SCT in the BD group decreased from 291.0 to 268.1 μm (p<0.001) during the mean period of 38.5 months. Mean change rate of SCT in the BD group was associated with longer active inflammation (p<0.001). Patients with longer disease duration showed smaller baseline SCT (p = 0.03). In VKH patients, the IV pulse group showed significantly lower mean SGF score, indicating less advanced depigmentary change (3.7 ± 1.5 vs. 5.1 ± 1.2, P = 0.007) and greater mean SCT (239.7 ± 71.1 μm vs. 183.8 ± 72.6 μm, P = 0.012) than the oral group. In a cross-sectional evaluation at multiple time points from disease onset, the IV pulse group showed significantly lower SGF scores from 1 to 6 years and greater SCTs from 2 to 5 years. Multivariable regression analysis showed that IV pulse therapy and less frequent and shorter duration of inflammation predicted a lower SGF score (R2 = 0.291, P < 0.001), and young age, IV pulse therapy, and shorter duration of inflammation predicted greater SCT (R2 = 0.27, P < 0.001).

Conclusions: In BD patients as well as VKH patients, choroidal thickness decreased over time, which was associated with length of active inflammation. In VKH disease, high dose IV pulse corticosteroids during the acute stage of VKH disease resulted in less choroidal change during the convalescent stage when compared to oral administration. Our studies indicate that choroidal change can be a useful anatomic biomarker of ocular inflammation in posterior uveitis.

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Notes ______________________________________________________________________________

17th International SPECTRALIS® Symposium (ISS) Oct 18-19, 2019 • Seoul • South Korea

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Novel Microperimetry Import Feature

K. Bailey Freund, MD1,2, Yoshimi Sugiura, MD3, Rosa Dolz-Marco, MD, PhD4

1 Vitreous Retina Macula Consultants of New York, New York, USA 2 New York University School of Medicine, New York, USA 3 University of Tsukuba, Ibaraki, Japan 4 Oftalvist Clinic, Valencia, Spain

Purpose: To demonstrate the clinical and research value of a simplified technique that enables precise alignment of functional microperimetry data with retinal structure as imaged by eye-tracked optical coherence tomography (OCT).

Methods: Normal eyes and eyes with a range of retinal diseases underwent simultaneous Spectralis OCT raster scans and confocal scanning laser ophthalmoscopy Macular Integrity Assessment (MAIA) microperimetry using a standard central 10° and/or custom scan pattern. A modified research version of Heidelberg Eye Explorer enabled importation and precise alignment of threshold retinal sensitivity (TRS) data with retinal structure seen on OCT B-scans. Eye-tracking use by both devices enabled real-time assessments of how focal changes in retinal structure affect TRS during follow-up.

Results: Sixty-three eyes of 38 patients (103 studies) aged 22-95 years (mean 62.1 ± 19.6 years) with both normal and pathologic macular changes were included. The average MAIA TRS of all 103 studies was 22.3 ± 5.0 (range; 0.1 – 30.3). Retinal sensitivity showed good correspondence with changes in retinal structure seen on OCT B-scans. In many eyes, visual acuity showed poor correspondence with TRS. Clinical examples demonstrating the utility of this imaging technique are shown.

Conclusions: We demonstrate a simple and practical method to align retinal sensitivity data with anatomic findings imaged with OCT. This technique enables precise correlation of changes in TRS related to a layer by layer structural assessment of macular anatomy in a manner not possible with standard visual acuity measures. Eye-tracked follow-up assessments offer the potential for more precise measures of changes in visual function due to disease and to those induced by therapeutic interventions.

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Novel Approaches to High Magnification Imaging

Frank G. Holz, Philipp Müller, Sarah Thiele, Chantal Dysli, Maximilian Pfau, Kristina Hess, Wolf M. Harmening

Department of Ophthalmology, University of Bonn, Germany

Purpose: To evaluate a refined, high-resolution SLO imaging modality for cellular resolved retinal imaging without adaptive optics.

Methods: A novel high magnification module available for a Heidelberg Engineering SPECTRALIS® HRA+OCT imaging platform was used to create near infrared confocal SLO images of a 7deg field of view in normal eyes and in eyes with retinal diseases.

Results: The cone photoreceptor mosaic could be readily visualized through dilated and natural pupils at parafoveal regions in the majority of our normal control eyes, as well as in a proportion of eyes with various different retinal diseases.

Conclusions: In eyes with favorable ocular optics and media, imaging the parafoveal cone mosaic is possible without the use of adaptive optics, and with the ease of use of a commercially available and clinically proven imaging device.

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Notes ______________________________________________________________________________


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Fluorescence Lifetime Imaging

Sebastian Wolf, Chantal Dysli, Martin S. Zinkernagel

Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Switzerland

Purpose: To investigate fluorescence lifetime characteristics in patients with retinal diseases and to correlate the measurements with clinical data and optical coherence tomography (OCT) findings.

Methods: Patients with either intermediate AMD or late AMD with geographic atrophy (GA) as well as patients with Stargardts disease were imaged with a fluorescence lifetime imaging ophthalmoscope (Heidelberg Engineering, Germany). Autofluorescence lifetimes were measured in a short and a long spectral channel (498-560 nm and 560-720 nm).

Results: Fluorescence lifetime maps of 105 eyes of 105 patients AMD and 30 eyes of patients with Stargardts disease were analyzed. Mean retinal autofluorescence lifetimes in patients with intermediate AMD was significantly prolonged compared with the healthy control eyes. Areas of drusen featured a wide range of fluorescence lifetime values. Mean lifetimes within areas of atrophy were prolonged in patients with AMD whereas patients with Stargardts disease showed shortened lifetimes in areas of atrophy. Flecks in Stargardts disease demonstrate various lifetimes depending on the stage of the disease.

Conclusions: Our data establish that autofluorescence lifetime changes in AMD and Stargardts disease. Various autofluorescence lifetime pattern can be distinguished. Intraretinal deposits cause prolonged lifetimes, whereas deposits in the area of the outer photoreceptor segments lead to short fluorescence lifetimes. We hypothesize that the short lifetimes seen within the atrophy may be used to estimate damage induced by atrophy and may be useful to monitor disease progression in the context of natural history or interventional therapeutic studies.

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Notes ______________________________________________________________________________


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A multimodal Imaging Approach for the CNV Classification: Why this is Important

Giovanni Staurenghi, MD

Eye Clinic Luigi Sacco Hospital University of Milan, Italy

The multimodal imaging approach is superior to identify the CNV types. Infrared, autofluorescence, fluorescein angiography, indocianine angiography, OCT and OCT-A all together increased the probability to identify correctly the CNV types.

The HARBOR, CATT, IVAN, RIVAL and real-world data will be discussed with a different approach.

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Notes ______________________________________________________________________________


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MMI for the Management of Myopic CNV

Tock-Han Lim

National Healthcare Group Eye Institute, Singapore

Most cases of Myopic choroidal neovascularisation (CNV) are diagnosed clinically, confirmed by spectral domain or swept source optical coherence tomography (SD/SS-OCT). Myopic CNV typically presents as type 2 CNV with overlying intraretinal changes. Treatment can be monitored by eye-tracked OCT B scans. It is safe to stop anti-vascular endothelial growth factor (anti-VEGF) treatment when SD/SS-OCT shows clear boundary of the subretinal hyperreflectivity and resolution of the overlying outer retinal changes, and improved / stability of visual acuity. After cessation of anti-VEGF therapy, close observation with serial SD/SS-OCT in the initial months is important, especially in cases with combined myopic macular schisis and history of past recurrences.

However, multimodal imaging becomes useful in some challenging cases. Lacquer crack bleed shows hypofluorescence on fundus fluorescein angiogram. OCT angiography show little or no flow signal with careful segmentation and projection artefact removal. Lacquer cracks are seen in infrared enface reflectance images. Late phase angiograms delineate these lesions well. Chorio-retinal atrophy (CRA) may show outer retinal reflectivity and wedge/double wedge sign that mimics a type 2 CNV on casual inspection of the SD/SS-OCT. OCTA and careful follow up may be necessary to differentiate these degenerative changes from myopic CNV, thus avoiding unnecessary anti-VEGF.

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Notes ______________________________________________________________________________


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Needs of Multimodal Imaging for CSC

Seung-Young Yu, Kiyoung Kim, Eung Suk Kim

Department of Ophthalmology, Kyung Hee University Hospital

Central serous chorioretinopathy (CSC), the fourth most common nonsurgical retinopathy, is characterized by serous retinal detachment most commonly involving the macular region. Multimodal imaging techniques for CSC include optical coherence tomography (OCT) with enhanced depth imaging, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, and OCT angiography. Evolution of new imaging techniques in addition to conventional imaging modalities has revolutionized the understanding about the pathophysiology of CSC and hence the diagnosis and management.

Fundus autofluorescence (FAF) is a noninvasive method that provides functional images of the fundus, by using the stimulated emission of light from endogenous fluorophores, the most significant being lipofuscin. Fundus autofluorescence detects changes of fluorophores, reflects the status of the RPE activity, and reveals changes in the retina over the early and late CSC. Thus, recently, FAF imaging has been widely used to study CSC. By analyzing the association between FAF, chronicity, visual acuity, and spectral domain optical coherence tomography (SD-OCT) in a large sample size, we can infer the association between FAF pattern and CSC status. In addition, when determining whether to hold or start active treatment, FAF patterns would be helpful in distinguishing acute from chronic CSC.

We evaluated the angiographic, tomographic, and clinical characteristics of idiopathic central serous chorioretinopathy (CSC) in elderly patients. Of 176 patients, 26 patients (15.1%) were 60 years or older. Complete resolution of subretinal fluid after treatment was noted in 72.0% of the elderly group and 90.8% of the young group (P = 0.021). The elderly group showed worse baseline and final vision, more bilateral involvement, and lower male preponderance than the young group (P < 0.05, respectively). The elderly group was also associated with a higher frequency of retinal pigment epithelium depigmentation, foveal thinning, and double-layer sign compared with the young group (P < 0.05, respectively). CSC in elderly patients was associated with a lower resolution of serous detachment, increased impairment of retinal pigment epithelial layers, foveal thinning, and worse visual outcome, suggesting a chronic insult to the choroidal vessels involving more severe damage to the outer retinal layers.

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Notes ______________________________________________________________________________


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MacTel: Novel insights

Holz FG1, Tzaridis S1, Heeren T2,3, Mai C3, Thiele S1, Charbel Issa P4, Herrmann P1

1 Department of Ophthalmology, University Hospital Bonn, Bonn, Germany

2 Moorfields Eye Hospital NHS Foundation Trust, London, UK

3 Institute of Ophthalmology, University College London, London, UK

4 Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, and Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.

Purpose: To evaluate the role of right-angled vessels (RAVs) during disease progression in macular telangiectasia type 2 (MacTel).

Methods: In this study, 100 eyes of 52 patients and 52 eyes of 26 age-related controls were examined using fundus photography, spectral-domain optical coherence tomography (SD-OCT), OCT angiography (OCT-A) and fundus fluorescein angiography (FFA). Two masked readers graded fundus photographs of patients' eyes into five disease stages according to Gass and Blodi and evaluated all eyes for the presence of RAVs. If RAVs were present, their course and origin (arterial vs venous) was evaluated with OCT-A and FFA, respectively. Additionally, we looked for morphological correlates of these vessels on SD-OCT scans. Neovascular eyes were analyzed for the presence of RAVs and for morphological changes on formation of neovascularisations (NVs).

Results: In OCT-A, RAVs were already detectable in eyes with early stages (1 to 2), could be tracked from superficial to outer retinal layers and were shown to form anastomoses in the outer retina with disease progression. These vessels were of both arterial and venous origin as shown by early phase FFA. Dilated capillaries and RAVs in OCT-A corresponded to hyper-reflective alterations of the outer retina on SD-OCT scans. In 19/19 eyes, NVs were associated with the presence of RAVs, and RAVs were shown to directly connect to neovascular complexes and to undergo morphological changes upon NV formation.

Conlusions: The results emphasise the role of RAVs during disease progression from an early stage on and demonstrate their involvement in the development of secondary NVs in MacTel.

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https://www.ncbi.nlm.nih.gov/pubmed/?term=Holz%20FG%5BAuthor%5D&cauthor=true&cauthor_uid=30808615

https://www.ncbi.nlm.nih.gov/pubmed/?term=Tzaridis%20S%5BAuthor%5D&cauthor=true&cauthor_uid=30808615

https://www.ncbi.nlm.nih.gov/pubmed/?term=Heeren%20T%5BAuthor%5D&cauthor=true&cauthor_uid=30808615

https://www.ncbi.nlm.nih.gov/pubmed/?term=Mai%20C%5BAuthor%5D&cauthor=true&cauthor_uid=30808615

https://www.ncbi.nlm.nih.gov/pubmed/?term=Thiele%20S%5BAuthor%5D&cauthor=true&cauthor_uid=30808615

https://www.ncbi.nlm.nih.gov/pubmed/?term=Charbel%20Issa%20P%5BAuthor%5D&cauthor=true&cauthor_uid=30808615

https://www.ncbi.nlm.nih.gov/pubmed/?term=Herrmann%20P%5BAuthor%5D&cauthor=true&cauthor_uid=30808615

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MMI for the Management of PCV

Tock-Han Lim, Colin Tan

National Healthcare Group Eye Institute, Singapore

Polypoidal choroidal vasculopathy (PCV) is an exudative macular neovascular disorder typically presenting with serosanguinous maculopathy. It is a bicomponent sub-retinal pigment epithelial vasculopathy consisting of a branching vascular network (BVN) and ‘polypoidal’ lesion(s) at its margin.

The diagnosis of PCV is based on the presence of typical nodular hyperfluorescence on indocyanine angiography (ICGA) not unlike aneurysmal vascular dilatations. Using confocal scanning laser ophthalmoscope (CSLO) ICGA, the associated (BVN) is better visualised, and is often indistinguishable from type 1 choroidal neovascularisation (CNV) on ICGA and OCTA. Hence PCV could be understood as ‘aneurysmal type 1 CNV’.

The EVEREST Criteria helps to differentiate PCV lesions from its mimickers such as central serous chorioretinopathy, retinal angiomatous proliferation and nodular type 2 CNV. The EVEREST diagnostic criteria are based on multi-model imaging (MMI), studying these aneurysmal lesions across CSLO-ICGA, optical coherence tomogram (OCT) and color fundus photography with co-location. Fundus fluorescein angiogram (FFA) and structural OCT help to differentiate whether the leakage comes from the aneurysmal dilatation(s) or the type 1 CNV or both. OCT angiography depicts the type 1 CNV well but not the polypoidal lesions consistently.

The EVEREST I and II studies had shown that prompt treatment with combined verteporfin photodynamic therapy (vPDT) in combination with ranibizumab provided better visual outcome compared to ranibizumab monotherapy at 12 months. The treatment benefit persisted over 24 months, with half the median number of ranibizumab injections without increased adverse events. Planet study showed that vPDT added as a rescue therapy did not show additional benefit compared with continuing with aflibercept monotherapy in cases of poor response.

Hence identification of PCV (aneurysmal type 1 CNV) avails the patient to prompt MMI guided vPDT in combination with anti-VEGF therapy. On average, after prompt combination therapy with 3 loading ranibizumab injections, the lesion remained quiescent for more than 200 days. Over 24 months, the medium numbers of additional vPDT and ranibizumab injections were 1 and 3 respectively.

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Polypoidal Choroidal Vasculopathy and Early Choroidal Hypofluorescence in Indocyanine Green Angiography

Ji Eun Lee, MD, PhD

Pusan National University Hospital, Busan, Korea

Purpose: To investigate the relationship between early choroidal hypofluorescence (ECH) in indocyanine green angiography (ICGA) and polypoidal choroidal vasculopathy (PCV).

Methods: Enlargement of PCV lesions that was within ECH at baseline were assessed in follow-up ICGA. Mechanism of ECH were analyzed in ICGA obtained in normal subjects.

Results: PCV growth was observed in 20 of 31 eyes and regional relationship was noted in 14 eyes (70%), as the shape of the PCV lesion conformed to the boundary of ECH and/or the growth of lesion was aligned to the peripheral extension of ECH. Involvement of the fovea by the PCV lesion was associated with subfoveal ECH.

ICGA was obtained in 61 normal subjects. Five types of ECH were identified; choroidal watershed zone, vascular paucity, delayed arterial perfusion, filling defect by a large choroidal vein and pachychoroid.

Conclusions: ECH associated pachychoroid implies possible compromised choroidal circulation, which would have a pathological implication as shown in relationship between ECH and PCV growth.

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Is ICGA still needed for the diagnosis and management of PCV?

Adrian Koh

The Balmoral Clinic, Singapore

In the pre OCT-angiography (OCT-A) era, indocyanine green angiography (ICGA) has always been considered the gold standard for the diagnosis of polypoidal choroidal vasculopathy (PCV). In addition, the accurate localisation of polypoidal lesion and branching vascular network are crucial to the application of angio-occlusive therapy such as verteporfin photodynamic therapy (vPDT). ICGA criteria for diagnosing PCV are well-defined and validated in large randomised clinical trials such as EVEREST 1 and 2, DRAGON and FUJISAN.

There are distinctive characteristics of PCV on spectral domain OCT, enhanced depth OCT and OCT-A. The combination of imaging techniques, also known as multimodal imaging, has reduced the reliance of ICGA alone for the diagnosis of PCV. The use of anti-vascular endothelial growth factor (VEGF) monotherapy has meant that ICGA may not be necessary in cases in which the diagnosis is unequivocal using OCT and OCT-A. OCT-A has a lower sensitivity of detecting polypoidal lesions compared to ICGA but recent studies show that with proper manual segmentation, the sensitivity can be greatly enhanced to above 90%. In addition, changes in OCT-A algorithms to detect slow flow lesions may enhance the capabilities to detect these lesions on a more consistent basis.

The rapid evolution and development of OCT-A technology may mean that ICGA can be replaced by OCT-A in the future.

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The Comparison of Multicolor Imaging and Color Fundus Photography in the Detection of Pathological Findings in Eyes with Polypoidal Choroidal Vasculopathy

Anna C.S Tan1,2,3, Yasuo Yanagi1,2,4, Gemmy Cheung Chui Ming1,2,3 1 Singapore National Eye Centre, Singapore Singapore 2 Singapore Eye Research Institute, Singapore Singapore 3 Duke-NUS Medical School, Singapore, Singapore 4 Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan

Purpose: To compare the appearance and frequency of detection of common features in eyes with polypoidal choroidal vasculopathy (PCV) using multicolor imaging (MC) or color fundus photography (CFP).

Methods: 38 eyes with ICGA-proven PCV, imaged with both MC and CFP were graded by 3 independent retinal specialists. The presence of 5 pre-specified pathological features (blood, exudation, polypoidal lesions, pigment epithelial detachments and atrophy) were graded on each modality independently. Multi-modal imaging including optical coherence tomography, fluorescein and indo-cyanine green angiography was used as the gold standard.

Results: Overall, there was no statistically significant difference in the ability of MC imaging compared to CFP in detecting the pathological features. Polypoidal lesions appear as small, dark green, round lesions which have higher contrast on MC compared to a nodular orange appearance seen on CFP. Polypoidal lesions can be identified non-invasively using both MC and CFP in about half of the cases.

Conclusions: There are differences in the appearance of PCV-associated features on MC compared to CFP. Both modalities are comparable for the detection of pathological features in eyes with PCV. MC imaging may be considered as an alternative to CFP.

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Longitudinal Changes of Retina in Reticular Pseudodrusen

Don-Il Ham, MD

Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea

Purpose: To investigate the long-term, longitudinal changes of retina in eyes with reticular pseudodrusen (RPD).

Methods: Imaging data of Korean RPD patients who had no late AMD at the first examination and completed 5 years of regular follow-up were retrospectively reviewed. All patients underwent multimodal imaging, including spectral domain optical coherence tomography (SD-OCT; Spectralis, Heidelberg). OCT scans included horizontal and vertical cross-sectional scans centered on the fovea and extended vertical scans including the fovea which covering superior and inferior portion of retina. Retinal thickness and photoreceptor length were measured at the fovea, 2mm, and 6mm superior and inferior to the fovea. Measurements at the baseline and at the 5 years follow-up visit were statistically analyzed.

Results: Thirty-eight eyes of 21 patients were included in this study. Mean age at baseline was 66.0 ± 8.9 years, and 20 patients were female (95%). Geographic atrophy occurred in 8 eyes (21.1%) during the follow-up. Retinal thickness and photoreceptor length showed statistically significant decrease at all measurement points except the fovea. Final photoreceptor length at 2mm superior to the fovea was significantly shorter in eyes with geographic atrophy than in eyes without geographic atrophy.

Conclusions: Diffuse retinal thinning developed in RPD eyes. The severity of reduction in photoreceptor length at 2mm superior to the fovea might be related with the risk of geographic atrophy.

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Biometric Analysis in Central Serous Chorioretinopathy

Hideki Koizumi, MD, PhD

Department of Ophthalmology, University of the Ryukyus, Okinawa, Japan

Purpose: To evaluate the ocular biometry in central serous chorioretinopathy (CSC).

Methods: A detailed ophthalmic examination was performed, including an interferometer measurement of axial length (AL). Multimodal imaging comprised color fundus photography, fluorescein angiography, indocyanine green angiography, fundus autofluorescence photography, and spectral-domain optical coherence tomography (OCT). AL and spherical equivalent (SE) were compared among unilateral and bilateral CSC and normal control eyes. In addition, scleral thickness (ST) was measured using anterior segment swept-source OCT.

Results: AL of bilateral and unilateral CSC was significantly shorter than that of the controls. Moreover, AL was significantly shorter in bilateral CSC than in unilateral CSC. SE in bilateral CSC was significantly greater than in unilateral CSC and the controls. All STs at upper, temporal, lower, and nasal points were greater in CSC than the controls.

Conclusions: Anatomical features, such as shorter AL, greater SE, and thicker sclera may be associated with the pathogenesis of CSC.

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Notes ______________________________________________________________________________


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More Effective Screening for Epiretinal Membranes with MultiColor Scanning Laser Ophthalmoscope than with Color Fundus Photographs

Hiroto Terasaki, Shozo Sonoda, Taiji Sakamoto

Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan

Purpose: To assess the ability of the multicolor scanning laser ophthalmoscope (MC-SLO) to screen for epiretinal membranes (ERMs).

Methods: A retrospective cross-sectional study of 35 eyes of 32 patients with an ERM detected by optical coherence tomography and 46 eyes of 23 healthy volunteers. The detection of the ERM was graded into three visibility scores (VS): 1, not visible, 2, barely visible, and 3, clearly visible by retina specialists or by ophthalmology residents. The sensitivity and specificity of the detection with the merged image of the MC-SLO or color fundus photographs (CFP) were calculated.

Results: The sensitivity for ERM detection in the MC-SLO and CFP were 91.4% and 65.7% by specialists and 97.1% and 60.0% by residents. The specificity for both devices was 100% by specialists and residents. The VS for the MC-SLO images were significantly higher than that for the CFP by both specialists and residents. In addition, the VS for the MC-SLO determined by residents was significantly higher than that for the CFP by specialists.

Conclusions: The detection of an ERM is better with the MC-SLO images than with CFP. Furthermore, the ERM detection in the MC-SLO images by residents was comparable to that by specialists.

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Notes ______________________________________________________________________________


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Multicolor Imaging for Assessment of the Optic Nerve and Macula

SriniVas Sadda, MD

Doheny Eye Centers Doheny and Stein Eye Institutes, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles (UCLA), CA, USA

Purpose: Spaceflight associated Neuro-ocular Syndrome (SANS) is defined by optic disc edema taken by color fundus photography. Other associated findings include retinal hemorrhages, cotton wool spots, choroidal folds, and hyperopic shifts. However, significant time is necessary for astronauts to setup, acquire, and stow equipment for color fundus photography. It has been estimated that shifting from color fundus photography to MCI will save ~36 hours per year because of the already frequent use of the Spectralis. Thus, we undertake a direct comparison between color fundus photography and MCI.

Methods: Subjects (n = 25) with and without ocular pathology were compared between color fundus photography (Zeiss Visupac FF 450 plus IR) and MCI (Heidelberg Spectralis). Many posterior segment pathologies were compared, although there was an emphasis on findings that are also found in SANS. Imaging using both modalities occurred for each patient on the same visit.

Results: Across all cases, MCI could be superior, equal, or inferior to color fundus photography. For example, MCI was superior in cases of retinal hemorrhages because retinal bleeding in different retinal layers were more easily distinguished by MCI. Critically important to SANS, disc edema was evaluated in cases of mild (Frisen grade 1-2) disc edema. MCI could not only identify the disc edema, but two unique outcomes were appreciated compared to standard fundus photography. In mild disc edema, A) a dark halo would appear around the nerve separating the disc from the visible RNFL and B) the papillomacular bundle became visible. Cotton wools spots were equally appreciated by MCI. Optic disc atrophy was better visualized by color fundus photography as the optic nerve normally appeared dark on MCI.

Conclusion: MCI presents certain advantages and disadvantages compared to standard color fundus photography. For SANS the primary advantage is time savings. This, coupled with equal to superior ability to detect pathology for most SANS endpoints, the NASA Space Medicine Program has transitioned to performing all standard astronaut surveillance with MCI and reserving color fundus photography for just those cases where pathology is seen by MCI.

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Notes ______________________________________________________________________________


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Unravelling the Pachychoroid Spectrum

Won Ki Lee

Nune Eye Hospital, Seoul, South Korea

The term pachychoroid was introduced to describe a phenotype characterized by focal or diffuse increase in choroidal thickness, presence of dilated choroidal vessels in Haller’s layer (pachyvessels) accompanied by thinning of choriocapillaris and Sattler’s layer. Several clinical manifestations have been described to reside within the pachychoroid disease spectrum, including central serous chorioretinopathy (CSC), pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy (PCV). Choroidal congestion and choroidal hyperpermeability as manifested by choroidal thickening and/or pachyvessels with attenuation of overlying choriocapillaris are thought to cause chronic mechanical or ischemic stress on retinal pigment epithelium (RPE) and Bruch’s membrane complex, leading to RPE alterations or fluid accumulation or neovascularization.

All these disorders are very prevalent and important in Asian population. PCV accounts for up to 60% of patients with presumed neovascular AMD. CSC is the most common form of non-neovascular maculopathy. Many patients with pachychoroid pigment epitheliopathy might be diagnosed as having dry AMD. Pachychoroid neovasculopathy is also very frequent in Asian population and may evolve into PCV providing some clue to the pathogenesis of PCV.

The concept of pachychoroid was introduced several years ago, and further research is needed to clarify several areas of uncertainty. There are no objective criteria for thickened choroid and pachyvessels. What is the pathologic sequence of choroidal changes (dilatation of Haller vessels vs. inner choroid)? A significant number of subjects with PCV and pachychoroid neovasculopathy does not have diffuse choroidal thickening. Pachyvessels with thinned choriocapillaris layer are seen under the disease focus. Those cases share a common pathophysiology with cases with diffuse thickenning? When does a switch occur from the non-neovascular pachychoroid disease entities (CSC, pachychoroid pigment epitheliopathy) to the neovascular variants (PCV and pachychoroid neovasculopathy)?

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Notes ______________________________________________________________________________


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Automate Biomarker Detection from OCT Scans

Sebastian Wolf, Martin Zinkernagel, Raphael Sznitman

Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Switzerland

ARTORG Center, University of Bern, Switzerland

Biological markers, or biomarkers of the retina, have traditionally played a central role in both clinical routine and research. For instance, monitoring fluid biomarkers using OCT is an essential part of the standard of care for managing chronic retinal conditions, while other biomarkers have been linked to how well patient respond to treatments. However, given the dozens of established biomarkers, their identification is both time consuming and challenging due to their number, size, shape and extent.

At the core of this work, we hypothesize that an automated method can identify biomarkers reliably and that these can help answer routine clinical tasks as well. To show this, we present a machine learning method that automatically identifies a wide range biomarkers in OCT scans. Our approach learns to identify biomarkers without needing to show the method where these are located in training scans and removes the need for burdensome segmentation annotations. By training our approach this way, our method is not only capable of identifying biomarkers more consistently then experienced experts, it also allows a robust characterization of patient eyes that can be used to identify pathologies in OCT scans acquired with different OCT devices.

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Notes ______________________________________________________________________________


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Function Follows Form: Morphology-Based Functions Prediction

Frank G. Holz1,2, Leon von der Emde1, Maximilian Pfau1,2, Chantal Dysli1,3, Sarah Thiele1,2, Philipp T. Möller1,2, Moritz Lindner4, Matthias Schmid5, Monika Fleckenstein1,2, Steffen Schmitz-Valckenberg1,2

1 Department of Ophthalmology, University of Bonn, Bonn, Germany

2 GRADE Reading Center, Bonn, Germany

3 Department of Ophthalmology and Department of Clinical Research, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland

4 The Nuffield Laboratory of Ophthalmology, Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom

5 Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Germany

Purpose: Spatially resolved mapping of rod- and cone-function may facilitate monitoring of macular diseases and severe as visual function endpoint. However, mesopic and dark-adapted two-color fundus-controlled perimetry (FCP, also called “microperimetry”) constitute laborious examinations. We have devised a machine-learning-based approach to predict mesopic and dark-adapted (DA) retinal sensitivity in eyes with neovascular age-related macular degeneration (nAMD).

Methods: Extensive psychophysical testing and volumetric multimodal retinal imaging data were acquired including mesopic, DA red and DA cyan FCP, spectral-domain optical coherence tomography and confocal scanning laser ophthalmoscopy infrared reflectance and fundus autofluorescence imaging.

Results: With patient-wise leave-one-out cross-validation, we have been able to reach prediction accuracies of (mean absolute error [95% CI]) 3.94 dB [3.38, 4.5] for mesopic, 4.93 dB [4.59, 5.27] for DA cyan and 4.02 dB [3.63, 4.42] for DA red testing. Partial addition of patient-specific sensitivity data decreased the cross-validated MAE to 2.8 dB [2.51, 3.09], 3.71 dB [3.46, 3.96] and 2.85 dB [2.62, 3.08]. The most important predictive feature was outer nuclear layer thickness.

Conclusions: This artificial intelligence-based analysis strategy, termed herein “inferred sensitivity”, enables to estimate differential effects of retinal structural abnormalities on cone- and rod-function in nAMD, providing the opportunity to be applied as a quasi-functional surrogate endpoint in clinical trials.

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Notes ______________________________________________________________________________


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Deep Transfer Learning Classification Algorithms Built on Fundus Photos Generalize with Variable Accuracy Across Devices

John B. Miller, MD1, Ashley Kras, MBBS, MBI1,2, Kun-Hsing Yu, MD, PHD3,4

1 Massachusetts Eye and Ear, Harvard Medical School

2 Royal Victorian Eye and Ear Hospital

3 Department Biomedical Informatics, Harvard Medical School

4 Brigham and Women’s Hospital

Purpose: As deep learning applications to ophthalmology imaging increase in clinical relevance and deployment, there is limited knowledge regarding generalizability of algorithm performance across different platforms. This study set out to examine the accuracy of a fundus photo classifier built on one device dataset can be replicated in a second dataset captured on a different device.

Method: 25,000 high quality fundus photos were manually selected from the UK Biobank (UKBB) (Topcon 3D OCT-1000, field angle 45°). A simple deep transfer learning model based on VGG architecture was built to classify images into right vs left eyes. This untouched algorithm was then validated on 2 smaller samples (n=430) of the fundus photos (Optos® California, field angle 200°) from Mass. Eye and Ear Infirmary (MEEI); the first sample was cropped to the posterior pole (MEEI-a) to approximate the region captured by the UKBB sample and the second same (same images) was cropped to the circular fundus edge (MEEI-b). The same process was then repeated in reverse; a model constructed on MEEI images was deployed on UKBB images.

Results: The UKBB laterality classification model (LCM) achieved AUROC 0.997. When evaluated on dataset MEEI-a and MEEI-b, the resulting AUROC’s were 0.944 and 0.778 respectively. The LCM subsequently built on MEEI-a achieved AUROC 0.991. When evaluated on MEEI-b and UKBB datasets, performance dropped to AUROC’s of 0.545 and 0.713 respectively.

Conclusion: Simple and accurate algorithms generalize variably across devices and scanning protocols. We expect to see similar limitations in other forms of multimodal imaging, including OCT, AF, and OCT-A. This finding highlights the importance of validation studies prior to clinical deployment.

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Notes ______________________________________________________________________________


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Identifying the Intra-Retinal Fluid and Sub-Retinal Fluid Using OCT 3D-Analytics and Multicolor Imaging

Suqin Yu1, Tianwei Qian1, MengXiao Li2, Yongjing Wan2, Xun Xu1

1 Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine; Shanghai Key Laboratory of Ocular Fundus Diseases; Shanghai, 200080, China

2 School of Information Science and Engineering, East China University of Science and Technology; Shanghai, 200237, China

Purpose: To identify the Intra-Retinal Fluid (IRF) and Sub-Retinal Fluid (SRF) using OCT 3D-Analytics and Multicolor Imaging. To improve the existing optical coherence tomography (OCT) inspection report and help the ophthalmologists to assess and analyze macular edema rapidly and comprehensively.

Methods: Digital image processing of OCT imaging. The algorithm of grabbing and calculating the volume of retinal fluid can be divided into three parts: 1) Image preprocessing: Reduce the noise influence and improve the accuracy and stratify the image according to the reflectance difference of different layers of retina; 2) Edema segmentation and display: segment the filtered image after obtaining the accurate retinal region by threshold and then the edema region in the tomographic image is mapped. SRF and IRF will be mapped separately by artificial intelligence (AI) and coded with different color. Both SRF and IRF areas will be presented overlaying on the infrared (IR) image and this composite inspection report is compared with multicolor image; 3) Edema volume calculation: the total sum of pixels in the edema area was counted as edema area. The area of all edema areas is summed, and the actual volume can be calculated according to the scaling ratio of the graph.

Results: AI can identify SRF and IRF separately and automatically. Based on this, the distribution of macular edema can easily be detected and the volume of SRF and IRF can be calculated and followed up individually. Multicolor image has some similarities with the composite IR image.

Conclusions: The composite IR image with different color-coding of both IRF and SRF can provide us a quicker way to master the type and distribution of macular edema comprehensively, than by reading the transverse sectional OCT images one by one. The calculation of the SRF and IRF volume during follow-ups can help us to better evaluate the edema treatment efficacy as well.

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Notes ______________________________________________________________________________


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Two-photon Imaging of Retinal Ganglion Cells

Balwantray C. Chauhan, PhD

Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada

Current clinical estimates of retinal ganglion cell (RGC) capacity (rim, retinal nerve fibre layer thickness and ganglion cell thickness in the macula) have advanced glaucoma diagnostics and measurement of disease progression. Nonetheless, these measurements remain an approximate surrogate of the number of functioning RGCs, as for a given number of viable axons, there is significant variation in these clinical measurements.

In vivo RGC imaging has been used in experimental glaucoma for over a decade to understand mechanisms of RGC loss and also assess the efficacy of therapeutic interventions. These techniques all rely on static structural imaging of RGCs (typically via fluorescent markers). This presentation will emphasize the importance of functional single RGC imaging and provide an overview of two-photon imaging applications.

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Notes ______________________________________________________________________________


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Effect of Glaucoma Surgery on Optic Disc and Peripapillary Retinal Circulation

Kyung Rim Sung, MD, PhD

Asan Medical Center, University of Ulsan, Seoul, Korea

Purpose: To evaluate peripapillary microvascular changes in patients with primary open-angle glaucoma (POAG) after trabeculectomy using optical coherence tomography (OCT) angiography, and to determine the influence of lamina cribrosa (LC) displacement on changes in peripapillary microvasculature.

Methods: The peripapillary retinal microvasculature and LC were imaged using OCT angiography and OCT-enhanced depth imaging, respectively. The microvasculature and LC depth (LCD) were measured before, and 1 week, 1 month, and 3 months after trabeculectomy. The microvascular improvement was arbitrarily defined as a reduction >30% of the area of vascular dropout (blue/black areas with <20% vessel density on the color-coded vessel density map). LCD was determined as the mean of vertical distance between the anterior LC surface and a reference plane of Bruch's membrane.

Results: Thirty-one eyes of 31 POAG patients were included. At 3 months postoperatively, intraocular pressure (IOP) and LCD were significantly decreased from 26.3 ± 11.8 mm Hg to 12.5 ± 3.6 mm Hg, and 501.1 ± 130.2 μm to 455.8 ± 112.7 μm, respectively (all P < 0.001), compared with baseline. The microvascular improvement was observed in 19 eyes (61.3%) at 3 months after trabeculectomy. The maximal reductions in IOP and LCD were significantly greater in eyes with improved microvasculature compared to eyes without improvement (P = 0.020 and P = 0.005). The microvascular improvement was significantly associated with maximal reduction in LCD (odds ratio, 1.062; P = 0.026).

Conclusions: Trabeculectomy can improve peripapillary retinal microcirculation in patients with POAG. This finding suggests that the reduction of LCD induced by lowering IOP may affect peripapillary microvascular improvement in eyes with POAG.

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Notes ______________________________________________________________________________


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Bleb Biology and Outflow

Alex S. Huang

Assistant Professor Doheny Eye Centers, Doheny and Stein Eye Institutes, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles (UCLA), USA

Purpose: Recent AHO imaging has evolved toward live human assessment and has focused on functional evaluation and documentation of fluid flow. We developed aqueous angiography in the past to perform this for conventional/trabecular outflow. We now transition our methods to studying subconjunctival outflow as another aqueous humor outflow pathway that can be leveraged to improve glaucoma medical and surgical treatments.

Methods: Aqueous angiography is a new method that demonstrated conventional aqueous humor outflow. Aqueous angiography was developed in the laboratory with delivery of clinically relevant tracers into the eye and imaging with the Heidelberg Spectralis. Aqueous angiography has been translated to live non-human primates for research, live normal humans during cataract surgery, and glaucoma patients undergoing trabecular Minimally Invasive Glaucoma Surgeries. Starting with this experience, aqueous angiography has been modified to image outflow after injecting similar tracers under the conjunctiva into the subconjunctival space to create a bleb. After bleb outflow imaging using a Spectralis, concurrent structural OCT and molecular labeling was utilized to identify the identity of these pathways.

Results: Previously, aqueous angiography has shown that conventional AHO is segmental, pulsatile, dynamic and rescuable by both surgery and pharmacological agents. These results have been obtained in the lab from post-mortem animal and human eyes to living patients. Aqueous angiography modified for the subconjunctival space also demonstrates distinct outflow pathways off blebs in multiple species in the laboratory. Quantitatively, this occurred more frequently on the nasal side of the eye. Concurrent OCT confirmed a luminal structure. Presence of biscuspid valves in these pathways and a molecular identification of lymphatic markers showed that these bleb-related outflow pathways were lymphatics.

Conclusion: Outflow imaging can both be performed for conventional and subconjunctival outflow. Basic discoveries have been made, showing that conventional outflow is segmental, pulsatile, dynamic and rescuable. Aqueous angiography that is modified for the subconjunctival space using the Spectralis is now a new modality we call ocular surface lymphangiography (OSL). Through this method, we prove an old hypothesis that lymphatics (and not blood vessels) drain blebs. This can be leveraged in the future to improve bleb-related glaucoma surgeries and/or drug delivery.

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Notes ______________________________________________________________________________


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Deep-Layer Microvasculature Dropout in Pre-perimetric Glaucoma Patients

Min Hee Suh, MD,1 Jeoung Ho Na, MD,1 Linda M. Zangwill, PhD,2 Robert N. Weinreb, MD,2

1 Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea

2 Hamilton Glaucoma Center, Shiley Eye1 Institute, and the Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA, USA

Purpose: To compare clinical features between pre-perimetric primary open-angle glaucoma (PPG) patients with and without deep-layer microvasculature dropout.

Methods: Ninety-four eyes of 94 PPG patients were categorized according to the presence of optical coherence tomography angiography-derived deep-layer microvasculature dropout. Age, visual field (VF) mean deviation (MD), global and sectoral (6-sector) retinal nerve fiber layer (RNFL) thickness, focal lamina cribrosa (LC) defect, width of β-zone parapapillary atrophy with and without Bruch’s membrane (βPPA+BM and βPPA-BM), and optic disc hemorrhage (DH) were assessed.

Results: Deep-layer microvasculature dropout was observed in 33 PPG eyes (35.1%). Eyes with dropout had significantly thinner RNFL thickness in all areas except the inferonasal sector, worse VF MD, higher prevalence of focal LC defect, and larger βPPA-BM (P < 0.05), whereas the two groups did not differ in age, DH or βPPA+BM width (P > 0.05). In the multivariable logistic regression, worse VF MD (odds ratio [OR], 1.485; P = 0.045), thinner RNFL (OR, 1.141; P < 0.001), higher prevalence of focal LC defect (OR, 6.673; P <0.001), and larger βPPA-BM (OR, 1.004; P < 0.011) were significantly associated with dropout.

Conclusions: Deep-layer microvasculature dropout was observed in a considerable number of pre-perimetric POAG eyes, and worse disease severity was associated with dropout. These results suggest that deep-layer microvasculature dropout may be a characteristic sign of early glaucoma in eyes with normal VF.

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Notes ______________________________________________________________________________


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What I Like in Anterior Segment Imaging – An Introduction to ANTERION

Cynthia J. Roberts, PhD

Martha G. and Milton Staub Chair for Research in Ophthalmology Departments of Ophthalmology & Visual Sciences; and Biomedical Engineering The Ohio State University, USA

Purpose: To describe important features and capabilities of the ANTERION.

Methods: Examples will be provided from each of the available Apps.

Results: The Cornea App, the Metrics App, and the Cataract App provide application-specific data which will be highlighted.

Conclusions: The ANTERION provides valuable biometry for multiple applications.

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Notes ______________________________________________________________________________


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Preliminary Experience with the ANTERION

Damien Gatinel, MD, PhD

Rothschild Foundation, Paris, France

ANTERION® provides high-resolution swept-source OCT images of the anterior segment from the anterior surface of the cornea to the posterior surface of the lens. It delivers impressive and revealing swept-source OCT images that provide visual confirmation and add reliability as well as accuracy to the diagnosis and follow-up of anterior segment alterations. The repeatability of the estimation of various corneal metrics will be reported and compared to other corneal topographers.

This presentation will also focus on the use that ophthalmologists can make of the three optional ANTERION applications – the Cornea App, Cataract App, and Metrics App. Beyond visualizing various anterior segment pathologies, the clinician can use the ANTERION to streamline cataract, cornea or lens based refractive surgery, and manage corneal diseases and glaucoma.

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Notes ______________________________________________________________________________


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Anterior Segment Imaging in Glaucoma

Alex S. Huang

Assistant Professor Doheny Eye Centers, Doheny and Stein Eye Institutes, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles (UCLA), USA

Purpose: The Anterion is a new anterior-segment OCT by Heidelberg Engineering. Advantaged by its longer-wavelength (deeper penetration) and intra-acquisition tracking (for improved oversampling and image contrast), the Anterion holds tremendous potential for anterior segment glaucoma applications. Thus, the Anterion was evaluated during human accommodation where superficial and deep glaucoma-relevant ocular structures can be simultaneously evaluated.

Methods: Normal human subjects were recruited (~ 10 each at age-ranges of 21-30, 31-40, 41-50, and >50; overall range 26 – 74; mean 47.1 +/- 14 years). The subject’s refraction was obtained and inputted for Anterion baseline imaging using the Metrics application. Baseline image acquisition was performed twice. Subjects were then instructed to accommodate 1, 3, and 5 diopters using the Anterion fixation target to the best of their abilities with repeat imaging. Anterior segment parameters were obtained using in-built software. Ciliary muscle thickness was measured manually and in a blinded fashion. Inter-session repeatability and inter-observer measurement reproducibility were calculated.

Results: Anterior chamber Anterion images were qualitatively clear and repeatability measurements calculated using in-built software calculated. Deeper imaging of the ciliary body was also possible although more clear in subjects with lighter colored irises. Overall, both inter-session repeatability (ICC [95% CI] for the temporal and nasal maximal ciliary body muscle thicknesses [CBMT] were 0.83 [0.83-0.95] and 0.89 [0.74-0.95], respectively) and inter-observer measurement reproducibility (ICC [95% CI] for the same measures were 0.92 [0.86-0.96] and 0.91 [0.83-0.95], respectively) were excellent. During accommodation, subjects changed ciliary muscle thickness, lens-vault, anterior chamber depth, and lens thickness at statistically significant amounts and in concordance with accommodation principles in an age-related fashion.

Conclusion: Anterion imaging of anterior chamber structures were clear with good repeatability of quantitative measures obtained by in-built software. Anterion imaging of the ciliary body, which is a deeper structure) was also possible but less clear compared to anterior chamber structures. Nevertheless, the device showed excellent inter-session repeatability and inter-observer reproducibility of these measurements. For accommodation, the Anterion can assess the ciliary muscle anatomy and contraction which is relevant for narrow angle glaucomas, presbyopia, and premium intraocular lens surgeries.

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Notes ______________________________________________________________________________


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ANTERION Applications

Cynthia J. Roberts, PhD

Martha G. and Milton Staub Chair for Research in Ophthalmology Departments of Ophthalmology & Visual Sciences; and Biomedical Engineering The Ohio State University, USA

Purpose: To describe our first experience with the ANTERION.

Methods: Subjects are enrolled under an IRB-approved protocol to evaluate tomography and biometry in multiple applications.

Results: Examples will be shown of how the ANTERION can be used in the clinic.

Conclusions: The ANTERION provides valuable biometry for multiple applications.

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Dense B-Scan OCTA

K. Bailey Freund MD1, 2

1 Vitreous Retina Macula Consultants of New York, New York, USA

2 Department of Ophthalmology, New York University School of Medicine, New York, USA

Purpose: To demonstrate the use of a novel imaging technique called dense B-scan optical coherence tomography angiography (DB OCTA) in which thin dense raster scans are used to produce highly resolved structural B-scans with superimposed flow signal that provide precise correlation between retinal microstructure and blood flow.

Methods: Eyes with macular findings of interest were imaged with DB-OCTA with 150-500 OCT B-scans acquired within a 3-degree raster with a width of 10-30 degrees. B-scans containing 5-7 consecutive frames were processed for OCTA signal and then combined and visualized post-acquisition by application of a Gaussian filter across neighboring scans. The result was a single smoothed, high-resolution image that contained both structural and flow information. Three-dimensional reconstruction of the DB-OCTA volumes was used to enhance visualization of anatomic relationships for both structure and flow. Eye-tracked follow-up DB OCTA was used to detect subtle changes in pathology over time.

Results: The utility of DB-OCTA was demonstrated through a series of clinical case examples including patients with aneurysmal pachychoroid neovascularization, type 3 macular neovascularization due to age-related macular degeneration, and lamellar hole associated epiretinal proliferation.

Conclusions: DB OCTA enables precise correlation between retinal microstructure and blood flow. The ability to obtain accurately aligned follow-up DB OCTA studies has the potential to refine the understanding and clinical management of a range of macular diseases.

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Retinal Biomarkers for Disease Prognostication

Adrian Koh

The Balmoral Clinic, Singapore

OCT has become an indispensable diagnostic tool in modern ophthalmology. It has helped to facilitate the rapid development and use of anti-VEGF agents in the treatment of many retinal diseases. We have seen a paradigm shift from quantitative OCT changes towards qualitative and specific morphological changes that have an impact on visual function, treatment outcomes and disease management. OCT biomarkers can help predict outcomes based on baseline characteristics, response to anti-VEGF treatment and natural history. In particular, emerging technologies such as OCT-A may guide treatment decisions and provide prognostic markers in neovascular AMD and diabetic maculopathy.

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OCTA in Diabetics

Wilson J Heriot FRANZCO1,2, Bang Bui PhD2, Andrew Metha PhD2 1 Retinology Institute, Glen Iris, Australia 2 Department of Optometry & Vision Sciences, The University of Melbourne,

Parkville, Australia

Purpose: Diabetes causes progressive neurovascular degeneration; however, the current classification of diabetic retinopathy is based solely on images of the retinal surface. OCT and OCTA reveal critical insights about the neurosensory retinal structures and the microvascular networks currently unclassified. We have developed a method which we call Functional Tomographic Angiography (FTA) to metabolically load the retina and quantify the capillary caliber changes. This method provides structural and functional data about the retinal microvascular integrity and thus disease severity.

Methods: We have developed a novel device that delivers a nontoxic photic load to the eye during OCT angiography (OCTA) on the Heidelberg Spectralis. In normal eyes this load triggers microvascular changes of that are measurable in all 6 vascular layers supplying the retina. The Spectralis is ideal because it allows stratification of all layers; – particularly the intermediate layer. This method involves fitting a microprocessor controlled light source mounted around the Spectralis aperture to generate increase photoreceptor and bipolar/ganglion cell activity and metabolic load. After performing baseline OCTA, imaging is repeated in follow up mode with a standardized photic load. OCTA Volumes are exported processed by custom software to measure the change vessel area in all microvascular layers in 100 subregions within the 3 x 3 mm area.

Results: In normal eyes, the intermediate and deep retinal layers (deep and intermediate capillary plexus) dilate more than the superficial vessel complex consistent with the increased demand of the synaptic layers. The choriocapillaris also measurably dilates. There is a variable pattern in diabetics with some showing no autoregulatory changes. The 4 main patterns of diabetic retinopathy that have been identified clinically will be discussed including their OCT, OCTA and FTA results

Conclusions: The development of Functional Tomographic Angiography with the accompanying image analysis software app and normative data could transform clinical investigation of retinal disease by integrating neurosensory retinal structural anatomical data, the microvascular network patterns together with functional behavior. FTA may help identify diabetic microvascular dysfunction long before the current clinical classification does. FTA also has potential application in other disease such as AMD and also the investigation of CNS disorders – particularly diabetic cognitive impairment.

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Friend or Foe: OCT Angiography based Type 1 CNV Detection and Progression of Geographic Atrophy

Frank G. Holz1,2Maximilian Pfau1,2, Philipp T. Möller1,2, Sandrine H. Künzel1, Leon von der Emde1, Moritz Lindner3, Sarah Thiele1, Chantal Dysli4, Jennifer Nadal5, Matthias Schmid5, Steffen Schmitz-Valckenberg1,2, Monika Fleckenstein1,2 1 Department of Ophthalmology, University of Bonn, Germany 2 GRADE Reading Center, Bonn, Germany 3 The Nuffield Laboratory of Ophthalmology, Sleep and Circadian Neuroscience Institute,

Nuffield Department of Clinical Neurosciences, University of Oxford, UK 4 Department of Ophthalmology and Department of Clinical Research, Inselspital, Bern

University Hospital and University of Bern, Switzerland 5 Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Germany

Purpose: To investigate the effect of quiescent and exudative type 1 choroidal neovascularization on the progression of geographic atrophy (GA) and retinal pigment epithelium (RPE)-atrophy in age-related macular degeneration.

Methods: Prospective, non interventional natural history study (Directional-Spread-in-Geographic-Atrophy [NCT02051998]). 114 eyes of 57 patients (40 female, 17 male) including 5 eyes with quiescent CNV and GA and 10 eyes with RPE-atrophy and exudative CNV with mean (± SD) baseline age of 76.54 ± 6.66 years and a median [IQR] follow-up 1.24 years [1.02, 1.55] Longitudinal fundus autofluorescence and infrared reflectance images were semi-automatically annotated for GA/RPE-atrophy using the RegionFinder software. CNV lesions were spatially mapped to these annotations based on optical coherence tomography angiography (OCTA). For overall GA/RPE-atrophy progression, a cross-validated prediction model based on lesion shape-descriptive factors was fitted. The prediction error in dependence of the presence of CNV served as outcome. For localized GA/RPE-atrophy progression, a cross-validated logistic regression was fitted. Hereby, the odds ratio for future atrophy involvement in dependence of the localized presence of CNV was evaluated.

Results: The model to predict overall GA/RPE-atrophy progression could explain (cross-validated) 42.8 % of the variability in progression rates. The overall predicted atrophy progression rates exceeded the observed rates in eyes with quiescent CNV ([estimate ± SE] 0.35 ± 0.15 mm2/year) and exudative CNV (0.44 ± 0.16 mm2/year). The localized prediction model achieved excellent results with a cross-validated Dice coefficient [95 % CI] of 0.87 [0.85, 0.89]. Hereby, localized presence of CNV significantly (p<0.001) reduced the odds for future atrophy involvement by a factor of 0.45 [0.42, 0.48].

Conclusions: The presence of quiescent and exudative type 1 CNV in eyes with atrophic AMD is associated with a reduced overall as well as the directional progression of GA/RPE-atrophy. This observation highlights the potential protective effect of CNV in regard to preservation of the RPE and overlying neuroretina.

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Chronic Neovascular Central Serous Chorioretinopathy: A Stress/Rest Optical Coherence Tomography Angiography Study

Marco Lupidi, MD1,2,3, Daniela Fruttini, PhD4, Chiara Maria Eandi, MD1,5, Massimo Nicolò, MD, PhD1,6 Diogo Cabral, MD7, Silvia Tito, CO1, Carlo Cagini, MD2, Felice Cardillo Piccolino, MD1

1 Fondazione per la Macula Onlus, Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), University Eye Clinic, Genova, Italy

2 Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy

3 Centre de l’Odéon, Paris, France 4 Department of Internal Medicine, University of Perugia, S. Maria della Misericordia Hospital,

Perugia, Italy 5 Department of Surgical Sciences, Eye Clinic, University of Torino, Torino, Italy 6 Clinica Oculistica D.I.N.O.G.Mi., Università di Genova, Ospedale Policlinico San Martino,

Genova, Italy 7 Instituto de Oftalmologia Dr. Gama Pinto, Lisboa, Portugal

Purpose: To use optical coherence tomography–angiography (OCT-A) under resting and stress conditions to investigate blood flow in choroidal neovascularization (CNV) within flat irregular pigment epithelial detachments (FIPEDs) in patients with chronic central serous chorioretinopathy (CSCR).

Methods: This multicenter study included patients with chronic CSCR and FIPEDs. All patients underwent OCT-A during the resting-phase and during isometric physical effort (i.e., hand-grip test [HGT]). Systemic hemodynamic data were simultaneously recorded. Baseline and HGT OCT-angiograms in the en-face and cross-sectional views were qualitatively compared to establish the degree of evidence of flow signals due to CNVs. The en-face angiograms underwent additional automated quantitative analysis to assess the rate of change in neovascular parameters during the stress condition.

Results: Twenty-nine eyes from 29 patients were enrolled. The ocular perfusion pressure significantly increased during the HGT (P<0.05). In the en-face and cross-sectional images, CNV was identified in 13 eyes with the baseline OCT-A and in 22 eyes with OCT-A conducted during HGT (P<0.05). Cross-sectional imaging was more sensitive than en-face imaging in detecting blood flow signs of CNV both in rest (P=0.125) and stress (P=0.001) conditions. Neovascular lesions detected in the rest condition showed increased perfusion during HGT. Quantitative analysis of the stress OCT-angiograms showed a significant increase in the neovascular area and fractal dimension (P<0.05).

Conclusions: Performing OCT-A during physical exercise with the HGT enhances the sensitivity of the examination in detecting CNV in chronic CSCR. Increased neovascular perfusion during experimentally increased BP is consistent with choroidal blood flow dysregulation in patients with CSCR.

Financial Support: This work was supported by Fondazione per la Macula Onlus, Genova, Italy, and Fondazione Ferrero, Alba, Italy

Conflict of Interest: No conflicting relationship exists for any author.

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Optical Coherence Tomography Angiography in Epiretinal Membrane

Kyu Hyung Park, Jongshin Kim

Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea

Purpose: To evaluate the temporal changes of parafoveal microvascular architecture in patients with ERM after surgery.

Methods: We retrospectively analyzed the records of 71 eyes of 71 patients who received vitrectomy for idiopathic ERM followed more than 10 months. Ophthalmic evaluation included best-corrected visual acuity (BCVA), spectral domain-OCT and swept-source OCTA before surgery and 1 week, 1month, 4 month and 10 months after the surgery. OCTA images of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were obtained for each eye. The length from the foveola to the vessel branching point (FBP) in SCP and fractal geometries of DCP, such as fractal dimension (FD) and lacunarity, were measured using ImageJ and FracLac. Correlations between FBP, FD, lacunarity, foveal thickness and visual outcomes were assessed before and after ERM surgery.

Results: Compared with the eyes with mild ERM, the eyes with severe ERM exhibited higher FBP difference in the SCP, lower fractal dimension and higher lacunarity in the DCP, and greater central foveal thickness (P < .05). The preoperative FBP difference in the SCP showed significant correlations with the preoperative fractal dimension and lacunarity in the DCP and central foveal thickness (P < .05). The FBP difference in the SCP and fractal dimension and lacunarity in the DCP improved significantly particularly at 1 month postoperatively (P < .05) and reached a plateau thereafter. Among the parafoveal angiographic parameters, the preoperative fractal dimension in the DCP showed significant correlations with BCVA at all follow-up time points except for 10-month follow-up time when it had a borderline significance, but, in the subgroup analysis with pseudophakic group for eliminating the confounding effect of cataracts progression and their removal, also showed a significant correlation with BCVA at 10-month follow-up time (P < .05).

Conclusions: The parafoveal capillary displacement in the SCP and fractal geometries in the DCP were significantly recovered in the early postoperative period. The fractal dimension of the DCP was significantly correlated with visual acuity before and after ERM surgery. This parafoveal fractal dimension may serve as a quantification marker for inner retinal distortion and a predictive marker for visual outcome in patients undergoing ERM surgery.

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Poster Presentation

A Case of Acute Optic Neuritis in a Physician

Manish Jain, Sarath Lal, Dhanya Kurian

NMC Specialty Hospital, Al Ain, United Arab Emirates

Purpose: To describe Optic nerve head tomography and clinical immunological correlates of a pediatrician with acute Optic neuritis following T dap vaccination that was required for occupational reasons.

Methods: Optic nerve head and macular tomography along with visual filed analysis and Computerized tomography with contrast of the retro-orbital part of optic nerve were studied; serological results available were also incorporated in the analysis.

Results: The optic nerve head showed mild elevation. The retrobulbar optic nerves showed unilateral thickening. The visual field analysis of the presenting eye was not possible due to profound diminution of vision; however, the presumably normal contralateral eye also exhibited field changes consistent with optic neuritis. There was no relative afferent pupillary defect. The visual functions reverted with oral steroids alone within a week.

Conclusion: In view of recent history of T dap vaccination, along with tomographic features and serological support, we conclude that the vaccination was the trigger in this case. This case also elucidates the underlying clinical immunology.

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Poster Presentation

Automated Identification of Spontaneous Venous Pulsation from Infrared Video of the Optic Nerve Head

Stainton SA1,2, Fu Z1, Hogg HDJ3,4, Sun Y1, Barney SJ1,2, Dlay SS1 and Innes W2,3,4

1. School of Engineering, Newcastle University, Newcastle upon Tyne, UK

2. Neura Health Group, Newcastle upon Tyne, UK

3. Royal Victoria Infirmary, Newcastle upon Tyne, UK

4. Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK

Purpose: Deriving a quantitative value of intracranial pressure currently relies on invasive procedures to the spine or skull. However, elevated intracranial pressure can be excluded non-invasively by the observation of retinal vein spontaneous venous pulsation (SVP), which requires significant clinical skill. We aim to validate an automated means of identifying SVP.

Methods: A Heidelberg Engineering Spectralis FLEX™ module was used to take Enface infrared videos of the optic nerve head (ONH) in 77 eyes from 41 participants. An ophthalmologist reviewed each video to establish whether they could identify SVP. Independently, a computer vision algorithm was constructed that aggregated venous motion detection via frame differencing to produce a feature map. A logistic regression function was applied to the algorithm’s normalized output to predict SVP. This algorithm then generated a prediction coefficient for each video and its ability to identify SVP was tested against ophthalmologist opinion then investigated via the receiver operator characteristic (ROC).

Results: In practice false positives could wrongly reassure a clinician that a patient’s intracranial pressure is normal, leading to mismanagement. False negatives simply fail to provide a reassurance without misleading clinicians. Consequently, the classification cut off for the algorithm was set to optimise specificity at the expense of sensitivity. Relative to ophthalmologist opinion the algorithm achieved a sensitivity of 0.52 and a specificity of 0.89.

Conclusions: Automated infrared video analysis could remove the need for lumbar puncture in a range of neurological diseases. A prospective clinical study of infrared videos with clinically quantified intracranial pressure is required to fully validate this algorithm.

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Poster Presentation

Detection of Retinal Microvascular Changes in von Hippel-Lindau Disease Using Optical Coherence Tomography Angiography

Raviv Katz1, Yifan Lu1,2, Jay Wang1,3, Rebecca Zeng1, Shizuo Mukai2,3, John B. Miller1,2,3

1 Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston MA, USA

2 Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA

3 Retina Service, Massachusetts Eye and Ear, Boston, MA, USA

Purpose: Von Hippel-Lindau (VHL) disease is a hereditary disorder that can lead to tumor and cancer development in multiple organs. The most common manifestation of VHL disease is retinal capillary hemangioma (RCH), a benign vascular tumor of the retina. RCH is diagnosed via fundus examination with additional imaging, such as fluorescein angiography (FA). Optical coherence tomography angiography (OCT-A), a nascent tool for non-invasive imaging and evaluation of the retinal microvasculature, has been considered an adjunct to FA. Herein, this retrospective review studied the use of OCT-A in detecting changes in the retinal microvasculature and development of RCH in patients with VHL disease.

Methods: The study and control groups were patients from the Massachusetts Eye and Ear Infirmary (MEEI) retina clinic. All subjects were scanned on the Optovue RTVue-XR device to acquire 3mm x 3mm OCT-A images of the superficial capillary plexus (SCP) and deep capillary plexus (DCP). SCP and DCP vessel density (VD) were calculated after the images were binarized using Fiji software. In addition, for study subjects with RCH, each OCT-A image was divided equally into four quadrants. SCP and DCP VD of quadrants with RCH were compared to SCP and DCP VD of quadrants without RCH. Two-tailed t-tests were performed for statistical analysis.

Results: 67 eyes from 39 patients with a history of VHL disease were included as study subjects, while 32 eyes from 32 patients were included as control group. Significant differences were found between patients with VHL disease and patients without VHL disease for both SCP VD (p = 0.0395) and DCP VD (p = 0.0053). When comparing macular quadrants with associated peripheral RCH development to those quadrants without, we found no significant difference in SCP VD (p = 0.160) or DCP VD (p = 0.484) between the two groups.

Conclusions: OCT-A detected changes in the retinal microvasculature of patients with VHL disease. OCT-A imaging should be considered an adjunctive method for the screening and early detection of VHL disease in patients at risk of developing ocular manifestations. Future studies should focus on the clinical applications of OCT-A in monitoring for the development of RCH, especially in detecting subtle changes in VD in specific quadrants with larger scan patterns.

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Poster Presentation

Multimodal Imaging Analysis of Abilateral Multiplies Serous Retinal Detachments Following Caffeine-Based Thermogenic Supplements

Clovis Arcoverde Freitas Neto

Hospital de Olhos Santa Luzia, Recife, Brazil

Purpose: To describe the multimodal imaging analysis of a patient with bilateral multiple serous retinal detachments following consumption of a caffeine-based thermogenic supplement. Caffeine, known to be a stimulant of the sympathetic nervous system, exerts a direct antagonistic effect on adenosine receptors. In the eye, blockade of these receptors limits the drainage and removal of subretinal fluids. Associated with the vasoconstrictor effect, the accumulation of extracellular fluid promotes changes in the hydrostatic / osmotic pressure gradients at the choroidal circulation, constituting a set of factors that may favor the appearance of serous retinal detachments.

Methods: Multimodal imaging analysis with SPECTRALIS®. Simultaneous retinal fluorescein and indocyanine green angiography were done as well as tomography, digital infrared, red-free and fundus autofluorescence images.

Results: A 30-year-old health male was attended complaining of "acute vision loss" in both eyes (OA). Best corrected visual acuity of 20/30 in OA. Patient reported weight loss of 45 kg in the last two years due to hypocaloric diet and consumption of caffeine-based thermogenic supplement. Ten days following the suspension of the thermogenic supplement, visual acuity was recovered to 20/20 AO and there were no more serous retinal detachments. Conclusions: Multimodal imaging analysis was essential to describe the retinal structural changes due to chronic consumption of caffeine-based thermogenic supplement and distinguish from other chorioretinal inflammatory diseases.

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Poster Presentation

The Periarterial Capillary-Free Zone and The “Fern-Like” Retinal Vascullitis Appearance: A Fluorescein Angiography And Optical Coherence Tomography Angiography Evaluation In A Patient With Intermediate Uveitis

Clovis Arcoverde Freitas Neto

Hospital de Olhos Santa Luzia, Recife, Brazil

Purpose: To describe the relationship of the “fern-like” retinal vasculitis appearance on fluorescein angiography (FA) and the periarterial capillary-free zone in a patient with retinal capillaritis.

Methods: Two eyes with intermediate uveitis and retinal capillaritis were imaged using optical coherence tomography angiography (OCT-A), optical coherence tomography (OCT) and fluorescent angiography (FA) and was compared to a normal eye. Images of the superficial plexus, deep vascular plexus, and periarterialavascular zone were evaluated.

Results: Inflamed and normal eyes presented both with physiological periarterial capillary-free zone on OCT-A. Inflamed eyes presented with hiperfluorescence and “leakage”at the level of capillaries. Arterioles and venules showed no leakage during examination in all eyes. FA has the ability to visualize breakdown of the blood-retinal barrier but is limited to the superficial capillary layer. Extravasated fluorescein only in the capillaries secondary to the inflammation can be explained by the anatomical characteristics of these vessels with thinner walls and absence of smooth muscle cell.

Conclusion: The “fern-like” retinal vasculitis FA appearance can be explained by the contrast betwee the hiperfluorescence of the extravasated fluorecein from the capillaries, the normal fluorescence of the arterioles and venules, and the absence of fluorescence of the periarterial capillary-free zone in the superficial vascular plexus.

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Poster Presentation

Optical Coherence Tomography Characteristics of Taxane-Induced Macular Edema and Other Multi-Modal Imaging Findings

Joel M. Perez 1-2, Kelvin Teo1-3, Ricardo Ong1-2, Maiko Maruyama-Inoue5, K. Bailey Freund4,6,7, Anna C.S. Tan1-3

1Singapore National Eye Centre, Singapore, Singapore 2Singapore Eye Research Institute, Singapore, Singapore 3Duke-NUS Medical School, Singapore, Singapore 4Vitreous Retina Macula Consultants of New York, New York, USA 5Yokohama City University Medical Center, Yokohama, Japan 6The LuEsther T. Mertz Retinal Research Center, New York, USA 7Department of Ophthalmology, New York University School of Medicine, New York, USA

Purpose: To identify common optical coherence tomography (OCT) characteristics of taxane-related CME (T-CME) to differentiate it from CME associated with other underlying causes (O-CME) and to present multi-modal imaging findings of T-CME.

Methods: To differentiate T-CME from other types of CME, pooled SD-OCT images obtained from our multi-center case series of 3 patients with multi-modal imaging of T-CME and previous published cases of T-CME, were compared to consecutive cases of O-CME. Images were graded by 2 masked retinal specialists based on the presence of pre-specified OCT characteristics such as: CME centred around fovea, outer retinal cysts more prominent, continuous outer plexiform layer (OPL) and inner plexiform layer (IPL), intact outer retina layer and attenuation of outer retina layers.

Results: Comparing 19 and 16 SD-OCT images of T-CME and O-CME respectively, T-CME showed a higher rate of the continuous OPL and IPL layer and a higher composite score of the various pre-specified OCT features. All our patients had T-CME that was angiographically silent on FA, with late leakage on ICGA. OCT angiography showed an intact foveal avascular zone.

Conclusions: T-CME is a rare but important complication of taxane chemotherapy. Specific OCT features can help distinguish T-CME from other types of CME and early diagnosis is clinically important as cessation of taxanes before the retinal layers are disrupted may prevent permanent vision loss.

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Poster Presentation

How Does OCT-A Scan Type Affect Discovery of Different Diabetic Retinopathy (DR) Lesions?

John B. Miller MD, Ying Cui, Ying Zhu, Jay Wang, Yifan Lu, Rebecca Zeng, Raviv Katz, Deeba Husain, David Wu, Demetrios G. Vavvas, Dean Eliott, Leo A. Kim

Massachusetts Eye and Ear, Harvard Medical School, Boston, MA USA

Purpose: OCT-A is becoming a helpful tool for in the management of diabetic retinopathy. As new devices emerge marketing wider scanning areas, it is not clear what scan or combination of scans is best for clinical use. Wider scanning protocols, as well as montaged images, require additional acquisition time and chair time for the patient. Our study examined the utility of several different scan types in detecting specific types of DR lesions.

Methods: A prospective observation study was performed at Mass. Eye and Ear with the Zeiss Plex Elite 9000 Swept Source OCT-A and an UWF photo for ETDRS grading. All patients underwent a Montage 15x9 scan. Additional scans were performed centered on the fovea and disc of 6x6, 12x12, and 12x12 montage in subsets of these patients. All scans were graded by two independent graders for several specific DR lesions, including: MA, IRMA, NVE, NVD, and NPAs.

Results: 151 eyes of 98 DR patients were included in the study. 79.4% were Type 2 DM, 46.4% male, with an average age of 56.27 and HgbA1c of 8.14. By ETDRS grading, 67 eyes had PDR, 5 severe NPDR, 19 moderate NPDR, 38 mild NPDR, and 22 no DR. Microaneurysms were best detected by 6x6 fovea (82.7%) and fovea plus disc (82.7%) compared to Montage 15x9 (77.2%). Conversely for IRMAs, the fovea 6x6 was worse for detection than wider scanning patterns. Similarly for NVE and NVD, the Montage 15x9 (34.2%) performed better than the fovea 6x6 (18.42%), but not as well as the combined 12x2 fovea plus optic scans (36.8%). Non-perfusion area was best measured with the Montage 15x9.

Conclusions: OCT-A can play an important role in the detection and management of diabetic retinopathy and its associated examination findings. Scan protocol selection can play a key role in the detection rates of DR lesions. As clinicians, we need to balance clinical utility with acquisition time and clinical efficiency.

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17th International · 2019. 10. 29. · 17th International Symposium (ISS) October 18-19, 2019 SIGNIEL Lotte World Tower · Seoul · South Korea ® Abstract Book Course Directors