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Publications (827)
Purpose
To study the associations between optic nerve head (ONH) strains under intraocular pressure (IOP) elevation with retinal sensitivity in glaucoma subjects.
Design
Clinic based cross-sectional study.
Participants
229 subjects with primary open angle glaucoma (subdivided into 115 high tension glaucoma (HTG) subjects and 114 normal tension gl...
Prcis:
A literature review of SLT energy dose response found no definitive relationship between IOP reduction with respect to total or pulse energy, race, pigmentation, or application pattern.
Purpose:
Selective laser trabeculoplasty (SLT) is a safe and effective treatment for lowering intraocular pressure (IOP). While evidence is mounting for t...
\mathbf{Purpose}$: To use artificial intelligence (AI) to: (1) exploit biomechanical knowledge of the optic nerve head (ONH) from a relatively large population; (2) assess ONH robustness from a single optical coherence tomography (OCT) scan of the ONH; (3) identify what critical three-dimensional (3D) structural features make a given ONH robust. $\...
To evaluate machine learning (ML) approaches for structure–function modeling to estimate visual field (VF) loss in glaucoma, models from different ML approaches were trained on optical coherence tomography thickness measurements to estimate global VF mean deviation (VF MD) and focal VF loss from 24‐2 standard automated perimetry. The models were co...
Background/Aims
Prophylactic laser peripheral iridotomy (LPI) is performed in primary angle-closure suspect (PACS) eyes to prevent acute angle-closure attacks. However, accelerated cataractogenesis is a potential risk of the procedure that may result in decreased visual acuity. We aimed to assess the long-term impact of LPI on cataract formation in...
Purpose
Angle-closure glaucoma is a major cause of blindness worldwide that carries an excess risk of severe, bilateral visual impairment. A common concern among clinicians is precipitating acute angle closure (AAC) attacks by mydriasis. We evaluated the risk of AAC after pharmacologic dilation in Chinese individuals classified as bilateral primary...
Glaucoma, a diverse group of eye disorders that results in the degeneration of retinal ganglion cells, is the world's leading cause of irreversible blindness. Apart from age and ancestry, the major risk factor for glaucoma is increased intraocular pressure (IOP). In primary open-angle glaucoma (POAG), the anterior chamber angle is open but there is...
Purpose: The optic nerve head (ONH) undergoes complex and deep 3D morphological changes during the development and progression of glaucoma. Optical coherence tomography (OCT) is the current gold standard to visualize and quantify these changes, however the resulting 3D deep-tissue information has not yet been fully exploited for the diagnosis and p...
Purpose: (1) To assess the performance of geometric deep learning (PointNet) in diagnosing glaucoma from a single optical coherence tomography (OCT) 3D scan of the optic nerve head (ONH); (2) To compare its performance to that obtained with a standard 3D convolutional neural network (CNN), and with a gold-standard glaucoma parameter, i.e. retinal n...
Aim:
To investigate the association between the extent of iridotrabecular contact and other quantitative anterior segment dimensions measured by swept-source optical coherence tomography (SS-OCT; CASIA SS-1000, Tomey, Nagoya, Japan) with intraocular pressure (IOP).
Methods:
Cross-sectional study. All subjects who were ≥50 years with no history o...
Purpose:
To assess whether the three-dimensional (3D) structural configuration of the central retinal vessel trunk and its branches (CRVT&B) could be used as a diagnostic marker for glaucoma.
Design:
Retrospective, deep-learning approach diagnosis study.
Method:
We trained a deep learning network to automatically segment the CRVT&B from the B-...
Purpose
To develop a classification system of visual field (VF) abnormalities in highly myopic eyes with and without glaucoma.
Design
Secondary analysis of VF data from a longitudinal cohort study.
Subjects
One thousand eight hundred and ninety-three VF tests from 1302 eyes (825 individuals).
Methods
All participants underwent VF testing (Humphr...
Objective
To determine the incidence and risk factors of primary angle closure disease (PACD) over six years in a multi-ethnic Asian population.
Design
Population-based, longitudinal study.
Subjects
The Singapore Epidemiology of Eye Diseases study is a population-based cohort study conducted amongst adults aged 40 years or more. The baseline exam...
Corneal diseases, along with glaucoma and cataract, are the leading causes of blindness worldwide. While corneal surgery offers good success rates, early diagnosis and disease prevention is the preferred choice over expensive and complex surgical procedures. Non-contact, high-resolution imaging modalities for imaging the corneal structures are high...
Purpose: To study the associations between optic nerve head (ONH) strains under intraocular pressure (IOP) elevation with retinal sensitivity in glaucoma subjects.
Design: Clinic based cross-sectional study.
Participants: 229 subjects with primary open angle glaucoma (subdivided into 115 high tension glaucoma (HTG) subjects and 114 normal tension g...
Purpose:
To investigate modeling of the focal visual field (VF) loss by combining structural measurements and vascular measurements in eyes with early primary open-angle glaucoma (POAG).
Methods:
In this cross-sectional study, subjects with early glaucoma (VF mean deviation, ≥-6 dB) underwent optical coherence tomography (OCT) imaging, optical c...
Background/aims
Early detection and treatment of glaucoma can delay vision loss. In this study, we evaluate the performance of handheld chromatic pupillometry (HCP) for the objective and rapid detection of functional loss in glaucoma.
Methods
In this clinic-based, prospective study, we enrolled 149 patients (median (IQR) years: 68.5 (13.6) years)...
High myopia is among the most common causes of vision impairment, and it is mainly characterized by abnormal elongation of the axial length, leading to pathologic changes in the ocular structures. Owing to the close relationship between high myopia and glaucoma, the association between intraocular pressure (IOP) and high myopia progression has garn...
Purpose: To assess whether the three-dimensional (3D) structural configuration of the central retinal vessel trunk and its branches (CRVT&B) could be used as a diagnostic marker for glaucoma. Method: We trained a deep learning network to automatically segment the CRVT&B from the B-scans of the optical coherence tomography (OCT) volume of the optic...
Purpose
Carriers of functionally deficient mutations in the CYP39A1 gene have been recently reported to have a 2-fold increased risk of exfoliation syndrome (XFS). The aim of this study was to evaluate the risk of blindness and related clinical phenotypes of XFS patients carrying the loss-of-function CYP39A1 G204E mutation in comparison to XFS pati...
Purpose: To investigate features of the steady-state pattern electroretinogram (ssPERG) in subjects with glaucoma (G), high myopia (HM; spherical equivalent ≤-6D) and glaucoma with high myopia (GHM).
Patients and Methods: Our study included 48 participants divided into 3 groups (G, HM, and GHM) who each underwent monocular ssPERG testing with Diop...
Purpose
To evaluate ethnic variations, ocular and systemic determinants of retinal nerve fibre layer (RNFL) thickness and neuroretinal rim area among Asians, using a large consortium of population-based eye studies.
Design
Cross-sectional pooled-analysis.
Participants
22436 participants (22436 eyes) from 10 population-based studies (China, Hong K...
Purpose:
To evaluate the biomechanical properties of the iris by evaluating iris movement during pupil constriction and to compare such properties between healthy and primary angle-closure glaucoma (PACG) subjects.
Methods:
A total of 140 subjects were recruited for this study. In a dark room, the anterior segments of one eye per subject were sc...
Purpose:
To assess the generalisability and performance of a deep learning classifier for automated detection of gonioscopic angle closure in anterior segment optical coherence tomography (AS-OCT) images.
Methods:
A convolutional neural network (CNN) model developed using data from the Chinese American Eye Study (CHES) was used to detect goniosc...
[This corrects the article DOI: 10.1371/journal.pgen.1009497.].
Purpose:
To assess baseline ocular biometric risk factors for progression from primary angle closure suspect (PACS) to primary angle closure (PAC) or acute angle closure (AAC).
Design:
Prospective observational study.
Participants:
643 mainland Chinese aged 50 to 70 years with untreated PACS.
Methods:
Participants received baseline clinical...
Objective
To develop and evaluate the performance of a three-dimensional deep-learning based automated digital gonioscopy system (3D DGS) in detecting two major characteristics in eyes suspected to have primary angle closure glaucoma (PACG): 1) narrow iridocorneal angles (static gonioscopy, Task I) and; 2) peripheral anterior synechiae (PAS) (dynam...
Purpose
Detection of early glaucoma remains limited with the conventional analysis of the retinal nerve fiber layer (RNFL). To assess whether compensating the RNFL thickness for multiple demographic and anatomical factors improves the detection of glaucoma.
Design
Cross-sectional study
Methods
2699 healthy participants were enrolled to construct...
Objective
We hypothesized that the effect of blood lipid-related metabolites on POAG would differ according to specific lipoprotein particles and lipid sub-fractions. We thus investigated the associations of blood levels of lipoprotein particles and lipid sub-fractions with POAG.
Design
Cross-sectional study.
Participants
Individuals recruited fo...
Introduction
Laser trabeculoplasty is an effective and widely used treatment for glaucoma. A new laser technology, the Eagle direct selective laser trabeculoplasty (DSLT) device, may provide automated, fast, simple, safe and effective laser treatment for glaucoma in a broader range of clinical settings. This trial aims to test the hypothesis that t...
Purpose:
To examine the efficacy of laser peripheral iridotomy (LPI) in subjects diagnosed as primary angle closure suspects (PACS) DESIGN: Prospective, randomized controlled trial PARTICIPANTS: This multi-center, randomized controlled trial (NCT00347178, Clinical trials.gov) enrolled 480 subjects over the age of 50 years from glaucoma clinics in...
Background
Glaucomatous optic nerve damage is caused by selective death of retinal ganglion cells (RGCs). Another condition with underlying loss of RGCs is autosomal dominant optic atrophy (ADOA). Majority of ADOA patients have mutations in OPA1, gene responsible for mitochondrial fusion final steps. Clinical resemblance between the two diseases ma...
Purpose
Common LOXL1 protein-altering variants are significant genetic risk factors for exfoliation syndrome (XFS) and the related secondary glaucoma (XFG). A rare LOXL1 missense allele has been associated with protective effects in a Japanese cohort, suggesting that other rare alleles may also exhibit protective effects. The goal of this study was...
Purpose:
To develop and test a multi-modal artificial intelligence (AI) algorithm, FusionNet, using the pattern deviation probability plots (PDPs) from visual field (VF) reports and circular peripapillary optical coherence tomography (OCT) to detect glaucomatous optic neuropathy (GON).
Design:
Cross-sectional study.
Subjects:
A total of 2463 p...
To investigate the association of peripheral anterior synechiae (PAS) with intraocular pressure (IOP) and anterior-segment parameters in subjects with primary angle-closure glaucoma (PACG). A total of 267 subjects with PACG were recruited and underwent gonioscopy and anterior-segment optical coherence tomography (ASOCT). Customized software was use...
Purpose
To evaluate the diagnostic performance of swept-source anterior segment optical coherence tomography (SS-OCT) in differentiating primary angle closure diseases (PACD) from control eyes, as well as primary angle closure (PAC) and primary angle closure glaucoma (PACG) from primary angle closure suspect (PACS) eyes.
Design
Multi-center cross-...
Purpose
To evaluate the performance of swept source optical coherence tomography (SS-OCT) to detect gonioscopic angle closure using different classification algorithms.
Methods
This was a cross-sectional study of 2028 subjects without ophthalmic symptoms recruited from a community-based clinic. All subjects underwent gonioscopy and SS-OCT (Casia,...
Importance
A glaucoma-specific instrument for estimating utilities across the spectrum of glaucoma severity is currently lacking, hindering the assessment of the cost-effectiveness of glaucoma treatments.
Objective
To develop and validate the preference-based Glaucoma Utility Instrument (Glau-U) and to ascertain the association between Glau-U util...
We report the sensitivity and specificity of van Herick (VH) grading in detecting gonioscopically-defined primary angle closure suspects (PACS) among subjects screened for participation in a population-based trial in southern China. A cut-off of VH≤25% was found to have sensitivity and specificity rates of 98.2% and 25.9%, respectively. Rates were...
Purpose
To develop a novel deep-learning approach that can describe the structural phenotype of the glaucomatous ONH and can be used as a robust glaucoma diagnosis tool.
Design
Retrospective, deep-learning approach diagnosis study.
Method
We trained a deep learning network to segment three neural-tissue and four connective-tissue layers of the ON...
Optical Coherence Tomography (OCT) enables non-invasive imaging of the retina and is used to diagnose and manage ophthalmic diseases including glaucoma. We present the first large-scale genome-wide association study of inner retinal morphology using phenotypes derived from OCT images of 31,434 UK Biobank participants. We identify 46 loci associated...
Purpose
To evaluate the biomechanical properties of the iris by evaluating iris movement during pupil constriction and to compare such properties between healthy and primary angle-closure glaucoma (PACG) subjects.
Methods
A total of 140 subjects were recruited for this study. In a dark room, the anterior segments of one eye per subject were scanne...
Prcis:
Laser peripheral iridotomy widened the iridocorneal angle and flattened the iris circumferentially in Caucasian eyes and baseline refractive error, lens vault and iris volume play a significant role in the angle widening.
Purpose:
To investigate circumferential angle widening and iris changes after laser peripheral iridotomy (LPI) using s...
Aims
To validate a deep learning (DL) algorithm (DLA) for 360° angle assessment on swept-source optical coherence tomography (SS-OCT) (CASIA SS-1000, Tomey Corporation, Nagoya, Japan).
Methods
This was a reliability analysis from a cross-sectional study. An independent test set of 39 936 SS-OCT scans from 312 phakic subjects (128 SS-OCT meridional...
Topic
Glaucoma is the leading cause of irreversible blindness despite having good prognosis with early treatment. We evaluated the global extent of undetected glaucoma and the factors associated with it in this systematic review and meta-analysis of population-based epidemiological studies.
Clinical relevance
Undetected glaucoma increases the risk...
Prcis:
Reduction of intraocular pressure by latanoprost in treatment-naïve eyes is significantly correlated to an increase in vessel density at the optic nerve head.
Purpose:
To evaluate the effect of topical latanoprost on ocular microvasculature using optical coherence tomography angiography (OCTA).
Patients and methods:
In this prospective...
Objective
MYOC (myocilin) mutations account for 3-5% of primary open angle glaucoma (POAG). We aimed to understand the true population-wide penetrance and characteristics of glaucoma among individuals with the most common MYOC variant (p.Gln368Ter) and the impact of a POAG polygenic risk score (PRS) in this population.
Design
Cross-sectional popul...
Primary open-angle glaucoma (POAG), is a heritable common cause of blindness world-wide. To identify risk loci, we conduct a large multi-ethnic meta-analysis of genome-wide association studies on a total of 34,179 cases and 349,321 controls, identifying 44 previously unreported risk loci and confirming 83 loci that were previously known. The majori...
Primary open-angle glaucoma (POAG), is a heritable common cause of blindness world-wide. To identify risk loci, we conduct a large multi-ethnic meta-analysis of genome-wide association studies on a total of 34,179 cases and 349,321 controls, identifying 44 previously unreported risk loci and confirming 83 loci that were previously known. The majori...
Purpose:
Aquaporins (AQPs) facilitate transmembrane osmotic water transport and may play a role in iris fluid conductivity, which is implicated in the pathophysiology of glaucoma. In this study, we compared the iris expression of AQPs and aqueous osmolality between primary angle closure glaucoma (PACG), primary open-angle glaucoma (POAG), and nong...
Glaucoma, a multifactorial ocular disease, is clinically and genetically heterogeneous. It is the second leading cause of blindness in elderly population worldwide. Because of the complex nature of glaucoma, the genetic spectrum has not been established globally. In Pakistan, both the familial and the sporadic forms of the disease are common, which...
Purpose
To evaluate the effect of signal strength (SS) on optical coherence tomography (OCT) parameters, and devise an algorithm to adjust the effect, when acceptable SS cannot be obtained.
Methods
5085 individuals (9582 eyes), aged ≥40 years from the Singapore Epidemiology of Eye Diseases population-based study were included. Everyone underwent a...
Purpose
To assess anatomical changes after laser peripheral iridotomy (LPI) and predictors of angle widening based on anterior segment OCT (AS-OCT) and angle opening based on gonioscopy in mainland Chinese primary angle closure suspects (PACS).
Design
Prospective observational study.
Participants
454 subjects aged 50 to 70 years with PACS.
Metho...
Background
In current approaches to vision screening in the community, a simple and efficient process is needed to identify individuals who should be referred to tertiary eye care centres for vision loss related to eye diseases. The emergence of deep learning technology offers new opportunities to revolutionise this clinical referral pathway. We ai...
Purpose:
To evaluate the focal structure-function associations among visual field (VF) loss, optical coherence tomography angiography (OCT-A) vascular measurements, and optical coherence tomography (OCT) structural measurements in glaucoma.
Methods:
In this cross-sectional study, subjects underwent standard automated perimetry, OCT-based nerve f...
The optic nerve head (ONH) typically experiences complex neural- and connective-tissue structural changes with the development and progression of glaucoma, and monitoring these changes could be critical for improved diagnosis and prognosis in the glaucoma clinic. The gold-standard technique to assess structural changes of the ONH clinically is opti...
Aims
To compare the shape of the anterior surface of the peripapillary sclera (PPS) between glaucoma and healthy subjects.
Methods
88 primary open angle glaucoma (POAG), 98 primary angle closure glaucoma (PACG) and 372 age-matched and gender-matched healthy controls were recruited in this study. The optic nerve head of one randomly selected eye of...
Nuclear cataract is the most common type of age-related cataract and a leading cause of blindness worldwide. Age-related nuclear cataract is heritable (h² = 0.48), but little is known about specific genetic factors underlying this condition. Here we report findings from the largest to date multi-ethnic meta-analysis of genome-wide association studi...
Speckle noise and retinal shadows within OCT B-scans occlude important edges, fine textures and deep tissues, preventing accurate and robust diagnosis by algorithms and clinicians. We developed a single process that successfully removed both noise and retinal shadows from unseen single-frame B-scans within 10.4ms. Mean average gradient magnitude (A...
Background:
Currently, whether and when intraocular pressure (IOP)-lowering medication should be used in glaucoma suspects with high myopia (GSHM) remains unknown. Glaucoma suspects are visual field (VF) defects that cannot be explained by myopic macular changes or other retinal and neurologic conditions. Glaucoma progression is defined by VF dete...
Objective:
To determine the 6-year incidence of primary glaucoma and its risk factors in an Indian population in Singapore DESIGN: Cohort population-based study PARTICIPANTS: Indian adults aged between 40 and 80 years living in Singapore. A total of 3,400 subjects participated in the baseline examination between 2007 and 2009. Of them, 2,200 (resp...
In humans, the longitudinal characterisation of early optic nerve head (ONH) damage in ocular hypertension (OHT) is difficult as patients with glaucoma usually have structural ONH damage at the time of diagnosis. Previous studies assessed glaucomatous ONH cupping by measuring the anterior lamina cribrosa depth (LCD) and minimal rim width (MRW) usin...
By 2040, ~100 million people will have glaucoma. To date, there are a lack of high-efficiency glaucoma diagnostic tools based on visual fields (VFs). Herein, we develop and evaluate the performance of ‘iGlaucoma’, a smartphone application-based deep learning system (DLS) in detecting glaucomatous VF changes. A total of 1,614,808 data points of 10,7...
Purpose:
Genome-wide association studies have identified several genes associated with glaucoma. However, their roles in the pathogenesis of glaucoma remain unclear, particularly their effects on retinal nerve fiber layer (RNFL) thickness. The aim of this study was to investigate the associations between the identified glaucoma risk genes and RNFL...
Optical Coherence Tomography (OCT) enables non-invasive imaging of the retina and is often used to diagnose and manage multiple ophthalmic diseases including glaucoma. We present the first large-scale quantitative genome-wide association study of inner retinal morphology using phenotypes derived from OCT images of 31,434 UK Biobank participants. We...
Objective
To compare the diagnostic performance of an artificial intelligence deep learning system with that of expert neuro‐ophthalmologists in classifying optic disc appearance.
Methods
The deep learning system was previously trained and validated on 14,341 ocular fundus photographs from 19 international centers. The performance of the system wa...
Purpose
To investigate whether recently identified genetic loci for primary angle closure glaucoma (PACG) are associated with disease severity.
Design
Case-control study
Participants
A total of 804 PACG patients and 943 controls of Chinese ethnicity from Singapore
Methods
The 8 PACG-associated single nucleotide polymorphisms (SNPs; rs11024102 at...
Purpose
To compare the distribution of plateau iris in eyes across varying severity of primary angle-closure glaucoma (PACG) using standardized ultrasound biomicroscopy (UBM) criteria.
Design
Cross-sectional study
Methods
UBM was performed on 210 PACG subjects who had previously undergone laser peripheral iridotomy. Plateau iris was defined as th...
Importance
Evidence‐based guidelines are essential for glaucoma screening to work effectively.
Background
To derive a vertical cup‐to‐disc ratio (VCDR) cut‐off for glaucoma screening in a multi‐ethnic Asian population.
Design
The Singapore Epidemiology of Eye Diseases (SEED) study is a population‐based study conducted from 2004 to 2011 in a singl...
Glaucoma is a progressive optic neuropathy that leads to loss of retinal ganglion cells and thinning of retinal nerve fiber layer (RNFL). Circumpapillary RNFL thickness measurements have been used for glaucoma diagnostic and monitoring purposes. However, manual measurement of the RNFL thickness is tedious and subjective. We proposed and evaluated t...