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- Advancing the understanding of pupil size variation in occupational safety and health: A systematic review and evaluation of open-source methodologiesPublication . Ferreira, Filipa; Ferreira, Simão; Mateus, Catarina; Rocha, Nuno; Coelho, Luís; Rodrigues, MatildePupil size can be used as an important biomarker for occupational risks. In recent years, there has been an increase in the development of open-source tools dedicated to obtaining and measuring pupil diameter. However, it remains undetermined determined whether these tools are suitable for use in occupational settings. This study explores the significance of pupil size variation as a biomarker for occupational risks and evaluates existing open-source methods for potential use in both research and occupational settings, with the goal of to prevent occupational accidents and improve the health and performance of workers. To this end, a two-phase systematic literature review was conducted in the Web of Science™, ScienceDirect®, and Scopus® databases. For the relevance of monitoring pupil size variation in occupational settings, 15 articles were included. The articles were divided into three groups: mental workload, occupational stress, and mental fatigue. In most cases, pupil dilation increased with workload enhancement and with higher levels of stress. Regarding fatigue, it was noted that an increase in this condition corresponded with a decrease in pupil size. With respect to the open-source methodologies, 16 articles were identified, which were categorized into two groups: algorithms and software. Convolutional neural networks (CNN)1 have exhibited superior performance among the various algorithmic approaches studied. Building on this insight, and considering the evaluations of software options, MEYE emerges as the premier open-source system for deployment in occupational settings due to its compatibility with a standard computer webcam. This feature positions MEYE as a particularly practical tool for workers in stable environments, like those of developers and administrators.
- Analysis of choroidal macular thickness in early post-Covid-19 patientsPublication . Jesus, Jeniffer Domingues de; Soares, Raquel J.; Dias, Libânia; Ventura, Suzana M.; Pedro, João C.Corona Virus Disease 2019 (COVID-19) is considered a critical global health challenge. Several investigations have suggested vascular dysfunction caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, but regarding ophthalmic involvement, only few data are available. Our aim was to evaluate the choroidal involvement in post-COVID-19 patients. 40 eyes from 40 patients with previous SARS-CoV-2 infection and 40 eyes from 40 age matched controls were included. Choroidal measurements were made using Enhanced Depth Imaging Optical Coherence Tomography (EDI-OCT) at 13 different locations: at central fovea and at intervals of 500μm to 1500μm away from the fovea in the temporal, nasal, superior and inferior regions. Post-COVID-19 patients showed a significant increase in choroidal thickness compared with the control group for all the regions analyzed (all p <0.01). In the Post-COVID-19 group, the choroid is thickest subfoveally and thinnest 1500μm nasal from fovea. In both groups, the superior and temporal macular choroid has been measured thicker than the inferior and nasal macular choroid, respectively. Our results cautiously suggest that post-COVID-19 patients showed an increase in choroidal thickness compared to control groups. This choroidal thickening may reflect the importance of vascular factors in the pathogenesis of SARS-CoV-2 infection. Keywords: Choroid; COVID-19; Hemodynamic Changes; Ocular Circulation; Retina; SARS-CoV-2
- Analysis of conjunctival vascular density in scleral contact lens wearers using optical coherence tomography angiographyPublication . Jesus, Jeniffer; Dias, Libânia; Almeida, Inês; Costa, Tatiana; Chibante-Pedro, JoãoTo investigate conjunctival vascular density (VD) using Anterior Segment Optical Coherence Tomography Angiography (OCTA) in Scleral Contact Lens (ScCL) wearers. In this cross-sectional study, the conjunctival blood VD was assessed using OCTA with an anterior segment lens adapter. The nasal surface of each eye (6 ×6 mm) was scanned to a depth of 800 μm with ScCL and fifteen minutes after removing the lens. Conjunctival VD was defined as the percentage of the scanned volume occupied by vessels in which blood flow was measured. Measures of limbal indentation were subjectively determined by two independent observers using Anterior Segment Optical Coherence Tomography (AS-OCT). Comparisons between VD measurements before and after ScCL removal and correlations between conjunctival VD, time of use, vault and indentation values were also investigated. A total of 23 patients (3 females, 20 males) with keratoconus, with a mean age (years±SD) of 38.74±10.38 were included in the study. VD was significantly higher without ScCL (71.75%±2.97) than VD measured with ScCL (69.81%±2.63), p=0.02. A moderately negative correlation was found between indentation and vault (r=-0.44, p<0.05) and a positive tendency regarding the time of wearing ScCL and indentation (r=0.11 and r=0.068, respectively). Using OCTA with an anterior segment lens adapter, the ocular surface blood VD was imaged and assessed with good repeatability and reliability. This study presents a new possible application of OCTA to investigate and monitor conjunctival vasculature in ScCL wearers. This results cautiously suggest that the repeated use of ScCL can cause vascular alterations in conjunctiva of the eyes of ScCL wearers, possibly due to a hidden hypoxia caused by prolonged limbal indentation.
- Angiografia por tomografia de coerência ótica na queratoplastia penetrantePublication . Aguiar, Catarina Pestana; Jesus, Jeniffer; Dias, Libânia; Gonçalves, Susana; João, Matias Maria; Miranda, Vítor; Ambrósio, João; Chibante-Pedro, João; Almeida, InêsA queratoplastia penetrante (QP) é um dos procedimentos cirúrgicos mais realizados na transplantação corneana mundialmente. A falência do enxerto e o risco de rejeição aumentam progressivamente com o aumento do número de quadrantes com neovascularização corneana (NVC). A angiografia por tomografia de coerência ótica (OCTA) é um exame não invasivo que tem sido largamente utilizado na visualização de anomalias vasculares da retina e algunsestudos demonstraram a sua potencial utilização no segmento anterior do olho. O objetivo deste estudo foi investigar o potencial da tecnologia da OCTA na aquisição de imagens e descrição quantitativa da NVC em olhos submetidos a QP. Estudo transversal, com 20 olhos de 18 doentes submetidos a QP pelo menos 5 anos antes e sem história de rejeição do transplante. A todos os olhos foi realizada uma fotografia do segmento anterior na lâmpada de fenda (LF) e uma aquisição de imagens en face, b-scans e c-scans da OCTA. A densidade vascular (DV) foi analisada na margem corneana inferior, nasal e temporal em todos os doentes. A medição da DV foi obtida após criação de imagens binárias com o software ImageJ, usando imagens da OCTA com 6 × 6 mm numa profundidade de 800 μm. A idade média dos doentes foi de 59 anos e a maioria foi submetido a QP por leucoma corneano, seguido de queratocone. A DV total média foi de 50,16% e foi mais alta no quadrante temporal e mais baixa no quadrante inferior. No entanto, não se verificou uma diferença estatisticamente significativa entre as 3 áreas analisadas (p=0,801) ou entre cada área e as duas restantes e não se verificou uma correlação entre as áreas. A OCTA foi capaz de identificar vasos anormais quando as fotografias na LF não os identificavam; a OCTA foi capaz de distinguir entre vasos de grande e pequeno calibre; a OCTA permitiu a investigação em diferentes planos corneanos. A OCTA poderá tornar-se um novo método para a monitorização de doenças corneanas e permitir o seguimento qualitativo e quantitativo de pacientes submetidos a QP, com a deteção precoce de NVC.
- Association between neurodegeneration and macular perfusion in the progression of diabetic retinopathy: a 3-year longitudinal studyPublication . Marques, Inês P.; Ferreira, Sónia; Santos, Torcato; Madeira, Maria H.; Santos, Ana Rita; Mendes, Luís; Lobo, Conceição; Cunha-Vaz, JoséThe aim of this study was to explore the relation between retinal neurodegenerative changes and vessel closure (VC) in individuals with nonproliferative diabetic retinopathy (NPDR) in a follow-up period of 3 years. This is a 3-year prospective longitudinal study with four annual visits. This study involved 74 individuals with type 2 diabetes, NPDR, and Early Treatment Diabetic Retinopathy Study grades from 10 to 47, one eye/person. An age-matched healthy control population of 84 eyes was used as control group. Participants were annually examined by color fundus photography, spectral domain-optical coherence tomography (SD-OCT) and OCT-angiography (OCTA). VC was assessed by OCTA vessel density maps. SD-OCT segmentations were performed to access central retinal thickness (CRT) and retinal neurodegeneration considered as thinning of the ganglion cell plus inner plexiform layer (GCL + IPL). Results: Type 2 diabetic individuals presented significantly higher CRT (p = 0.001), GCL + IPL thinning (p = 0.042), and decreased vessel density at the superficial capillary plexus (p < 0.001) and full retina (FR) (p = 0.001). When looking at changes occurring over the 3-year period of follow-up (Table 2), there were statistically significant decreases in GCL + IPL thickness (−0.438 μm/year; p = 0.038), foveal avascular zone circularity (−0.009; p = 0.047), and vessel density in superficial capillary plexus (−0.172 mm−1/year; p < 0.001), deep capillary plexus (DCP) (−0.350 mm−1/year; p < 0.001), and FR (−0.182 mm−1/year; p < 0.001). A statistically significant association was identified between GCL + IPL thinning and decrease in DCP vessel density (β = 0.196 [95% confidence interval: 0.037, 0.355], z = 2.410, p = 0.016), after controlling for age, gender, diabetes duration, hemoglobin A1c level, and CRT. Retinal neurodegenerative changes show a steady progression during a 3-year period of follow-up in eyes with NPDR and appear to be directly associated with progression in decreased vessel density including vascular closure through preferential involvement of the DCP. Our findings provide evidence that retinal neuropathy is linked with microvascular changes occurring in diabetic patients.
- Baseline Characterization of Retinal Vascular Disease in Eyes with Mild to Moderate Non Proliferative Diabetic Retinopathy (NPDR) in Diabetes Type 2, Using Novel Non-Invasive Imaging Methods, in a Longitudinal, Prospective and Interventional 2-Year Clinical Study (Cordis)Publication . Ribeiro, M.; Marques, I.P.; Santos, Ana Rita; Coimbra, R.; Santos, T.; Figueira, J.; Cunha-Vaz, J.G.Characterization of retinal microvascular changes occurring in eyes with mild to moderate non proliferative diabetic retinopathy (NPDR), during a period of 2 years using lower than optical normal reflectivity (LOR) ratios obtained with OCT-Leakage. Capillary closure in the superficial and deep retinal vascular layers using OCTAngiography (OCTA) will be also analyzed in eyes that are at risk for developing sight threatening diabetic retinopathy (central involved macular edema (CIME) or proliferative diabetic retinopathy (PDR).
- Baseline predictors for visual acuity loss during observation in diabetic macular oedema with good baseline visual acuityPublication . Busch, Catharina; Okada, Mali; Zur, Dinah; Fraser-Bell, Samantha; Rodríguez-Valdés, Patricio; Cebeci, Zafer; Lupidi, Marco; Fung, Adrian T.; Gabrielle, Pierre-Henry; Giancipoli, Ermete; Chaikitmongkol, Voraporn; Laíns, Inês; Santos, Ana Rita; Kunavisarut, Paradee; Sala-Puigdollers, Anna; Chhablani, Jay; Ozimek, Malgorzata; Hilely, Assaf; Degenhardt, Valentin; Loewenstein, Anat; Iglicki, Matias; Rehak, MatusPatients with DMO and good baseline VA, managed by observation, are of increased risk for VA loss if DRIL, HRF and EZ disruption are present at baseline. Earlier treatment with anti‐VEGF in these patients may potentially decrease the risk of VA loss at 12 months.
- Central and peripheral involvement of the retina in the initial stages of diabetic retinophatyPublication . Santos, Ana Rita; Almeida, Ana Catarina; Rocha, Ana Cláudia; Reste-Ferreira, Débora; Marques, Inês Pereira; Martinho, António Cunha-Vaz; Mendes, Luís; Santos, Torcato; Lewis, Warren; Cunha-Vaz, José; Santos, Ana RitaTo determine the degree of central microvascular closure using optical coherence tomography angiography in eyes of patients with type 2 diabetes with visible lesions only in the central retina or only in the periphery. Cross-sectional study. All 127 eyes underwent ultra-widefield fundus photography 200° examinations with OPTOS California (Optos, Dunfermline, United Kingdom) and Cirrus Angioplex optical coherence tomography angiography 3 × 3 mm acquisitions (ZEISS, Dublin, CA). Twenty-five eyes showed visible lesions only in the central retina, 57 only in the peripheral retina, and 45 presented visible lesions in entire retina. The group with visible lesions only in the periphery showed definite closure in the superficial capillary plexus in 49% of the eyes, whereas the group with visible lesions only in the central seven-early treatment diabetic retinopathy study fields area showed a definite closure in 64%. Central capillary closure is already present in the initial stages of diabetic retinopathy even when lesions are only visible in the peripheral retina. Capillary closure in the superficial capillary plexus is three times more frequent than in the deep capillary plexus, demonstrating earlier closure of the superficial capillary plexus. Eyes with visible lesions only in the periphery show a milder form of retinopathy.
- Characterisation of progression of macular oedema in the initial stages of diabetic retinopathy: a 3-year longitudinal studyPublication . Lobo, Conceição; Santos, Torcato; Marques, Inês P.; Madeira, Maria H.; Santos, Ana Rita; Figueira, João; Cunha-Vaz, JoséTo characterise the prevalence and three-year progression of centre-involving diabetic macular oedema (CI-DMO) in minimal to moderate non-proliferative diabetic retinopathy, using optical coherence tomography (OCT) and measurements of retinal fluid using tissue optical reflectivity ratios (OCT-Leakage). Seventy-four eyes from 74 patients were followed in a 3-year prospective longitudinal observational cohort of type 2 diabetes (T2D) patients using spectral-domain optical coherence tomography (SD-OCT), OCT-Angiography (OCT-A) and OCT-Leakage (OCT-L). Eyes were examined four times with 1-year intervals. Sixteen eyes (17.8%) were excluded from the analysis due to quality control standards. Retinal oedema was measured by central retinal thickness and retinal fluid by using optical reflectivity ratios obtained with the OCT-L algorithm. Vessel density was measured by OCT-A. Thinning of the ganglion cell and inner plexiform layers (GCL + IPL) was examined to identify retinal neurodegenerative changes. Diabetic retinopathy ETDRS classification was performed using the seven-field ETDRS protocol. CI-DMO was identified in the first visit in 9% of eyes in ETDRS groups 10–20, 10% of eyes in ETDRS group 35 and 15% of eyes in ETDRS groups 43–47. The eyes with CI-DMO and subclinical CI-DMO showed a progressive increase in retinal extracellular fluid during the 3-year period of follow-up. The eyes with CI-DMO and increased retinal extracellular fluid accumulation were associated with vision loss. The prevalence of subclinical CI-DMO and CI-DMO in the initial stages of NPDR occurs independently of severity grading of the retinopathy, showing progressive increase in retinal extracellular fluid and this increase is associated with vision loss (82% 9 out of 11 cases).
- Characterization of 2-year progression of different phenotypes of nonproliferative diabetic retinopathyPublication . Ribeiro, Luísa; Marques, Inês P.; Santos, Torcato; Carvalho, Sara; Santos, Ana Rita; Mendes, Luís; Lobo, Conceição; Cunha-Vaz, JoséThe aim of the study was to characterize the 2-year progression of risk phenotypes of nonproliferative diabetic retinopathy (NPDR) in type 2 diabetes (T2D) phenotype C, or ischemic phenotype, identified by decreased skeletonized retinal vessel density (VD), ≥2 SD over normal values, and phenotype B, or edema phenotype, identified by increased retinal thickness, i.e., subclinical macular edema, and no significant decrease in VD. A prospective longitudinal cohort study (CORDIS, NCT03696810) was conducted with 4 visits (baseline, 6 months, 1 year, and 2 years). Ophthalmological examinations included best-corrected visual acuity, color fundus photography (CFP), and optical coherence tomography (OCT) and OCT angiography. Early Treatment Diabetic Retinopathy Study grading was performed at the baseline and last visits based on 7-field CFP. Results: One hundred and twenty-two eyes from T2D individuals with NPDR fitted in the categories of phenotypes B and C and completed the 2-year follow-up. Sixty-five (53%) of the eyes were classified as phenotype B and 57 (47%) eyes as phenotype C. Neurodegeneration represented by thinning of the ganglion cell layer and inner plexiform layer was present in both phenotypes and showed significant progression over the 2-year period (p < 0.001). In phenotype C, significant progression in the 2-year period was identified in decreased skeletonized VD (p = 0.01), whereas in phenotype B microvascular changes involved preferentially decrease in perfusion density (PD, p = 0.012). Phenotype B with changes in VD and PD (flow) and preferential involvement of the deep capillary plexus (p < 0.001) is associated with development of center-involved macular edema. In the 2-year period of follow-up, both phenotypes B and C showed progression in retinal neurodegeneration, with changes at the microvascular level characterized by decreases in PD in phenotype B and decreases in VD in phenotype C.