Papers by Alberto Diniz-Filho
PURPOSE. The purpose of this study was to compare retinal nerve fiber layer (RNFL) thickness and ... more PURPOSE. The purpose of this study was to compare retinal nerve fiber layer (RNFL) thickness and optical coherence tomography angiography (OCT-A) retinal vasculature measurements in healthy, glaucoma suspect, and glaucoma patients. METHODS. Two hundred sixty-one eyes of 164 healthy, glaucoma suspect, and open-angle glaucoma (OAG) participants from the Diagnostic Innovations in Glaucoma Study with good quality OCT-A images were included. Retinal vasculature information was summarized as a vessel density map and as vessel density (%), which is the proportion of flowing vessel area over the total area evaluated. Two vessel density measurements extracted from the RNFL were analyzed: (1) circumpapillary vessel density (cpVD) measured in a 750-lm-wide elliptical annulus around the disc and (2) whole image vessel density (wiVD) measured over the entire image. Areas under the receiver operating characteristic curves (AUROC) were used to evaluate diagnostic accuracy. RESULTS. Age-adjusted me...
Investigative Ophthalmology & Visual Science, 2016
Investigative Ophthalmology & Visual Science, 2016
Clinical & Experimental Ophthalmology
The COVID‐19 pandemic has had an unprecedented impact on ophthalmology. This review compiles gene... more The COVID‐19 pandemic has had an unprecedented impact on ophthalmology. This review compiles general aspects of the novel coronavirus and COVID‐19, further dissects the most recent data on the role of the eye regarding disease transmission and manifestations, and summarizes preventive measures in the particular context of eye care.
Investigative Ophthalmology & Visual Science, 2016
Investigative Ophthalmology & Visual Science, 2016
Investigative Ophthalmology & Visual Science, 2015
Investigative Ophthalmology & Visual Science, 2017
Investigative Ophthalmology & Visual Science, 2016
Investigative Ophthalmology & Visual Science, 2015
Translational Vision Science & Technology
Purpose This concise review aims to explore the potential for the clinical implementation of arti... more Purpose This concise review aims to explore the potential for the clinical implementation of artificial intelligence (AI) strategies for detecting glaucoma and monitoring glaucoma progression. Methods Nonsystematic literature review using the search combinations “Artificial Intelligence,” “Deep Learning,” “Machine Learning,” “Neural Networks,” “Bayesian Networks,” “Glaucoma Diagnosis,” and “Glaucoma Progression.” Information on sensitivity and specificity regarding glaucoma diagnosis and progression analysis as well as methodological details were extracted. Results Numerous AI strategies provide promising levels of specificity and sensitivity for structural (e.g. optical coherence tomography [OCT] imaging, fundus photography) and functional (visual field [VF] testing) test modalities used for the detection of glaucoma. Area under receiver operating curve (AROC) values of > 0.90 were achieved with every modality. Combining structural and functional inputs has been shown to even more improve the diagnostic ability. Regarding glaucoma progression, AI strategies can detect progression earlier than conventional methods or potentially from one single VF test. Conclusions AI algorithms applied to fundus photographs for screening purposes may provide good results using a simple and widely accessible test. However, for patients who are likely to have glaucoma more sophisticated methods should be used including data from OCT and perimetry. Outputs may serve as an adjunct to assist clinical decision making, whereas also enhancing the efficiency, productivity, and quality of the delivery of glaucoma care. Patients with diagnosed glaucoma may benefit from future algorithms to evaluate their risk of progression. Challenges are yet to be overcome, including the external validity of AI strategies, a move from a “black box” toward “explainable AI,” and likely regulatory hurdles. However, it is clear that AI can enhance the role of specialist clinicians and will inevitably shape the future of the delivery of glaucoma care to the next generation. Translational Relevance The promising levels of diagnostic accuracy reported by AI strategies across the modalities used in clinical practice for glaucoma detection can pave the way for the development of reliable models appropriate for their translation into clinical practice. Future incorporation of AI into healthcare models may help address the current limitations of access and timely management of patients with glaucoma across the world.
International Journal of Keratoconus and Ectatic Corneal Diseases
Purpose To present a case series of patients that developed Urrets-Zavalia syndrome (UZS) after d... more Purpose To present a case series of patients that developed Urrets-Zavalia syndrome (UZS) after deep anterior lamellar keratoplasty (DALK) for treating keratoconus and discuss the mechanisms for the syndrome. Materials and methods Retrospective chart analysis of patients who developed UZS after DALK at the Cornea Unit, Hospital São Geraldo, Federal University of Minas Gerais. Results We present a series of 3 patients with features consistent with UZS, after undergoing DALK. Elevated intraocular pressure (IOP) was noted in the early postoperative period in 2 cases, despite the fact that the other case reported eye pain, headache, and nausea at the night after the surgery with undocumented IOP. Although at different extents, the pupil remained atrophic and dilated in all 3 eyes, and 2 of them developed anterior subcapsular cataract. Conclusion Iris ischemia resulting from occlusion of iris root vessels due to elevated IOP higher than diastolic blood pressure causes UZS. Elevated IOP s...
Arquivos Brasileiros de Oftalmologia
Glaucoma is the leading cause of irreversible blindness worldwide and can affect a broad array of... more Glaucoma is the leading cause of irreversible blindness worldwide and can affect a broad array of daily activities, including driving. Recently, studies investigating the relationship between driving performance and glaucoma have received a great deal of interest. Assessment of driving behavior is not straightforward because driving is a complex skill involving significant multi-tasking ability. In this review, we summarize recent work from clinical studies investigating how glaucoma can affect driving performance. Patients with glaucoma are more likely to be involved in motor vehicle collisions when compared to healthy subjects. Here we describe how conventional functional tests performed in glaucoma patients, such as visual field measure ments via standard automatic perimetry, are associated with driving performance. However, the risk of motor vehicle collisions is not entirely attributable to visual field impairment in glaucoma, suggesting that other factors also account for both driving safety and performance. Finally, we show different studies suggesting that parameters from driving simulators can be helpful because they can identify the impact of visual loss on complex situations.
Ophthalmology
Purpose-To investigate the associations between intraocular pressure (IOP) measurements obtained ... more Purpose-To investigate the associations between intraocular pressure (IOP) measurements obtained by different tonometric methods and rates of visual field loss in a cohort of glaucoma patients followed over time. Design-Prospective observational cohort study. Participants-This study included 213 eyes of 125 glaucomatous patients that were followed for an average of 2.4 ± 0.6 years. Methods-At each visit, IOP measurements were obtained using Goldmann applanation tonometer (GAT), Ocular Response Analyzer (ORA) corneal-compensated IOP (IOP cc), and ICare rebound tonometer (RBT). Rates of visual field loss were assessed by Standard Automated Perimetry (SAP) mean deviation (MD). Linear mixed models were used to investigate the relationship between mean IOP by each tonometer and rates of visual field loss over time, while adjusting for age, race, central corneal thickness, and corneal hysteresis (CH). Main Outcome Measures-Strength of associations (R 2) between IOP measurements from each tonometer and rates of SAP MD change over time. Results-Average values for mean IOP over time measured by GAT, ORA and RBT were 14.4 ± 3.3, 15.2 ± 4.2, and 13.4 ± 4.2 mmHg, respectively. Mean IOP cc had the strongest relationship with SAP MD loss over time (R 2 =24.5%), and was significantly different from the models using mean GAT IOP (R 2 =11.1%; 95% confidence interval (CI) of the difference: 6.6% to 19.6%) and mean RBT IOP (R 2 =5.8%; 95% CI of the difference: 11.1% to 25.0%).
International ophthalmology, Jan 24, 2017
This paper introduces a surgical technique for the sutureless management of zonular dialysis grea... more This paper introduces a surgical technique for the sutureless management of zonular dialysis greater than 120° using a capsular tension segment (CTS) or a modified capsular tension ring (m-CTR; CTR with suturing eyelets) and a haptic removed from a 3-piece polypropylene IOL. A CTR is used as normal. Cataract removal is followed by connection of the CTS or m-CTR to the single haptic and created using heat to make a flange in one haptic's extremity. The other extremity is placed in the CTS or m-CTR's central hole. The CTS or m-CTR/flanged-haptic complex is introduced into the capsular bag and aligned with the weakest zonular quadrant. A 30-gauge needle guides the externalization of the free haptic extremity through the adjacent pars plana and creates a flange on the second haptic tip permitting intrascleral fixation of the CTS or m-CTR. The result is a successful IOL implantation with a sutureless technique. This double-flanged m-CTR/CTS technique allows suture-free option for...
Investigative ophthalmology & visual science, 2018
To investigate the association between the microstructure of β-zone parapapillary atrophy (βPPA) ... more To investigate the association between the microstructure of β-zone parapapillary atrophy (βPPA) and parapapillary deep-layer microvasculature dropout assessed by optical coherence tomography angiography (OCT-A). Thirty-seven eyes with βPPA devoid of the Bruch's membrane (BM) (γPPA) ranging between completely absent and discontinuous BM were matched by severity of the visual field (VF) damage with 37 eyes with fully intact BM (βPPA+BM) based on the spectral-domain (SD) OCT imaging. Parapapillary deep-layer microvasculature dropout was defined as a dropout of the microvasculature within choroid or scleral flange in the βPPA on the OCT-A. The widths of βPPA, γPPA, and βPPA+BM were measured on six radial SD-OCT images. Prevalence of the dropout was compared between eyes with and without γPPA. Logistic regression was performed for evaluating association of the dropout with the width of βPPA, γPPA, and βPPA+BM, and the γPPA presence. Eyes with γPPA had significantly higher prevalence...
American journal of ophthalmology, 2018
To investigate the role of corneal hysteresis (CH) as a risk factor for development of glaucoma. ... more To investigate the role of corneal hysteresis (CH) as a risk factor for development of glaucoma. Prospective observational cohort study. Two hundred and eighty-seven eyes of 199 patients suspected of having glaucoma were followed for an average of 3.9 ± 1.8 years. All eyes had normal visual fields at baseline. Development of glaucoma was defined as occurrence of 3 consecutive abnormal standard automated perimetry tests during follow-up, defined as pattern standard deviation (PSD) < 5%, and/or Glaucoma Hemifield Test outside normal limits. Measurements of CH were acquired at baseline using the Ocular Response Analyzer (ORA). Univariable and multivariable Cox regression models were used to investigate baseline factors associated with development of visual field loss over time. Fifty-four (19%) eyes developed repeatable visual field defects during follow-up. Measurements of CH at baseline were significantly lower in patients who developed glaucoma vs those who did not (9.5 ± 1.5 mm ...
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Papers by Alberto Diniz-Filho