Browsing by Author "Zukerman, Ryan"

Now showing 1 - 5 of 5
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    Artificial Intelligence to Aid Glaucoma Diagnosis and Monitoring: State of the Art and New Directions
    (MDPI, 2022) Nunez, Roberto; Harris, Alon; Ibrahim, Omar; Keller, James; Wikle, Christopher K.; Robinson, Erin; Zukerman, Ryan; Siesky, Brent; Verticchio, Alice; Rowe, Lucas; Guidoboni, Giovanna; Ophthalmology, School of Medicine
    Recent developments in the use of artificial intelligence in the diagnosis and monitoring of glaucoma are discussed. To set the context and fix terminology, a brief historic overview of artificial intelligence is provided, along with some fundamentals of statistical modeling. Next, recent applications of artificial intelligence techniques in glaucoma diagnosis and the monitoring of glaucoma progression are reviewed, including the classification of visual field images and the detection of glaucomatous change in retinal nerve fiber layer thickness. Current challenges in the direct application of artificial intelligence to further our understating of this disease are also outlined. The article also discusses how the combined use of mathematical modeling and artificial intelligence may help to address these challenges, along with stronger communication between data scientists and clinicians.
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    Glaucoma Treatment Outcomes in Open-Angle Glaucoma Patients of African Descent
    (World Scientific, 2022) Siesky, Brent; Harris, Alon; Belamkar, Aditya; Zukerman, Ryan; Horn, Avery; Verticchio Vercellin, Alice; Mendoza, Kristen Ann V.; Sidoti, Paul A.; Oddone, Francesco; Ophthalmology, School of Medicine
    Open angle glaucoma (OAG), characterized by structural changes to the optic nerve head and retinal nerve fiber layer, is a progressive multifactorial optic neuropathy and leading cause of irreversible blindness globally. Currently intraocular pressure is the only modifiable risk factor; however, others have been identified including genetics and race. Importantly, OAG is much more prevalent in persons of African descent (AD) compared to those of European descent (ED). OAG patients of AD are also known to have a more severe course of the disease, a finding potentially explained by structural and/or vascular differences within eye tissues. In addition, disparities in treatment outcomes have been identified in OAG patients of AD. Specifically, prostaglandin analogues have been suggested to be more effective in patients of AD than in those ED, while beta-adrenergic receptors have been suggested to be less effective, although the evidence is inconsistent. Being of AD has also been identified as a risk factor for trabeculectomy failure while laser trabeculoplasty, has been conversely found to be very effective in lowering IOP in patients of AD. Alternative surgical options including Ex-Press shunt implantation, viscocanalostomy, and canaloplasty are promising in equivalence but require further research to properly evaluate disparity in outcomes. In addition to treatment outcomes, social disparities affecting clinical care also exist for persons of AD in the form of reduced adherence, access, and choice. Overall, data suggests the need for properly designed prospective trials with AD populations as a primary focus to identify the potential mechanisms driving disparities in treatment and address overall potential bias in glaucoma management.
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    Physiology-Enhanced Data Analytics to Evaluate the Effect of Altitude on Intraocular Pressure and Ocular Hemodynamics
    (MDPI, 2022) Verticchio Vercellin, Alice; Harris, Alon; Belamkar, Aditya; Zukerman, Ryan; Carichino, Lucia; Szopos, Marcela; Siesky, Brent; Quaranta, Luciano; Bruttini, Carlo; Oddone, Francesco; Riva, Ivano; Guidoboni, Giovanna; Ophthalmology, School of Medicine
    Altitude affects intraocular pressure (IOP); however, the underlying mechanisms involved and its relationship with ocular hemodynamics remain unknown. Herein, a validated mathematical modeling approach was used for a physiology-enhanced (pe-) analysis of the Mont Blanc study (MBS), estimating the effects of altitude on IOP, blood pressure (BP), and retinal hemodynamics. In the MBS, IOP and BP were measured in 33 healthy volunteers at 77 and 3466 m above sea level. Pe-retinal hemodynamics analysis predicted a statistically significant increase (p < 0.001) in the model predicted blood flow and pressure within the retinal vasculature following increases in systemic BP with altitude measured in the MBS. Decreased IOP with altitude led to a non-monotonic behavior of the model predicted retinal vascular resistances, with significant decreases in the resistance of the central retinal artery (p < 0.001) and retinal venules (p = 0.003) and a non-significant increase in the resistance in the central retinal vein (p = 0.253). Pe-aqueous humor analysis showed that a decrease in osmotic pressure difference (OPD) may underlie the difference in IOP measured at different altitudes in the MBS. Our analysis suggests that venules bear the significant portion of the IOP pressure load within the ocular vasculature, and that OPD plays an important role in regulating IOP with changes in altitude.
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    Prevalence Rates and Risk Factors for Primary Open Angle Glaucoma in the Middle East
    (Knowledge E, 2021-10-25) Torabi, Rana; Harris, Alon; Siesky, Brent; Zukerman, Ryan; Oddone, Francesco; Mathew, Sunu; Januleviciene, Ingrida; Verticchio Vercellin, Alice C.; Ophthalmology, School of Medicine
    Glaucoma is a multifactorial disease and a leading cause of irreversible blindness worldwide. Current data has demonstrated the approximate distribution of primary open-angle glaucoma (POAG) in patients of European, African, Hispanic, and Eastern Asian descent. However, a significant gap in the literature exists regarding the prevalence of POAG in Middle Eastern (ME) populations. Current studies estimate ME POAG prevalence based on a European model. Herein we screened 65 total publications on ME prevalence of POAG and specific risk factors using keywords: “glaucoma”, “prevalence”, “incidence”, “risk factor”, “Middle East”, “Mideast”, “Persian”, “Far East”, as well as searching by individual ME countries through PubMed, Embase, Ovid, Scopus, and Trip searches with additional reference list searches from relevant articles published up to and including March 1, 2021. Fifty qualifying records were included after 15 studies identified with low statistical power, confounding co-morbid ophthalmic diseases, and funding bias were excluded. Studies of ME glaucoma risk factors that identify chromosomes, familial trend, age/gender, socioeconomic status, lifestyle, intraocular pressure, vascular influences, optic disc hemorrhage, cup-to-disc ratio, blood pressure, obstructive sleep apnea, and diabetes mellitus were included in this systematic review. We conclude that the prevalence of POAG in the ME is likely higher than the prevalence rate that European models suggest, with ME specific risk factors likely playing a role. However, these findings are severely limited by the paucity of population-level data in the ME. Well-designed, longitudinal population-based studies with rigorous inclusion and exclusion criteria are ultimately needed to accurately assess the epidemiology and specific mechanistic risk factors of glaucoma in ME populations.
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    Sustained release glaucoma therapies: Novel modalities for overcoming key treatment barriers associated with topical medications
    (Taylor & Francis, 2022) Belamkar, Aditya; Harris, Alon; Zukerman, Ryan; Siesky, Brent; Oddone, Francesco; Verticchio Vercellin, Alice; Ciulla, Thomas A.; Ophthalmology, School of Medicine
    Glaucoma is a progressive optic neuropathy and a leading cause of irreversible blindness. The disease has conventionally been characterized by an elevated intraocular pressure (IOP); however, recent research has built the consensus that glaucoma is not only dependent on IOP but rather represents a multifactorial optic neuropathy. Although many risk factors have been identified ranging from demographics to co-morbidities to ocular structural predispositions, IOP is currently the only modifiable risk factor, most often treated by topical IOP-lowering medications. However, topical hypotensive regimens are prone to non-adherence and are largely inefficient, leading to disease progression in spite of treatment. As a result, several companies are developing sustained release (SR) drug delivery systems as alternatives to topical delivery to potentially overcome these barriers. Currently, Bimatoprost SR (DurystaTM) from Allergan plc is the only FDA-approved SR therapy for POAG. Other SR therapies under investigation include: bimatoprost ocular ring (Allergan) (ClinicalTrials.gov identifier: NCT01915940), iDose® (Glaukos Corporation) (NCT03519386), ENV515 (Envisia Therapeutics) (NCT02371746), OTX-TP (Ocular Therapeutix) (NCT02914509), OTX-TIC (Ocular Therapeutix) (NCT04060144), and latanoprost free acid SR (PolyActiva) (NCT04060758). Additionally, a wide variety of technologies for SR therapeutics are under investigation including ocular surface drug delivery systems such as contact lenses and nanotechnology. While challenges remain for SR drug delivery technology in POAG management, this technology may shift treatment paradigms and dramatically improve outcomes.