ORCID Profile
0000-0001-7113-3896
Current Organisation
Michigan State University
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Publisher: Informa UK Limited
Date: 08-12-2022
DOI: 10.1080/08164622.2021.2003691
Abstract: The complement system is part of the innate immune system activated by three distinct pathways: classical, lectin and alternative. It is also involved in retinal development and homoeostasis. Dense deposit disease is a rare renal disease associated with mutations in
Publisher: BMJ
Date: 12-2018
DOI: 10.1136/BJOPHTHALMOL-2018-312944
Abstract: To compare 24 months outcomes of eyes with retinal angiomatous proliferations (RAPs) treated with antivascular endothelial growth factor (anti-VEGF) with a group of controls diagnosed with other neovascular age-related macular degeneration (nAMD) subtypes in a real-world setting. Treatment-naïve nAMD eyes that commenced anti-VEGF between January 2006 and November 2015 were identified from a registry of nAMD treatment outcomes. Cases were defined as eyes diagnosed with RAP. Three controls per case were selected among nAMD eyes with non-RAP lesions and matched on baseline visual acuity (VA), year of treatment initiation, anti-VEGF agent first injected and follow-up. Baseline VA was compared with 12 and 24 months VA. Change in VA, number of injections received, proportion of visits with active nAMD and time to first inactivation were compared between RAPs and controls. 157 RAPs and 469 controls were included. Baseline VA (mean (SD)) increased at 12 months (61.4 (15.5) vs 68.7 (14.7) letters, p .001) and remained higher (66.6 (17.3) letters) at 24 months (p .001) in RAPs. The change from baseline VA (mean(95% CI)) was significantly higher in RAPs than in controls at 12 months (7.3 (5.4 to 9.1) vs 4.1 (2.8 to 5.4) letters, p=0.01) and at 24 months (5.1 (2.8 to 7.3) vs 2.5 (1 to 4) letters, p=0.056). Both groups received a median of 13 injections. RAPs inactivated earlier and were less active than controls (both p .001). RAPs responded well to anti-VEGF, with a significant improvement in VA persisting at 24 months. RAPs had better visual outcomes than controls at 12 and 24 months, tended to inactivate earlier and were less active throughout 2 years follow-up.
Publisher: Informa UK Limited
Date: 18-08-2022
DOI: 10.1080/08820538.2022.2109939
Abstract: Over the past two decades, advancements in imaging modalities have significantly evolved the diagnosis and management of retinal diseases. Through these novel platforms, we have developed a deeper understanding of the anatomy of the choroidal vasculature and the choriocapillaris. The recently developed tools such as optical coherence tomography (OCT) and OCT angiography (OCTA) have helped elucidate the pathological mechanisms of several posterior segment diseases. In this review, we have explained the anatomy of the choriocapillaris and its close relationship to the outer retina and retinal pigment epithelium. A comprehensive search of medical literature was performed through the Medline/PubMed database using search terms: choriocapillaris, choroid, quantification, biomarkers, diabetic retinopathy, age-related macular degeneration, choroidal blood flow, mean blur rate, flow deficit, optical coherence tomography, optical coherence tomography angiography, fluorescein angiography, indocyanine green angiography, OCTA, Doppler imaging, uveitis, choroiditis, white dot syndrome, tubercular serpiginous-like choroiditis, choroidal granuloma, pachychoroid, toxoplasmosis, central serous chorioretinopathy, multifocal choroiditis, choroidal neovascularization, choroidal thickness, choroidal vascularity index, choroidal vascular density, and choroidal blood supply. The search terms were used either independently or combined with choriocapillaris/choroid. The imaging techniques which are used to qualitatively and quantitatively analyze choriocapillaris are described. The pathological alterations in the choriocapillaris in an array of conditions such as diabetes mellitus, age-related macular degeneration, pachychoroid spectrum of diseases, and inflammatory disorders have been comprehensively reviewed. The future directions in the study of choriocapillaris have also been discussed. The development of imaging tools such as OCT and OCTA has dramatically improved the assessment of choriocapillaris in health and disease. The choriocapillaris can be delineated from the stromal choroid using the OCT and quantified by manual or automated methods. However, these techniques have inherent limitations due to the lack of an anatomical distinction between the choriocapillaris and the stromal choroid, which can be overcome with the use of predefined segmentation slabs on OCT and OCTA. These segmentation slabs help in standardizing the choriocapillaris imaging and obtain repeatable measurements in various conditions such as diabetic retinopathy, age-related macular degeneration, pachychoroid spectrum, and ocular inflammations. Additionally, Doppler imaging has also been effectively used to evaluate the choroidal blood flow and quantifying the choriocapillaris and establishing its role in the pathogenesis of various retinochoroidal diseases. As tremendous technological advancements such as wide-field and ultra-wide field imaging take place, there will be a significant improvement in the ease and accuracy of quantifying the choriocapillaris.
Publisher: Elsevier BV
Date: 04-2015
Publisher: BMJ
Date: 19-11-2019
DOI: 10.1136/BJOPHTHALMOL-2019-315257
Abstract: There is still no established treatment regimen for eyes with inflammatory choroidal neovascularisation (iCNV) treated with intravitreal anti-vascular endothelial growth factor (VEGF) injections. This study compared the 24-month outcomes of two treatment regimens of anti-VEGF injections in eyes with iCNV. Eyes with iCNV treated with anti-VEGF injections were ided into two groups: eyes treated with a loading phase of 3 monthly injections and then re-treated as needed (LOADING group) and eyes treated as needed from the beginning (PRN group). Visual acuity (VA), number of injections and iCNV recurrences at 24 months were compared between the groups. Eighty-two eyes were included, 42 in the LOADING and 40 in the PRN group. Baseline VA (mean(SD)) was 57.3 (15.8) letters in the LOADING vs 60.7 (15.6) letters in the PRN group (p=0.32). The VA (mean (95% CI)) increased at 3 months (+14.8 (10.6 to 18.9) and +11.2 (6.4 to 16) letters in the LOADING and PRN group, respectively) and remained significantly higher than baseline over the entire follow-up in both groups (all p .001). At 24 months, there was no difference in VA between the LOADING and PRN group (72.3 (14.0) vs 74.7 (11.3) letters, p=0.36) but the LOADING group received significantly more injections (median (Q1–Q3)) than the PRN (4.5 (3–7) vs 2.5 (2–3.2), p .0001). The iCNV recurrences were similar in both groups. iCNV responded well to anti-VEGF with significant and sustained VA improvement. The loading phase did not confer any advantage in terms of outcomes. PRN regimen from the beginning was as effective as more intensive treatment.
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.OPHTHA.2017.08.031
Abstract: Identification and characterization of patients with diabetic macular edema (DME) are important for in idualizing treatment and optimizing outcome. We investigated OCT biomarkers for DME treated by intravitreal dexamethasone (DEX) implant. Multicenter, retrospective, observational cohort study. A total of 299 eyes from 284 patients treated with DEX implant for DME (naïve, n = 209 refractory, n = 90). Baseline best-corrected visual acuity (BCVA) was between 0.3 and 1.0 on a logarithm of minimum angle of resolution visual chart. The OCT scans previous to DEX implants were evaluated for submacular fluid, size and location of cystoid changes, inner segment-outer segment (IS-OS) continuity, quantity and location of hyperreflective foci (HRF), vitreomacular interface abnormalities, and epiretinal membrane. The BCVA and central macular thickness were recorded at baseline and at 1, 2, and 4 months after treatment with DEX implants. Correlations between OCT measures and visual outcome were analyzed using the generalized estimating equations procedure. The correlation between spectral-domain (SD) OCT measures at baseline and BCVA response (mean change from baseline categorized improvement [<5, 5-9, or ≥10 Early Treatment Diabetic Retinopathy Study letters] in BCVA) after treatment with a DEX implant. The presence of subretinal fluid (odds ratio [OR], 1.98 95% confidence interval [CI], 1.23-3.20 P = 0.01), absence of HRF (OR, 3.66 95% CI, 1.40-9.62 P = 0.01), and integrity of the IS-OS layer (OR, 2.09 95% CI, 1.30-3.37 P = 0.003) were all predictive of better visual outcome after treatment with DEX implants. Although eyes with naïve DME gained more vision than refractory eyes (P < 0.001), the predictive value of OCT findings did not differ according to this classification. Spectral-domain OCT is useful in identifying various imaging findings in DME. Among eyes with DME, those with submacular fluid, no HRF, and a continuous IS-OS layer responded better to DEX implants than those without these features. These findings call for further study of combinations of OCT and metabolic biomarkers.
Publisher: Elsevier BV
Date: 04-2021
Publisher: Elsevier BV
Date: 04-2015
Publisher: Wiley
Date: 23-10-2023
DOI: 10.1111/CEO.14305
Publisher: Wiley
Date: 02-05-2018
DOI: 10.1111/CEO.13300
Publisher: BMJ
Date: 25-01-2022
DOI: 10.1136/BJOPHTHALMOL-2021-320482
Abstract: To describe baseline characteristics and 12-month outcomes with vascular endothelial growth factor (VEGF) inhibitors of treatment-naïve hemiretinal vein occlusion (HRVO) compared with branch (BRVO) and central (CRVO) variants in routine clinical care. A database observational study recruited 79 HRVO eyes, 590 BRVO eyes and 344 CRVO eyes that initiated therapy over 10 years. The primary outcome was mean change in visual acuity (VA—letters read on a logarithm of minimal angle of resolution chart) at 12 months. Secondary outcomes included mean change in central subfield thickness (CST), injections and visits. At baseline, mean VA in HRVO (53.8) was similar to CRVO (51.9 p=0.40) but lower than BRVO (59.4 p=0.009). HRVO eyes improved to match BRVO eyes from soon after treatment started through 12 months. Mean change in VA was greater in HRVO (+16.4) than both BRVO (+11.4 p=0.006) and CRVO (+8.5 p .001). Mean change in CST in HRVO (−231 µm) was similar to CRVO (−259 µm p=0.33) but greater than BRVO eyes (−151 µm p=0.003). The groups had similar median burdens of eight injections and nine visits. HRVO generally experienced the greatest mean change in VA of the three types of RVO when treated with VEGF inhibitors, ending with similar 12-month VA and CST to BRVO despite starting closer to CRVO. Inclusion of HRVO in BRVO or CRVO cohorts of clinical trials would be expected to proportionally inflate and skew the visual and anatomic outcomes.
Publisher: Research Square Platform LLC
Date: 08-2023
DOI: 10.21203/RS.3.RS-2968305/V1
Abstract: Aim: To compare baseline characteristics, initial response and 12-month efficacy and safety outcomes in eyes with branch and central retinal vein occlusion (BRVO and CRVO) initially treated with either dexamethasone implants (DEX) or vascular endothelial growth factor (VEGF) inhibitors where both are available as first-line therapy. Methods: Multi-centre study from European Fight Retinal Blindness! centres using the retinal vein occlusion module in routine clinical care. Results: Of 725 eligible eyes, only 10% received DEX initially with very frequent adjunctive VEGF inhibitors (BRVO-DEX 49%, CRVO-DEX 60%). The primary outcome of mean adjusted change in VA at 12 months with DEX and VEGF inhibitors initiated groups were not statistically significantly different (BRVO: DEX +6.7, VEGF +10.6 letters CRVO: DEX +2.8, VEGF +6.8 letters). DEX initiated eyes had fewer injections and visits than VEGF inhibitors initiated eyes but intraocular pressure required treatment more often in BRVO with DEX than VEGF inhibitors. We found the BRVO-DEX eyes had greater initial mean changes in VA and central subfield thickness (CST) and achieved inactivity sooner than BRVO-VEGF eyes. The mean CST after the first three months was above 350μm in all but the BRVO-VEGF group, suggesting undertreatment in routine care. Conclusion: In routine care DEX is uncommonly used when available as initial treatment of BRVO and CRVO and is often supplemented with VEGF inhibitors within the first year. The 12-month outcomes were similar, but DEX initiated eyes did have fewer injections and visits but more episodes of raised IOP compared with those starting VEGF inhibitors.
Publisher: Springer Science and Business Media LLC
Date: 07-2023
DOI: 10.1038/S41433-023-02652-3
Abstract: To compare the change in lesion area over 4 years of follow-up in eyes with neovascular age-related macular degeneration (nAMD) treated with anti-vascular endothelial growth factor (VEGF) agents using either a proactive or a reactive regimen in routine clinical practice. This was a multicentre, retrospective comparative study. Totally, 202 treatment-naïve nAMD eyes (183 patients) received anti-VEGF therapy according to a proactive ( n = 105) or reactive ( n = 97) regimen. Eyes were included if they had received anti-VEGF injections for a period of at least 4 years and had baseline fluorescein angiography and annual optical coherence tomography (OCT) imaging. Two masked graders independently delineated the lesion’s margins from serial OCT images and growth rates were calculated. At baseline, the mean [SD] lesion area was 7.24 [5.6] mm 2 in the proactive group and 6.33 [4.8] mm 2 in the reactive group respectively ( p = 0.22). After four years of treatment, the mean [SD] lesion area in the proactive group was 5.16 [4.5] mm 2 showing a significant reduction compared to the baseline ( p 0.001). By contrast, the mean [SD] lesion area kept expanding in the reactive group during the follow-up and was 9.24 [6.0] mm 2 at four years ( p 0.001). The lesion area at 4 years was significantly influenced by treatment regimen, baseline lesion area, and proportion of visits with active lesions. Eyes treated using a reactive strategy had an increased lesion area and worse visual outcomes at 4 years. By contrast, the proactive regimen was associated with fewer recurrences of active disease, shrinkage of the lesion area, and better vision at four years.
Publisher: Elsevier BV
Date: 12-2020
No related grants have been discovered for Robert Richardson.