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Purpose: Retinopathy of prematurity (ROP) stage is defined by the visual appearance of the vascular-avascular border, which reflects a spectrum of pathologic neurovascular tissue (NVT). Previous work demonstrated that the thickness of the ridge lesion, measured using OCT, corresponds to higher clinical diagnosis of stage. This study evaluates whether the volume of anomalous NVT (ANVTV), defined as abnormal tissue protruding from the regular contour of the retina, can be measured automatically using deep learning to develop quantitative OCT-based biomarkers in ROP. Design: Single-center retrospective case series. Participants: Thirty-three infants with ROP in the Oregon Health & Science University neonatal intensive care unit. Methods: OCT B-scans were collected using an investigational ultrawidefield OCT. The ANVTV was manually segmented. A set of 3347 B-scans and corresponding manual segmentations from 12 volumes from 6 patients were used to train an automated segmentation tool using a U-Net. An additional held-out test data set of 60 B-scans from 6 infants was used to evaluate model performance. The Dice–Sorensen coefficient (DSC) comparing manual and automated segmentation of ANVTV was calculated. Scans from 21 additional infants were used for clinical evaluation of ANVTV using the visit in which they had developed their peak stage of ROP. Each infant had every B-scan in a volume automatically segmented for ANVTV (total number of segmented voxels within the 60° temporal to the optic disc). The ANVTV was compared between infants with stage 1 to 3 ROP using a Kruskal–Wallis test and tracked over time in all infants with stage 3 ROP. Main Outcome Measurements: Cross sectional and longitudinal association between ANVTV and stages 1 to 3 ROP. Results: Comparing automated and manual segmentation of ANVTV achieved a DSC of 0.61 ± 0.13. Using the U-Net, ANVTV was associated with higher disease stage both cross sectionally and longitudinally. Median ANVTV significantly increased as ROP stage worsened from 1 (0, [interquartile range: 0–0] kilovoxels) to 2 (170.1 [interquartile range: 104.2–183.6] kilovoxels) to 3 (421.4 [interquartile range: 312.3–1110.8] kilovoxels; P < 0.001). Conclusions: Automated OCT-based measurement of ANVTV was associated with clinical disease stage in ROP, both cross sectionally and longitudinally. Ultrawidefield-OCT may facilitate more objective screening, diagnosis, and monitoring in the future. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Abstract Shape-morphable electrode arrays can form 3D surfaces to conform to complex neural anatomy and provide consistent positioning needed for next-generation neural interfaces. Retinal prostheses need a curved interface to match the spherical eye and a coverage of several cm to restore peripheral vision. We fabricated a full-field array that can (1) cover a visual field of 57° based on electrode position and of 113° based on the substrate size; (2) fold to form a compact shape for implantation; (3) self-deploy into a curvature fitting the eye after implantation. The full-field array consists of multiple polymer layers, specifically, a sandwich structure of elastomer/polyimide-based-electrode/elastomer, coated on one side with hydrogel. Electrodeposition of high-surface-area platinum/iridium alloy significantly improved the electrical properties of the electrodes. Hydrogel over-coating reduced electrode performance, but the electrodes retained better properties than those without platinum/iridium. The full-field array was rolled into a compact shape and, once implanted into ex vivo pig eyes, restored to a 3D curved surface. The full-field retinal array provides significant coverage of the retina while allowing surgical implantation through an incision 33% of the final device diameter. The shape-changing material platform can be used with other neural interfaces that require conformability to complex neuroanatomy.

Purpose. To evaluate the methodological quality of age-related macular degeneration (AMD) clinical practice guidelines (CPGs). Methods. AMD CPGs published by the American Academy of Ophthalmology (AAO) and Royal College of Ophthalmologists (RCO) were appraised by independent reviewers using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, which comprises six domains (Scope and Purpose, Stakeholder Involvement, Rigor of Development, Clarity of Presentation, Applicability, and Editorial Independence), and an Overall Assessment score summarizing methodological quality across all domains. Results. Average domain scores ranged from 35% to 83% for the AAO CPG and from 17% to 83% for the RCO CPG. Intraclass correlation coefficients for the reliability of mean scores for the AAO and RCO CPGs were 0.74 and 0.88, respectively. The strongest domains were Scope and Purpose and Clarity of Presentation. The weakest were Stakeholder Involvement (AAO) and Editorial Independence (RCO). Conclusions. Future AMD CPGs can be improved by involving all relevant stakeholders in guideline development, ensuring transparency of guideline development and review methodology, improving guideline applicability with respect to economic considerations, and addressing potential conflict of interests within the development group.