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Paul W, Burlina P, Mocharla R, Joshi N, Li Z, Gu S, Nanegrungsunk O, Lin K, Bressler SB, Cai CX, Kong J, Liu TYA, Moini H, Du W, Amer F, Chu K, Vitti R, Sepehrband F, Bressler NM. Accuracy of Artificial Intelligence in Estimating Best-Corrected Visual Acuity From Fundus Photographs in Eyes With Diabetic Macular Edema. JAMA Ophthalmol 2023; 141:677-685. [PMID: 37289463 PMCID: PMC10251243 DOI: 10.1001/jamaophthalmol.2023.2271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/17/2023] [Indexed: 06/09/2023]
Abstract
Importance Best-corrected visual acuity (BCVA) is a measure used to manage diabetic macular edema (DME), sometimes suggesting development of DME or consideration of initiating, repeating, withholding, or resuming treatment with anti-vascular endothelial growth factor. Using artificial intelligence (AI) to estimate BCVA from fundus images could help clinicians manage DME by reducing the personnel needed for refraction, the time presently required for assessing BCVA, or even the number of office visits if imaged remotely. Objective To evaluate the potential application of AI techniques for estimating BCVA from fundus photographs with and without ancillary information. Design, Setting, and Participants Deidentified color fundus images taken after dilation were used post hoc to train AI systems to perform regression from image to BCVA and to evaluate resultant estimation errors. Participants were patients enrolled in the VISTA randomized clinical trial through 148 weeks wherein the study eye was treated with aflibercept or laser. The data from study participants included macular images, clinical information, and BCVA scores by trained examiners following protocol refraction and VA measurement on Early Treatment Diabetic Retinopathy Study (ETDRS) charts. Main Outcomes Primary outcome was regression evaluated by mean absolute error (MAE); the secondary outcome included percentage of predictions within 10 letters, computed over the entire cohort as well as over subsets categorized by baseline BCVA, determined from baseline through the 148-week visit. Results Analysis included 7185 macular color fundus images of the study and fellow eyes from 459 participants. Overall, the mean (SD) age was 62.2 (9.8) years, and 250 (54.5%) were male. The baseline BCVA score for the study eyes ranged from 73 to 24 letters (approximate Snellen equivalent 20/40 to 20/320). Using ResNet50 architecture, the MAE for the testing set (n = 641 images) was 9.66 (95% CI, 9.05-10.28); 33% of the values (95% CI, 30%-37%) were within 0 to 5 letters and 28% (95% CI, 25%-32%) within 6 to 10 letters. For BCVA of 100 letters or less but more than 80 letters (20/10 to 20/25, n = 161) and 80 letters or less but more than 55 letters (20/32 to 20/80, n = 309), the MAE was 8.84 letters (95% CI, 7.88-9.81) and 7.91 letters (95% CI, 7.28-8.53), respectively. Conclusions and Relevance This investigation suggests AI can estimate BCVA directly from fundus photographs in patients with DME, without refraction or subjective visual acuity measurements, often within 1 to 2 lines on an ETDRS chart, supporting this AI concept if additional improvements in estimates can be achieved.
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Affiliation(s)
- William Paul
- Applied Physics Laboratory, Johns Hopkins University, Laurel, Maryland
| | - Philippe Burlina
- Applied Physics Laboratory, Johns Hopkins University, Laurel, Maryland
- Department of Computer Science and Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, Maryland
- Zoox, Foster City, California
| | - Rohita Mocharla
- Applied Physics Laboratory, Johns Hopkins University, Laurel, Maryland
| | - Neil Joshi
- Applied Physics Laboratory, Johns Hopkins University, Laurel, Maryland
| | - Zhuolin Li
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sophie Gu
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York–Presbyterian Hospital, New York, New York
| | - Onnisa Nanegrungsunk
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kira Lin
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Ruiz Department of Ophthalmology and Visual Science at McGovern Medical School at UTHealth Houston, Houston, Texas
| | - Susan B. Bressler
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cindy X. Cai
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jun Kong
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - T. Y. Alvin Liu
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hadi Moini
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | - Weiming Du
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | - Fouad Amer
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | - Karen Chu
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | - Robert Vitti
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | | | - Neil M. Bressler
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Editor, JAMA Ophthalmology
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Pavlenko D, Pavlenko M, Pavlenko R. Advantages and limitations of teleophthalmology during the war in Ukraine. Graefes Arch Clin Exp Ophthalmol 2023; 261:1761-1763. [PMID: 36648510 DOI: 10.1007/s00417-022-05967-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/03/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Affiliation(s)
- Dmytro Pavlenko
- Department of Ophthalmology, Bogomolets National Medical University, 13 T. Shevchenko Blvd, Kyiv, 01601, Ukraine.
| | | | - Roman Pavlenko
- Department of Ophthalmology, Bogomolets National Medical University, 13 T. Shevchenko Blvd, Kyiv, 01601, Ukraine
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3
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Ahmed Y, Pereira A, Rai AS, Leung VC, Ahmed A, Rai AS. Prospective evaluation of medical student accuracy conducting direct ophthalmoscopy with an unmodified iPhone X. Int Ophthalmol 2022; 42:3933-3940. [PMID: 35871237 PMCID: PMC9308475 DOI: 10.1007/s10792-022-02377-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 06/14/2022] [Indexed: 11/27/2022]
Abstract
Purpose To evaluate fundus examination accuracy of medical students when using an unmodified iPhone X or a direct ophthalmoscope in comparison to a staff ophthalmologist’s retinal examination. Methods In this prospective comparative analysis, patients underwent dilated fundus examination by novice medical trainees using either an unmodified iPhone X or standard direct ophthalmoscope. The primary outcome was the mean difference and degree of agreement in cup-to-disc ratio between student examination and the staff ophthalmologist’s cup-to-disc observation. Results A total of 18 medical students conducted 230 retinal examinations, 117 with the iPhone X and 113 with the direct ophthalmoscope. A greater proportion of students were unable to report cup-to-disc ratio using the iPhone X (81.2%) vs direct ophthalmoscope (30.1%). Student examination of cup-to-disc ratio led to a systematic bias (95% limits of agreement) of + 0.16 (−0.22 to + 0.54) and + 0.10 (−0.36 to + 0.56) with the iPhone X and direct ophthalmoscope, respectively. iPhone X and direct ophthalmoscope student observation concordance for optic disc colour (88.7 and 82.4%, respectively) and contour (68.3 and 74.2%, respectively) demonstrated low agreement with staff ophthalmologist findings. Student iPhone X observations demonstrated lower agreement with staff findings compared to direct ophthalmoscope observations for spontaneous venous pulsations (Cohen’s Kappa = −0.044 vs 0.099). Conclusion Amongst medical trainees, optic disc visualization using an unmodified iPhone X was inferior to the direct ophthalmoscope. When able to visualize the optic nerve head, there was no significant difference in reported cup-to-disc ratio between modalities. However, both modalities demonstrated poor reliability in comparison to staff ophthalmologist findings. Supplementary Information The online version contains supplementary material available at 10.1007/s10792-022-02377-4.
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Affiliation(s)
- Yusuf Ahmed
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Austin Pereira
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Amrit S Rai
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Victoria C Leung
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | | | - Amandeep S Rai
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.
- Kensington Eye Institute, University of Toronto, Toronto, ON, Canada.
- Kensington Vision and Research Centre, Suite 600, 340 College Street, Toronto, ON, M5T 3A9, Canada.
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4
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Pujari A. Smartphone Ophthalmoscopy: is there a place for it? Clin Ophthalmol 2021; 15:4333-4337. [PMID: 34737548 PMCID: PMC8560125 DOI: 10.2147/opth.s243103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/20/2021] [Indexed: 12/12/2022] Open
Abstract
Smartphone technology is advancing at a rapid pace. Their role in day-to-day life is becoming more and more intricate and irreplaceable. Of late, they have gained immense importance in different medical specialities where they possess an active ability to guide the clinician. This is particularly evident in ophthalmology, where the constantly evolving camera-illumination systems and the artificial intelligence integrated technology have unravelled many novel observations for non-contact posterior segment imaging. The scope of this review is to highlight the role of smartphones as ophthalmoscopes (direct as well as indirect). Nevertheless, their limitations and future directions are also stated here with the intention of making progress in the field of smartphone fundus imaging.
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Affiliation(s)
- Amar Pujari
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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5
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Nikolaidou A, Tsaousis KT. Teleophthalmology and Artificial Intelligence As Game Changers in Ophthalmic Care After the COVID-19 Pandemic. Cureus 2021; 13:e16392. [PMID: 34408945 PMCID: PMC8363234 DOI: 10.7759/cureus.16392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 12/17/2022] Open
Abstract
The current COVID-19 pandemic has boosted a sudden demand for telemedicine due to quarantine and travel restrictions. The exponential increase in the use of telemedicine is expected to affect ophthalmology drastically. The aim of this review is to discuss the utility, effectiveness and challenges of teleophthalmological new tools for eyecare delivery as well as its implementation and possible facilitation with artificial intelligence. We used the terms: “teleophthalmology,” “telemedicine and COVID-19,” “retinal diseases and telemedicine,” “virtual ophthalmology,” “cost effectiveness of teleophthalmology,” “pediatric teleophthalmology,” “Artificial intelligence and ophthalmology,” “Glaucoma and teleophthalmology” and “teleophthalmology limitations” in the database of PubMed and selected the articles being published in the course of 2015-2020. After the initial search, 321 articles returned as relevant. A meticulous screening followed and eventually 103 published manuscripts were included and used as our references. Emerging in the market, teleophthalmology is showing great potential for the future of ophthalmological care, benefiting both patients and ophthalmologists in times of pandemics. The spectrum of eye diseases that could benefit from teleophthalmology is wide, including mostly retinal diseases such as diabetic retinopathy, retinopathy of prematurity, age-related macular degeneration but also glaucoma and anterior segment conditions. Simultaneously, artificial intelligence provides ways of implementing teleophthalmology easier and with better outcomes, contributing as significant changing factors for ophthalmology practice after the COVID-19 pandemic.
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Affiliation(s)
- Anna Nikolaidou
- Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, GRC
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6
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Pujari A, Saluja G, Agarwal D, Sinha A, P R A, Kumar A, Sharma N. Clinical Role of Smartphone Fundus Imaging in Diabetic Retinopathy and Other Neuro-retinal Diseases. Curr Eye Res 2021; 46:1605-1613. [PMID: 34325587 DOI: 10.1080/02713683.2021.1958347] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Purpose: In today's life, many electronic gadgets have the potential to become invaluable health care devices in future. The gadgets in this category include smartphones, smartwatches, and others. Till now, smartphone role has been highlighted on many occasions in different areas, and they continue to possess immense role in clinical documentation, clinical consultation, and digitalization of ocular care. In last one decade, many treatable conditions including diabetic retinopathy, glaucoma, and other pediatric retinal diseases are being imaged using smartphones.Methods: To comprehend this cumulative knowledge, a detailed medical literature search was conducted on PubMed/Medline, Scopus, and Web of Science till February 2021.Results: The included literature revealed a definitive progress in posterior segment imaging. From simple torch light with smartphone examination to present day compact handy devices with artificial intelligence integrated software's have changed the very perspectives of ocular imaging in ophthalmology. The consistently reproducible results, constantly improving imaging techniques, and most importantly their affordable costs have renegotiated their role as effective screening devices in ophthalmology. Moreover, the obtained field of view, ocular safety, and their key utility in non-ophthalmic specialties are also growing.Conclusions: To conclude, smartphone imaging can now be considered as a quick, cost-effective, and digitalized tool for posterior segment screenings, however, their definite role in routine ophthalmic clinics is yet to be established.
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Affiliation(s)
- Amar Pujari
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Gunjan Saluja
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Divya Agarwal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ayushi Sinha
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ananya P R
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Abstract
The ophthalmoscope has been a mainstay for non-specialist physicians to review a range of disorders affecting patient fundi. Its design has remained unchanged since its inception and while relatively easy to operate, gaining mastery of it can prove challenging. Training is limited by its single-user interface with the lack of attachments to augment its design and therefore facilitate skill acquisition. Documentation is variable depending on the competence of the individual to satisfactorily see enough of the fundi, and the accuracy with which they can describe their findings. Several groups have looked to find adaptions to smartphones in order to develop user-friendly and affordable alternative to the traditional ophthalmoscope. A digital solution has the potential to provide greater versatility by enhancing documentation, improved training pathways and facilitating more efficient care, with options for geographically disparate healthcare settings to access teleophthalmology input.
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8
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Akkara JD, Kuriakose A. Commentary: Is it time for teleophthalmology, virtual glaucoma clinics and uberization of eye care? Indian J Ophthalmol 2021; 69:719-720. [PMID: 33595508 PMCID: PMC7942080 DOI: 10.4103/ijo.ijo_3823_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- John Davis Akkara
- Consultant Ophthalmologist, Department of Ophthalmology, Sri Ramachandra Institute of Higher Education and Research, Cochin, Kerala, India
- Department of Glaucoma, Westend Eye Hospital, Cochin, Kerala, India
| | - Anju Kuriakose
- Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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9
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Clinically useful smartphone ophthalmic imaging techniques. Graefes Arch Clin Exp Ophthalmol 2021; 259:279-287. [PMID: 32915278 DOI: 10.1007/s00417-020-04917-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/12/2020] [Accepted: 08/25/2020] [Indexed: 01/18/2023] Open
Abstract
Imaging devices in ophthalmology are numerous, and most of them are sophisticated and specialized for specific regions of the eye. In addition, these are fixed and involve close interaction of the patient and the examiner; therefore, simple, portable and tele facility-imbibed imaging tools can be considered optimal alternatives to routine exercises. In the last 10 years, utility of smartphones in ophthalmology is being continuously explored to unearth their potential benefits. In this direction, a smartphone device with/without simple attachments has been noted to aid in detailed, high-quality imaging of the ocular adnexa, cornea, angle, iris, lens, optic disc, and the retina including its periphery. In addition, such utility has also been extended in strabismology workup and intraocular pressure measurements. Hence, using these clinician friendly tools and techniques or by devising newer and more comprehensive tool kits, ophthalmic care can be well-managed with apt use of technology. Also, the smartphone companies are encouraged to collaborate with the medical experts to endeavor more, and help and serve the people better.
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10
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Abstract
PURPOSE OF REVIEW Telemedicine for neuro-ophthalmology (tele-neuro-ophthalmology) has the potential to increase access to neuro-ophthalmic care by improving efficiency and decreasing the need for long-distance travel for patients. Requirements for decreased person-to-person contacts during the COVID-19 pandemic accelerated adoption of tele-neuro-ophthalmology. This review highlights the challenges and opportunities with tele-neuro-ophthalmology. RECENT FINDINGS Tele-neuro-ophthalmology programs can be used for triage, diagnostic consultation, and long-term treatment monitoring. Formats include telephone appointments, interprofessional collaborations, remote data interpretation, online asynchronous patient communication, and video visits. Barriers to long-term implementation of tele-neuro-ophthalmology arise from data quality, patient engagement, workflow integration, state and federal regulations, and reimbursement. General neurologists may collaborate with local eye care providers for ophthalmic examination, imaging, and testing to facilitate efficient and effective tele-neuro-ophthalmology consultation. SUMMARY Tele-neuro-ophthalmology has tremendous potential to improve patient access to high-quality cost-effective neuro-ophthalmic care. However, many factors may impact its long-term sustainability.
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Affiliation(s)
- Yin Allison Liu
- UC Davis Eye Center, Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, California, USA
| | - Melissa Ko
- Departments of Neurology, Ophthalmology, and Neurological Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Heather E. Moss
- Departments of Ophthalmology, Neurology and Neurological Sciences, Stanford University, Stanford, California, USA
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11
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Tiosano A, Hindi I, Bahar I, Nahum Y. Continuity of ophthalmology education during a pandemic by combining video conferencing application with a slit-lamp camera. Can J Ophthalmol 2020; 56:e44-e46. [PMID: 33220175 PMCID: PMC7980230 DOI: 10.1016/j.jcjo.2020.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/10/2020] [Accepted: 10/16/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Alon Tiosano
- Rabin Medical Center, Petach Tikva, Israel; Tel Aviv University, Tel Aviv, Israel.
| | - Isaac Hindi
- Hillel Yaffe Medical Center, Hadera, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel
| | - Irit Bahar
- Rabin Medical Center, Petach Tikva, Israel; Tel Aviv University, Tel Aviv, Israel
| | - Yoav Nahum
- Rabin Medical Center, Petach Tikva, Israel; Tel Aviv University, Tel Aviv, Israel
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12
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Smartphone Disc Photography Versus Standard Stereoscopic Disc Photography as a Teaching Tool. J Glaucoma 2020; 28:e109-e111. [PMID: 30921278 DOI: 10.1097/ijg.0000000000001251] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Optic disc photographic assessment was performed using an unmodified iPhone Xs Max. A video recording of the disc and peripapillary area was obtained in 5 patients. Good quality screenshots were acquired from the video, and, from them, a single best quality image was selected. This was compared with their respective standard optic disc stereo photograph. A glaucomatologist blinded to the type of image acquisition studied these images and concluded that both images could help well in the identification of glaucomatous optic disc features; however, the stereo photograph had better clarity than the iPhone static image. Nevertheless, the iPhone offered the advantage of real-time video assessment of the disc and peripapillary area and could serve as a practical and handy tool for telemedicine and teaching purposes.
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13
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Grossman SN, Calix R, Tow S, Odel JG, Sun LD, Balcer LJ, Galetta SL, Rucker JC. Neuro-ophthalmology in the Era of COVID-19: Future Implications of a Public Health Crisis. Ophthalmology 2020; 127:e72-e74. [PMID: 32387481 PMCID: PMC7204645 DOI: 10.1016/j.ophtha.2020.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/02/2020] [Accepted: 05/05/2020] [Indexed: 11/17/2022] Open
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MII RetCam assisted smartphone-based fundus imaging (MSFI)-A boon for paediatric retinal imaging. Eye (Lond) 2020; 34:1307-1309. [PMID: 32107464 DOI: 10.1038/s41433-020-0822-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 12/25/2022] Open
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Mayro EL, Wang M, Elze T, Pasquale LR. The impact of artificial intelligence in the diagnosis and management of glaucoma. Eye (Lond) 2020; 34:1-11. [PMID: 31541215 PMCID: PMC7002653 DOI: 10.1038/s41433-019-0577-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/07/2019] [Indexed: 12/12/2022] Open
Abstract
Deep learning (DL) is a subset of artificial intelligence (AI), which uses multilayer neural networks modelled after the mammalian visual cortex capable of synthesizing images in ways that will transform the field of glaucoma. Autonomous DL algorithms are capable of maximizing information embedded in digital fundus photographs and ocular coherence tomographs to outperform ophthalmologists in disease detection. Other unsupervised algorithms such as principal component analysis (axis learning) and archetypal analysis (corner learning) facilitate visual field interpretation and show great promise to detect functional glaucoma progression and differentiate it from non-glaucomatous changes when compared with conventional software packages. Forecasting tools such as the Kalman filter may revolutionize glaucoma management by accounting for a host of factors to set target intraocular pressure goals that preserve vision. Activation maps generated from DL algorithms that process glaucoma data have the potential to efficiently direct our attention to critical data elements embedded in high throughput data and enhance our understanding of the glaucomatous process. It is hoped that AI will realize more accurate assessment of the copious data encountered in glaucoma management, improving our understanding of the disease, preserving vision, and serving to enhance the deep bonds that patients develop with their treating physicians.
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Affiliation(s)
- Eileen L Mayro
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Mengyu Wang
- Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA
| | - Tobias Elze
- Schepens Eye Research Institute, Harvard Medical School, Boston, MA, USA
- Max Planck Institute for Mathematics in the Sciences, Leipzig, Germany
| | - Louis R Pasquale
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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16
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Pujari A, Markan A, Chawla R, Gagrani M. The additional role of unmodified iPhone X as a direct ophthalmoscope. Indian J Ophthalmol 2019; 67:1253-1254. [PMID: 31238488 PMCID: PMC6611294 DOI: 10.4103/ijo.ijo_90_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Amar Pujari
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Markan
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Meghal Gagrani
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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17
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Pujari A, Lomi N, Goel S, Yadav S, Mukhija R, Kumar P, Kumar A. Unmodified iPhone XS Max for fundus montage imaging in cases of retinoblastoma. Indian J Ophthalmol 2019; 67:948-949. [PMID: 31124525 PMCID: PMC6552607 DOI: 10.4103/ijo.ijo_2144_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Amar Pujari
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, AIIMS, New Delhi, India
| | - Neiwete Lomi
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, AIIMS, New Delhi, India
| | - Siddhi Goel
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, AIIMS, New Delhi, India
| | - Saumya Yadav
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, AIIMS, New Delhi, India
| | - Ritika Mukhija
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, AIIMS, New Delhi, India
| | - Prashant Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, AIIMS, New Delhi, India
| | - Atul Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, AIIMS, New Delhi, India
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Akkara JD, Kuriakose A. Commentary: Seeing the big picture: Panoramic smartphone fundus imaging sans accessories. Indian J Ophthalmol 2019; 67:949-950. [PMID: 31124526 PMCID: PMC6552597 DOI: 10.4103/ijo.ijo_727_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- John D Akkara
- Department of Ophthalmology, Little Flower Hospital and Research Centre, Angamaly; Department of Glaucoma, Westend Eye Hospital, Kochi, Kerala, India
| | - Anju Kuriakose
- Department of Ophthalmology, Jubilee Mission Medical College, Thrissur, Kerala, India
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Direct Smartphone Disc Video Documentation for Pediatric Glaucomas During Evaluation Under Anesthesia. J Glaucoma 2019; 28:e143-e144. [DOI: 10.1097/ijg.0000000000001294] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Akkara JD, Kuriakose A. Commentary: Tsunami of grassroot innovations from makers. Indian J Ophthalmol 2019; 67:545-546. [PMID: 30900592 PMCID: PMC6446642 DOI: 10.4103/ijo.ijo_96_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- John Davis Akkara
- Department of Glaucoma, Westend Eye Hospital, Cochin; Department of Glaucoma, Little Flower Hospital, Angamaly, Kerala, India
| | - Anju Kuriakose
- Department of Ophthalmology, Jubilee Mission Medical College, Thrissur, Kerala, India
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