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Li F, Wang D, Yang Z, Zhang Y, Jiang J, Liu X, Kong K, Zhou F, Tham CC, Medeiros F, Han Y, Grzybowski A, Zangwill LM, Lam DSC, Zhang X. The AI revolution in glaucoma: Bridging challenges with opportunities. Prog Retin Eye Res 2024; 103:101291. [PMID: 39186968 DOI: 10.1016/j.preteyeres.2024.101291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 08/19/2024] [Accepted: 08/19/2024] [Indexed: 08/28/2024]
Abstract
Recent advancements in artificial intelligence (AI) herald transformative potentials for reshaping glaucoma clinical management, improving screening efficacy, sharpening diagnosis precision, and refining the detection of disease progression. However, incorporating AI into healthcare usages faces significant hurdles in terms of developing algorithms and putting them into practice. When creating algorithms, issues arise due to the intensive effort required to label data, inconsistent diagnostic standards, and a lack of thorough testing, which often limits the algorithms' widespread applicability. Additionally, the "black box" nature of AI algorithms may cause doctors to be wary or skeptical. When it comes to using these tools, challenges include dealing with lower-quality images in real situations and the systems' limited ability to work well with diverse ethnic groups and different diagnostic equipment. Looking ahead, new developments aim to protect data privacy through federated learning paradigms, improving algorithm generalizability by diversifying input data modalities, and augmenting datasets with synthetic imagery. The integration of smartphones appears promising for using AI algorithms in both clinical and non-clinical settings. Furthermore, bringing in large language models (LLMs) to act as interactive tool in medicine may signify a significant change in how healthcare will be delivered in the future. By navigating through these challenges and leveraging on these as opportunities, the field of glaucoma AI will not only have improved algorithmic accuracy and optimized data integration but also a paradigmatic shift towards enhanced clinical acceptance and a transformative improvement in glaucoma care.
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Affiliation(s)
- Fei Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China.
| | - Deming Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China.
| | - Zefeng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China.
| | - Yinhang Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China.
| | - Jiaxuan Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China.
| | - Xiaoyi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China.
| | - Kangjie Kong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China.
| | - Fengqi Zhou
- Ophthalmology, Mayo Clinic Health System, Eau Claire, WI, USA.
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Felipe Medeiros
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Ying Han
- University of California, San Francisco, Department of Ophthalmology, San Francisco, CA, USA; The Francis I. Proctor Foundation for Research in Ophthalmology, University of California, San Francisco, CA, USA.
| | - Andrzej Grzybowski
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland.
| | - Linda M Zangwill
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, CA, USA.
| | - Dennis S C Lam
- The International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), Shenzhen, China; The C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China.
| | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China.
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Mohammadi M, Su E, Mohammadzadeh V, Besharati S, Martinyan A, Coleman AL, Law SK, Caprioli J, Weiss RE, Nouri-Mahdavi K. Comparison of Retinal Nerve Fiber Layer and Ganglion Cell Complex Rates of Change in Patients With Moderate to Advanced Glaucoma. Am J Ophthalmol 2024; 268:190-198. [PMID: 39111519 DOI: 10.1016/j.ajo.2024.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 07/16/2024] [Accepted: 07/24/2024] [Indexed: 09/01/2024]
Abstract
PURPOSE To compare ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL) rates of change (RoC) in eyes with central or moderate to advanced glaucoma. DESIGN Prospective cohort study. PARTICIPANTS A total of 918 matched macular and RNFL OCT scan pairs from 109 eyes (109 patients) enrolled in the Advanced Glaucoma Progression Study with ≥2 years of follow-up and ≥4 OCT scans. METHODS We exported GCC and RNFL thickness measurements in 49 central macular superpixels and 12 RNFL clock-hour sectors, respectively. We applied our latest Bayesian hierarchical longitudinal model to estimate population and subject-specific baseline thickness (intercepts) and rates of change (RoC) in macular superpixels and RNFL sectors. Global RNFL and GCC RoC were analyzed in a single bivariate longitudinal model to properly compare them accounting for the correlation between their RoC. MAIN OUTCOME MEASURES Proportion of significant negative (deteriorating) and positive (improving) RoC expressed in μm/year. Standardized RoC were calculated by dividing RoC by the corresponding population SD. Analyses were repeated in eyes with visual field mean deviation (MD) ≤-6 and > -6 dB. RESULTS Average (SD) 24-2 visual field MD and follow-up length were -8.6 (6.3) dB and 4.2 (0.5) years, respectively. Global RNFL RoC (-0.70 µm/year) were faster than GCC (-0.44 µm/year) (P < .001); corresponding normalized RoC were not significantly different (P = .052). In bivariate analysis, patients with a significant negative global RNFL RoC (n = 63, 57%) or GCC (n = 56, 51%) frequently did so for both outcomes (n = 49, 45%). The average proportion of significantly decreasing RNFL sectors within an eye was 30.7% in eyes with MD > -6 dB compared to 20.5% in those with MD ≤ -6 dB (P = .014); the proportions for GCC superpixels were 21.1% versus 18.7%, respectively (P = .63). CONCLUSIONS Both GCC and RNFL measures can detect structural progression in glaucoma patients with central damage or moderate to advanced glaucoma. The clinical utility of RNFL imaging decreases with worsening severity of glaucoma.
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Affiliation(s)
- Massood Mohammadi
- Glaucoma Division, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles (M.M., E.S., V.M., S.B., A.M., A.L.C., S.K.L., J.C., and K.N.-M.), Los Angeles, California, USA
| | - Erica Su
- Glaucoma Division, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles (M.M., E.S., V.M., S.B., A.M., A.L.C., S.K.L., J.C., and K.N.-M.), Los Angeles, California, USA
| | - Vahid Mohammadzadeh
- Glaucoma Division, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles (M.M., E.S., V.M., S.B., A.M., A.L.C., S.K.L., J.C., and K.N.-M.), Los Angeles, California, USA
| | - Sajad Besharati
- Glaucoma Division, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles (M.M., E.S., V.M., S.B., A.M., A.L.C., S.K.L., J.C., and K.N.-M.), Los Angeles, California, USA
| | - Arthur Martinyan
- Glaucoma Division, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles (M.M., E.S., V.M., S.B., A.M., A.L.C., S.K.L., J.C., and K.N.-M.), Los Angeles, California, USA
| | - Anne L Coleman
- Glaucoma Division, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles (M.M., E.S., V.M., S.B., A.M., A.L.C., S.K.L., J.C., and K.N.-M.), Los Angeles, California, USA
| | - Simon K Law
- Glaucoma Division, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles (M.M., E.S., V.M., S.B., A.M., A.L.C., S.K.L., J.C., and K.N.-M.), Los Angeles, California, USA
| | - Joseph Caprioli
- Glaucoma Division, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles (M.M., E.S., V.M., S.B., A.M., A.L.C., S.K.L., J.C., and K.N.-M.), Los Angeles, California, USA
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles (R.E.W.), Los Angeles, California, USA
| | - Kouros Nouri-Mahdavi
- Glaucoma Division, David Geffen School of Medicine, Stein Eye Institute, University of California Los Angeles (M.M., E.S., V.M., S.B., A.M., A.L.C., S.K.L., J.C., and K.N.-M.), Los Angeles, California, USA.
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Castillejos AG, Devlin J, Saini C, Sun JA, Wang M, Johnson G, Chodosh J, Shen LQ. Artifacts in OCT Retinal Nerve Fiber Layer Imaging in Patients with Boston Keratoprosthesis Type 1. Ophthalmol Glaucoma 2024; 7:206-215. [PMID: 37783274 DOI: 10.1016/j.ogla.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/13/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To determine the clinical utility of OCT retinal nerve fiber layer (OCT RNFL) imaging for glaucoma evaluation in patients with Boston keratoprosthesis type 1 (KPro) by investigating imaging artifacts. DESIGN Case-control study. SUBJECTS Patients with KPro and without KPro (controls) matched for age, gender, and glaucoma diagnosis. METHODS The most recent Cirrus OCT RNFL scan from 1 eye was categorized as having good signal strength (SS; ≥ 6 out of 10) or poor SS (< 6). Those with good SS were analyzed by 2 independent reviewers for artifacts. Images with good SS and no artifacts affecting the scanning circle were considered useful for glaucoma evaluation. MAIN OUTCOME MEASURES The incidence of poor SS and artifacts in OCT RNFL images; patient characteristics associated with useful scans. RESULTS Sixty-five patients with KPro and 75 controls were included; 89.2% of KPro patients and 89.3% of control subjects had glaucoma (P = 0.98). Forty percent of KPro patients and 5.3% of controls had poor SS (P < 0.001). The proportion of images with either poor SS or artifacts was similar in KPro (76.9%) vs. controls (72.0%, P = 0.51). The most common artifacts in both groups were missing data (43.6%, 53.2%, respectively, P = 0.32) and motion artifact (25.6%, 19.7%, respectively, P = 0.47). Images were useful for glaucoma evaluation in 43.1% of KPro patients and in 69.3% of controls (P = 0.002). In the KPro group, patients with useful OCT scans, compared with those without, had better visual acuity (0.4 ± 0.3 vs. 0.9 ± 0.7 logarithm of the minimum angle of resolution, P = 0.004), and did not have congenital corneal pathologies (0.0% vs. 24.3%, P = 0.008). A multivariate analysis showed that KPro patients with older age had higher odds of useful OCT images (odds ratio, 1.05; P = 0.03). Among KPro patients with useful OCT scans, retinal nerve fiber layer thickness correlated with observed cup-to-disc ratio (Pearson correlation: r = -0.42, P = 0.03). CONCLUSIONS The rate of OCT RNFL images with either poor signal strength or artifacts in the KPro and control population was comparable. In patients with KPro, where intraocular pressure measurements are difficult and glaucoma is highly prevalent and often severe, OCT RNFL imaging can be useful for glaucoma evaluation. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Alexandra G Castillejos
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Julia Devlin
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Chhavi Saini
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Jessica A Sun
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Mengyu Wang
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Grace Johnson
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - James Chodosh
- Department of Ophthalmology and Visual Sciences, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Lucy Q Shen
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
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Kirik F, Iskandarov F, Erturk KM, Ozdemir H. Quantitative analysis of deep learning-based denoising model efficacy on optical coherence tomography images with different noise levels. Photodiagnosis Photodyn Ther 2024; 45:103891. [PMID: 37949385 DOI: 10.1016/j.pdpdt.2023.103891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/01/2023] [Accepted: 11/07/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND To quantitatively evaluate the effectiveness of the Noise2Noise (N2N) model, a deep learning (DL)-based noise reduction algorithm, on enhanced depth imaging-optical coherence tomography (EDI-OCT) images with different noise levels. METHODS The study included 30 subfoveal EDI-OCT images averaged with 100 frames from 30 healthy participants. Artificial Gaussian noise at 25.00, 50.00, and 75.00 standard deviations were added to the averaged (original) images, and the images were grouped as 25N, 50N, and 75N. Afterward, noise-added images were denoised with the N2N model and grouped as 25dN, 50dN, and 75dN, according to previous noise levels. The choroidal vascularity index (CVI) and deep choroidal contrast-to-noise ratio (CNR) were calculated for all images, and noise-added and denoised images were compared with the original images. The structural similarity of the noise-added and denoised images to the original images was assessed by the Multi-Scale Structural Similarity Index (MS-SSI). RESULTS The CVI and CNR parameters of the original images (68.08 ± 2.47 %, and 9.71 ± 2.80) did not differ from the only 25dN images (67.97 ± 2.34 % and 8.50 ± 2.43) (p:1.000, and p:0.062, respectively). Noise reduction improved the MS-SSI at each noise level (p < 0.001). However, the highest MS-SSI was achieved in 25dN images. CONCLUSIONS The DL-based N2N denoising model can be used effectively for images with low noise levels, but at increasing noise levels, this model may be insufficient to provide both the original structural features of the choroid and structural similarity to the original image.
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Affiliation(s)
- Furkan Kirik
- Department of Ophthalmology, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes (Vatan) Avenue, Fatih, Istanbul 34093, Turkiye.
| | - Farid Iskandarov
- Department of Ophthalmology, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes (Vatan) Avenue, Fatih, Istanbul 34093, Turkiye
| | - Kamile Melis Erturk
- Department of Ophthalmology, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes (Vatan) Avenue, Fatih, Istanbul 34093, Turkiye
| | - Hakan Ozdemir
- Department of Ophthalmology, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes (Vatan) Avenue, Fatih, Istanbul 34093, Turkiye
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Shi M, Sun JA, Lokhande A, Tian Y, Luo Y, Elze T, Shen LQ, Wang M. Artifact Correction in Retinal Nerve Fiber Layer Thickness Maps Using Deep Learning and Its Clinical Utility in Glaucoma. Transl Vis Sci Technol 2023; 12:12. [PMID: 37934137 PMCID: PMC10631515 DOI: 10.1167/tvst.12.11.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/15/2023] [Indexed: 11/08/2023] Open
Abstract
Purpose Correcting retinal nerve fiber layer thickness (RNFLT) artifacts in glaucoma with deep learning and evaluate its clinical usefulness. Methods We included 24,257 patients with optical coherence tomography and reliable visual field (VF) measurements within 30 days and 3,233 patients with reliable VF series of at least five measurements over ≥4 years. The artifacts are defined as RNFLT less than the known floor value of 50 µm. We selected 27,319 high-quality RNFLT maps with an artifact ratio (AR) of <2% as the ground truth. We created pseudo-artifacts from 21,722 low-quality RNFLT maps with AR of >5% and superimposed them on high-quality RNFLT maps to predict the artifact-free ground truth. We evaluated the impact of artifact correction on the structure-function relationship and progression forecasting. Results The mean absolute error and Pearson correlation of the artifact correction were 9.89 µm and 0.90 (P < 0.001), respectively. Artifact correction improved R2 for VF prediction in RNFLT maps with AR of >10% and AR of >20% up to 0.03 and 0.04 (P < 0.001), respectively. Artifact correction improved (P < 0.05) the AUC for progression prediction in RNFLT maps with AR of ≤10%, >10%, and >20%: (1) total deviation pointwise progression: 0.68 to 0.69, 0.62 to 0.63, and 0.62 to 0.64; and (2) mean deviation fast progression: 0.67 to 0.68, 0.54 to 0.60, and 0.45 to 0.56. Conclusions Artifact correction for RNFLTs improves VF and progression prediction in glaucoma. Translational Relevance Our model improves clinical usability of RNFLT maps with artifacts.
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Affiliation(s)
- Min Shi
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Jessica A. Sun
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Anagha Lokhande
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Yu Tian
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Yan Luo
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Tobias Elze
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Lucy Q. Shen
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Mengyu Wang
- Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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Li C, Yuan Y, Kong X, Han X, Zhang J, Xuan M, Yin Q, He M, Wang W. Segmentation Errors and Off-Center Artifacts in SS-OCT: Insight from a Population-Based Imaging Study. Curr Eye Res 2023; 48:949-955. [PMID: 37294109 DOI: 10.1080/02713683.2023.2223869] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/06/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE To evaluate the frequency and associated factors of artifacts in swept-source optical coherence tomography (SS-OCT) imaging. METHODS This was a population-based cross-sectional study. Individuals aged 35 years or older, residing in the Yuexiu district of Guangzhou, China, were recruited by random cluster sampling. Nearly half of the participants were randomly selected for SS-OCT imaging centered on the optic nerve head. Six types of artifacts in the peripapillary choroidal layer and retinal nerve fiber layer (RNFL) were graded and identified. Univariate and multivariate logistic regression analyses were used to investigate the association between the presence of artifacts and clinical characteristics. RESULTS Out of the 616 eligible individuals who underwent SS-OCT imaging, 18.3% and 13.6% of subjects exhibited at least one artifact in peripapillary RNFL (pRNFL) and peripapillary choroidal thickness (pCT) measurements, respectively, with posterior segmentation error and off-center artifact ranked as the most common artifacts. The presence of artifacts was significantly associated with age (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01-1.06; p = .003), refractive error (OR, 0.80; 95% CI, 0.71-0.89; p < .001), and signal strength (OR, 0.95; 95% CI, 0.90-0.997; p = .039) in pRNFL thickness measurement. Similarly, the presence of artifacts in pCT measurement was significantly associated with age (OR, 1.05; 95% CI, 1.03-1.08; p < .001), and refractive error (OR, 0.76; 95% CI, 0.68-0.86; p < .001). CONCLUSION Nearly one-fifth of the eyes were noted with at least one artifact in the population-scale SS-OCT study. Age was a risk factor for the presence of artifacts and should be considered in clinical settings.
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Affiliation(s)
- Cong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yixiong Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiangbin Kong
- Department of Ophthalmology, Affiliated Foshan Hospital, Southern Medical University, Foshan, China
| | - Xiaotong Han
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jian Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Meng Xuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Qiuxia Yin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Asrani S, Thompson AC. Which Optical Coherence Tomography Parameter, If Any, Identifies Glaucoma in High Myopia? JAMA Ophthalmol 2023; 141:639-640. [PMID: 37200010 DOI: 10.1001/jamaophthalmol.2023.1830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Affiliation(s)
- Sanjay Asrani
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Atalie C Thompson
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
- Atrium Health Wake Forest Baptist, Department of Surgical Ophthalmology, Winston-Salem, North Carolina
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Karn PK, Abdulla WH. On Machine Learning in Clinical Interpretation of Retinal Diseases Using OCT Images. Bioengineering (Basel) 2023; 10:bioengineering10040407. [PMID: 37106594 PMCID: PMC10135895 DOI: 10.3390/bioengineering10040407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
Optical coherence tomography (OCT) is a noninvasive imaging technique that provides high-resolution cross-sectional retina images, enabling ophthalmologists to gather crucial information for diagnosing various retinal diseases. Despite its benefits, manual analysis of OCT images is time-consuming and heavily dependent on the personal experience of the analyst. This paper focuses on using machine learning to analyse OCT images in the clinical interpretation of retinal diseases. The complexity of understanding the biomarkers present in OCT images has been a challenge for many researchers, particularly those from nonclinical disciplines. This paper aims to provide an overview of the current state-of-the-art OCT image processing techniques, including image denoising and layer segmentation. It also highlights the potential of machine learning algorithms to automate the analysis of OCT images, reducing time consumption and improving diagnostic accuracy. Using machine learning in OCT image analysis can mitigate the limitations of manual analysis methods and provide a more reliable and objective approach to diagnosing retinal diseases. This paper will be of interest to ophthalmologists, researchers, and data scientists working in the field of retinal disease diagnosis and machine learning. By presenting the latest advancements in OCT image analysis using machine learning, this paper will contribute to the ongoing efforts to improve the diagnostic accuracy of retinal diseases.
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Nakakura S, Asaoka R, Oogi S, Aoki R, Terao E, Ueda K, Kiuchi Y. Effect of idiopathic epiretinal membrane on macular ganglion cell complex measurement in eyes with glaucoma. Front Med (Lausanne) 2022; 9:972962. [PMID: 36388915 PMCID: PMC9644160 DOI: 10.3389/fmed.2022.972962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 10/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background/objectivesCo-existing idiopathic epiretinal membrane (ERM) and glaucoma complicate the estimation of glaucoma severity via optical coherence tomography (OCT). We investigated the effect of ERM and a new associated parameter, SUKIMA (space between the ERM and retinal surface), on ganglion cell complex (GCC) thickness in eyes with glaucoma, based on a matched comparison of visual field defects.Subjects/methodsWe retrospectively recruited 41 eyes from 34 glaucoma patients with idiopathic ERM and 41 eyes from 41 glaucoma patients without ERM as controls (matched by age, axial length, and mean visual field deviation). The thicknesses of GCC layers [retinal nerve fiber layer (RNFL), ganglion cell layer + inner plexiform layer (GCIPL), and GCC (RNFL + GCIPL)] were measured with swept-source OCT. We investigated the presence of SUKIMA and its effect on GCC measurements.ResultsRNFL, GCIPL, and GCC were thicker in ERM (+) eyes than in control eyes (31.0 ± 12.3 μm vs. 22.7 ± 10.8 μm, 62.6 ± 12.2 μm vs. 53.8 ± 5.9 μm, and 91.8 ± 16.6 μm vs. 76.8 ± 13.3 μm, respectively; P < 0.01). Eyes in the ERM-associated SUKIMA (+) group had thicker GCIPL and GCC than those in the ERM-associated SUKIMA (−) and control groups (P < 0.01).ConclusionERM-associated SUKIMA affects GCC thickness and can result in underestimations of glaucoma severity. We should check for the presence of ERM using a B mode scan as well as check for the SKIMA sign.
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Affiliation(s)
- Shunsuke Nakakura
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan
- *Correspondence: Shunsuke Nakakura,
| | - Ryo Asaoka
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
- Department of Nursing, Seirei Christopher University, Hamamatsu, Japan
- Nanovision Research Division, Research Institute of Electronics, Shizuoka University, Shizuoka, Japan
- The Graduate School for the Creation of New Photonics Industries, Hamamatsu, Japan
- Ryo Asaoka,
| | - Satomi Oogi
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan
| | - Ryota Aoki
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan
| | - Etsuko Terao
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan
| | - Kanae Ueda
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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10
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Yamane M, Ferreyra H, Xu BY, Weinreb RN, Camp AS. Detection of Nonglaucomatous Macula Findings With Ganglion Cell Analysis Printouts vs Full Macular Cube Scans. JAMA Ophthalmol 2022; 140:1002-1005. [PMID: 36074490 PMCID: PMC9459896 DOI: 10.1001/jamaophthalmol.2022.3450] [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: 05/05/2022] [Accepted: 07/19/2022] [Indexed: 11/14/2022]
Abstract
Importance Ganglion cell analysis (GCA) of ocular coherence tomography (OCT) imaging is routinely used to detect and monitor glaucomatous damage of the ganglion cell complex in the macula. The GCA printout provides qualitative and quantitative data about the macular ganglion cell-inner plexiform layer and a single B-scan of the retina through the fovea. However, the full macular cube scan, including all 128 B-scans, is available for review. The macular cube scan provides considerable information about nonglaucomatous ocular pathology that may be missed if clinicians review only the GCA printout. Objective To determine the frequency and type of nonglaucomatous macular findings that are observable in the full macular cube scan but not the GCA printout. Design, Setting, and Participants A retrospective cross-sectional analysis of GCA printouts and full macular cube scans to detect nonglaucomatous macular pathology at a tertiary care academic center. Consecutive patients undergoing ganglion cell complex imaging during routine glaucoma evaluations over a 1-week period in a multi-clinician glaucoma clinic. Main Outcomes and Measures The prevalence and type of nonglaucomatous macular pathology visible on the GCA printout or macular cube scan. Results Among 105 patients (mean (SD) age, 67 (15.46) years; 63 [60%] female and 42 [40%] male) 201 eyes were imaged (64 [31.7%] with suspected glaucoma, 126 [62.4%] with open-angle glaucoma, 6 [3.0%] with closed-angle glaucoma, and 6 [3.0%] with other glaucoma). GCA printouts and macular cube scans revealed nonglaucomatous macular pathology in 65 eyes (32.2%). Of these, 25 eyes (38.5%) included findings that were not visible on the GCA printout. Of the cases not visible on the printout, 16 eyes (64.0% ) included macular pathology that required further evaluation. Conclusions and Relevance The findings indicate that nonglaucomatous macular pathology may be missed based on GCA printouts alone. While it may be beneficial to review the full macular cube to detect potentially vision-threatening disease and ensure proper patient care, this study cannot determine if this missed pathology affects clinical outcomes.
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Affiliation(s)
- Maya Yamane
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego
| | - Henry Ferreyra
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego
| | - Benjamin Y. Xu
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles
| | - Robert N. Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego
| | - Andrew S. Camp
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego
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11
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Cheng W, Song Y, Lin F, Xiong J, Li F, Jin L, Wang Z, Yang C, Yang B, Wang F, Ning G, Wang W, Zhang X. Assessment of Artifacts in Swept-Source Optical Coherence Tomography Angiography for Glaucomatous and Normal Eyes. Transl Vis Sci Technol 2022; 11:23. [PMID: 35040917 PMCID: PMC8764211 DOI: 10.1167/tvst.11.1.23] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the frequency of and identify the factors that influence the artifacts of swept-source optical coherence tomography angiography (SS-OCTA) in glaucomatous and normal eyes. Methods Artifacts of OCTA images of open-angle glaucoma (OAG) and normal subjects were analyzed using SS-OCTA. Univariate and multivariate logistic regression analyses were performed to evaluate the association of age, sex, best-corrected visual acuity, axial length (AL), intraocular pressure, presence and severity of OAG, and image quality score (IQS) with the presence of artifacts. Results Images from 4426 subjects were included in the study. At least one type of artifact was present in 24.54% of the images. The most common artifacts were occurrence of motion (705 eyes, 15.93%), followed by defocus (628 eyes, 14.19%), decentration (134 eyes, 3.03%), masking (62 eyes,1.40%), and segmentation errors (23 eyes, 0.52%). Multivariate logistic analyses showed that the presence of OAG (odds ratio [OR] = 2.71; 95% confidence interval [CI], 2.09-3.51; P < 0.001), female sex (OR = 1.34; 95% CI, 1.12-1.61; P = 0.001), longer AL (OR = 1.09; 95% CI, 1.02-1.17; P = 0.017), and IQS < 40 (OR = 3.75; 95% CI, 3.15-4.48; P < 0.001) were significantly associated with higher odds for the presence of any artifact. The IQS had poor performance for detecting artifacts, with an area under the curve of 0.723, sensitivity of 73.04%, and specificity of 62.53%. Conclusions OAG eyes had more SS-OCTA image artifacts than normal eyes. IQS is an imperfect tool for identifying artifacts. Translational Relevance Special attention should be paid to the effect of artifacts when using SS-OCTA in the clinical setting to assess vascular parameters in patients with glaucoma.
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Affiliation(s)
- Weijing Cheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Yunhe Song
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Fengbin Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Jian Xiong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Fei Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Zhenyu Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Chunman Yang
- Department of Ophthalmology, The Second Affiliated Hospital of Guizhou Medical University, Guizhou, China
| | - Bin Yang
- Department of Ophthalmology, Zigong Third People's Hospital, Zigong, China
| | - Fanyin Wang
- Department of Ophthalmology, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, China
| | - Guili Ning
- Department of Ophthalmology, Guizhou Aerospace Hospital, Zunyi, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
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12
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LePosa AC, Cason D, Arteaga R. Case Report: Longitudinal Effect of Progressive Epiretinal Membrane on the Retinal Nerve Fiber Layer. Optom Vis Sci 2022; 99:82-87. [PMID: 34882602 DOI: 10.1097/opx.0000000000001832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Epiretinal membrane is a common macular pathology known to cause morphologic changes observed on macular optical coherence tomography (OCT) and retinal nerve fiber layer (RNFL) OCT. However, the longitudinal effect of epiretinal membrane progression on RNFL OCT morphology is not well studied. PURPOSE This report documents a case of epiretinal membrane progression with associated quantifiable changes to the RNFL OCT over time. CASE REPORT A 63-year-old man initially presented in 2014 with a grade 0 epiretinal membrane in his left eye and low suspicion of glaucoma in both eyes. Over the next 6 years, his left eye's epiretinal membrane gradually worsened. Along with this change, the RNFL OCT started to show areas of adjacent suspected RNFL thickening and thinning compared with baseline per guided progression analysis (GPA). Despite this, clinical suspicion for actual glaucomatous progression was low. Closer retrospective analysis suggested that the RNFL was continuously dragged temporally toward the macula over this period. Because of traction, values such as the angular location, width, and peak thickness of the inferior RNFL bundles changed. This dynamic shift of a typically stationary structure contributed to an inability to rely on the RNFL OCT GPA to correctly stratify concern for glaucomatous progression. CONCLUSIONS Both macular and RNFL OCT allow us to observe morphologic changes to the retina caused by epiretinal membrane. Other authors have described this phenomenon, but this case demonstrates the continual change over time, suggestive of a dynamic process that requires continuous awareness and monitoring. Clinicians should be especially aware of this phenomenon when a patient is also suspicious of glaucoma. These RNFL changes can make it more problematic to rely on the OCT GPA to determine early progressive glaucomatous changes to the RNFL.
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Affiliation(s)
| | - Daniel Cason
- Baltimore VA Medical Center, Baltimore, Maryland
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13
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Dysli C, Dysli M, Lincke J, Jaggi D, Wolf S, Zinkernagel MS. IMAGING ARTIFACTS IN FLUORESCENCE LIFETIME IMAGING OPHTHALMOSCOPY. Retina 2021; 41:2378-2390. [PMID: 34111887 DOI: 10.1097/iae.0000000000003235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate and quantify the influence of imaging artifacts on retinal fluorescence lifetime (FLIO) values and to provide helpful hints and tricks to avoid imaging artifacts and to improve FLIO image acquisition quality. METHODS A systematic analysis of potential parameters influencing FLIO quality and/or fluorescence lifetime values was performed in a prospective systematic experimental imaging study in five eyes of five healthy subjects. For image acquisition, a fluorescence lifetime imaging ophthalmoscope (Heidelberg Engineering) was used. Quantitative analysis of FLIO lifetime changes due to imaging artifacts was performed. RESULTS Imaging artifacts with significant influence on fluorescence lifetimes included too short image acquisition time, insufficient illumination, ocular surface problems, and image defocus. Prior use of systemic or topical fluorescein makes analysis of retinal fluorescence lifetimes impossible. CONCLUSION Awareness of possible sources of imaging artifacts is important for FLIO image acquisition and analysis. Therefore, standardized imaging and analysis procedure in FLIO is crucial for high-quality image acquisition and the possibility for systematic quantitative fluorescence lifetime analysis.
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Affiliation(s)
- Chantal Dysli
- Department of Ophthalmology, Inselspital, Bern University Hospital, Bern, Switzerland; and
- Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - Muriel Dysli
- Department of Ophthalmology, Inselspital, Bern University Hospital, Bern, Switzerland; and
- Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - Joel Lincke
- Department of Ophthalmology, Inselspital, Bern University Hospital, Bern, Switzerland; and
- Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - Damian Jaggi
- Department of Ophthalmology, Inselspital, Bern University Hospital, Bern, Switzerland; and
- Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - Sebastian Wolf
- Department of Ophthalmology, Inselspital, Bern University Hospital, Bern, Switzerland; and
- Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - Martin S Zinkernagel
- Department of Ophthalmology, Inselspital, Bern University Hospital, Bern, Switzerland; and
- Department of BioMedical Research, University of Bern, Bern, Switzerland
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