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Rojas-Carabali W, Cifuentes-González C, Gutierrez-Sinisterra L, Heng LY, Tsui E, Gangaputra S, Sadda S, Nguyen QD, Kempen JH, Pavesio CE, Gupta V, Raman R, Miao C, Lee B, de-la-Torre A, Agrawal R. Managing a patient with uveitis in the era of artificial intelligence: Current approaches, emerging trends, and future perspectives. Asia Pac J Ophthalmol (Phila) 2024:100082. [PMID: 39019261 DOI: 10.1016/j.apjo.2024.100082] [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: 05/11/2024] [Revised: 06/30/2024] [Accepted: 07/04/2024] [Indexed: 07/19/2024] Open
Abstract
The integration of artificial intelligence (AI) with healthcare has opened new avenues for diagnosing, treating, and managing medical conditions with remarkable precision. Uveitis, a diverse group of rare eye conditions characterized by inflammation of the uveal tract, exemplifies the complexities in ophthalmology due to its varied causes, clinical presentations, and responses to treatments. Uveitis, if not managed promptly and effectively, can lead to significant visual impairment. However, its management requires specialized knowledge, which is often lacking, particularly in regions with limited access to health services. AI's capabilities in pattern recognition, data analysis, and predictive modelling offer significant potential to revolutionize uveitis management. AI can classify disease etiologies, analyze multimodal imaging data, predict outcomes, and identify new therapeutic targets. However, transforming these AI models into clinical applications and meeting patient expectations involves overcoming challenges like acquiring extensive, annotated datasets, ensuring algorithmic transparency, and validating these models in real-world settings. This review delves into the complexities of uveitis and the current AI landscape, discussing the development, opportunities, and challenges of AI from theoretical models to bedside application. It also examines the epidemiology of uveitis, the global shortage of uveitis specialists, and the disease's socioeconomic impacts, underlining the critical need for AI-driven approaches. Furthermore, it explores the integration of AI in diagnostic imaging and future directions in ophthalmology, aiming to highlight emerging trends that could transform management of a patient with uveitis and suggesting collaborative efforts to enhance AI applications in clinical practice.
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Affiliation(s)
- William Rojas-Carabali
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore.
| | - Carlos Cifuentes-González
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore.
| | - Laura Gutierrez-Sinisterra
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore.
| | - Lim Yuan Heng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
| | - Edmund Tsui
- Stein Eye Institute, David Geffen of Medicine at UCLA, Los Angeles, CA, USA.
| | - Sapna Gangaputra
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Srinivas Sadda
- Doheny Eye Institute, David Geffen of Medicine at UCLA, Los Angeles, CA, USA.
| | | | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear/Harvard Medical School; and Schepens Eye Research Institute; Boston, MA, USA; Department of Ophthalmology, Myungsung Medical College/MCM Comprehensive Specialized Hospital, Addis Abeba, Ethiopia; Sight for Souls, Bellevue, WA, USA.
| | | | - Vishali Gupta
- Advanced Eye Centre, Post, graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Rajiv Raman
- Department of Ophthalmology, Sankara Nethralaya, Chennai, India.
| | - Chunyan Miao
- School of Computer Science and Engineering at Nanyang Technological University, Singapore.
| | - Bernett Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
| | - Alejandra de-la-Torre
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.
| | - Rupesh Agrawal
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore; Singapore Eye Research Institute, Singapore; Duke NUS Medical School, Singapore.
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Stanescu-Segall D, Sales de Gauzy T, Reynolds R, Faes L, Pohlmann D, Pakzad-Vaezi K, Ting D, Saadoun D, Ambati J, Loewenstein A, Bodaghi B, de Smet MD, Touhami S. Expert opinion on the management and follow-up of uveitis patients during SARS-CoV-2 outbreak. Expert Rev Clin Immunol 2020; 16:651-657. [PMID: 32615046 DOI: 10.1080/1744666x.2020.1791086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Routine medical and ophthalmic care is being drastically curtailed in the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Uveitis patients require particular attention because of their theoretical risk of viral infection, in the context of therapeutic immunosuppression. AREAS COVERED This collaborative work proposes practical management and follow-up criteria for uveitis patients in the context of the ongoing SARS-CoV-2 pandemic. EXPERT OPINION Management should proceed as usual when access to health care possible in patients who do not belong to a group at high risk of severe SARS-CoV-2 infection, and in uncontrolled uveitis cases. In case of reduced access to eye clinics or high risk of SARS-CoV-2 infection, patients' management should be stratified based on their clinical presentation. In non-severe uveitis cases, the use of systemic steroids should be avoided, and local steroids preferred whenever possible. In uncontrolled situations where there is real risk of permanent visual loss, high-dose intravenous steroids and/or systemic immunosuppressants and/or biotherapies can be administered depending on the severity of eye disease. Immunosuppressive therapy should not be withheld, unless the patient develops SARS-CoV2 infection.
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Affiliation(s)
- Dinu Stanescu-Segall
- Department of Ophthalmology, IHU FOReSIGHT, Sorbonne University-APHP , Paris, France
| | - Thomas Sales de Gauzy
- Department of Ophthalmology, IHU FOReSIGHT, Sorbonne University-APHP , Paris, France
| | - Rhianon Reynolds
- Department of Ophthalmology, Aneurin Bevan University Health Board , Newport, UK
| | - Livia Faes
- Department of Ophthalmology, Cantonal Hospital Lucerne , Lucerne, Switzerland
| | - Dominika Pohlmann
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health , Berlin, Germany
| | - Kaivon Pakzad-Vaezi
- Department of Ophthalmology and Visual Sciences, University of British Columbia , Vancouver, Canada
| | - Daniel Ting
- Singapore National Eye Center , Singapore, Singapore
| | - David Saadoun
- Department of Internal Medicine, Pitié Salpétrière University Hospital, Sorbonne University-APHP , Paris, France
| | - Jayakrishna Ambati
- Center for Advanced Vision Science, Department of Ophthalmology, Department of Pathology, Department of Microbiology, Immunology, and Cancer Biology, University of Virginia School of Medicine , Charlottesville, VA, USA
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Bahram Bodaghi
- Department of Ophthalmology, IHU FOReSIGHT, Sorbonne University-APHP , Paris, France
| | - Marc D de Smet
- Department of Ophthalmology, University of Leiden, the Netherlands; MIOS - Retina and Ocular Inflammation Center , Lausanne, Switzerland
| | - Sara Touhami
- Department of Ophthalmology, IHU FOReSIGHT, Sorbonne University-APHP , Paris, France
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Safadi K, Kruger JM, Chowers I, Solomon A, Amer R, Aweidah H, Frenkel S, Mechoulam H, Anteby I, Ben Eli H, Lavy I, Jaouni T, Landau D, Tiosano L, Greifner G, Ofir S, Levi Vineberg T, Levy J. Ophthalmology practice during the COVID-19 pandemic. BMJ Open Ophthalmol 2020; 5:e000487. [PMID: 32432169 PMCID: PMC7222613 DOI: 10.1136/bmjophth-2020-000487] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To present an established practice protocol for safe and effective hospital-setting ophthalmic practice during the coronavirus disease 2019 (COVID-19) pandemic. METHODS AND ANALYSIS Literature was reviewed to identify articles relevant to COVID-19 pandemic and ophthalmology. The following keywords were used: COVID-19, SARS-CoV-2 and telemedicine, combined with eye, ophthalmology, conjunctivitis and tears. Data were extracted from the identified manuscripts and discussed among subspecialists to obtain consensus evidence-based practice. RESULTS A protocol for ophthalmic practice in the era of COVID-19 pandemic was established. The protocol covered patient screening, clinic flow, required personal protective equipment and modifications of ophthalmic equipment for improved safety. CONCLUSION Important literature emerged with respect to the practice of ophthalmology in the era of COVID-19. An evidence-based ophthalmic practice protocol was established and should be modified in the future to accommodate new insights on the COVID-19 pandemic.
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Affiliation(s)
- Khaled Safadi
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Joshua M Kruger
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Itay Chowers
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Abraham Solomon
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Radgonde Amer
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Hamzah Aweidah
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Shahar Frenkel
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Hadas Mechoulam
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Irene Anteby
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Hadas Ben Eli
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Itay Lavy
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Tarek Jaouni
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - David Landau
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Liran Tiosano
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Gabriel Greifner
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Shay Ofir
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | | | - Jaime Levy
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
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de Andrade FA, Fiorot SHS, Benchimol EI, Provenzano J, Martins VJ, Levy RA. The autoimmune diseases of the eyes. Autoimmun Rev 2016; 15:258-71. [DOI: 10.1016/j.autrev.2015.12.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 11/27/2015] [Indexed: 02/06/2023]
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Gutman DA, Dunn WD, Cobb J, Stoner RM, Kalpathy-Cramer J, Erickson B. Web based tools for visualizing imaging data and development of XNATView, a zero footprint image viewer. Front Neuroinform 2014; 8:53. [PMID: 24904399 PMCID: PMC4034701 DOI: 10.3389/fninf.2014.00053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 04/29/2014] [Indexed: 11/13/2022] Open
Abstract
Advances in web technologies now allow direct visualization of imaging data sets without necessitating the download of large file sets or the installation of software. This allows centralization of file storage and facilitates image review and analysis. XNATView is a light framework recently developed in our lab to visualize DICOM images stored in The Extensible Neuroimaging Archive Toolkit (XNAT). It consists of a PyXNAT-based framework to wrap around the REST application programming interface (API) and query the data in XNAT. XNATView was developed to simplify quality assurance, help organize imaging data, and facilitate data sharing for intra- and inter-laboratory collaborations. Its zero-footprint design allows the user to connect to XNAT from a web browser, navigate through projects, experiments, and subjects, and view DICOM images with accompanying metadata all within a single viewing instance.
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Affiliation(s)
- David A Gutman
- Department of Biomedical Informatics, Emory University Atlanta, GA, USA
| | - William D Dunn
- Department of Biomedical Informatics, Emory University Atlanta, GA, USA
| | - Jake Cobb
- Georgia Institute of Technology, College of Computing Atlanta, GA, USA
| | - Richard M Stoner
- Department of Neurosciences, University of California San Diego School of Medicine La Jolla, CA, USA
| | - Jayashree Kalpathy-Cramer
- Harvard-MIT Division of Health Sciences and Technology, Martinos Center for Biomedical Imaging Charlestown, MA, USA
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Gupta V, Al-Dhibi HA, Arevalo JF. Retinal imaging in uveitis. Saudi J Ophthalmol 2014; 28:95-103. [PMID: 24843301 DOI: 10.1016/j.sjopt.2014.02.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 02/24/2014] [Indexed: 11/25/2022] Open
Abstract
Ancillary investigations are the backbone of uveitis workup for posterior segment inflammations. They help in establishing the differential diagnosis and making certain diagnosis by ruling out certain pathologies and are a useful aid in monitoring response to therapy during follow-up. These investigations include fundus photography including ultra wide field angiography, fundus autofluorescence imaging, fluorescein angiography, optical coherence tomography and multimodal imaging. This review aims to be an overview describing the role of these retinal investigations for posterior uveitis.
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Affiliation(s)
- Vishali Gupta
- Vitreoretinal and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Hassan A Al-Dhibi
- Vitreoretinal and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - J Fernando Arevalo
- Vitreoretinal and Uveitis Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia ; Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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de Smet MD. Image diagnostic agreement in uveitis: a picture is worth a thousand words but is it sufficient to diagnose? Can J Ophthalmol 2013; 48:223-5. [PMID: 23931457 DOI: 10.1016/j.jcjo.2013.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 06/03/2013] [Indexed: 10/26/2022]
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