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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 2024:101291. [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, Wisconsin, 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, Florida, 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, California, 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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Huang L, Zhang N, Yi Y, Zhou W, Zhou B, Dai J, Wang J. SAMCF: Adaptive global style alignment and multi-color spaces fusion for joint optic cup and disc segmentation. Comput Biol Med 2024; 178:108639. [PMID: 38878394 DOI: 10.1016/j.compbiomed.2024.108639] [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: 01/26/2024] [Revised: 04/21/2024] [Accepted: 05/18/2024] [Indexed: 07/24/2024]
Abstract
The optic cup (OC) and optic disc (OD) are two critical structures in retinal fundus images, and their relative positions and sizes are essential for effectively diagnosing eye diseases. With the success of deep learning in computer vision, deep learning-based segmentation models have been widely used for joint optic cup and disc segmentation. However, there are three prominent issues that impact the segmentation performance. First, significant differences among datasets collecting from various institutions, protocols, and devices lead to performance degradation of models. Second, we find that images with only RGB information struggle to counteract the interference caused by brightness variations, affecting color representation capability. Finally, existing methods typically ignored the edge perception, facing the challenges in obtaining clear and smooth edge segmentation results. To address these drawbacks, we propose a novel framework based on Style Alignment and Multi-Color Fusion (SAMCF) for joint OC and OD segmentation. Initially, we introduce a domain generalization method to generate uniformly styled images without damaged image content for mitigating domain shift issues. Next, based on multiple color spaces, we propose a feature extraction and fusion network aiming to handle brightness variation interference and improve color representation capability. Lastly, an edge aware loss is designed to generate fine edge segmentation results. Our experiments conducted on three public datasets, DGS, RIM, and REFUGE, demonstrate that our proposed SAMCF achieves superior performance to existing state-of-the-art methods. Moreover, SAMCF exhibits remarkable generalization ability across multiple retinal fundus image datasets, showcasing its outstanding generality.
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Affiliation(s)
- Longjun Huang
- School of Software, Nanchang Key Laboratory for Blindness and Visual Impairment Prevention Technology and Equipment, Jiangxi Normal University, Nanchang, 330022, China
| | - Ningyi Zhang
- School of Software, Nanchang Key Laboratory for Blindness and Visual Impairment Prevention Technology and Equipment, Jiangxi Normal University, Nanchang, 330022, China
| | - Yugen Yi
- School of Software, Nanchang Key Laboratory for Blindness and Visual Impairment Prevention Technology and Equipment, Jiangxi Normal University, Nanchang, 330022, China.
| | - Wei Zhou
- College of Computer Science, Shenyang Aerospace University, Shenyang, 110136, China
| | - Bin Zhou
- School of Software, Nanchang Key Laboratory for Blindness and Visual Impairment Prevention Technology and Equipment, Jiangxi Normal University, Nanchang, 330022, China
| | - Jiangyan Dai
- School of Computer Engineering, Weifang University, 261061, China.
| | - Jianzhong Wang
- College of Information Science and Technology, Northeast Normal University, Changchun, 130117, China
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Wang CY, Nguyen HT, Fan WS, Lue JH, Saenprasarn P, Chen MM, Huang SY, Lin FC, Wang HC. Glaucoma Detection through a Novel Hyperspectral Imaging Band Selection and Vision Transformer Integration. Diagnostics (Basel) 2024; 14:1285. [PMID: 38928700 PMCID: PMC11202918 DOI: 10.3390/diagnostics14121285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
Conventional diagnostic methods for glaucoma primarily rely on non-dynamic fundus images and often analyze features such as the optic cup-to-disc ratio and abnormalities in specific retinal locations like the macula and fovea. However, hyperspectral imaging techniques focus on detecting alterations in oxygen saturation within retinal vessels, offering a potentially more comprehensive approach to diagnosis. This study explores the diagnostic potential of hyperspectral imaging for glaucoma by introducing a novel hyperspectral imaging conversion technique. Digital fundus images are transformed into hyperspectral representations, allowing for a detailed analysis of spectral variations. Spectral regions exhibiting differences are identified through spectral analysis, and images are reconstructed from these specific regions. The Vision Transformer (ViT) algorithm is then employed for classification and comparison across selected spectral bands. Fundus images are used to identify differences in lesions, utilizing a dataset of 1291 images. This study evaluates the classification performance of models using various spectral bands, revealing that the 610-780 nm band outperforms others with an accuracy, precision, recall, F1-score, and AUC-ROC all approximately at 0.9007, indicating its superior effectiveness for the task. The RGB model also shows strong performance, while other bands exhibit lower recall and overall metrics. This research highlights the disparities between machine learning algorithms and traditional clinical approaches in fundus image analysis. The findings suggest that hyperspectral imaging, coupled with advanced computational techniques such as the ViT algorithm, could significantly enhance glaucoma diagnosis. This understanding offers insights into the potential transformation of glaucoma diagnostics through the integration of hyperspectral imaging and innovative computational methodologies.
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Affiliation(s)
- Ching-Yu Wang
- Department of Ophthalmology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan; (C.-Y.W.); (W.-S.F.)
| | - Hong-Thai Nguyen
- Department of Mechanical Engineering, National Chung Cheng University, Chiayi 62102, Taiwan;
| | - Wen-Shuang Fan
- Department of Ophthalmology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan; (C.-Y.W.); (W.-S.F.)
| | - Jiann-Hwa Lue
- Department of Optometry, Central Taiwan University of Science and Technology, No. 666, Buzih Road, Taichung City 406053, Taiwan; (J.-H.L.); (S.-Y.H.)
| | - Penchun Saenprasarn
- School of Nursing, Shinawatra University, 99 Moo 10, Bangtoey, Samkhok, Pathum Thani 12160, Thailand;
| | - Meei-Maan Chen
- Center for Innovative Research on Aging Society (CIRAS), National Chung Cheng University, 168, University Rd., Min Hsiung, Chiayi 62102, Taiwan;
| | - Shuan-Yu Huang
- Department of Optometry, Central Taiwan University of Science and Technology, No. 666, Buzih Road, Taichung City 406053, Taiwan; (J.-H.L.); (S.-Y.H.)
| | - Fen-Chi Lin
- Department of Ophthalmology, Kaohsiung Armed Forces General Hospital, 2, Zhongzheng 1st. Rd., Kaohsiung City 80284, Taiwan
| | - Hsiang-Chen Wang
- Department of Optometry, Central Taiwan University of Science and Technology, No. 666, Buzih Road, Taichung City 406053, Taiwan; (J.-H.L.); (S.-Y.H.)
- Hitspectra Intelligent Technology Co., Ltd., Kaohsiung City 80661, Taiwan
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Wada-Koike C, Terauchi R, Fukai K, Sano K, Nishijima E, Komatsu K, Ito K, Kato T, Tatemichi M, Kabata Y, Nakano T. Comparative Evaluation of Fundus Image Interpretation Accuracy in Glaucoma Screening Among Different Physician Groups. Clin Ophthalmol 2024; 18:583-589. [PMID: 38435375 PMCID: PMC10908285 DOI: 10.2147/opth.s453663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose To examine the variability in glaucoma screening using fundus images among physicians, including non-ophthalmologists. Patients and Methods Sixty-nine eyes from 69 patients, including 25 eyes with glaucoma, were included from the Jikei University Hospital from July 2019 to December 2022. Fundus images were captured using TRC-NW8 (Topcon Corporation, Tokyo, Japan), and were interpreted by 10 non-ophthalmologists, 10 non-specialist ophthalmologists, and 9 specialists for diagnostic accuracy. We analyzed differences in diagnostic accuracy among the three groups. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Kappa coefficient were compared, using the Kruskal-Wallis test followed by a post hoc Dunn's test. Results The sensitivity and specificity were 0.22 and 0.92 for non-ophthalmologists, 0.49 and 0.83 for non-specialist ophthalmologists, and 0.68 and 0.87 for specialists, respectively. Both specialists and non-specialist ophthalmologists showed significantly higher sensitivity than non-ophthalmologists (Dunn's test, P<0.001 and P=0.031). There was no significant difference in specificity among the three groups (Kruskal-Wallis test, P=0.086). The PPV did not differ significantly between the groups (Kruskal-Wallis test, P=0.108), while the NPV was significantly higher in specialists compared to non-ophthalmologists (Dunn's test, P<0.001). Specialists also had a significantly higher Kappa coefficient than non-ophthalmologists and non-specialist ophthalmologists (Dunn's test, P<0.001 and P=0.024). Conclusion Diagnostic accuracy varied significantly based on the physician's background.
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Affiliation(s)
- Chiharu Wada-Koike
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ryo Terauchi
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kota Fukai
- Department of Preventive Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Kei Sano
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
| | - Euido Nishijima
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
| | - Koji Komatsu
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kyoko Ito
- Centre for Preventive Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Tomohiro Kato
- Centre for Preventive Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Masayuki Tatemichi
- Department of Preventive Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Yoshiaki Kabata
- Department of Ophthalmology, Jikei University School of Medicine, Daisan Hospital, Tokyo, Japan
| | - Tadashi Nakano
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
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Vilela MAP, Arrigo A, Parodi MB, da Silva Mengue C. Smartphone Eye Examination: Artificial Intelligence and Telemedicine. Telemed J E Health 2024; 30:341-353. [PMID: 37585566 DOI: 10.1089/tmj.2023.0041] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Background: The current medical scenario is closely linked to recent progress in telecommunications, photodocumentation, and artificial intelligence (AI). Smartphone eye examination may represent a promising tool in the technological spectrum, with special interest for primary health care services. Obtaining fundus imaging with this technique has improved and democratized the teaching of fundoscopy, but in particular, it contributes greatly to screening diseases with high rates of blindness. Eye examination using smartphones essentially represents a cheap and safe method, thus contributing to public policies on population screening. This review aims to provide an update on the use of this resource and its future prospects, especially as a screening and ophthalmic diagnostic tool. Methods: In this review, we surveyed major published advances in retinal and anterior segment analysis using AI. We performed an electronic search on the Medical Literature Analysis and Retrieval System Online (MEDLINE), EMBASE, and Cochrane Library for published literature without a deadline. We included studies that compared the diagnostic accuracy of smartphone ophthalmoscopy for detecting prevalent diseases with an accurate or commonly employed reference standard. Results: There are few databases with complete metadata, providing demographic data, and few databases with sufficient images involving current or new therapies. It should be taken into consideration that these are databases containing images captured using different systems and formats, with information often being excluded without essential detailing of the reasons for exclusion, which further distances them from real-life conditions. The safety, portability, low cost, and reproducibility of smartphone eye images are discussed in several studies, with encouraging results. Conclusions: The high level of agreement between conventional and a smartphone method shows a powerful arsenal for screening and early diagnosis of the main causes of blindness, such as cataract, glaucoma, diabetic retinopathy, and age-related macular degeneration. In addition to streamlining the medical workflow and bringing benefits for public health policies, smartphone eye examination can make safe and quality assessment available to the population.
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Affiliation(s)
| | - Alessandro Arrigo
- Department of Ophthalmology, Scientific Institute San Raffaele, Milan, Italy
- University Vita-Salute, Milan, Italy
| | - Maurizio Battaglia Parodi
- Department of Ophthalmology, Scientific Institute San Raffaele, Milan, Italy
- University Vita-Salute, Milan, Italy
| | - Carolina da Silva Mengue
- Post-Graduation Ophthalmological School, Ivo Corrêa-Meyer/Cardiology Institute, Porto Alegre, Brazil
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Zhu Y, Salowe R, Chow C, Li S, Bastani O, O'Brien JM. Advancing Glaucoma Care: Integrating Artificial Intelligence in Diagnosis, Management, and Progression Detection. Bioengineering (Basel) 2024; 11:122. [PMID: 38391608 PMCID: PMC10886285 DOI: 10.3390/bioengineering11020122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
Glaucoma, the leading cause of irreversible blindness worldwide, comprises a group of progressive optic neuropathies requiring early detection and lifelong treatment to preserve vision. Artificial intelligence (AI) technologies are now demonstrating transformative potential across the spectrum of clinical glaucoma care. This review summarizes current capabilities, future outlooks, and practical translation considerations. For enhanced screening, algorithms analyzing retinal photographs and machine learning models synthesizing risk factors can identify high-risk patients needing diagnostic workup and close follow-up. To augment definitive diagnosis, deep learning techniques detect characteristic glaucomatous patterns by interpreting results from optical coherence tomography, visual field testing, fundus photography, and other ocular imaging. AI-powered platforms also enable continuous monitoring, with algorithms that analyze longitudinal data alerting physicians about rapid disease progression. By integrating predictive analytics with patient-specific parameters, AI can also guide precision medicine for individualized glaucoma treatment selections. Advances in robotic surgery and computer-based guidance demonstrate AI's potential to improve surgical outcomes and surgical training. Beyond the clinic, AI chatbots and reminder systems could provide patient education and counseling to promote medication adherence. However, thoughtful approaches to clinical integration, usability, diversity, and ethical implications remain critical to successfully implementing these emerging technologies. This review highlights AI's vast capabilities to transform glaucoma care while summarizing key achievements, future prospects, and practical considerations to progress from bench to bedside.
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Affiliation(s)
- Yan Zhu
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Rebecca Salowe
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Caven Chow
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Shuo Li
- Department of Computer & Information Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Osbert Bastani
- Department of Computer & Information Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Joan M O'Brien
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA
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Brown A, Cousins H, Cousins C, Esquenazi K, Elze T, Harris A, Filipowicz A, Barna L, Yonwook K, Vinod K, Chadha N, Altman RB, Coote M, Pasquale LR. Deep Learning for Localized Detection of Optic Disc Hemorrhages. Am J Ophthalmol 2023; 255:161-169. [PMID: 37490992 DOI: 10.1016/j.ajo.2023.07.007] [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: 02/25/2023] [Revised: 06/12/2023] [Accepted: 07/05/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE To develop an automated deep learning system for detecting the presence and location of disc hemorrhages in optic disc photographs. DESIGN Development and testing of a deep learning algorithm. METHODS Optic disc photos (597 images with at least 1 disc hemorrhage and 1075 images without any disc hemorrhage from 1562 eyes) from 5 institutions were classified by expert graders based on the presence or absence of disc hemorrhage. The images were split into training (n = 1340), validation (n = 167), and test (n = 165) datasets. Two state-of-the-art deep learning algorithms based on either object-level detection or image-level classification were trained on the dataset. These models were compared to one another and against 2 independent glaucoma specialists. We evaluated model performance by the area under the receiver operating characteristic curve (AUC). AUCs were compared with the Hanley-McNeil method. RESULTS The object detection model achieved an AUC of 0.936 (95% CI = 0.857-0.964) across all held-out images (n = 165 photographs), which was significantly superior to the image classification model (AUC = 0.845, 95% CI = 0.740-0.912; P = .006). At an operating point selected for high specificity, the model achieved a specificity of 94.3% and a sensitivity of 70.0%, which was statistically indistinguishable from an expert clinician (P = .7). At an operating point selected for high sensitivity, the model achieves a sensitivity of 96.7% and a specificity of 73.3%. CONCLUSIONS An autonomous object detection model is superior to an image classification model for detecting disc hemorrhages, and performed comparably to 2 clinicians.
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Affiliation(s)
- Aaron Brown
- From the Department of Ophthalmology (A.B., K.E., A.H., A.F., L.B., K.Y., K.V., N.C., L.R.P.), Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Ophthalmology (A.B., K.E., A.H., A.F., L.B., K.Y., K.V., N.C., L.R.P.), New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Henry Cousins
- Biomedical Data Science (H.C., R.B.A.), Stanford University, Stanford, California, USA
| | - Clara Cousins
- David Geffen School of Medicine, University of Los Angeles (C.C.), Los Angeles, California, USA
| | - Karina Esquenazi
- From the Department of Ophthalmology (A.B., K.E., A.H., A.F., L.B., K.Y., K.V., N.C., L.R.P.), Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Ophthalmology (A.B., K.E., A.H., A.F., L.B., K.Y., K.V., N.C., L.R.P.), New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Tobias Elze
- Department of Ophthalmology (T.E.), Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Alon Harris
- From the Department of Ophthalmology (A.B., K.E., A.H., A.F., L.B., K.Y., K.V., N.C., L.R.P.), Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Ophthalmology (A.B., K.E., A.H., A.F., L.B., K.Y., K.V., N.C., L.R.P.), New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Artur Filipowicz
- From the Department of Ophthalmology (A.B., K.E., A.H., A.F., L.B., K.Y., K.V., N.C., L.R.P.), Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Ophthalmology (A.B., K.E., A.H., A.F., L.B., K.Y., K.V., N.C., L.R.P.), New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Laura Barna
- From the Department of Ophthalmology (A.B., K.E., A.H., A.F., L.B., K.Y., K.V., N.C., L.R.P.), Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Ophthalmology (A.B., K.E., A.H., A.F., L.B., K.Y., K.V., N.C., L.R.P.), New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Kim Yonwook
- From the Department of Ophthalmology (A.B., K.E., A.H., A.F., L.B., K.Y., K.V., N.C., L.R.P.), Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Ophthalmology (A.B., K.E., A.H., A.F., L.B., K.Y., K.V., N.C., L.R.P.), New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Kateki Vinod
- From the Department of Ophthalmology (A.B., K.E., A.H., A.F., L.B., K.Y., K.V., N.C., L.R.P.), Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Ophthalmology (A.B., K.E., A.H., A.F., L.B., K.Y., K.V., N.C., L.R.P.), New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Nisha Chadha
- From the Department of Ophthalmology (A.B., K.E., A.H., A.F., L.B., K.Y., K.V., N.C., L.R.P.), Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Ophthalmology (A.B., K.E., A.H., A.F., L.B., K.Y., K.V., N.C., L.R.P.), New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA
| | - Russ B Altman
- Biomedical Data Science (H.C., R.B.A.), Stanford University, Stanford, California, USA
| | - Michael Coote
- Glaucoma Research Unit (M.C.), The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Louis R Pasquale
- From the Department of Ophthalmology (A.B., K.E., A.H., A.F., L.B., K.Y., K.V., N.C., L.R.P.), Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Ophthalmology (A.B., K.E., A.H., A.F., L.B., K.Y., K.V., N.C., L.R.P.), New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA.
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Khosravi P, Huck NA, Shahraki K, Hunter SC, Danza CN, Kim SY, Forbes BJ, Dai S, Levin AV, Binenbaum G, Chang PD, Suh DW. Deep Learning Approach for Differentiating Etiologies of Pediatric Retinal Hemorrhages: A Multicenter Study. Int J Mol Sci 2023; 24:15105. [PMID: 37894785 PMCID: PMC10606803 DOI: 10.3390/ijms242015105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/29/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Retinal hemorrhages in pediatric patients can be a diagnostic challenge for ophthalmologists. These hemorrhages can occur due to various underlying etiologies, including abusive head trauma, accidental trauma, and medical conditions. Accurate identification of the etiology is crucial for appropriate management and legal considerations. In recent years, deep learning techniques have shown promise in assisting healthcare professionals in making more accurate and timely diagnosis of a variety of disorders. We explore the potential of deep learning approaches for differentiating etiologies of pediatric retinal hemorrhages. Our study, which spanned multiple centers, analyzed 898 images, resulting in a final dataset of 597 retinal hemorrhage fundus photos categorized into medical (49.9%) and trauma (50.1%) etiologies. Deep learning models, specifically those based on ResNet and transformer architectures, were applied; FastViT-SA12, a hybrid transformer model, achieved the highest accuracy (90.55%) and area under the receiver operating characteristic curve (AUC) of 90.55%, while ResNet18 secured the highest sensitivity value (96.77%) on an independent test dataset. The study highlighted areas for optimization in artificial intelligence (AI) models specifically for pediatric retinal hemorrhages. While AI proves valuable in diagnosing these hemorrhages, the expertise of medical professionals remains irreplaceable. Collaborative efforts between AI specialists and pediatric ophthalmologists are crucial to fully harness AI's potential in diagnosing etiologies of pediatric retinal hemorrhages.
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Affiliation(s)
- Pooya Khosravi
- Department of Ophthalmology, School of Medicine, University of California, Irvine, CA 92697, USA; (P.K.); (N.A.H.); (K.S.); (C.N.D.)
- Gavin Herbert Eye Institute, University of California, Irvine, CA 92697, USA
- Donald Bren School of Information and Computer Sciences, University of California, Irvine, CA 92697, USA;
| | - Nolan A. Huck
- Department of Ophthalmology, School of Medicine, University of California, Irvine, CA 92697, USA; (P.K.); (N.A.H.); (K.S.); (C.N.D.)
- Gavin Herbert Eye Institute, University of California, Irvine, CA 92697, USA
| | - Kourosh Shahraki
- Department of Ophthalmology, School of Medicine, University of California, Irvine, CA 92697, USA; (P.K.); (N.A.H.); (K.S.); (C.N.D.)
- Gavin Herbert Eye Institute, University of California, Irvine, CA 92697, USA
| | - Stephen C. Hunter
- School of Medicine, University of California, 900 University Ave, Riverside, CA 92521, USA;
| | - Clifford Neil Danza
- Department of Ophthalmology, School of Medicine, University of California, Irvine, CA 92697, USA; (P.K.); (N.A.H.); (K.S.); (C.N.D.)
- Gavin Herbert Eye Institute, University of California, Irvine, CA 92697, USA
| | - So Young Kim
- Department of Ophthalmology, College of Medicine, Soonchunhyang University, Cheonan 31151, Chungcheongnam-do, Republic of Korea;
| | - Brian J. Forbes
- Division of Ophthalmology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (B.J.F.); (G.B.)
| | - Shuan Dai
- Department of Ophthalmology, Queensland Children’s Hospital, South Brisbane, QLD 4101, Australia;
| | - Alex V. Levin
- Department of Ophthalmology, Flaum Eye Institute, Golisano Children’s Hospital, Rochester, NY 14642, USA;
| | - Gil Binenbaum
- Division of Ophthalmology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (B.J.F.); (G.B.)
| | - Peter D. Chang
- Donald Bren School of Information and Computer Sciences, University of California, Irvine, CA 92697, USA;
- Department of Radiological Sciences, School of Medicine, University of California, Irvine, CA 92697, USA
| | - Donny W. Suh
- Department of Ophthalmology, School of Medicine, University of California, Irvine, CA 92697, USA; (P.K.); (N.A.H.); (K.S.); (C.N.D.)
- Gavin Herbert Eye Institute, University of California, Irvine, CA 92697, USA
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9
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Podnar B, Albreht T, Cvenkel B. Relative Importance of Glaucoma-Referral Indicators in Retinal Images in a Diabetic Retinopathy Screening Programme in Slovenia: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1441. [PMID: 37629731 PMCID: PMC10456555 DOI: 10.3390/medicina59081441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/26/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Glaucoma is a major cause of irreversible visual impairment and blindness, so its timely detection is crucial. Retinal images from diabetic retinopathy screening programmes (DRSP) provide an opportunity to detect undiagnosed glaucoma. Our aim was to find out which retinal image indicators are most suitable for referring DRSP patients for glaucoma assessment and to determine the glaucoma detection potential of Slovenian DRSP. Materials and Methods: We reviewed retinal images of patients from the DRSP at the University Medical Centre Ljubljana (November 2019-January 2020, May-August 2020). Patients with at least one indicator and some randomly selected patients without indicators were invited for an eye examination. Suspect glaucoma and glaucoma patients were considered accurately referred. Logistic regression (LOGIT) with patients as statistical units and generalised estimating equation with logistic regression (GEE) with eyes as statistical units were used to determine the referral accuracy of indicators. Results: Of the 2230 patients reviewed, 209 patients (10.1%) had at least one indicator on a retinal image of either one eye or both eyes. A total of 149 (129 with at least one indicator and 20 without) attended the eye exam. Seventy-nine (53.0%) were glaucoma negative, 54 (36.2%) suspect glaucoma, and 16 (10.7%) glaucoma positive. Seven glaucoma patients were newly detected. Neuroretinal rim notch predicted glaucoma in all cases. The cup-to-disc ratio was the most important indicator for accurate referral (odds ratio 7.59 (95% CI 3.98-14.47; p < 0.001) and remained statistically significant multivariably. Family history of glaucoma also showed an impact (odds ratio 3.06 (95% CI 1.02-9.19; p = 0.046) but remained statistically significant only in the LOGIT multivariable model. Other indicators and confounders were not statistically significant in the multivariable models. Conclusions: Our results suggest that the neuroretinal rim notch and cup-to-disc ratio are the most important for accurate glaucoma referral from retinal images in DRSP. Approximately half of the glaucoma cases in DRSPs may be undiagnosed.
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Affiliation(s)
- Barbara Podnar
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (T.A.); (B.C.)
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Tit Albreht
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (T.A.); (B.C.)
- National Institute of Public Health, 1000 Ljubljana, Slovenia
| | - Barbara Cvenkel
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia; (T.A.); (B.C.)
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
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10
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Al-Hammuri K, Gebali F, Kanan A, Chelvan IT. Vision transformer architecture and applications in digital health: a tutorial and survey. Vis Comput Ind Biomed Art 2023; 6:14. [PMID: 37428360 DOI: 10.1186/s42492-023-00140-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/30/2023] [Indexed: 07/11/2023] Open
Abstract
The vision transformer (ViT) is a state-of-the-art architecture for image recognition tasks that plays an important role in digital health applications. Medical images account for 90% of the data in digital medicine applications. This article discusses the core foundations of the ViT architecture and its digital health applications. These applications include image segmentation, classification, detection, prediction, reconstruction, synthesis, and telehealth such as report generation and security. This article also presents a roadmap for implementing the ViT in digital health systems and discusses its limitations and challenges.
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Affiliation(s)
- Khalid Al-Hammuri
- Electrical and Computer Engineering, University of Victoria, Victoria, V8W 2Y2, Canada.
| | - Fayez Gebali
- Electrical and Computer Engineering, University of Victoria, Victoria, V8W 2Y2, Canada
| | - Awos Kanan
- Computer Engineering, Princess Sumaya University for Technology, Amman, 11941, Jordan
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11
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Ji Y, Ji Y, Liu Y, Zhao Y, Zhang L. Research progress on diagnosing retinal vascular diseases based on artificial intelligence and fundus images. Front Cell Dev Biol 2023; 11:1168327. [PMID: 37056999 PMCID: PMC10086262 DOI: 10.3389/fcell.2023.1168327] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
As the only blood vessels that can directly be seen in the whole body, pathological changes in retinal vessels are related to the metabolic state of the whole body and many systems, which seriously affect the vision and quality of life of patients. Timely diagnosis and treatment are key to improving vision prognosis. In recent years, with the rapid development of artificial intelligence, the application of artificial intelligence in ophthalmology has become increasingly extensive and in-depth, especially in the field of retinal vascular diseases. Research study results based on artificial intelligence and fundus images are remarkable and provides a great possibility for early diagnosis and treatment. This paper reviews the recent research progress on artificial intelligence in retinal vascular diseases (including diabetic retinopathy, hypertensive retinopathy, retinal vein occlusion, retinopathy of prematurity, and age-related macular degeneration). The limitations and challenges of the research process are also discussed.
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Affiliation(s)
- Yuke Ji
- The Laboratory of Artificial Intelligence and Bigdata in Ophthalmology, Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China
| | - Yun Ji
- Affiliated Hospital of Shandong University of traditional Chinese Medicine, Jinan, Shandong, China
| | - Yunfang Liu
- Department of Ophthalmology, The First People’s Hospital of Huzhou, Huzhou, Zhejiang, China
| | - Ying Zhao
- Affiliated Hospital of Shandong University of traditional Chinese Medicine, Jinan, Shandong, China
- *Correspondence: Liya Zhang, ; Ying Zhao,
| | - Liya Zhang
- Department of Ophthalmology, The First People’s Hospital of Huzhou, Huzhou, Zhejiang, China
- *Correspondence: Liya Zhang, ; Ying Zhao,
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12
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Saraiva SM, Martín-Banderas L, Durán-Lobato M. Cannabinoid-Based Ocular Therapies and Formulations. Pharmaceutics 2023; 15:pharmaceutics15041077. [PMID: 37111563 PMCID: PMC10146987 DOI: 10.3390/pharmaceutics15041077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
The interest in the pharmacological applications of cannabinoids is largely increasing in a wide range of medical areas. Recently, research on its potential role in eye conditions, many of which are chronic and/or disabling and in need of new alternative treatments, has intensified. However, due to cannabinoids’ unfavorable physicochemical properties and adverse systemic effects, along with ocular biological barriers to local drug administration, drug delivery systems are needed. Hence, this review focused on the following: (i) identifying eye disease conditions potentially subject to treatment with cannabinoids and their pharmacological role, with emphasis on glaucoma, uveitis, diabetic retinopathy, keratitis and the prevention of Pseudomonas aeruginosa infections; (ii) reviewing the physicochemical properties of formulations that must be controlled and/or optimized for successful ocular administration; (iii) analyzing works evaluating cannabinoid-based formulations for ocular administration, with emphasis on results and limitations; and (iv) identifying alternative cannabinoid-based formulations that could potentially be useful for ocular administration strategies. Finally, an overview of the current advances and limitations in the field, the technological challenges to overcome and the prospective further developments, is provided.
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Affiliation(s)
- Sofia M. Saraiva
- CPIRN-IPG—Center of Potential and Innovation of Natural Resources, Polytechnic Institute of Guarda, Av. Dr. Francisco de Sá Carneiro, No. 50, 6300-559 Guarda, Portugal
| | - Lucía Martín-Banderas
- Departamento Farmacia y Tecnología Farmacéutica, Facultad de Farmacia, Universidad de Sevilla, C/Prof. García González n °2, 41012 Sevilla, Spain;
- Instituto de Biomedicina de Sevilla (IBIS), Campus Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain
- Correspondence: ; Tel.: +34-954556754
| | - Matilde Durán-Lobato
- Departamento Farmacia y Tecnología Farmacéutica, Facultad de Farmacia, Universidad de Sevilla, C/Prof. García González n °2, 41012 Sevilla, Spain;
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13
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A novel biosensing platform for detection of glaucoma biomarker GDF15 via an integrated BLI-ELASA strategy. Biomaterials 2023; 294:121997. [PMID: 36638554 DOI: 10.1016/j.biomaterials.2023.121997] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/26/2022] [Accepted: 01/07/2023] [Indexed: 01/11/2023]
Abstract
Glaucoma is a leading cause of irreversible blindness worldwide. Early discovery and prioritized intervention significantly impact its prognosis. Precise monitoring of the biomarker GDF15 contributes towards effective diagnosis and assessment of glaucoma. In this study, we demonstrate that GDF15 monitoring can also aid screening for glaucoma risk and early diagnosis. We obtained an aptamer (APT2TM) with high affinity, high specificity, and high stability for binding to both human-derived and rat-derived GDF15. Simulation results showed that the binding capabilities of APT2TM are mainly affected by the interplay between van der Waals forces and polar solvation energy, and that salt bridges and hydrogen bonds play critical roles. We then integrated an enzyme-linked aptamer sandwich assay (ELASA) into a biolayer interferometry (BLI) system to develop an automated, high-throughput, real-time monitoring BLI-ELASA biosensing platform. This platform exhibited a wide linear detection window (10-810 pg/mL range) and high sensitivity for GDF15 (detection limit of 5-6 pg/mL). Moreover, we confirmed its excellent performance when applied to GDF15 quantification in real samples from glaucomatous rats and clinical patients. We believe that this technology represents a robust, convenient, and cost-effective approach for risk screening, early diagnosis, and animal modeling evaluation of glaucoma in the near future.
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