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Williamson DJ, Struyven RR, Antaki F, Chia MA, Wagner SK, Jhingan M, Wu Z, Guymer R, Skene SS, Tammuz N, Thomson B, Chopra R, Keane PA. Artificial Intelligence to Facilitate Clinical Trial Recruitment in Age-Related Macular Degeneration. OPHTHALMOLOGY SCIENCE 2024; 4:100566. [PMID: 39139546 PMCID: PMC11321286 DOI: 10.1016/j.xops.2024.100566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/30/2024] [Accepted: 06/10/2024] [Indexed: 08/15/2024]
Abstract
Objective Recent developments in artificial intelligence (AI) have positioned it to transform several stages of the clinical trial process. In this study, we explore the role of AI in clinical trial recruitment of individuals with geographic atrophy (GA), an advanced stage of age-related macular degeneration, amidst numerous ongoing clinical trials for this condition. Design Cross-sectional study. Subjects Retrospective dataset from the INSIGHT Health Data Research Hub at Moorfields Eye Hospital in London, United Kingdom, including 306 651 patients (602 826 eyes) with suspected retinal disease who underwent OCT imaging between January 1, 2008 and April 10, 2023. Methods A deep learning model was trained on OCT scans to identify patients potentially eligible for GA trials, using AI-generated segmentations of retinal tissue. This method's efficacy was compared against a traditional keyword-based electronic health record (EHR) search. A clinical validation with fundus autofluorescence (FAF) images was performed to calculate the positive predictive value of this approach, by comparing AI predictions with expert assessments. Main Outcome Measures The primary outcomes included the positive predictive value of AI in identifying trial-eligible patients, and the secondary outcome was the intraclass correlation between GA areas segmented on FAF by experts and AI-segmented OCT scans. Results The AI system shortlisted a larger number of eligible patients with greater precision (1139, positive predictive value: 63%; 95% confidence interval [CI]: 54%-71%) compared with the EHR search (693, positive predictive value: 40%; 95% CI: 39%-42%). A combined AI-EHR approach identified 604 eligible patients with a positive predictive value of 86% (95% CI: 79%-92%). Intraclass correlation of GA area segmented on FAF versus AI-segmented area on OCT was 0.77 (95% CI: 0.68-0.84) for cases meeting trial criteria. The AI also adjusts to the distinct imaging criteria from several clinical trials, generating tailored shortlists ranging from 438 to 1817 patients. Conclusions This study demonstrates the potential for AI in facilitating automated prescreening for clinical trials in GA, enabling site feasibility assessments, data-driven protocol design, and cost reduction. Once treatments are available, similar AI systems could also be used to identify individuals who may benefit from treatment. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Dominic J. Williamson
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Centre for Medical Image Computing, University College London, London, UK
| | - Robbert R. Struyven
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Centre for Medical Image Computing, University College London, London, UK
| | - Fares Antaki
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Mark A. Chia
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Siegfried K. Wagner
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Mahima Jhingan
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Zhichao Wu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia
| | - Robyn Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia
| | - Simon S. Skene
- Surrey Clinical Trials Unit, University of Surrey, Guildford, UK
| | | | | | - Reena Chopra
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Pearse A. Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
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Künzel SH, Broadbent E, Möller PT, Lindner M, Goerdt L, Czauderna J, Schmitz-Valckenberg S, Holz FG, Pfau M, Fleckenstein M. Association of Lesion Location and Functional Parameters with Vision-Related Quality of Life in Geographic Atrophy Secondary to Age-related Macular Degeneration. Ophthalmol Retina 2024; 8:794-803. [PMID: 38311207 DOI: 10.1016/j.oret.2024.01.025] [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: 11/10/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE The primary goal of this study was to determine how structural and functional parameters influence the vision-related quality of life (VRQoL) in patients suffering from geographic atrophy (GA) secondary to age-related macular degeneration. DESIGN This study was designed as a prospective, noninterventional, natural-history study (Directional Spread in Geographic-Atrophy study, NCT02051998). SUBJECTS The research involved 82 patients with bilateral GA. METHODS The study examined parameters including GA location as assessed by the ETDRS grid, best-corrected visual acuity, low-luminance visual acuity (LLVA), reading acuity, and speed. These parameters were then correlated with VRQoL, which was gauged using the National Eye Institute Visual Function Questionnaire 25. The analysis method employed was the least absolute shrinkage and selection operator with linear mixed-effects models. MAIN OUTCOME MEASURES The central parameters measured in this study encompassed GA area, VRQoL scores associated with different GA subfields, and the significance of LLVA for foveal-sparing patients. RESULTS On average, patients showed a total GA area of 2.9 ± 1.2 mm2 in the better eye (BE) and 3.1 ± 1.3 mm2 in the worse eye. The most significant associations with VRQoL scores for distance and near activities were observed in the inner lower and inner left subfields of the BE, respectively. For patients with foveal-sparing GA, the LLVA of the BE stood out as the most influential variable across all VRQoL scales. CONCLUSIONS The study's findings point toward the pivotal role of GA location, especially the inner lower and inner left subfields of the BE, in relation to VRQoL in GA patients. The LLVA's importance becomes even more pronounced for foveal-sparing patients. These observations highlight the need for health care professionals to better understand the association between lesion location and patient-reported outcomes. This is critical for informing treatment decisions and refining the planning of interventional trials. 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)
| | - Eliza Broadbent
- Department of Ophthalmology & Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | | | - Moritz Lindner
- Department of Neurophysiology, Institute of Physiology and Pathophysiology, Philipps University, Marburg, Germany; Nuffield Laboratory of Ophthalmology, Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Lukas Goerdt
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany; Department of Ophthalmology & Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Maximilian Pfau
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
| | - Monika Fleckenstein
- Department of Ophthalmology & Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
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Zhang R, Wang L, Li Y, Liu Y, Dong K, Pei Y, Zhao J, Liu G, Li J, Zhang X, Cui T, Gao Y, Wang W, Wang Y, Gui C, Zhou G. CYTOR-NFAT1 feedback loop regulates epithelial-mesenchymal transition of retinal pigment epithelial cells. Hum Cell 2024; 37:1056-1069. [PMID: 38744794 DOI: 10.1007/s13577-024-01075-w] [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: 02/24/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024]
Abstract
Epithelial mesenchymal transition (EMT) occurring in retinal pigment epithelial cells (RPE) is a crucial mechanism that contributes to the development of age-related macular degeneration (AMD), a pivotal factor leading to permanent vision impairment. Long non-coding RNAs (lncRNAs) have emerged as critical regulators orchestrating EMT in RPE cells. In this study, we explored the function of the lncRNA CYTOR (cytoskeleton regulator RNA) in EMT of RPE cells and its underlying mechanisms. Through weighted correlation network analysis, we identified CYTOR as an EMT-related lncRNA associated with AMD. Experimental validation revealed that CYTOR orchestrates TGF-β1-induced EMT, as well as proliferation and migration of ARPE-19 cells. Further investigation demonstrated the involvement of CYTOR in regulating the WNT5A/NFAT1 pathway and NFAT1 intranuclear translocation in the ARPE-19 cell EMT model. Mechanistically, CHIP, EMSA and dual luciferase reporter assays confirmed NFAT1's direct binding to CYTOR's promoter, promoting transcription. Reciprocally, CYTOR overexpression promoted NFAT1 expression, while NFAT1 overexpression increased CYTOR transcription. These findings highlight a mutual promotion between CYTOR and NFAT1, forming a positive feedback loop that triggers the EMT phenotype in ARPE-19 cells. These discoveries provide valuable insights into the molecular mechanisms of EMT and its association with AMD, offering potential avenues for targeted therapies in EMT-related conditions, including AMD.
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Affiliation(s)
- Rong Zhang
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, 030002, Shanxi, China
| | - Lin Wang
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, 030002, Shanxi, China
| | - Yang Li
- Department of Ophthalmology, Yuncheng Central Hospital, Yuncheng, 044000, Shanxi, China
| | - Yan Liu
- Shanxi Province Cancer Hospital/ Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, 030013, Shanxi, China
| | - Kui Dong
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, 030002, Shanxi, China
| | - Yajing Pei
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, 030002, Shanxi, China
| | - Junmei Zhao
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, 030002, Shanxi, China
| | - Gang Liu
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, 030002, Shanxi, China
| | - Jing Li
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, 030002, Shanxi, China
| | - Xiaodan Zhang
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, 030002, Shanxi, China
| | - Tong Cui
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, 030002, Shanxi, China
| | - Yan Gao
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, 030002, Shanxi, China
| | - Wenjuan Wang
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, 030002, Shanxi, China
| | - Yongrui Wang
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, 030002, Shanxi, China
| | - Chenwei Gui
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, 030002, Shanxi, China
| | - Guohong Zhou
- Department of Ophthalmology, Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, 030002, Shanxi, China.
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Han G, Wei P, He M, Jia L, Su Q, Yang X, Hao R. Role of plasma fatty acid in age-related macular degeneration: insights from a mendelian randomization analysis. Lipids Health Dis 2024; 23:206. [PMID: 38951820 PMCID: PMC11218068 DOI: 10.1186/s12944-024-02197-8] [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: 04/04/2024] [Accepted: 06/20/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND An imbalance in lipid metabolism has been linked to the development of AMD, but the causal relationship between AMD and plasma fatty acids (FAs) remains controversial. Using a two-sample Mendelian randomization (MR) approach, we sought to evaluate the impact of specific FA plasma levels on the risk of different AMD subtypes. METHODS We analysed genome-wide association data of circulating FAs from 115,006 European-descended individuals in the UK Biobank. These data were used in a two-sample MR framework to assess the potential role of circulating FAs in developing wet and dry AMD. Sensitivity analyses were conducted to ensure the robustness of our findings. Additional multivariable and locus-specific MR analyses were conducted to evaluate direct effects of FA on AMD subtypes, minimizing biases from lipoprotein-related traits and triglycerides. RESULTS Mendelian randomization revealed associations of omega-3 was associated with decreased wet (OR 0.78, 95%CI 0.66-0.92) and dry AMD (0.85, 0.74-0.97) risk, showed a protective effect on AMD. Notably, the omega-6 to omega-3 ratio showed potential causal effects on both wet (1.27, 1.03-1.56) and dry AMD (1.18, 1.02-1.37). Multivariable MR suggested that the causal relationship of omega-3, omega-6 to omega-3 ratio on wet AMD persists after conditioning on HDL, LDL and triglycerides, albeit with slightly diminished evidence strength. Locus-specific MR linked to omega-3(FADS1, 0.89, 0.82-0.98; FADS2, 0.88, 0.81-0.96) and omega-6 to omega-3 ratio (FADS1, 1.10, 1.02-1.20; FADS2, 1.11, 1.03-1.20) suggests causal effects of these factors on wet AMD. CONCLUSIONS The associations between plasma FA concentrations and AMD, suggest potential causal role of omega-3, and the omega-6 to omega-3 ratio in wet AMD. These results underscore the impact of an imbalanced circulating omega-3 and omega-6 FA ratio on AMD pathophysiology from MR perspective.
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Affiliation(s)
- Guoge Han
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, PR China.
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Nankai University, Tianjin, PR China.
- Nankai University Eye Institute, Nankai University Affiliated Eye Hospital, Nankai University, Tianjin, China.
| | - Pinghui Wei
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, PR China
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Nankai University, Tianjin, PR China
- Nankai University Eye Institute, Nankai University Affiliated Eye Hospital, Nankai University, Tianjin, China
| | - Meiqin He
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, PR China
| | - Lanbo Jia
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Nankai University, Tianjin, PR China
- Nankai University Eye Institute, Nankai University Affiliated Eye Hospital, Nankai University, Tianjin, China
| | - Qi Su
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Nankai University, Tianjin, PR China
- Nankai University Eye Institute, Nankai University Affiliated Eye Hospital, Nankai University, Tianjin, China
| | - Xiru Yang
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Nankai University, Tianjin, PR China
- Nankai University Eye Institute, Nankai University Affiliated Eye Hospital, Nankai University, Tianjin, China
| | - Rui Hao
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, PR China
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Nankai University, Tianjin, PR China
- Nankai University Eye Institute, Nankai University Affiliated Eye Hospital, Nankai University, Tianjin, China
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5
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Romano F, Vingopoulos F, Yuan M, Ding X, Garcia M, Ploumi I, Rodriguez J, Garg I, Tracy JH, Bannerman A, Choi H, Stettler I, Bennett C, Overbey KM, Laìns I, Kim LA, Vavvas DG, Husain D, Miller JW, Miller JB. Decreased Macular Choriocapillaris Perfusion Correlates with Contrast Sensitivity Function in Dry Age-Related Macular Degeneration. Ophthalmol Retina 2024:S2468-6530(24)00274-4. [PMID: 38878897 DOI: 10.1016/j.oret.2024.06.005] [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: 02/22/2024] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE To investigate the relationships between contrast sensitivity (CS), choriocapillaris perfusion, and other structural OCT biomarkers in dry age-related macular degeneration (AMD). DESIGN Cross-sectional, observational study. PARTICIPANTS One hundred AMD eyes (22 early, 52 intermediate, and 26 late) from 74 patients and 45 control eyes from 37 age-similar subjects. METHODS All participants had visual acuity (VA) assessment, quantitative CS function (qCSF) testing, macular OCT, and 6 × 6-mm swept-source OCT angiography scans on the same day. OCT volumes were analyzed for subretinal drusenoid deposits and hyporeflective drusen cores, and to measure thickness of the outer nuclear layer. OCT angiography scans were utilized to calculate drusen volume and inner choroid flow deficit percentage (IC-FD%), and to measure the area of choroidal hypertransmission defects (HTDs). Inner choroid flow deficit percentage was measured from a 16-μm thick choriocapillaris slab after compensation and binarization with Phansalkar's method. Generalized linear mixed-effects models were used to evaluate the associations between functional and structural variables. MAIN OUTCOME MEASURES To explore the associations between qCSF-measured CS, IC-FD%, and various AMD imaging biomarkers. RESULTS Age-related macular degeneration exhibited significantly reduced qCSF metrics eyes across all stages compared with controls. Univariate analysis revealed significant associations between various imaging biomarkers, reduced qCSF metrics, and VA in both groups. Multivariate analysis confirmed that higher IC-FD% in the central 5 mm was significantly associated with decreases in all qCSF metrics in AMD eyes (β = -0.74 to -0.25, all P < 0.05), but not with VA (P > 0.05). Outer nuclear layer thickness in the central 3 mm correlated with both VA (β = 2.85, P < 0.001) and several qCSF metrics (β = 0.01-0.90, all P < 0.05), especially in AMD eyes. Further, larger HTD areas were associated with decreased VA (β = -0.89, P < 0.001) and reduced CS at low-intermediate frequencies across AMD stages (β = -0.30 to -0.29, P < 0.001). CONCLUSIONS The significant association between IC-FD% in the central 5 mm and qCSF-measured CS reinforces the hypothesis that decreased macular choriocapillaris perfusion contributes to visual function changes in AMD, which are more pronounced in CS than in VA. 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)
- Francesco Romano
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Filippos Vingopoulos
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
| | - Melissa Yuan
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Xinyi Ding
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Mauricio Garcia
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Ioanna Ploumi
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Jocelyn Rodriguez
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Itika Garg
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Jack H Tracy
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Augustine Bannerman
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Hanna Choi
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Isabella Stettler
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Cade Bennett
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Katherine M Overbey
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Inês Laìns
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Leo A Kim
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Demetrios G Vavvas
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Deeba Husain
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Joan W Miller
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - John B Miller
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts.
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Miranda M, Santos-Oliveira J, Mendonça AM, Sousa V, Melo T, Carneiro Â. Human versus Artificial Intelligence: Validation of a Deep Learning Model for Retinal Layer and Fluid Segmentation in Optical Coherence Tomography Images from Patients with Age-Related Macular Degeneration. Diagnostics (Basel) 2024; 14:975. [PMID: 38786273 PMCID: PMC11119996 DOI: 10.3390/diagnostics14100975] [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: 03/29/2024] [Revised: 04/25/2024] [Accepted: 04/28/2024] [Indexed: 05/25/2024] Open
Abstract
Artificial intelligence (AI) models have received considerable attention in recent years for their ability to identify optical coherence tomography (OCT) biomarkers with clinical diagnostic potential and predict disease progression. This study aims to externally validate a deep learning (DL) algorithm by comparing its segmentation of retinal layers and fluid with a gold-standard method for manually adjusting the automatic segmentation of the Heidelberg Spectralis HRA + OCT software Version 6.16.8.0. A total of sixty OCT images of healthy subjects and patients with intermediate and exudative age-related macular degeneration (AMD) were included. A quantitative analysis of the retinal thickness and fluid area was performed, and the discrepancy between these methods was investigated. The results showed a moderate-to-strong correlation between the metrics extracted by both software types, in all the groups, and an overall near-perfect area overlap was observed, except for in the inner segment ellipsoid (ISE) layer. The DL system detected a significant difference in the outer retinal thickness across disease stages and accurately identified fluid in exudative cases. In more diseased eyes, there was significantly more disagreement between these methods. This DL system appears to be a reliable method for accessing important OCT biomarkers in AMD. However, further accuracy testing should be conducted to confirm its validity in real-world settings to ultimately aid ophthalmologists in OCT imaging management and guide timely treatment approaches.
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Affiliation(s)
- Mariana Miranda
- Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, 4200 Porto, Portugal
| | - Joana Santos-Oliveira
- Department of Ophthalmology, Centro Hospitalar Universitário of São João, 4200 Porto, Portugal
| | - Ana Maria Mendonça
- Electrical and Computer Engineering Department, Faculty of Engineering of the University of Porto, 4200 Porto, Portugal
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200 Porto, Portugal
| | - Vânia Sousa
- Department of Ophthalmology, Centro Hospitalar Universitário of São João, 4200 Porto, Portugal
| | - Tânia Melo
- Electrical and Computer Engineering Department, Faculty of Engineering of the University of Porto, 4200 Porto, Portugal
- INESC TEC—Institute for Systems and Computer Engineering, Technology and Science, 4200 Porto, Portugal
| | - Ângela Carneiro
- Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, 4200 Porto, Portugal
- Department of Ophthalmology, Centro Hospitalar Universitário of São João, 4200 Porto, Portugal
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Fleckenstein M, Schmitz-Valckenberg S, Chakravarthy U. Age-Related Macular Degeneration: A Review. JAMA 2024; 331:147-157. [PMID: 38193957 DOI: 10.1001/jama.2023.26074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Importance Age-related macular degeneration (AMD) affects approximately 20 million people in the US and 196 million people worldwide. AMD is a leading cause of severe vision impairment in older people and is expected to affect approximately 288 million people worldwide by 2040. Observations Older age, genetic factors, and environmental factors, such as cigarette smoking, are associated with development of AMD. AMD occurs when extracellular deposits accumulate in the outer retina, ultimately leading to photoreceptor degeneration and loss of central vision. The late stages of AMD are characterized by outer retinal atrophy, termed geographic atrophy, or neovascularization associated with subretinal and/or intraretinal exudation, termed exudative neovascular AMD. The annual incidence of AMD ranges from 0.3 per 1000 in people who are aged 55 to 59 years to 36.7 per 1000 in people aged 90 years or older. The estimated heritability of late-stage AMD is approximately 71% (95% CI, 18%-88%). Long-term prospective cohort studies show a significantly higher AMD incidence in people who smoke more than 20 cigarettes per day compared with people who never smoked. AMD is diagnosed primarily with clinical examination that includes a special lens that focuses light of the slit lamp through the pupil. Exudative neovascular AMD is best identified using angiography and by optical coherence tomography. Individuals with AMD who take nutritional supplements consisting of high-dose vitamin C, vitamin E, carotenoids, and zinc have a 20% probability to progress to late-stage AMD at 5 years vs a 28% probability for those taking a placebo. In exudative neovascular AMD, 94.6% of patients receiving monthly intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections experience less than a 15-letter visual acuity loss after 12 months compared with 62.2% receiving sham treatment. Conclusions and Relevance The prevalence of AMD is anticipated to increase worldwide to 288 million individuals by 2040. Intravitreally administered anti-VEGF treatment is first-line therapy for exudative neovascular AMD.
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Affiliation(s)
| | - Steffen Schmitz-Valckenberg
- John A. Moran Eye Center, University of Utah Health, Salt Lake City
- Department of Ophthalmology, University of Bonn, Bonn, Germany
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