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Cheung R, So S, Malvankar-Mehta MS. Diagnostic accuracy of machine learning classifiers for cataracts: a systematic review and meta-analysis. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2142120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Ronald Cheung
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Samantha So
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Monali S. Malvankar-Mehta
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
- Department of Ophthalmology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
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Diagnostic accuracy of current machine learning classifiers for age-related macular degeneration: a systematic review and meta-analysis. Eye (Lond) 2022; 36:994-1004. [PMID: 33958739 PMCID: PMC9046206 DOI: 10.1038/s41433-021-01540-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/23/2021] [Accepted: 04/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The objective of this study was to systematically review and meta-analyze the diagnostic accuracy of current machine learning classifiers for age-related macular degeneration (AMD). Artificial intelligence diagnostic algorithms can automatically detect and diagnose AMD through training data from large sets of fundus or OCT images. The use of AI algorithms is a powerful tool, and it is a method of obtaining a cost-effective, simple, and fast diagnosis of AMD. METHODS MEDLINE, EMBASE, CINAHL, and ProQuest Dissertations and Theses were searched systematically and thoroughly. Conferences held through Association for Research in Vision and Ophthalmology, American Academy of Ophthalmology, and Canadian Society of Ophthalmology were searched. Studies were screened using Covidence software and data on sensitivity, specificity and area under curve were extracted from the included studies. STATA 15.0 was used to conduct the meta-analysis. RESULTS Our search strategy identified 307 records from online databases and 174 records from gray literature. Total of 13 records, 64,798 subjects (and 612,429 images), were used for the quantitative analysis. The pooled estimate for sensitivity was 0.918 [95% CI: 0.678, 0.98] and specificity was 0.888 [95% CI: 0.578, 0.98] for AMD screening using machine learning classifiers. The relative odds of a positive screen test in AMD cases were 89.74 [95% CI: 3.05-2641.59] times more likely than a negative screen test in non-AMD cases. The positive likelihood ratio was 8.22 [95% CI: 1.52-44.48] and the negative likelihood ratio was 0.09 [95% CI: 0.02-0.52]. CONCLUSION The included studies show promising results for the diagnostic accuracy of the machine learning classifiers for AMD and its implementation in clinical settings.
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Awan MA, Shaheen F, Mohsin F. Impact of COVID-19 lockdown on Retinal Surgeries. Pak J Med Sci 2021; 37:1808-1812. [PMID: 34912399 PMCID: PMC8613012 DOI: 10.12669/pjms.37.7.4291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/08/2021] [Accepted: 07/04/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To determine the frequency and severity of surgical Vitreo-Retinal diseases during COVID-19 lockdown period (LP) and compare it with same period last year. METHODS Single hospital based retrospective Cohort Study. Data of the patients that underwent retinal surgeries during the COVID-19 LP i.e., 23-03-2020 till 23-06-2020 and same period last year i.e., 23-03-2019 till 23-06-2019 was analyzed. RESULTS One hundred thirty-six eyes of 105 patients were included. Among these eyes, 48 (35.3%) were operated during the COVID-19 LP while 88 (64.7%) were operated during the same time last year. A decline of 45.5% (p=0.023) was observed in the frequency of surgeries during the LP. Mean age of patients during the LP was 43.2 ± 20.3 years compared to 48.4 ± 17.9 years last year. There was reduction in the surgeries for Diabetic Tractional Retinal Detachment (11.4% vs 4.2% during LP, p=0.166), Vitreous hemorrhage (10.2 % vs 8.3% during LP, p=0.04), Full thickness macular hole (3.4% vs 0% during LP) and Epiretinal membrane (12.5% vs 0% during LP). While Rhegmatogenous retinal detachment (27.3% vs 58.3% during LP, p<0.001) among other disorders had a higher proportion during the LP. CONCLUSION The decline in the frequency of retinal surgeries during the LP is indicative of complex pathologies presenting later with more advanced disease. However, earlier presentation and an increase trend in surgeries for RRD during the LP shows the positive impact of free time on the health concerns of our population.
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Affiliation(s)
- Muhammad Amer Awan
- Dr. Muhammad Amer Awan, Department of Ophthalmology, Shifa International Hospital, Islamabad, Pakistan
| | - Fiza Shaheen
- Dr. Fiza Shaheen, Department of Ophthalmology, Shifa International Hospital, Islamabad, Pakistan
| | - Fatima Mohsin
- Dr. Fatima Mohsin. Department of Ophthalmology, Shifa International Hospital, Islamabad, Pakistan
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Real-world vitreoretinal practice patterns during the 2020 COVID-19 pandemic: a nationwide, aggregated health record analysis. Curr Opin Ophthalmol 2020; 31:427-434. [PMID: 32740067 DOI: 10.1097/icu.0000000000000692] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW The COVID-19 pandemic has posed an unprecedented challenge to the healthcare community. To reduce disease transmission, national regulatory agencies temporarily recommended curtailment of all nonurgent office visits and elective surgeries in March 2020, including vitreoretinal outpatient care in the USA. The effect of these guidelines on utilization of vitreoretinal care has not been explored to date. RECENT FINDINGS Retinal outpatient visits, new patient visits, intravitreal antivascular endothelial growth factor injections and in-office multimodal retinal imaging has seen a significant decline in utilization in the early phase of the pandemic. Intravitreal injections were performed at a comparatively higher rate than office visits. Utilization appeared to steadily increase in April 2020. Telemedicine visits, enabled by new national legislation for all areas of medicine, have been adopted to a modest degree by the retina community. SUMMARY In-office retinal care declined in response to the COVID-19 pandemic and national regulatory guidelines limiting nonurgent care. These trends in practice patterns and care utilization may be of interest to vitreoretinal providers and all ophthalmologists at large.
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Snyder BM, Nam SM, Khunsongkiet P, Ausayakhun S, Leeungurasatien T, Leiter MR, Sevastopolsky A, Joye AS, Berlinberg EJ, Liu Y, Ramirez DA, Moe CA, Ausayakhun S, Stamper RL, Keenan JD. Accuracy of computer-assisted vertical cup-to-disk ratio grading for glaucoma screening. PLoS One 2019; 14:e0220362. [PMID: 31393904 PMCID: PMC6687168 DOI: 10.1371/journal.pone.0220362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/15/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose Glaucoma screening can be performed by assessing the vertical-cup-to-disk ratio (VCDR) of the optic nerve head from fundus photography, but VCDR grading is inherently subjective. This study investigated whether computer software could improve the accuracy and repeatability of VCDR assessment. Methods In this cross-sectional diagnostic accuracy study, 5 ophthalmologists independently assessed the VCDR from a set of 200 optic disk images, with the median grade used as the reference standard for subsequent analyses. Eight non-ophthalmologists graded each image by two different methods: by visual inspection and with assistance from a custom-made publicly available software program. Agreement with the reference standard grade was assessed for each method by calculating the intraclass correlation coefficient (ICC), and the sensitivity and specificity determined relative to a median ophthalmologist grade of ≥0.7. Results VCDR grades ranged from 0.1 to 0.9 for visual assessment and from 0.1 to 1.0 for software-assisted grading, with a median grade of 0.4 for each. Agreement between each of the 8 graders and the reference standard was higher for visual inspection (median ICC 0.65, interquartile range 0.57 to 0.82) than for software-assisted grading (median ICC 0.59, IQR 0.44 to 0.71); P = 0.02, Wilcoxon signed-rank test). Visual inspection and software assistance had similar sensitivity and specificity for detecting glaucomatous cupping. Conclusion The computer software used in this study did not improve the reproducibility or validity of VCDR grading from fundus photographs compared with simple visual inspection. More clinical experience was correlated with higher agreement with the ophthalmologist VCDR reference standard.
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Affiliation(s)
- Blake M. Snyder
- School of Medicine, University of Colorado Denver, Aurora, Colorado, United States of America
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, United States of America
| | - Sang Min Nam
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, United States of America
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Preeyanuch Khunsongkiet
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sakarin Ausayakhun
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Maxwell R. Leiter
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, United States of America
| | - Artem Sevastopolsky
- Youth Laboratories LLC, Moscow, Russia
- Skolkovo Institute of Science and Technology, Moscow, Russia
| | - Ashlin S. Joye
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, United States of America
| | - Elyse J. Berlinberg
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, United States of America
| | - Yingna Liu
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, United States of America
| | - David A. Ramirez
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, United States of America
| | - Caitlin A. Moe
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, United States of America
| | - Somsanguan Ausayakhun
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Robert L. Stamper
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, United States of America
| | - Jeremy D. Keenan
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, United States of America
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, United States of America
- * E-mail:
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Sabri K, Moinul P, Tehrani N, Wiggins R, Fleming N, Farrokhyar F. Video interpretation and diagnosis of pediatric amblyopia and eye disease. J Telemed Telecare 2019; 27:116-122. [PMID: 31364472 DOI: 10.1177/1357633x19864823] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM The aim of this study was to assess the potential of using video screening to interpret the results of paediatric eye examinations. DESIGN Prospective multi-centred, blinded study. METHODS Children aged 5 months to 11 years referred to a paediatric ophthalmology centre were enrolled in the study. Outcome measures included the degree of agreement between examiners for assessment of various aspects of paediatric eye examination. In Phase 1, children were individually assessed in the clinic by three different examiners to determine the level of agreement. In Phase 2 a video recording was made of the first ophthalmologist examining the children. The other two examiners viewed the video recordings to make their diagnoses. Areas of assessment included lid function, pupillary function, ocular motility, strabismus, nystagmus, torticollis and facial asymmetry. Agreement between examiners was measured using Gwet's agreement coefficient (AC1). RESULTS A total of 27 patients in Phase 1 (mean age 4.0 years) and 160 children in Phase 2 (mean age 4.8 years) underwent clinical and video-recorded screening. In Phase 1, all but one area of ocular examination (heterotropia) achieved ≥84% agreement between three examiners. In Phase 2, there was greater variation between direct clinical examination and interpretation of video findings, ranging from 55-100% agreement. CONCLUSION Using experienced clinicians and changing only one variable in Phase 2 (the method of assessment - direct examination versus video interpretation), the results show the possible usefulness of video-recorded screening as a means of assessing children. Further research is indicated to assess the accuracy of ophthalmologists interpreting video recordings of eye examinations performed by trained non-eye-care professionals.
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Affiliation(s)
- Kourosh Sabri
- Department of Surgery, Division of Ophthalmology, McMaster University, Canada.,Department of Surgery, McMaster Paediatric Eye Research Group, Canada.,Department of Surgery, McMaster Pediatric Surgery Research Collaborative, Canada
| | - Prima Moinul
- Department of Surgery, Division of Ophthalmology, McMaster University, Canada
| | - Nasrin Tehrani
- Department of Surgery, Division of Ophthalmology, University of Toronto, Canada
| | - Rick Wiggins
- Department of Optometry, University of Waterloo, Canada
| | - Natalie Fleming
- Department of Surgery, McMaster Pediatric Surgery Research Collaborative, Canada
| | - Forough Farrokhyar
- Department of Surgery, McMaster Paediatric Eye Research Group, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Canada.,Office of Surgical Research Services, Department of Surgery, McMaster University, Canada
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Kawaguchi A, Sharafeldin N, Sundaram A, Campbell S, Tennant M, Rudnisky C, Weis E, Damji KF. Tele-Ophthalmology for Age-Related Macular Degeneration and Diabetic Retinopathy Screening: A Systematic Review and Meta-Analysis. Telemed J E Health 2017; 24:301-308. [PMID: 28783458 DOI: 10.1089/tmj.2017.0100] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To synthesize high-quality evidence to compare traditional in-person screening and tele-ophthalmology screening. METHODS Only randomized controlled trials (RCTs) were included in this systematic review and meta-analysis. The intervention of interest was any type of tele-ophthalmology, including screening of diseases using remote devices. Studies involved patients receiving care from any trained provider via tele-ophthalmology, compared with those receiving equivalent face-to-face care. A search was executed on the following databases: Medline, EMBASE, EBM Reviews, Global Health, EBSCO-CINAHL, SCOPUS, ProQuest Dissertations and Theses Global, OCLC Papers First, and Web of Science Core Collection. Six outcomes of care for age-related macular degeneration (AMD), diabetic retinopathy (DR), or glaucoma were measured and analyzed. RESULTS Two hundred thirty-seven records were assessed at the full-text level; six RCTs fulfilled inclusion criteria and were included in this review. Four studies involved participants with diabetes mellitus, and two studies examined choroidal neovascularization in AMD. Only data of detection of disease and participation in the screening program were used for the meta-analysis. Tele-ophthalmology had a 14% higher odds to detect disease than traditional examination; however, the result was not statistically significant (n = 2,012, odds ratio: 1.14, 95% confidence interval (CI): 0.52-2.53, p = 0.74). Meta-analysis results show that odds of having DR screening in the tele-ophthalmology group was 13.15 (95% CI: 8.01-21.61; p < 0.001) compared to the traditional screening program. CONCLUSIONS The current evidence suggests that tele-ophthalmology for DR and age-related macular degeneration is as effective as in-person examination and potentially increases patient participation in screening.
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Affiliation(s)
- Atsushi Kawaguchi
- 1 School of Public Health, University of Alberta , Edmonton, Canada .,2 Pediatric Critical Care Medicine, Department of Pediatrics, University of Alberta , Edmonton, Canada
| | - Noha Sharafeldin
- 1 School of Public Health, University of Alberta , Edmonton, Canada .,3 School of Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - Aishwarya Sundaram
- 4 Department of Ophthalmology and Visual Sciences, Dalhousie University , Halifax, Canada
| | - Sandy Campbell
- 5 JW Scott Library, Health Sciences Library, University of Alberta , Edmonton, Canada
| | - Matthew Tennant
- 6 Department of Ophthalmology and Visual Sciences, University of Alberta , Edmonton, Canada
| | - Christopher Rudnisky
- 6 Department of Ophthalmology and Visual Sciences, University of Alberta , Edmonton, Canada
| | - Ezekiel Weis
- 6 Department of Ophthalmology and Visual Sciences, University of Alberta , Edmonton, Canada .,7 Division of Ophthalmology, Department of Surgery, University of Calgary , Calgary, Canada
| | - Karim F Damji
- 6 Department of Ophthalmology and Visual Sciences, University of Alberta , Edmonton, Canada
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Hassibian MR, Hassibian S. Telemedicine Acceptance and Implementation in Developing Countries: Benefits, Categories, and Barriers. RAZAVI INTERNATIONAL JOURNAL OF MEDICINE 2016. [DOI: 10.17795/rijm38332] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Coronado AC, Zaric GS, Martin J, Malvankar-Mehta M, Si FF, Hodge WG. Diabetic retinopathy screening with pharmacy-based teleophthalmology in a semiurban setting: a cost-effectiveness analysis. CMAJ Open 2016; 4:E95-E102. [PMID: 27280120 PMCID: PMC4866927 DOI: 10.9778/cmajo.20150085] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Diabetic eye complications are the leading cause of visual loss among working-aged people. Pharmacy-based teleophthalmology has emerged as a possible alternative to in-person examination that may facilitate compliance with evidence-based recommendations and reduce barriers to specialized eye care. The objective of this study was to estimate the cost-effectiveness of mobile teleophthalmology screening compared with in-person examination (primary care) for the diabetic population residing in semiurban areas of southwestern Ontario. METHODS A decision tree was constructed to compare in-person examination (comparator program) versus pharmacy-based teleophthalmology (intervention program). The economic model was designed to identify patients with more than minimal diabetic retinopathy, manifested by at least 1 microaneurysm at examination (modified Airlie House classification grade of ≥ 20). Cost-effectiveness was assessed as cost per case detected (true-positive result) and cost per case correctly diagnosed (including true-positive and true-negative results). RESULTS The cost per case detected was $510 with in-person examination and $478 with teleophthalmology, and the cost per case correctly diagnosed was $107 and $102 respectively. The incremental cost-effectiveness ratio was $314 per additional case detected and $73 per additional case correctly diagnosed. Use of pharmacologic dilation and health care specialists' fees were the most important cost drivers. INTERPRETATION The study showed that a compound teleophthalmology program in a semiurban community would be more effective but more costly than in-person examination. The findings raise the question of whether the benefits of pharmacy-based teleophthalmology in semiurban areas, where in-person examination is still available, are equivalent to those observed in remote communities. Further study is needed to investigate the impact of this program on the prevention of severe vision loss and quality of life in a semiurban setting.
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Affiliation(s)
- Andrea C Coronado
- Department of Epidemiology & Biostatistics (Coronado, Martin, Malvankar-Mehta, Hodge), Western University; Richard Ivey School of Business (Zaric), Western University; Ivey Eye Institute (Malvankar-Mahta, Si, Hodge), Western University, London, Ont
| | - Gregory S Zaric
- Department of Epidemiology & Biostatistics (Coronado, Martin, Malvankar-Mehta, Hodge), Western University; Richard Ivey School of Business (Zaric), Western University; Ivey Eye Institute (Malvankar-Mahta, Si, Hodge), Western University, London, Ont
| | - Janet Martin
- Department of Epidemiology & Biostatistics (Coronado, Martin, Malvankar-Mehta, Hodge), Western University; Richard Ivey School of Business (Zaric), Western University; Ivey Eye Institute (Malvankar-Mahta, Si, Hodge), Western University, London, Ont
| | - Monali Malvankar-Mehta
- Department of Epidemiology & Biostatistics (Coronado, Martin, Malvankar-Mehta, Hodge), Western University; Richard Ivey School of Business (Zaric), Western University; Ivey Eye Institute (Malvankar-Mahta, Si, Hodge), Western University, London, Ont
| | - Francie F Si
- Department of Epidemiology & Biostatistics (Coronado, Martin, Malvankar-Mehta, Hodge), Western University; Richard Ivey School of Business (Zaric), Western University; Ivey Eye Institute (Malvankar-Mahta, Si, Hodge), Western University, London, Ont
| | - William G Hodge
- Department of Epidemiology & Biostatistics (Coronado, Martin, Malvankar-Mehta, Hodge), Western University; Richard Ivey School of Business (Zaric), Western University; Ivey Eye Institute (Malvankar-Mahta, Si, Hodge), Western University, London, Ont
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Zvornicanin J, Zvornicanin E, Sabanovic Z. Ophthalmology and information technology in tuzla canton health care system. Acta Inform Med 2013; 20:90-3. [PMID: 23322959 PMCID: PMC3544322 DOI: 10.5455/aim.2012.20.90-93] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 03/30/2012] [Indexed: 11/30/2022] Open
Abstract
Purpose: To analyze organization of ophthalmology health care in Tuzla canton and use of information technologies(IT). Introduction: IT in ophthalmology is the technology required for the data processing and other information important for patient and essential for building an electronic health record(EHR). IT in ophthalmology should include the study, science, and solution sets for all aspects of data, information and knowledge management in health information processing. Material and methods: We have analyzed organization of ophthalmology health care in Tuzla canton. Data relevant for this research were acquired from annual reports of Tuzla Canton health ministry. All institutions and ambulances were visited and all health care professionals interviewed. A questionnaire was made which included questions for health care professionals about knowledge and use of computers, internet and information technology. Results: Ophthalmology health care in Tuzla canton has paper based medical record. There is no information system with any possibility to exchange data electronically. None of the medical devices is directly connected to the Internet and all data are typed, printed and delivered directly to the patient. All interviewed health care professionals agree that implementation of IT and EHR would contribute and improve work quality. Conclusion: Computer use and easy information access will make a qualitative difference in eye-care delivery in Tuzla canton. Implementation phase will be difficult because it will likely impact present style of practice. Strategy for implementation of IT in medicine in general must be made at the country level.
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Affiliation(s)
- Jasmin Zvornicanin
- Eye Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
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Gili P, Flores-Rodríguez P, Yangüela J, Orduña-Azcona J, Martín-Ríos MD. Sensitivity and specificity of monochromatic photography of the ocular fundus in differentiating optic nerve head drusen and optic disc oedema. Graefes Arch Clin Exp Ophthalmol 2012; 251:923-8. [DOI: 10.1007/s00417-012-2223-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 10/26/2012] [Accepted: 11/20/2012] [Indexed: 11/28/2022] Open
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Mines MJ, Bower KS, Lappan CM, Mazzoli RA, Poropatich RK. The United States Army Ocular Teleconsultation program 2004 through 2009. Am J Ophthalmol 2011; 152:126-132.e2. [PMID: 21570049 DOI: 10.1016/j.ajo.2011.01.028] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 01/12/2011] [Accepted: 01/13/2011] [Indexed: 12/01/2022]
Abstract
PURPOSE To describe the United States Army Ocular Teleconsultation program and all consultations received from its inception in July 2004 through December 2009. DESIGN Retrospective, noncomparative, consecutive case series. METHODS All 301 consecutive ocular teleconsultations received were reviewed. The main outcome measures were differential diagnosis, evacuation recommendations, and origination of consultation. Secondary measures included patient demographics, reason for consultation, and inclusion of clinical images. RESULTS The average response time was 5 hours and 41 minutes. Most consultations originated from Iraq (58.8%) and Afghanistan (18.6%). Patient care-related requests accounted for 94.7% of consultations; nonphysicians submitted 26.3% of consultations. Most patients (220/285; 77.2%) were United States military personnel; the remainder included local nationals and coalition forces. Children accounted for 23 consultations (8.1%). Anterior segment disease represented the largest grouping of cases (129/285; 45.3%); oculoplastic problems represented nearly one quarter (68/285; 23.9%). Evacuation was recommended in 123 (43.2%) of 285 cases and in 21 (58.3%) of 36 cases associated with trauma. Photographs were included in 38.2%, and use was highest for pediatric and strabismus (83.3%) and oculoplastic (67.6%) consultations. Consultants facilitated evacuation in 87 (70.7%) of 123 consultations where evacuation was recommended and avoided unnecessary evacuations in 28 (17.3%) of 162 consultations. CONCLUSIONS This teleconsultation program has brought valuable tertiary level support to deployed providers, thereby helping to facilitate appropriate and timely referrals, and in some cases avoiding unnecessary evacuation. Advances in remote diagnostic and imaging technology could further enhance consultant support to distant providers and their patients.
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Affiliation(s)
- Michael J Mines
- Ophthalmology Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
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Wu Y, Wei Z, Yao H, Zhao Z, Ngoh LH, Deng RH, Yu S. TeleOph: a secure real-time teleophthalmology system. ACTA ACUST UNITED AC 2010; 14:1259-66. [PMID: 20667812 DOI: 10.1109/titb.2010.2058124] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Teleophthalmology (TeleOph) is an electronic counterpart of today's face-to-face, patient-to-specialist ophthalmology system. It enables one or more ophthalmologists to remotely examine a patient's condition via a confidential and authentic communication channel. Specifically, TeleOph allows a trained nonspecialist in a primary clinic to screen the patients with digital instruments (e.g., camera, ophthalmoscope). The acquired medical data are delivered to the hospital where an ophthalmologist will review the data collected and, if required, provide further consultation for the patient through a real-time secure channel established over a public Internet network. If necessary, the ophthalmologist is able to further sample the images/video of the patient's eyes remotely. In order to increase the productivity of the ophthalmologist in terms of number of patients reviewed, and to increase the efficiency of network resource, we manage the network bandwidth based on a Poisson model to estimate patient arrival at the clinics, and the rate of ophthalmologist consultation service for better overall system efficiency. The main objective of TeleOph is therefore to provide the remote patients with a cost-effective access to specialist's eye checkups at primary healthcare clinics, and at the same time, minimize unnecessary face-to-face consultation at the hospital specialist's center.
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Affiliation(s)
- Yongdong Wu
- Institute for Infocomm Research, Singapore 138632.
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Wei Z, Wu Y, Deng RH, Yu S, Yao H, Zhao Z, Ngoh LH, Han LT, Poh EWT. A secure and synthesis tele-ophthalmology system. Telemed J E Health 2009; 14:833-45. [PMID: 18954255 DOI: 10.1089/tmj.2008.0086] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This paper describes a secure and synthesis ophthalmology telemedicine system, referred to as TeleOph. Under a Secure Socket Layer (SSL) channel, patient prerecorded data can be safely transferred via the Internet. With encrypted videoconference and white-board, the system not only supports hospital-to-clinic consultation, but also supplies hospital-tohospital joint discussion. Based on Directshow technology (Microsoft Corporation, Redmond, WA), video cameras connected to the computer by firewire can be captured and controlled to sample video data. By using TWAIN technology, the system automatically identifies networked still cameras (on fundus and slitlamp devices) and retrieves images. All the images are stored in a selected format (such as JPEG, DICOM, BMP). Besides offline-transferring prerecorded data, the system also supplies online sampling of patient data (real-time capturing from remote places). The system was deployed at Tan Tock Seng Hospital, Singapore and Ang Mo Kio, Singapore, where 100 patients were enrolled in the system for examination. TeleOph can be successfully used for patient consultation, and hospital joint discussion. Meanwhile, TeleOph can supply both offline and online sampling of patient data.
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Affiliation(s)
- Zhuo Wei
- College of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, China
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Castro AF, Silva-Turnes JC, Gonzalez F. Evaluation of retinal digital images by a general practitioner. Telemed J E Health 2007; 13:287-92. [PMID: 17603831 DOI: 10.1089/tmj.2006.0046] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Diabetes and systemic hypertension are among the most prevalent diseases in developed countries. Since both can produce retinal involvement, they often cause long waiting lists for ophthalmologist consultation. The inspection of digital eye fundus images by a general practitioner would help to divert only those cases with retinal involvement. To evaluate this possibility we studied the agreement between the assessment of digital fundus images made by a general practitioner and an ophthalmologist. A total of 776 fundus images of 194 patients were inspected by both observers looking for retinal lesions consistent with diabetic or hypertensive retinopathy. Contingency tables were made, and the agreement between both observers was assessed by using the kappa index. We found good agreement between the findings reported by the general practitioner and those reported by the ophthalmologist (kappa = 0.80 for patients with only diabetes, 1.00 for patients with only hypertension, and 0.79 for patients with both diseases). Our results suggest that the inspection of digital retinal images by a general practitioner could reduce the number of referred patients for specialist consultation.
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Affiliation(s)
- Adrian F Castro
- Department of Physiology, School of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain.
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16
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Patton N, Aslam TM, MacGillivray T, Deary IJ, Dhillon B, Eikelboom RH, Yogesan K, Constable IJ. Retinal image analysis: concepts, applications and potential. Prog Retin Eye Res 2005; 25:99-127. [PMID: 16154379 DOI: 10.1016/j.preteyeres.2005.07.001] [Citation(s) in RCA: 257] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
As digital imaging and computing power increasingly develop, so too does the potential to use these technologies in ophthalmology. Image processing, analysis and computer vision techniques are increasing in prominence in all fields of medical science, and are especially pertinent to modern ophthalmology, as it is heavily dependent on visually oriented signs. The retinal microvasculature is unique in that it is the only part of the human circulation that can be directly visualised non-invasively in vivo, readily photographed and subject to digital image analysis. Exciting developments in image processing relevant to ophthalmology over the past 15 years includes the progress being made towards developing automated diagnostic systems for conditions, such as diabetic retinopathy, age-related macular degeneration and retinopathy of prematurity. These diagnostic systems offer the potential to be used in large-scale screening programs, with the potential for significant resource savings, as well as being free from observer bias and fatigue. In addition, quantitative measurements of retinal vascular topography using digital image analysis from retinal photography have been used as research tools to better understand the relationship between the retinal microvasculature and cardiovascular disease. Furthermore, advances in electronic media transmission increase the relevance of using image processing in 'teleophthalmology' as an aid in clinical decision-making, with particular relevance to large rural-based communities. In this review, we outline the principles upon which retinal digital image analysis is based. We discuss current techniques used to automatically detect landmark features of the fundus, such as the optic disc, fovea and blood vessels. We review the use of image analysis in the automated diagnosis of pathology (with particular reference to diabetic retinopathy). We also review its role in defining and performing quantitative measurements of vascular topography, how these entities are based on 'optimisation' principles and how they have helped to describe the relationship between systemic cardiovascular disease and retinal vascular changes. We also review the potential future use of fundal image analysis in telemedicine.
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Affiliation(s)
- Niall Patton
- Lions Eye Institute, 2, Verdun Street, Nedlands, WA 6009, Australia.
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17
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Stefánsson E. Scientific contributions and citations. ACTA OPHTHALMOLOGICA SCANDINAVICA 2005; 83:275-7. [PMID: 15948776 DOI: 10.1111/j.1600-0420.2005.00504.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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