1
|
Lan WZ, Tang H, Wen LB, Chen Z, Zhou YL, Dai WW, Wang M, Li XN, Wang WJ, Tang F, Yang ZK, Tang Y. Artificial Intelligence-Assisted Prescription Determination for Orthokeratology Lens Fitting: From Algorithm to Clinical Practice. Eye Contact Lens 2024; 50:297-304. [PMID: 38695745 DOI: 10.1097/icl.0000000000001091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES To explore the potential of artificial intelligence (AI) to assist prescription determination for orthokeratology (OK) lenses. METHODS Artificial intelligence algorithm development followed by a real-world trial. A total of 11,502 OK lenses fitting records collected from seven clinical environments covering major brands. Records were randomly divided in a three-way data split. Cross-validation was used to identify the most accurate algorithm, followed by an evaluation using an independent test data set. An online AI-assisted system was implemented and assessed in a real-world trial involving four junior and three senior clinicians. RESULTS The primary outcome measure was the algorithm's accuracy (ACC). The ACC of the best performance of algorithms to predict the targeted reduction amplitude, lens diameter, and alignment curve of the prescription was 0.80, 0.82, and 0.83, respectively. With the assistance of the AI system, the number of trials required to determine the final prescription significantly decreased for six of the seven participating clinicians (all P <0.01). This reduction was more significant among junior clinicians compared with consultants (0.76±0.60 vs. 0.32±0.60, P <0.001). Junior clinicians achieved clinical outcomes comparable to their seniors, as 93.96% (140/149) and 94.44% (119/126), respectively, of the eyes fitted achieved unaided visual acuity no worse than 0.8 ( P =0.864). CONCLUSIONS AI can improve prescription efficiency and reduce discrepancies in clinical outcomes among clinicians with differing levels of experience. Embedment of AI in practice should ultimately help lessen the medical burden and improve service quality for myopia boom emerging worldwide.
Collapse
Affiliation(s)
- Wei-Zhong Lan
- Guangzhou Aier Eye Hospital (W.-Z.L.), Jinan University, Guanghzou, China; School of Stomatology and Ophthalmology (W.-Z.L., X.L., Z.Y.), Xianning Medical College, Hubei University of Science and Technology, Xianing, China; SoC Design Center (H.T.), University of Electronic Science and Technology of China, Chengdu, China; School of Electronic Science and Engineering (H.T.), University of Electronic Science and Technology of China, Chengdu, China; Aier School of Ophthalmology (L.-B.W., Z.C., Y.Z., Z.Y.), Central South University, Changsha, China; Information Center (W.D., M.W., F.T.), Aier Eye Hospital Group, Changsha, China; School of Information and Software Engineering (W.-J.W.), University of Electronic Science and Technology of China, Chengdu, China; School of Computer Science and Engineering (Y.T.), University of Electronic Science and Technology of China, Chengdu, China; Hunan Province Optometry Engineering and Technology Research Center (W.-Z.L., L.-B.W., Z.C., X.L., Z.Y.), Changsha, China; and Hunan Province International Cooperation Base for Optometry Science and Technology (W.-Z.L., L.-B.W., Z.C., X.L., Z.Y.), Changsha, China
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Zhou H, Yang W, Sun L, Huang L, Li S, Luo X, Jin Y, Sun W, Yan W, Li J, Ding X, He Y, Xie Z. RDLR: A Robust Deep Learning-Based Image Registration Method for Pediatric Retinal Images. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01154-2. [PMID: 38874699 DOI: 10.1007/s10278-024-01154-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/24/2024] [Accepted: 05/24/2024] [Indexed: 06/15/2024]
Abstract
Retinal diseases stand as a primary cause of childhood blindness. Analyzing the progression of these diseases requires close attention to lesion morphology and spatial information. Standard image registration methods fail to accurately reconstruct pediatric fundus images containing significant distortion and blurring. To address this challenge, we proposed a robust deep learning-based image registration method (RDLR). The method consisted of two modules: registration module (RM) and panoramic view module (PVM). RM effectively integrated global and local feature information and learned prior information related to the orientation of images. PVM was capable of reconstructing spatial information in panoramic images. Furthermore, as the registration model was trained on over 280,000 pediatric fundus images, we introduced a registration annotation automatic generation process coupled with a quality control module to ensure the reliability of training data. We compared the performance of RDLR to the other methods, including conventional registration pipeline (CRP), voxel morph (WM), generalizable image matcher (GIM), and self-supervised techniques (SS). RDLR achieved significantly higher registration accuracy (average Dice score of 0.948) than the other methods (ranging from 0.491 to 0.802). The resulting panoramic retinal maps reconstructed by RDLR also demonstrated substantially higher fidelity (average Dice score of 0.960) compared to the other methods (ranging from 0.720 to 0.783). Overall, the proposed method addressed key challenges in pediatric retinal imaging, providing an effective solution to enhance disease diagnosis. Our source code is available at https://github.com/wuwusky/RobustDeepLeraningRegistration .
Collapse
Affiliation(s)
- Hao Zhou
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Wenhan Yang
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Limei Sun
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Li Huang
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Songshan Li
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaoling Luo
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yili Jin
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Wei Sun
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Wenjia Yan
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jing Li
- Department of Ophthalmology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Xiaoyan Ding
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
| | - Yao He
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
| | - Zhi Xie
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
| |
Collapse
|
3
|
Rao DP, Shroff S, Savoy FM, S S, Hsu CK, Negiloni K, Pradhan ZS, P V J, Sivaraman A, Rao HL. Evaluation of an offline, artificial intelligence system for referable glaucoma screening using a smartphone-based fundus camera: a prospective study. Eye (Lond) 2024; 38:1104-1111. [PMID: 38092938 PMCID: PMC11009383 DOI: 10.1038/s41433-023-02826-z] [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: 10/11/2022] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND/OBJECTIVES An affordable and scalable screening model is critical for undetected glaucoma. The study evaluated the performance of an offline, smartphone-based AI system for the detection of referable glaucoma against two benchmarks: specialist diagnosis following full glaucoma workup and consensus image grading. SUBJECTS/METHODS This prospective study (tertiary glaucoma centre, India) included 243 subjects with varying severity of glaucoma and control group without glaucoma. Disc-centred images were captured using a validated smartphone-based fundus camera analysed by the AI system and graded by specialists. Diagnostic ability of the AI in detecting referable Glaucoma (Confirmed glaucoma) and no referable Glaucoma (Suspects and No glaucoma) when compared to a final diagnosis (comprehensive glaucoma workup) and majority grading (image grading) by Glaucoma specialists (pre-defined criteria) were evaluated. RESULTS The AI system demonstrated a sensitivity and specificity of 93.7% (95% CI: 87.6-96.9%) and 85.6% (95% CI:78.6-90.6%), respectively, in the detection of referable glaucoma when compared against final diagnosis following full glaucoma workup. True negative rate in definite non-glaucoma cases was 94.7% (95% CI: 87.2-97.9%). Amongst the false negatives were 4 early and 3 moderate glaucoma. When the same set of images provided to the AI was also provided to the specialists for image grading, specialists detected 60% (67/111) of true glaucoma cases versus a detection rate of 94% (104/111) by the AI. CONCLUSION The AI tool showed robust performance when compared against a stringent benchmark. It had modest over-referral of normal subjects despite being challenged with fundus images alone. The next step involves a population-level assessment.
Collapse
Affiliation(s)
| | - Sujani Shroff
- Narayana Nethralaya Eye Hospital, Glaucoma Services, Bangalore, India
| | | | - Shruthi S
- Narayana Nethralaya Eye Hospital, Glaucoma Services, Bangalore, India
| | - Chao-Kai Hsu
- Medios Technologies Pte Ltd, Singapore, Singapore
| | | | | | - Jayasree P V
- Narayana Nethralaya Eye Hospital, Glaucoma Services, Bangalore, India
| | | | - Harsha L Rao
- Narayana Nethralaya Eye Hospital, Glaucoma Services, Bangalore, India
| |
Collapse
|
4
|
Lapka M, Straňák Z. The Current State of Artificial Intelligence in Neuro-Ophthalmology. A Review. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2024; 80:179-186. [PMID: 38538291 DOI: 10.31348/2023/33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
This article presents a summary of recent advances in the development and use of complex systems using artificial intelligence (AI) in neuro-ophthalmology. The aim of the following article is to present the principles of AI and algorithms that are currently being used or are still in the stage of evaluation or validation within the neuro-ophthalmology environment. For the purpose of this text, a literature search was conducted using specific keywords in available scientific databases, cumulatively up to April 2023. The AI systems developed across neuro-ophthalmology mostly achieve high sensitivity, specificity and accuracy. Individual AI systems and algorithms are subsequently selected, simply described and compared in the article. The results of the individual studies differ significantly, depending on the chosen methodology, the set goals, the size of the test, evaluated set, and the evaluated parameters. It has been demonstrated that the evaluation of various diseases will be greatly speeded up with the help of AI and make the diagnosis more efficient in the future, thus showing a high potential to be a useful tool in clinical practice even with a significant increase in the number of patients.
Collapse
|
5
|
Qian X, Xian S, Yifei S, Wei G, Liu H, Xiaoming X, Chu C, Yilong Y, Shuang Y, Kai M, Mei C, Yi Q. External validation of a deep learning detection system for glaucomatous optic neuropathy: a real-world multicentre study. Eye (Lond) 2023; 37:3813-3818. [PMID: 37322379 PMCID: PMC10698045 DOI: 10.1038/s41433-023-02622-9] [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: 11/23/2022] [Revised: 05/17/2023] [Accepted: 06/02/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVES To conduct an external validation of an automated artificial intelligence (AI) diagnostic system using fundus photographs from a real-life multicentre cohort. METHODS We designed external validation in multiple scenarios, consisting of 3049 images from Qilu Hospital of Shandong University in China (QHSDU, validation dataset 1), 7495 images from three other hospitals in China (validation dataset 2), and 516 images from high myopia (HM) population of QHSDU (validation dataset 3). The corresponding sensitivity, specificity and accuracy of this AI diagnostic system to identify glaucomatous optic neuropathy (GON) were calculated. RESULTS In validation datasets 1 and 2, the algorithm yielded accuracy of 93.18% and 91.40%, area under the receiver operating curves (AUC) of 95.17% and 96.64%, and significantly higher sensitivity of 91.75% and 91.41%, respectively, compared to manual graders. On the subsets complicated with retinal comorbidities, such as diabetic retinopathy or age-related macular degeneration, in validation datasets 1 and 2, the algorithm achieved accuracy of 87.54% and 93.81%, and AUC of 97.02% and 97.46%, respectively. In validation dataset 3, the algorithm achieved comparable accuracy of 81.98% and AUC of 87.49%, with a sensitivity of 83.61% and specificity of 81.76% on GON recognition specifically in the HM population. CONCLUSIONS With acceptable generalization capability across varying levels of image quality, different clinical centres, or certain retinal comorbidities, such as HM, the automatic AI diagnostic system had the potential to provide expert-level glaucoma detection.
Collapse
Affiliation(s)
- Xu Qian
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, No. 107, Wenhuaxi Road, Jinan, 250012, China
- Key Laboratory of Cardiovascular Proteomics of Shandong Province, Jinan, China
- Jinan Clinical Research Center for Geriatric Medicine (202132001), Jinan, China
| | - Song Xian
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, No. 107, Wenhuaxi Road, Jinan, 250012, China
- Key Laboratory of Cardiovascular Proteomics of Shandong Province, Jinan, China
- Jinan Clinical Research Center for Geriatric Medicine (202132001), Jinan, China
| | - Su Yifei
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, Jiangsu Province, 215316, China
| | - Guo Wei
- Lunan Eye Hospital, Linyi, 276000, China
| | - Hanruo Liu
- Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
- School of Information and Electronics, Beijing Institute of Technology, Beijing, 100730, China
| | - Xi Xiaoming
- School of Computer Science and Technology, Shandong Jianzhu University, Jinan, 250101, China
| | | | - Yin Yilong
- School of Software, Shandong University, Jinan, 250101, China
| | - Yu Shuang
- Tencent Healthcare, Shenzhen, 51800, China
| | - Ma Kai
- Tencent Healthcare, Shenzhen, 51800, China
| | - Cheng Mei
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, No. 107, Wenhuaxi Road, Jinan, 250012, China
- Key Laboratory of Cardiovascular Proteomics of Shandong Province, Jinan, China
- Jinan Clinical Research Center for Geriatric Medicine (202132001), Jinan, China
| | - Qu Yi
- Department of Geriatric Medicine, Qilu Hospital of Shandong University, No. 107, Wenhuaxi Road, Jinan, 250012, China.
- Key Laboratory of Cardiovascular Proteomics of Shandong Province, Jinan, China.
- Jinan Clinical Research Center for Geriatric Medicine (202132001), Jinan, China.
| |
Collapse
|
6
|
Wang M, Lin T, Wang L, Lin A, Zou K, Xu X, Zhou Y, Peng Y, Meng Q, Qian Y, Deng G, Wu Z, Chen J, Lin J, Zhang M, Zhu W, Zhang C, Zhang D, Goh RSM, Liu Y, Pang CP, Chen X, Chen H, Fu H. Uncertainty-inspired open set learning for retinal anomaly identification. Nat Commun 2023; 14:6757. [PMID: 37875484 PMCID: PMC10598011 DOI: 10.1038/s41467-023-42444-7] [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: 04/11/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023] Open
Abstract
Failure to recognize samples from the classes unseen during training is a major limitation of artificial intelligence in the real-world implementation for recognition and classification of retinal anomalies. We establish an uncertainty-inspired open set (UIOS) model, which is trained with fundus images of 9 retinal conditions. Besides assessing the probability of each category, UIOS also calculates an uncertainty score to express its confidence. Our UIOS model with thresholding strategy achieves an F1 score of 99.55%, 97.01% and 91.91% for the internal testing set, external target categories (TC)-JSIEC dataset and TC-unseen testing set, respectively, compared to the F1 score of 92.20%, 80.69% and 64.74% by the standard AI model. Furthermore, UIOS correctly predicts high uncertainty scores, which would prompt the need for a manual check in the datasets of non-target categories retinal diseases, low-quality fundus images, and non-fundus images. UIOS provides a robust method for real-world screening of retinal anomalies.
Collapse
Affiliation(s)
- Meng Wang
- Institute of High Performance Computing (IHPC), Agency for Science, Technology and Research (A*STAR), 1 Fusionopolis Way, #16-16 Connexis, Singapore, 138632, Republic of Singapore
| | - Tian Lin
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, 515041, Shantou, Guangdong, China
| | - Lianyu Wang
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, 211100, Nanjing, Jiangsu, China
- Laboratory of Brain-Machine Intelligence Technology, Ministry of Education Nanjing University of Aeronautics and Astronautics, 211106, Nanjing, Jiangsu, China
| | - Aidi Lin
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, 515041, Shantou, Guangdong, China
| | - Ke Zou
- National Key Laboratory of Fundamental Science on Synthetic Vision and the College of Computer Science, Sichuan University, 610065, Chengdu, Sichuan, China
| | - Xinxing Xu
- Institute of High Performance Computing (IHPC), Agency for Science, Technology and Research (A*STAR), 1 Fusionopolis Way, #16-16 Connexis, Singapore, 138632, Republic of Singapore
| | - Yi Zhou
- School of Electronics and Information Engineering, Soochow University, 215006, Suzhou, Jiangsu, China
| | - Yuanyuan Peng
- School of Biomedical Engineering, Anhui Medical University, 230032, Hefei, Anhui, China
| | - Qingquan Meng
- School of Electronics and Information Engineering, Soochow University, 215006, Suzhou, Jiangsu, China
| | - Yiming Qian
- Institute of High Performance Computing (IHPC), Agency for Science, Technology and Research (A*STAR), 1 Fusionopolis Way, #16-16 Connexis, Singapore, 138632, Republic of Singapore
| | - Guoyao Deng
- National Key Laboratory of Fundamental Science on Synthetic Vision and the College of Computer Science, Sichuan University, 610065, Chengdu, Sichuan, China
| | - Zhiqun Wu
- Longchuan People's Hospital, 517300, Heyuan, Guangdong, China
| | - Junhong Chen
- Puning People's Hospital, 515300, Jieyang, Guangdong, China
| | - Jianhong Lin
- Haifeng PengPai Memory Hospital, 516400, Shanwei, Guangdong, China
| | - Mingzhi Zhang
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, 515041, Shantou, Guangdong, China
| | - Weifang Zhu
- School of Electronics and Information Engineering, Soochow University, 215006, Suzhou, Jiangsu, China
| | - Changqing Zhang
- College of Intelligence and Computing, Tianjin University, 300350, Tianjin, China
| | - Daoqiang Zhang
- College of Computer Science and Technology, Nanjing University of Aeronautics and Astronautics, 211100, Nanjing, Jiangsu, China
- Laboratory of Brain-Machine Intelligence Technology, Ministry of Education Nanjing University of Aeronautics and Astronautics, 211106, Nanjing, Jiangsu, China
| | - Rick Siow Mong Goh
- Institute of High Performance Computing (IHPC), Agency for Science, Technology and Research (A*STAR), 1 Fusionopolis Way, #16-16 Connexis, Singapore, 138632, Republic of Singapore
| | - Yong Liu
- Institute of High Performance Computing (IHPC), Agency for Science, Technology and Research (A*STAR), 1 Fusionopolis Way, #16-16 Connexis, Singapore, 138632, Republic of Singapore
| | - Chi Pui Pang
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, 515041, Shantou, Guangdong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, 999077, Hong Kong, China
| | - Xinjian Chen
- School of Electronics and Information Engineering, Soochow University, 215006, Suzhou, Jiangsu, China.
- State Key Laboratory of Radiation Medicine and Protection, Soochow University, 215006, Suzhou, China.
| | - Haoyu Chen
- Joint Shantou International Eye Center, Shantou University and the Chinese University of Hong Kong, 515041, Shantou, Guangdong, China.
| | - Huazhu Fu
- Institute of High Performance Computing (IHPC), Agency for Science, Technology and Research (A*STAR), 1 Fusionopolis Way, #16-16 Connexis, Singapore, 138632, Republic of Singapore.
| |
Collapse
|
7
|
Wiedemann P. Artificial intelligence in ophthalmology. Int J Ophthalmol 2023; 16:1357-1360. [PMID: 37724277 PMCID: PMC10409517 DOI: 10.18240/ijo.2023.09.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/19/2023] [Indexed: 09/20/2023] Open
|
8
|
Pucchio A, Krance S, Pur DR, Bassi A, Miranda R, Felfeli T. The role of artificial intelligence in analysis of biofluid markers for diagnosis and management of glaucoma: A systematic review. Eur J Ophthalmol 2023; 33:1816-1833. [PMID: 36426575 PMCID: PMC10469503 DOI: 10.1177/11206721221140948] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 11/01/2022] [Indexed: 08/31/2023]
Abstract
PURPOSE This review focuses on utility of artificial intelligence (AI) in analysis of biofluid markers in glaucoma. We detail the accuracy and validity of AI in the exploration of biomarkers to provide insight into glaucoma pathogenesis. METHODS A comprehensive search was conducted across five electronic databases including Embase, Medline, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science. Studies pertaining to biofluid marker analysis using AI or bioinformatics in glaucoma were included. Identified studies were critically appraised and assessed for risk of bias using the Joanna Briggs Institute Critical Appraisal tools. RESULTS A total of 10,258 studies were screened and 39 studies met the inclusion criteria, including 23 cross-sectional studies (59%), nine prospective cohort studies (23%), six retrospective cohort studies (15%), and one case-control study (3%). Primary open angle glaucoma (POAG) was the most commonly studied subtype (55% of included studies). Twenty-four studies examined disease characteristics, 10 explored treatment decisions, and 5 provided diagnostic clarification. While studies examined at entire metabolomic or proteomic profiles to determine changes in POAG, there was heterogeneity in the data with over 175 unique, differentially expressed biomarkers reported. Discriminant analysis and artificial neural network predictive models displayed strong differentiating ability between glaucoma patients and controls, although these tools were untested in a clinical context. CONCLUSION The use of AI models could inform glaucoma diagnosis with high sensitivity and specificity. While insight into differentially expressed biomarkers is valuable in pathogenic exploration, no clear pathogenic mechanism in glaucoma has emerged.
Collapse
Affiliation(s)
- Aidan Pucchio
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Saffire Krance
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Daiana R Pur
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Arshpreet Bassi
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Rafael Miranda
- Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Ontario, Canada
- The Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Tina Felfeli
- Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ontario, Canada
- The Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
9
|
Shroff S, Rao DP, Savoy FM, Shruthi S, Hsu CK, Pradhan ZS, Jayasree PV, Sivaraman A, Sengupta S, Shetty R, Rao HL. Agreement of a Novel Artificial Intelligence Software With Optical Coherence Tomography and Manual Grading of the Optic Disc in Glaucoma. J Glaucoma 2023; 32:280-286. [PMID: 36730188 DOI: 10.1097/ijg.0000000000002147] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 11/19/2022] [Indexed: 02/03/2023]
Abstract
PRCIS The offline artificial intelligence (AI) on a smartphone-based fundus camera shows good agreement and correlation with the vertical cup-to-disc ratio (vCDR) from the spectral-domain optical coherence tomography (SD-OCT) and manual grading by experts. PURPOSE The purpose of this study is to assess the agreement of vCDR measured by a new AI software from optic disc images obtained using a validated smartphone-based imaging device, with SD-OCT vCDR measurements, and manual grading by experts on a stereoscopic fundus camera. METHODS In a prospective, cross-sectional study, participants above 18 years (Glaucoma and normal) underwent a dilated fundus evaluation, followed by optic disc imaging including a 42-degree monoscopic disc-centered image (Remidio NM-FOP-10), a 30-degree stereoscopic disc-centered image (Kowa nonmyd WX-3D desktop fundus camera), and disc analysis (Cirrus SD-OCT). Remidio FOP images were analyzed for vCDR using the new AI software, and Kowa stereoscopic images were manually graded by 3 fellowship-trained glaucoma specialists. RESULTS We included 473 eyes of 244 participants. The vCDR values from the new AI software showed strong agreement with SD-OCT measurements [95% limits of agreement (LoA)=-0.13 to 0.16]. The agreement with SD-OCT was marginally better in eyes with higher vCDR (95% LoA=-0.15 to 0.12 for vCDR>0.8). Interclass correlation coefficient was 0.90 (95% CI, 0.88-0.91). The vCDR values from AI software showed a good correlation with the manual segmentation by experts (interclass correlation coefficient=0.89, 95% CI, 0.87-0.91) on stereoscopic images (95% LoA=-0.18 to 0.11) with agreement better for eyes with vCDR>0.8 (LoA=-0.12 to 0.08). CONCLUSIONS The new AI software vCDR measurements had an excellent agreement and correlation with the SD-OCT and manual grading. The ability of the Medios AI to work offline, without requiring cloud-based inferencing, is an added advantage.
Collapse
Affiliation(s)
- Sujani Shroff
- Department of Glaucoma, Narayana Nethralaya, Rajajinagar
| | - Divya P Rao
- Remidio Innovative Solution Inc., Glen Allen, VA
| | - Florian M Savoy
- Medios Technologies, Remidio Innovative Solutions Pvt Ltd, Singapore
| | - S Shruthi
- Department of Glaucoma, Narayana Nethralaya, Rajajinagar
| | - Chao-Kai Hsu
- Medios Technologies, Remidio Innovative Solutions Pvt Ltd, Singapore
| | - Zia S Pradhan
- Department of Glaucoma, Narayana Nethralaya, Rajajinagar
| | - P V Jayasree
- Department of Glaucoma, Narayana Nethralaya, Rajajinagar
| | - Anand Sivaraman
- Remidio Innovative Solution Pvt Ltd, Bengaluru, Karnataka, India
| | | | - Rohit Shetty
- Department of Glaucoma, Narayana Nethralaya, Rajajinagar
| | - Harsha L Rao
- Department of Glaucoma, Narayana Nethralaya, Bannerghatta Road
| |
Collapse
|
10
|
Wang J, Zhang Y, Meng X, Liu G. Application of diffusion tensor imaging technology in glaucoma diagnosis. Front Neurosci 2023; 17:1125638. [PMID: 36816120 PMCID: PMC9932933 DOI: 10.3389/fnins.2023.1125638] [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: 12/16/2022] [Accepted: 01/11/2023] [Indexed: 02/05/2023] Open
Abstract
Glaucoma is the first major category of irreversible blinding eye illnesses worldwide. Its leading cause is the death of retinal ganglion cells and their axons, which results in the loss of vision. Research indicates that glaucoma affects the optic nerve and the whole visual pathway. It also reveals that degenerative lesions caused by glaucoma can be found outside the visual pathway. Diffusion tensor imaging (DTI) is a magnetic resonance imaging (MRI) technique that can investigate the complete visual system, including alterations in the optic nerve, optic chiasm, optic tract, lateral geniculate nuclear, and optic radiation. In order to provide a more solid foundation for the degenerative characteristics of glaucoma, this paper will discuss the standard diagnostic techniques for glaucoma through a review of the literature, describe the use of DTI technology in glaucoma in humans and animal models, and introduce these techniques. With the advancement of DTI technology and its coupling with artificial intelligence, DTI represents a potential future for MRI technology in glaucoma research.
Collapse
|
11
|
Aspberg J, Heijl A, Bengtsson B. Estimating the Length of the Preclinical Detectable Phase for Open-Angle Glaucoma. JAMA Ophthalmol 2023; 141:48-54. [PMID: 36416831 PMCID: PMC9857634 DOI: 10.1001/jamaophthalmol.2022.5056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/09/2022] [Indexed: 11/24/2022]
Abstract
Importance A 50% reduction of glaucoma-related blindness has previously been demonstrated in a population that was screened for open-angle glaucoma. Ongoing screening trials of high-risk populations and forthcoming low-cost screening methods suggest that such screening may become more common in the future. One would then need to estimate a key component of the natural history of chronic disease, the mean preclinical detectable phase (PCDP). Knowledge of the PCDP is essential for the planning and early evaluation of screening programs and has been estimated for several types of cancer that are screened for. Objective To estimate the mean PCDP for open-angle glaucoma. Design, Setting, and Participants A large population-based screening for open-angle glaucoma was conducted from October 1992 to January 1997 in Malmö, Sweden, including 32 918 participants aged 57 to 77 years. A retrospective medical record review was conducted to assess the prevalence of newly detected cases at the screening, incidence of new cases after the screening, and the expected clinical incidence, ie, the number of new glaucoma cases expected to be detected without a screening. The latter was derived from incident cases in the screened age cohorts before the screening started and from older cohorts not invited to the screening. A total of 2029 patients were included in the current study. Data were analyzed from March 2020 to October 2021. Main Outcomes and Measures The length of the mean PCDP was calculated by 2 different methods: first, by dividing the prevalence of screen-detected glaucoma with the clinical incidence, assuming that the screening sensitivity was 100% and second, by using a Markov chain Monte Carlo (MCMC) model simulation that simultaneously derived both the length of the mean PCDP and the sensitivity of the screening. Results Of 2029 included patients, 1352 (66.6%) were female. Of 1420 screened patients, the mean age at screening was 67.4 years (95% CI, 67.2-67.7). The mean length of the PCDP of the whole study population was 10.7 years (95% CI, 8.7-13.0) by the prevalence/incidence method and 10.1 years (95% credible interval, 8.9-11.2) by the MCMC method. Conclusions and Relevance The mean PCDP was similar for both methods of analysis, approximately 10 years. A mean PCDP of 10 years found in the current study allows for screening with reasonably long intervals, eg, 5 years.
Collapse
Affiliation(s)
- Johan Aspberg
- Department of Clinical Sciences in Malmö, Ophthalmology, Lund University, Malmö, Sweden
- Department of Ophthalmology, Skåne University Hospital, Malmö, Sweden
| | - Anders Heijl
- Department of Clinical Sciences in Malmö, Ophthalmology, Lund University, Malmö, Sweden
- Department of Ophthalmology, Skåne University Hospital, Malmö, Sweden
| | - Boel Bengtsson
- Department of Clinical Sciences in Malmö, Ophthalmology, Lund University, Malmö, Sweden
| |
Collapse
|
12
|
Bragança CP, Torres JM, Soares CPDA, Macedo LO. Detection of Glaucoma on Fundus Images Using Deep Learning on a New Image Set Obtained with a Smartphone and Handheld Ophthalmoscope. Healthcare (Basel) 2022; 10:healthcare10122345. [PMID: 36553869 PMCID: PMC9778370 DOI: 10.3390/healthcare10122345] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/18/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
Statistics show that an estimated 64 million people worldwide suffer from glaucoma. To aid in the detection of this disease, this paper presents a new public dataset containing eye fundus images that was developed for glaucoma pattern-recognition studies using deep learning (DL). The dataset, denoted Brazil Glaucoma, comprises 2000 images obtained from 1000 volunteers categorized into two groups: those with glaucoma (50%) and those without glaucoma (50%). All images were captured with a smartphone attached to a Welch Allyn panoptic direct ophthalmoscope. Further, a DL approach for the automatic detection of glaucoma was developed using the new dataset as input to a convolutional neural network ensemble model. The accuracy between positive and negative glaucoma detection, sensitivity, and specificity were calculated using five-fold cross-validation to train and refine the classification model. The results showed that the proposed method can identify glaucoma from eye fundus images with an accuracy of 90.0%. Thus, the combination of fundus images obtained using a smartphone attached to a portable panoptic ophthalmoscope and artificial intelligence algorithms yielded satisfactory results in the overall accuracy of glaucoma detection tests. Consequently, the proposed approach can contribute to the development of technologies aimed at massive population screening of the disease.
Collapse
Affiliation(s)
- Clerimar Paulo Bragança
- ISUS Unit, Faculdade de Ciência e Tecnologia, Universidade Fernando Pessoa, 4249-004 Porto, Portugal
- Correspondence: ; Tel.: +351-22-507-1300
| | - José Manuel Torres
- ISUS Unit, Faculdade de Ciência e Tecnologia, Universidade Fernando Pessoa, 4249-004 Porto, Portugal
- Artificial Intelligence and Computer Science Laboratory, LIACC, University of Porto, 4100-000 Porto, Portugal
| | - Christophe Pinto de Almeida Soares
- ISUS Unit, Faculdade de Ciência e Tecnologia, Universidade Fernando Pessoa, 4249-004 Porto, Portugal
- Artificial Intelligence and Computer Science Laboratory, LIACC, University of Porto, 4100-000 Porto, Portugal
| | - Luciano Oliveira Macedo
- Department of Ophthalmology, Eye Hospital of Southern Minas Gerais State, R. Joaquim Rosa, 14, Itanhandu 37464-000, MG, Brazil
| |
Collapse
|
13
|
Measurement of retinal nerve fiber layer thickness with a deep learning algorithm in ischemic optic neuropathy and optic neuritis. Sci Rep 2022; 12:17109. [PMID: 36224300 PMCID: PMC9556618 DOI: 10.1038/s41598-022-22135-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/10/2022] [Indexed: 01/04/2023] Open
Abstract
This work aims at determining the ability of a deep learning (DL) algorithm to measure retinal nerve fiber layer (RNFL) thickness from optical coherence tomography (OCT) scans in anterior ischemic optic neuropathy (NAION) and demyelinating optic neuritis (ON). The training/validation dataset included 750 RNFL OCT B-scans. Performance of our algorithm was evaluated on 194 OCT B-scans from 70 healthy eyes, 82 scans from 28 NAION eyes, and 84 scans of 29 ON eyes. Results were compared to manual segmentation as a ground-truth and to RNFL calculations from the built-in instrument software. The Dice coefficient for the test images was 0.87. The mean average RNFL thickness using our U-Net was not different from the manually segmented best estimate and OCT machine data in control and ON eyes. In NAION eyes, while the mean average RNFL thickness using our U-Net algorithm was not different from the manual segmented value, the OCT machine data were different from the manual segmented values. In NAION eyes, the MAE of the average RNFL thickness was 1.18 ± 0.69 μm and 6.65 ± 5.37 μm in the U-Net algorithm segmentation and the conventional OCT machine data, respectively (P = 0.0001).
Collapse
|
14
|
Al-Aswad LA, Ramachandran R, Schuman JS, Medeiros F, Eydelman MB. Artificial Intelligence for Glaucoma: Creating and Implementing Artificial Intelligence for Disease Detection and Progression. Ophthalmol Glaucoma 2022; 5:e16-e25. [PMID: 35218987 PMCID: PMC9399304 DOI: 10.1016/j.ogla.2022.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/14/2022] [Accepted: 02/17/2022] [Indexed: 12/15/2022]
Abstract
On September 3, 2020, the Collaborative Community on Ophthalmic Imaging conducted its first 2-day virtual workshop on the role of artificial intelligence (AI) and related machine learning techniques in the diagnosis and treatment of various ophthalmic conditions. In a session entitled "Artificial Intelligence for Glaucoma," a panel of glaucoma specialists, researchers, industry experts, and patients convened to share current research on the application of AI to commonly used diagnostic modalities, including fundus photography, OCT imaging, standard automated perimetry, and gonioscopy. The conference participants focused on the use of AI as a tool for disease prediction, highlighted its ability to address inequalities, and presented the limitations of and challenges to its clinical application. The panelists' discussion addressed AI and health equities from clinical, societal, and regulatory perspectives.
Collapse
Affiliation(s)
- Lama A Al-Aswad
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York; Department of Population Health, NYU Langone Health, NYU Grossman School of Medicine, New York, New York.
| | - Rithambara Ramachandran
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York
| | - Joel S Schuman
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York; Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, New York; Department of Electrical and Computer Engineering, New York University Tandon School of Engineering, Brooklyn, New York; Center for Neural Science, NYU, New York, New York; Neuroscience Institute, NYU Langone Health, New York, New York
| | - Felipe Medeiros
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina
| | | |
Collapse
|
15
|
Leong YY, Vasseneix C, Finkelstein MT, Milea D, Najjar RP. Artificial Intelligence Meets Neuro-Ophthalmology. Asia Pac J Ophthalmol (Phila) 2022; 11:111-125. [PMID: 35533331 DOI: 10.1097/apo.0000000000000512] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
ABSTRACT Recent advances in artificial intelligence have provided ophthalmologists with fast, accurate, and automated means for diagnosing and treating ocular conditions, paving the way to a modern and scalable eye care system. Compared to other ophthalmic disciplines, neuro-ophthalmology has, until recently, not benefitted from significant advances in the area of artificial intelligence. In this narrative review, we summarize and discuss recent advancements utilizing artificial intelligence for the detection of structural and functional optic nerve head abnormalities, and ocular movement disorders in neuro-ophthalmology.
Collapse
Affiliation(s)
| | - Caroline Vasseneix
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | | | - Dan Milea
- Singapore National Eye Center, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Raymond P Najjar
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
16
|
Wu CW, Chen HY, Chen JY, Lee CH. Glaucoma Detection Using Support Vector Machine Method Based on Spectralis OCT. Diagnostics (Basel) 2022; 12:diagnostics12020391. [PMID: 35204482 PMCID: PMC8871188 DOI: 10.3390/diagnostics12020391] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/17/2022] [Accepted: 01/30/2022] [Indexed: 02/01/2023] Open
Abstract
Spectralis optical coherence tomography (OCT) provided more detailed parameters in the peripapillary and macular areas among the OCT machines, but it is not easy to understand the enormous information (114 features) generated from Spectralis OCT in glaucoma assessment. Machine learning methodology has been well-applied in glaucoma detection in recent years and has the ability to process a large amount of information at once. Here we aimed to analyze the diagnostic capability of Spectralis OCT parameters on glaucoma detection using Support Vector Machine (SVM) classification method in our population. Our results showed that applying all OCT features with the SVM method had good capability in the detection of glaucomatous eyes (area under curve (AUC) = 0.82), as well as discriminating normal eyes from early, moderate, or severe glaucomatous eyes (AUC = 0.78, 0.89, and 0.93, respectively). Apart from using all OCT features, the minimum rim width (MRW) may be good feature groups to discriminate early glaucomatous from normal eyes (AUC = 0.78). The combination of peripapillary and macular parameters, including MRW_temporal inferior (TI), MRW_global (G), ganglion cell layer (GCL)_outer temporal (T2), GCL_inner inferior (I1), peripapillary nerve fiber layer thickness (ppNFLT)_temporal superior (TS), and GCL_inner temporal (T1), provided better results (AUC = 0.84). This study showed promise in glaucoma management in the Taiwanese population. However, further validation study is needed to test the performance of our proposed model in the real world.
Collapse
Affiliation(s)
- Chao-Wei Wu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City 807378, Taiwan;
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 807378, Taiwan
| | - Hsin-Yi Chen
- Department of Ophthalmology, Fu Jen Catholic University Hospital, New Taipei City 24352, Taiwan
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242062, Taiwan
- Correspondence: (H.-Y.C.); (C.-H.L.)
| | - Jui-Yu Chen
- Institute of Electrical and Control Engineering, National Yang Ming Chiao Tung University, Hsinchu City 30010, Taiwan;
| | - Ching-Hung Lee
- Department of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu City 30010, Taiwan
- Correspondence: (H.-Y.C.); (C.-H.L.)
| |
Collapse
|
17
|
Research on Management Efficiency and Dynamic Relationship in Intelligent Management of Tourism Engineering Based on Industry 4.0. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:5831062. [PMID: 35103056 PMCID: PMC8800595 DOI: 10.1155/2022/5831062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/20/2021] [Accepted: 12/31/2021] [Indexed: 11/17/2022]
Abstract
The digital age of artificial intelligence marks the rapid development of tourism engineering and the gradual improvement of intelligent management theory. This study aims to solve the problems of low efficiency of dynamic relationship analysis and low data utilization in traditional intelligent management methods of tourism engineering. This work studies the dynamic optimization model of tourism engineering management theory based on the artificial intelligence data analysis model and designs the dynamic analysis model of tourism engineering management data based on the convolution neural network. The model can collect dynamic data information of tourism management from many aspects and can also be used to study and analyze human behavior patterns based on the convolutional neural network algorithm. According to the human behavior data analysis model and convolution neural network algorithm, this study formulates the real-time management data scheme of tourism engineering and better extracts the characteristic information of the dynamic data of tourism engineering management. The results show that the topology optimization model of tourism intelligent management based on the convolutional neural network achieves high feasibility, high data accuracy, and high response speed. It can improve the collaborative coupling relationship between management efficiency and dynamic data in tourism engineering management based on big data analysis technology. It realizes the effective combination of tourism management, digital management, and artificial intelligence algorithm.
Collapse
|
18
|
Ahuja A, Bommakanti S, Wagner I, Dorairaj S, Ten Hulzen R, Checo L. Current and future implications of using artificial intelligence in glaucoma care. J Curr Ophthalmol 2022; 34:129-132. [PMID: 36147268 PMCID: PMC9486995 DOI: 10.4103/joco.joco_39_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/18/2022] [Accepted: 06/28/2022] [Indexed: 12/05/2022] Open
|
19
|
Schuman JS, Angeles Ramos Cadena MDL, McGee R, Al-Aswad LA, Medeiros FA. A Case for The Use of Artificial Intelligence in Glaucoma Assessment. Ophthalmol Glaucoma 2021; 5:e3-e13. [PMID: 34954220 PMCID: PMC9133028 DOI: 10.1016/j.ogla.2021.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 12/23/2022]
Abstract
We hypothesize that artificial intelligence applied to relevant clinical testing in glaucoma has the potential to enhance the ability to detect glaucoma. This premise was discussed at the recent Collaborative Community for Ophthalmic Imaging meeting, "The Future of Artificial Intelligence-Enabled Ophthalmic Image Interpretation: Accelerating Innovation and Implementation Pathways," held virtually September 3-4, 2020. The Collaborative Community in Ophthalmic Imaging (CCOI) is an independent self-governing consortium of stakeholders with broad international representation from academic institutions, government agencies, and the private sector whose mission is to act as a forum for the purpose of helping speed innovation in healthcare technology. It was one of the first two such organizations officially designated by the FDA in September 2019 in response to their announcement of the collaborative community program as a strategic priority for 2018-2020. Further information on the CCOI can be found online at their website (https://www.cc-oi.org/about). Artificial intelligence for glaucoma diagnosis would have high utility globally, as access to care is limited in many parts of the world and half of all people with glaucoma are unaware of their illness. The application of artificial intelligence technology to glaucoma diagnosis has the potential to broadly increase access to care worldwide, in essence flattening the Earth by providing expert level evaluation to individuals even in the most remote regions of the planet.
Collapse
Affiliation(s)
- Joel S Schuman
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA; Departments of Biomedical Engineering and Electrical and Computer Engineering, New York University Tandon School of Engineering, Brooklyn, NY, USA; Center for Neural Science, NYU, New York, NY, USA; Neuroscience Institute, NYU Langone Health, New York, NY, USA.
| | | | - Rebecca McGee
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Lama A Al-Aswad
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA; Department of Population Health, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Felipe A Medeiros
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | | |
Collapse
|
20
|
Wu Y, Szymanska M, Hu Y, Fazal MI, Jiang N, Yetisen AK, Cordeiro MF. Measures of disease activity in glaucoma. Biosens Bioelectron 2021; 196:113700. [PMID: 34653715 DOI: 10.1016/j.bios.2021.113700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/01/2021] [Accepted: 10/08/2021] [Indexed: 12/13/2022]
Abstract
Glaucoma is the leading cause of irreversible blindness globally which significantly affects the quality of life and has a substantial economic impact. Effective detective methods are necessary to identify glaucoma as early as possible. Regular eye examinations are important for detecting the disease early and preventing deterioration of vision and quality of life. Current methods of measuring disease activity are powerful in describing the functional and structural changes in glaucomatous eyes. However, there is still a need for a novel tool to detect glaucoma earlier and more accurately. Tear fluid biomarker analysis and new imaging technology provide novel surrogate endpoints of glaucoma. Artificial intelligence is a post-diagnostic tool that can analyse ophthalmic test results. A detail review of currently used clinical tests in glaucoma include intraocular pressure test, visual field test and optical coherence tomography are presented. The advanced technologies for glaucoma measurement which can identify specific disease characteristics, as well as the mechanism, performance and future perspectives of these devices are highlighted. Applications of AI in diagnosis and prediction in glaucoma are mentioned. With the development in imaging tools, sensor technologies and artificial intelligence, diagnostic evaluation of glaucoma must assess more variables to facilitate earlier diagnosis and management in the future.
Collapse
Affiliation(s)
- Yue Wu
- Department of Surgery and Cancer, Imperial College London, South Kensington, London, United Kingdom; Department of Chemical Engineering, Imperial College London, South Kensington, London, United Kingdom
| | - Maja Szymanska
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, United Kingdom
| | - Yubing Hu
- Department of Chemical Engineering, Imperial College London, South Kensington, London, United Kingdom.
| | - M Ihsan Fazal
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, United Kingdom
| | - Nan Jiang
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China
| | - Ali K Yetisen
- Department of Chemical Engineering, Imperial College London, South Kensington, London, United Kingdom
| | - M Francesca Cordeiro
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, London, United Kingdom; The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, United Kingdom; Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, London, United Kingdom.
| |
Collapse
|
21
|
Cai S, Han IC, Scott AW. Artificial intelligence for improving sickle cell retinopathy diagnosis and management. Eye (Lond) 2021; 35:2675-2684. [PMID: 33958737 PMCID: PMC8452674 DOI: 10.1038/s41433-021-01556-4] [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: 01/01/2021] [Revised: 03/17/2021] [Accepted: 04/13/2021] [Indexed: 02/04/2023] Open
Abstract
Sickle cell retinopathy is often initially asymptomatic even in proliferative stages, but can progress to cause vision loss due to vitreous haemorrhages or tractional retinal detachments. Challenges with access and adherence to screening dilated fundus examinations, particularly in medically underserved areas where the burden of sickle cell disease is highest, highlight the need for novel approaches to screening for patients with vision-threatening sickle cell retinopathy. This article reviews the existing literature on and suggests future research directions for coupling artificial intelligence with multimodal retinal imaging to expand access to automated, accurate, imaging-based screening for sickle cell retinopathy. Given the variability in retinal specialist practice patterns with regards to monitoring and treatment of sickle cell retinopathy, we also discuss recent progress toward development of machine learning models that can quantitatively track disease progression over time. These artificial intelligence-based applications have great potential for informing evidence-based and resource-efficient clinical diagnosis and management of sickle cell retinopathy.
Collapse
Affiliation(s)
- Sophie Cai
- Retina Division, Duke Eye Center, Durham, NC, USA
| | - Ian C Han
- Institute for Vision Research, Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Adrienne W Scott
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine and Hospital, Baltimore, MD, USA.
| |
Collapse
|
22
|
Nuzzi R, Boscia G, Marolo P, Ricardi F. The Impact of Artificial Intelligence and Deep Learning in Eye Diseases: A Review. Front Med (Lausanne) 2021; 8:710329. [PMID: 34527682 PMCID: PMC8437147 DOI: 10.3389/fmed.2021.710329] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/23/2021] [Indexed: 12/21/2022] Open
Abstract
Artificial intelligence (AI) is a subset of computer science dealing with the development and training of algorithms that try to replicate human intelligence. We report a clinical overview of the basic principles of AI that are fundamental to appreciating its application to ophthalmology practice. Here, we review the most common eye diseases, focusing on some of the potential challenges and limitations emerging with the development and application of this new technology into ophthalmology.
Collapse
Affiliation(s)
- Raffaele Nuzzi
- Ophthalmology Unit, A.O.U. City of Health and Science of Turin, Department of Surgical Sciences, University of Turin, Turin, Italy
| | | | | | | |
Collapse
|
23
|
Research on control strategy and policy optimal scheduling based on an improved genetic algorithm. Neural Comput Appl 2021. [DOI: 10.1007/s00521-021-06415-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
24
|
Nikolaidou A, Tsaousis KT. Teleophthalmology and Artificial Intelligence As Game Changers in Ophthalmic Care After the COVID-19 Pandemic. Cureus 2021; 13:e16392. [PMID: 34408945 PMCID: PMC8363234 DOI: 10.7759/cureus.16392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 12/17/2022] Open
Abstract
The current COVID-19 pandemic has boosted a sudden demand for telemedicine due to quarantine and travel restrictions. The exponential increase in the use of telemedicine is expected to affect ophthalmology drastically. The aim of this review is to discuss the utility, effectiveness and challenges of teleophthalmological new tools for eyecare delivery as well as its implementation and possible facilitation with artificial intelligence. We used the terms: “teleophthalmology,” “telemedicine and COVID-19,” “retinal diseases and telemedicine,” “virtual ophthalmology,” “cost effectiveness of teleophthalmology,” “pediatric teleophthalmology,” “Artificial intelligence and ophthalmology,” “Glaucoma and teleophthalmology” and “teleophthalmology limitations” in the database of PubMed and selected the articles being published in the course of 2015-2020. After the initial search, 321 articles returned as relevant. A meticulous screening followed and eventually 103 published manuscripts were included and used as our references. Emerging in the market, teleophthalmology is showing great potential for the future of ophthalmological care, benefiting both patients and ophthalmologists in times of pandemics. The spectrum of eye diseases that could benefit from teleophthalmology is wide, including mostly retinal diseases such as diabetic retinopathy, retinopathy of prematurity, age-related macular degeneration but also glaucoma and anterior segment conditions. Simultaneously, artificial intelligence provides ways of implementing teleophthalmology easier and with better outcomes, contributing as significant changing factors for ophthalmology practice after the COVID-19 pandemic.
Collapse
Affiliation(s)
- Anna Nikolaidou
- Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | | |
Collapse
|
25
|
Hamid S, Desai P, Hysi P, Burr JM, Khawaja AP. Population screening for glaucoma in UK: current recommendations and future directions. Eye (Lond) 2021; 36:504-509. [PMID: 34345031 PMCID: PMC8873198 DOI: 10.1038/s41433-021-01687-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 11/24/2022] Open
Abstract
Effective population screening for glaucoma would enable earlier diagnosis and prevention of irreversible vision loss. The UK National Screening Committee (NSC) recently published a review that examined the viability, effectiveness and appropriateness of a population-based screening programme for primary open-angle glaucoma (POAG). In our article, we summarise the results of the review and discuss some future directions that may enable effective population screening for glaucoma in the future. Two key questions were addressed by the UK NSC review; is there a valid, accurate screening test for POAG, and does evidence exist that screening reduces morbidity from POAG compared with standard care. Six new studies were identified since the previous 2015 review. The review concluded that screening for glaucoma in adults is not recommended because there is no clear evidence for a sufficiently accurate screening test or for better outcomes with screening compared to current care. The next UK NSC review is due to be conducted in 2023. One challenge for POAG screening is that the relatively low disease prevalence results in too many false-positive referrals, even with an accurate test. In the future, targeted screening of a population subset with a higher prevalence of glaucoma may be effective. Recent developments in POAG polygenic risk prediction and deep learning image analysis offer potential avenues to identifying glaucoma-enriched sub-populations. Until such time, opportunistic case finding through General Ophthalmic Services remains the primary route for identification of glaucoma in the UK and greater public awareness of the service would be of benefit.
Collapse
Affiliation(s)
- Sana Hamid
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, UK
| | - Parul Desai
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, UK
| | - Pirro Hysi
- Section of Ophthalmology, School of Life Course Sciences, King's College London, London, UK.,Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Jennifer M Burr
- School of Medicine, University of St Andrews, St Andrews, Scotland, UK
| | - Anthony P Khawaja
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, UK.
| |
Collapse
|
26
|
Saeed AQ, Sheikh Abdullah SNH, Che-Hamzah J, Abdul Ghani AT. Accuracy of Using Generative Adversarial Networks for Glaucoma Detection During the COVID-19 Pandemic: A Systematic Review and Bibliometric Analysis. J Med Internet Res 2021; 23:e27414. [PMID: 34236992 PMCID: PMC8493455 DOI: 10.2196/27414] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/11/2021] [Accepted: 07/05/2021] [Indexed: 01/19/2023] Open
Abstract
Background Glaucoma leads to irreversible blindness. Globally, it is the second most common retinal disease that leads to blindness, slightly less common than cataracts. Therefore, there is a great need to avoid the silent growth of this disease using recently developed generative adversarial networks (GANs). Objective This paper aims to introduce a GAN technology for the diagnosis of eye disorders, particularly glaucoma. This paper illustrates deep adversarial learning as a potential diagnostic tool and the challenges involved in its implementation. This study describes and analyzes many of the pitfalls and problems that researchers will need to overcome to implement this kind of technology. Methods To organize this review comprehensively, articles and reviews were collected using the following keywords: (“Glaucoma,” “optic disc,” “blood vessels”) and (“receptive field,” “loss function,” “GAN,” “Generative Adversarial Network,” “Deep learning,” “CNN,” “convolutional neural network” OR encoder). The records were identified from 5 highly reputed databases: IEEE Xplore, Web of Science, Scopus, ScienceDirect, and PubMed. These libraries broadly cover the technical and medical literature. Publications within the last 5 years, specifically 2015-2020, were included because the target GAN technique was invented only in 2014 and the publishing date of the collected papers was not earlier than 2016. Duplicate records were removed, and irrelevant titles and abstracts were excluded. In addition, we excluded papers that used optical coherence tomography and visual field images, except for those with 2D images. A large-scale systematic analysis was performed, and then a summarized taxonomy was generated. Furthermore, the results of the collected articles were summarized and a visual representation of the results was presented on a T-shaped matrix diagram. This study was conducted between March 2020 and November 2020. Results We found 59 articles after conducting a comprehensive survey of the literature. Among the 59 articles, 30 present actual attempts to synthesize images and provide accurate segmentation/classification using single/multiple landmarks or share certain experiences. The other 29 articles discuss the recent advances in GANs, do practical experiments, and contain analytical studies of retinal disease. Conclusions Recent deep learning techniques, namely GANs, have shown encouraging performance in retinal disease detection. Although this methodology involves an extensive computing budget and optimization process, it saturates the greedy nature of deep learning techniques by synthesizing images and solves major medical issues. This paper contributes to this research field by offering a thorough analysis of existing works, highlighting current limitations, and suggesting alternatives to support other researchers and participants in further improving and strengthening future work. Finally, new directions for this research have been identified.
Collapse
Affiliation(s)
- Ali Q Saeed
- Faculty of Information Science & Technology (FTSM), Universiti Kebangsaan Malaysia (UKM), UKM, 43600 Bangi, Selangor, Malaysia, Selangor, MY.,Computer Center, Northern Technical University, Ninevah, IQ
| | - Siti Norul Huda Sheikh Abdullah
- Faculty of Information Science & Technology (FTSM), Universiti Kebangsaan Malaysia (UKM), UKM, 43600 Bangi, Selangor, Malaysia, Selangor, MY
| | - Jemaima Che-Hamzah
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Cheras, Kuala Lumpur, MY
| | - Ahmad Tarmizi Abdul Ghani
- Faculty of Information Science & Technology (FTSM), Universiti Kebangsaan Malaysia (UKM), UKM, 43600 Bangi, Selangor, Malaysia, Selangor, MY
| |
Collapse
|
27
|
Sharma S, Bhatia V. Nanoscale Drug Delivery Systems for Glaucoma: Experimental and In Silico Advances. Curr Top Med Chem 2021; 21:115-125. [PMID: 32962618 DOI: 10.2174/1568026620666200922114210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 12/25/2022]
Abstract
In this review, nanoscale-based drug delivery systems, particularly in relevance to the antiglaucoma drugs, have been discussed. In addition to that, the latest computational/in silico advances in this field are examined in brief. Using nanoscale materials for drug delivery is an ideal option to target tumours, and the drug can be released in areas of the body where traditional drugs may fail to act. Nanoparticles, polymeric nanomaterials, single-wall carbon nanotubes (SWCNTs), quantum dots (QDs), liposomes and graphene are the most important nanomaterials used for drug delivery. Ocular drug delivery is one of the most common and difficult tasks faced by pharmaceutical scientists because of many challenges like circumventing the blood-retinal barrier, corneal epithelium and the blood-aqueous barrier. Authors found compelling empirical evidence of scientists relying on in-silico approaches to develop novel drugs and drug delivery systems for treating glaucoma. This review in nanoscale drug delivery systems will help us understand the existing queries and evidence gaps and will pave the way for the effective design of novel ocular drug delivery systems.
Collapse
Affiliation(s)
- Smriti Sharma
- Department of Chemistry, Miranda House, University of Delhi, Delhi, India
| | - Vinayak Bhatia
- ICARE Eye Hospital and Postgraduate Institute, Noida, UP, India
| |
Collapse
|
28
|
Pantalon A, Feraru C, Tarcoveanu F, Chiselita D. Success of Primary Trabeculectomy in Advanced Open Angle Glaucoma. Clin Ophthalmol 2021; 15:2219-2229. [PMID: 34079219 PMCID: PMC8166817 DOI: 10.2147/opth.s308228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/21/2021] [Indexed: 12/15/2022] Open
Abstract
Aim The study assesed trabeculectomy survival in advanced open angle glaucoma (OAG). Methods This is a retrospective longitudinal study in advanced OAG undergoing primary trabeculectomy. Clinical and demographic parameters were recorded. Surgical survival (qualified/complete) was calculated by Kaplan–Meier analysis for multiple upper limits of intraocular pressure (IOP) with/without medication (≤21 mmHg, ≤18 mmHg, ≤15 mmHg, ≤12 mmHg); Cox hazard ratio analysis identified parameters influencing survival. Results We included 165 eyes from 165 OAG patients: primary forms (POAG) – 86 eyes and secondary (pseudoexfoliative, SOAG) – 79 eyes; mean follow-up interval was 36.21 ± 13.49 months. Clinical parameters were comparable between sub-groups at baseline, except a higher IOP in SOAG vs POAG (36.6 ± 13.2 vs 32.7 ± 11.1 mmHg, p = 0.04); IOP reduction was similar (SOAG vs POAG) 53.93% vs 56.19%, p = 0.45, yet longer hospitalization (8.47 ± 4.39 (SOAG) vs 6.69 ± 3.01 days (POAG), p=0.03) and more medications (0.65 ± 0.24 vs 0.36 ± 0.16, p = 0.05) were needed to achieve comparable final IOP (16.0 ± 9.1 vs 15.1 ± 7.8 mmHg, p = 0.45). Kaplan Meier survival analysis applied for IOP ≤21 mmHg, ≤18 mmHg, ≤15 mmHg and ≤12 mmHg, revealed complete success in 26.2%, 27.3%, 34.5% and 54.6% eyes, respectively; qualified success was found in 45.7%, 48.6%, 77% and 88.6% eyes, respectively. Multiple medications at baseline diminished survival in all tested models (hazard ratio HR > 1, p<0.05), while 5FU+needling improved survival, mostly if combined with lower IOP regime: HR = 0.15, 95% CI = [0.07 −1.12], p = 0.06, if IOP ≤15 mmHg and HR = 0.09, 95% CI = [0.02–1.25], p = 0.06, if IOP ≤12 mmHg. Conclusion Trabeculectomy in advanced OAG reached very good survival rates (77% and 88.6%) at 36 months postoperative, if IOP could be maintained ≤15 mmHg, respectively ≤12 mmHg with medication and additional needling+5FU maneuvers. Specific factors influencing survival were identified for each success definition.
Collapse
Affiliation(s)
- Anca Pantalon
- Ophthalmology Clinic, St. Spiridon Emergency University Hospital, Iași, Romania
| | - Crenguta Feraru
- Ophthalmology Department, Gr. T. Popa University of Medicine and Pharmacy, Iași, Romania
| | - Filip Tarcoveanu
- Ophthalmology Department, Gr. T. Popa University of Medicine and Pharmacy, Iași, Romania.,Ophthalmology Department, Countess of Chester Hospital NHS Trust, Chester, UK
| | - Dorin Chiselita
- Ophthalmology Clinic, St. Spiridon Emergency University Hospital, Iași, Romania.,Ophthalmology Department, Gr. T. Popa University of Medicine and Pharmacy, Iași, Romania
| |
Collapse
|
29
|
AlRyalat SA. Machine learning on glaucoma: the missing point. Eye (Lond) 2021; 35:2456-2457. [PMID: 33927354 DOI: 10.1038/s41433-021-01561-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 03/27/2021] [Accepted: 04/14/2021] [Indexed: 01/30/2023] Open
|
30
|
Da Soh Z, Yu M, Betzler BK, Majithia S, Thakur S, Tham YC, Wong TY, Aung T, Friedman DS, Cheng CY. The Global Extent of Undetected Glaucoma in Adults: A Systematic Review and Meta-analysis. Ophthalmology 2021; 128:1393-1404. [PMID: 33865875 DOI: 10.1016/j.ophtha.2021.04.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 01/30/2023] Open
Abstract
TOPIC Glaucoma is the leading cause of irreversible blindness, despite having good prognosis with early treatment. We evaluated the global extent of undetected glaucoma and the factors associated with it in this systematic review and meta-analysis. CLINICAL RELEVANCE Undetected glaucoma increases the risk of vision impairment, which leads to detrimental effects on the quality-of-life and socioeconomic well-being of those affected. Detailed information on the extent and factors associated with undetected glaucoma aid in the development of public health interventions. METHODS We conducted a systematic review and meta-analysis of population-based studies published between January 1, 1990, and June 1, 2020. Article search was conducted in online databases (PubMED, Web-of-Science), grey literatures (OpenGrey), and nongovernment organization reports. Our outcome measure was the proportion of glaucoma cases that were undetected previously. Manifest glaucoma included any form of glaucoma reported in the original studies and may include primary open-angle glaucoma (POAG), primary angle-closure-glaucoma, secondary glaucoma, or a combination thereof. Undetected glaucoma was defined as glaucoma cases that were undetected prior to diagnosis in the respective study. Random-effect meta-analysis was used to estimate the pooled proportion of undetected glaucoma. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Meta-analysis of Observational Studies in Epidemiology guidelines in our study. RESULTS We identified 61 articles from 55 population-based studies (n = 189 359 participants; n = 6949 manifest glaucoma). Globally, more than half of all glaucoma cases were undetected previously on average in each geographical region. Africa (odds ratio [OR], 12.70; 95% confidence interval [CI], 4.91-32.86) and Asia (OR, 3.41; 95% CI, 1.63-7.16) showed higher odds of undetected glaucoma as compared with Europe. Countries with low Human Development Index (HDI; <0.55) showed a higher proportion of undetected manifest glaucoma as compared with countries of medium to very high HDI (≥0.55; all P < 0.001). In 2020, 43.78 million POAG cases were projected to be undetected, of which 76.7% were in Africa and Asia. DISCUSSION Undetected glaucoma is highly prevalent across diverse communities worldwide and more common in Africa and Asia. Strategies to improve detection are needed to prevent excess visual disability and blindness resulting from glaucoma.
Collapse
Affiliation(s)
- Zhi Da Soh
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Marco Yu
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Bjorn Kaijun Betzler
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Shivani Majithia
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Sahil Thakur
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Yih Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Republic of Singapore
| | - David S Friedman
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Republic of Singapore.
| |
Collapse
|
31
|
Kumar R, Khan FU, Sharma A, Aziz IB, Poddar NK. Recent Applications of Artificial Intelligence in detection of Gastrointestinal, Hepatic and Pancreatic Diseases. Curr Med Chem 2021; 29:66-85. [PMID: 33820515 DOI: 10.2174/0929867328666210405114938] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/25/2021] [Accepted: 03/06/2021] [Indexed: 11/22/2022]
Abstract
There is substantial progress in artificial intelligence (AI) algorithms and their medical sciences applications in the last two decades. AI-assisted programs have already been established for remotely health monitoring using sensors and smartphones. A variety of AI-based prediction models available for the gastrointestinal inflammatory, non-malignant diseases, and bowel bleeding using wireless capsule endoscopy, electronic medical records for hepatitis-associated fibrosis, pancreatic carcinoma using endoscopic ultrasounds. AI-based models may be of immense help for healthcare professionals in the identification, analysis, and decision support using endoscopic images to establish prognosis and risk assessment of patient's treatment using multiple factors. Although enough randomized clinical trials are warranted to establish the efficacy of AI-algorithms assisted and non-AI based treatments before approval of such techniques from medical regulatory authorities. In this article, available AI approaches and AI-based prediction models for detecting gastrointestinal, hepatic, and pancreatic diseases are reviewed. The limitation of AI techniques in such disease prognosis, risk assessment, and decision support are discussed.
Collapse
Affiliation(s)
- Rajnish Kumar
- Amity Institute of Biotechnology, Amity University Uttar Pradesh Lucknow Campus, Uttar Pradesh. India
| | - Farhat Ullah Khan
- Computer and Information Sciences Department, Universiti Teknologi Petronas, 32610, Seri Iskander, Perak. Malaysia
| | - Anju Sharma
- Department of Applied Science, Indian Institute of Information Technology, Allahabad, Uttar Pradesh. India
| | - Izzatdin Ba Aziz
- Computer and Information Sciences Department, Universiti Teknologi Petronas, 32610, Seri Iskander, Perak. Malaysia
| | | |
Collapse
|
32
|
Stagg B, Stein JD, Medeiros FA, Cummins M, Kawamoto K, Hess R. Interests and needs of eye care providers in clinical decision support for glaucoma. BMJ Open Ophthalmol 2021; 6:e000639. [PMID: 33501378 PMCID: PMC7813287 DOI: 10.1136/bmjophth-2020-000639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/21/2020] [Accepted: 12/31/2020] [Indexed: 01/30/2023] Open
Abstract
Objective To study whether clinicians who treat glaucoma are interested in using clinical decision support (CDS) tools for glaucoma, what glaucoma clinical decisions they feel would benefit from CDS, and what characteristics of CDS design they feel would be important in glaucoma clinical practice. Methods and analysis Working with the American Glaucoma Society, the Utah Ophthalmology Society and the Utah Optometric Association, we identified a group of clinicians who care for patients with glaucoma. We asked these clinicians about interest in CDS, what glaucoma clinical decisions would benefit from CDS, and what characteristics of CDS tool design would be important in glaucoma clinical practice. Results Of the 105 clinicians (31 optometrists, 10 general ophthalmologists and 64 glaucoma specialists), 93 (88.6%) were either ‘definitely’ or ‘probably’ interested in using CDS for glaucoma. There were no statistically significant differences in interest between clinical specialties (p=0.12), years in practice (p=0.85) or numbers of patients seen daily (p=0.99). Identifying progression of glaucoma was the clinical decision the largest number of clinicians felt would benefit from CDS (104/105, 99.1%). An easy to use interface was the CDS characteristic the largest number of clinicians felt would be ‘very important’ (93/105, 88.6%). Conclusion Of this group of clinicians who treat glaucoma, 88.6% were interested in using CDS for glaucoma and 99.1% felt that identification of glaucomatous progression could benefit from CDS. This level of interest supports future work to develop CDS for glaucoma.
Collapse
Affiliation(s)
- Brian Stagg
- Ophthalmology and Visual Sciences, University of Utah Health John A Moran Eye Center, Salt Lake City, Utah, USA.,Population Health Sciences, University of Utah Health, Salt Lake City, Utah, USA
| | - Joshua D Stein
- Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA.,Institute for Healthcare Policty and Innovation, University of Michigan, Ann Arbor, Michigan, USA.,Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | | | - Mollie Cummins
- College of Nursing, University of Utah Health, Salt Lake City, Utah, USA
| | - Kensaku Kawamoto
- Biomedical Informatics, University of Utah Health, Salt Lake City, Utah, USA
| | - Rachel Hess
- Population Health Sciences, University of Utah Health, Salt Lake City, Utah, USA.,Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
33
|
Lai TYY. Ocular imaging at the cutting-edge. Eye (Lond) 2020; 35:1-3. [PMID: 33177656 DOI: 10.1038/s41433-020-01268-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 10/28/2020] [Accepted: 10/28/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Timothy Y Y Lai
- Hong Kong Eye Hospital, Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong. .,2010 Retina & Macula Centre, Kowloon, Hong Kong.
| |
Collapse
|
34
|
Sunaric Megevand G, Bron AM. Personalising surgical treatments for glaucoma patients. Prog Retin Eye Res 2020; 81:100879. [PMID: 32562883 DOI: 10.1016/j.preteyeres.2020.100879] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 02/06/2023]
Abstract
Surgical treatments for glaucoma have relied for decades on traditional filtering surgery such as trabeculectomy and, in more challenging cases, tubes. Antifibrotics were introduced to improve surgical success in patients at increased risk of failure but have been shown to be linked to a greater incidence of complications, some being potentially vision-threatening. As our understanding of glaucoma and its early diagnosis have improved, a more individualised management has been suggested. Recently the term "precision medicine" has emerged as a new concept of an individualised approach to disease management incorporating a wide range of individual data in the choice of therapeutic modalities. For glaucoma surgery, this involves evaluation of the right timing, individual risk factors, targeting the correct anatomical and functional outflow pathways and appropriate prevention of scarring. As a consequence, there is an obvious need for better knowledge of anatomical and functional pathways and for more individualised surgical approaches with new, less invasive and safer techniques allowing for earlier intervention. With the recent advent of minimally invasive glaucoma surgery (MIGS) a large number of novel devices have been introduced targeting potential new sites of the outflow pathway for lowering intraocular pressure (IOP). Their popularity is growing in view of the relative surgical simplicity and apparent lack of serious side effects. However, these new surgical techniques are still in an era of early experiences, short follow-up and lack of evidence of their superiority in safety and cost-effectiveness over the traditional methods. Each year several new devices are introduced while others are withdrawn from the market. Glaucoma continues to be the primary cause of irreversible blindness worldwide and access to safe and efficacious treatment is a serious problem, particularly in the emerging world where the burden of glaucoma-related blindness is important and concerning. Early diagnosis, individualised treatment and, very importantly, safe surgical management should be the hallmarks of glaucoma treatment. However, there is still need for a better understanding of the disease, its onset and progression, the functional and structural elements of the outflow pathways in relation to the new devices as well as their long-term IOP-lowering efficacy and safety. This review discusses current knowledge and the future need for personalised glaucoma surgery.
Collapse
Affiliation(s)
- Gordana Sunaric Megevand
- Clinical Eye Research Centre Memorial Adolphe de Rothschild, Geneva, Switzerland; Centre Ophtalmologique de Florissant, Geneva, Switzerland.
| | - Alain M Bron
- Department of Ophthalmology, University Hospital, Dijon, France; Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, F-21000, Dijon, France
| |
Collapse
|