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Li Z, Wang L, Qiang W, Chen K, Wang Z, Zhang Y, Xie H, Wu S, Jiang J, Chen W. DeepMonitoring: a deep learning-based monitoring system for assessing the quality of cornea images captured by smartphones. Front Cell Dev Biol 2024; 12:1447067. [PMID: 39258227 PMCID: PMC11385315 DOI: 10.3389/fcell.2024.1447067] [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: 06/11/2024] [Accepted: 08/19/2024] [Indexed: 09/12/2024] Open
Abstract
Smartphone-based artificial intelligence (AI) diagnostic systems could assist high-risk patients to self-screen for corneal diseases (e.g., keratitis) instead of detecting them in traditional face-to-face medical practices, enabling the patients to proactively identify their own corneal diseases at an early stage. However, AI diagnostic systems have significantly diminished performance in low-quality images which are unavoidable in real-world environments (especially common in patient-recorded images) due to various factors, hindering the implementation of these systems in clinical practice. Here, we construct a deep learning-based image quality monitoring system (DeepMonitoring) not only to discern low-quality cornea images created by smartphones but also to identify the underlying factors contributing to the generation of such low-quality images, which can guide operators to acquire high-quality images in a timely manner. This system performs well across validation, internal, and external testing sets, with AUCs ranging from 0.984 to 0.999. DeepMonitoring holds the potential to filter out low-quality cornea images produced by smartphones, facilitating the application of smartphone-based AI diagnostic systems in real-world clinical settings, especially in the context of self-screening for corneal diseases.
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Affiliation(s)
- Zhongwen Li
- Ningbo Key Laboratory of Medical Research on Blinding Eye Diseases, Ningbo Eye Institute, Ningbo Eye Hospital, Wenzhou Medical University, Ningbo, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Lei Wang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Wei Qiang
- Ningbo Key Laboratory of Medical Research on Blinding Eye Diseases, Ningbo Eye Institute, Ningbo Eye Hospital, Wenzhou Medical University, Ningbo, China
| | - Kuan Chen
- Cangnan Hospital, Wenzhou Medical University, Wenzhou, China
| | - Zhouqian Wang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yi Zhang
- School of Electronic Engineering, Xi'an University of Posts and Telecommunications, Xi'an, China
| | - He Xie
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Shanjun Wu
- Ningbo Key Laboratory of Medical Research on Blinding Eye Diseases, Ningbo Eye Institute, Ningbo Eye Hospital, Wenzhou Medical University, Ningbo, China
| | - Jiewei Jiang
- School of Electronic Engineering, Xi'an University of Posts and Telecommunications, Xi'an, China
| | - Wei Chen
- Ningbo Key Laboratory of Medical Research on Blinding Eye Diseases, Ningbo Eye Institute, Ningbo Eye Hospital, Wenzhou Medical University, Ningbo, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
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Qurban Q, Cassidy L. Artificial intelligence and machine learning a new frontier in the diagnosis of ocular adnexal tumors: A review. SAGE Open Med 2024; 12:20503121241274197. [PMID: 39206232 PMCID: PMC11350536 DOI: 10.1177/20503121241274197] [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: 12/04/2023] [Accepted: 07/11/2024] [Indexed: 09/04/2024] Open
Abstract
In our article, we explore the transformative potential of Artificial Intelligence and Machine Learning in oculo-oncology, focusing on the diagnosis and management of ocular adnexal tumors. Delving into the intricacies of adnexal conditions such as conjunctival melanoma and squamous conjunctival carcinoma, the study emphasizes recent breakthroughs, such as Artificial Intelligence-driven early detection methods. While acknowledging challenges like the scarcity of specialized datasets and issues in standardizing image capture, the research underscores encouraging patient acceptance, as demonstrated in melanoma diagnosis studies. The abstract calls for overcoming obstacles, conducting clinical trials, establishing global regulatory norms and fostering collaboration between ophthalmologists and Artificial Intelligence experts. Overall, the article envisions Artificial Intelligence's imminent transformative impact on ocular and periocular cancer diagnosis.
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Affiliation(s)
- Qirat Qurban
- Department of Ophthalmology and Oculoplastic, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
| | - Lorraine Cassidy
- Department of Ophthalmology and Oculoplastic, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
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Zhang X, Zhou Z, Cai Y, Grzybowski A, Ye J, Lou L. Global research of artificial intelligence in eyelid diseases: A bibliometric analysis. Heliyon 2024; 10:e34979. [PMID: 39148986 PMCID: PMC11325384 DOI: 10.1016/j.heliyon.2024.e34979] [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: 02/20/2024] [Revised: 07/08/2024] [Accepted: 07/19/2024] [Indexed: 08/17/2024] Open
Abstract
Purpose To generate an overview of global research on artificial intelligence (AI) in eyelid diseases using a bibliometric approach. Methods All publications related to AI in eyelid diseases from 1900 to 2023 were retrieved from the Web of Science (WoS) Core Collection database. After manual screening, 98 publications published between 2000 and 2023 were finally included. We analyzed the annual trend of publication and citation count, productivity and co-authorship of countries/territories and institutions, research domain, source journal, co-occurrence and evolution of the keywords and co-citation and clustering of the references, using the analytic tool of the WoS, VOSviewer, Wordcloud Python package and CiteSpace. Results By analyzing a total of 98 relevant publications, we detected that this field had continuously developed over the past two decades and had entered a phase of rapid development in the last three years. Among these countries/territories and institutions contributing to this field, China was the most productive country and had the most institutions with high productivity, while USA was the most active in collaborating with others. The most popular research domains was Ophthalmology and the most productive journals were Ocular Surface. The co-occurrence network of keywords could be classified into 3 clusters respectively concerned about blepharoptosis, meibomian gland dysfunction and blepharospasm. The evolution of research hotspots is from clinical features to clinical scenarios and from image processing to deep learning. In the clustering analysis of co-cited reference network, cluster "0# deep learning" was the largest and latest, and cluster "#5 meibomian glands visibility assessment" existed for the longest time. Conclusions Although the research of AI in eyelid diseases has rapidly developed in the last three years, there are still gaps in this area. Our findings provide researchers with a better understanding of the development of the field and a reference for future research directions.
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Affiliation(s)
- Xuan Zhang
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, China
| | - Ziying Zhou
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, China
| | - Yilu Cai
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, China
| | - Andrzej Grzybowski
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, 60-836, Poznan, Poland
| | - Juan Ye
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, China
| | - Lixia Lou
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, China
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Cai Y, Zhang X, Cao J, Grzybowski A, Ye J, Lou L. Application of artificial intelligence in oculoplastics. Clin Dermatol 2024; 42:259-267. [PMID: 38184122 DOI: 10.1016/j.clindermatol.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2024]
Abstract
Oculoplastics is a subspecialty of ophthalmology/dermatology concerned with eyelid, orbital, and lacrimal diseases. Artificial intelligence (AI), with its powerful ability to analyze large data sets, has dramatically benefited oculoplastics. The cutting-edge AI technology is widely applied to extract ocular parameters and to use these results for further assessment, such as screening and diagnosis of blepharoptosis and predicting the progression of thyroid eye disease. AI also assists in treatment procedures, such as surgical strategy planning in blepharoptosis. High efficiency and high reliability are the most apparent advantages of AI, with promising prospects. The possibilities of AI in oculoplastics may lie in three-dimensional modeling technology and image generation. We retrospectively summarize AI applications involving eyelid, orbital, and lacrimal diseases in oculoplastics, and we also examine the strengths and weaknesses of AI technology in oculoplastics.
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Affiliation(s)
- Yilu Cai
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, China
| | - Xuan Zhang
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, China
| | - Jing Cao
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, China
| | - Andrzej Grzybowski
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - Juan Ye
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, China
| | - Lixia Lou
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, China.
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Li A, Tandon AK, Sun G, Dinkin MJ, Oliveira C. Early Detection of Optic Nerve Changes on Optical Coherence Tomography Using Deep Learning for Risk-Stratification of Papilledema and Glaucoma. J Neuroophthalmol 2024; 44:47-52. [PMID: 37494177 DOI: 10.1097/wno.0000000000001945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
BACKGROUND The use of artificial intelligence is becoming more prevalence in medicine with numerous successful examples in ophthalmology. However, much of the work has been focused on replicating the works of ophthalmologists. Given the analytical potentials of artificial intelligence, it is plausible that artificial intelligence can detect microfeatures not readily distinguished by humans. In this study, we tested the potential for artificial intelligence to detect early optic coherence tomography changes to predict progression toward papilledema or glaucoma when no significant changes are detected on optical coherence tomography by clinicians. METHODS Prediagnostic optical coherence tomography of patients who developed papilledema (n = 93, eyes = 166) and glaucoma (n = 187, eyes = 327) were collected. Given discrepancy in average cup-to-disc ratios of the experimental groups, control groups for papilledema (n = 254, eyes = 379) and glaucoma (n = 441, eyes = 739) are matched by cup-to-disc ratio. Publicly available Visual Geometry Group-19 model is retrained using each experimental group and its respective control group to predict progression to papilledema or glaucoma. Images used for training include retinal nerve fiber layer thickness map, extracted vertical tomogram, ganglion cell thickness map, and ILM-RPE thickness map. RESULTS Trained model was able to predict progression to papilledema with a precision of 0.714 and a recall of 0.769 when trained with retinal nerve fiber layer thickness map, but not other image types. However, trained model was able to predict progression to glaucoma with a precision of 0.682 and recall of 0.857 when trained with extracted vertical tomogram, but not other image types. Area under precision-recall curve of 0.826 and 0.785 were achieved for papilledema and glaucoma models, respectively. CONCLUSIONS Computational and analytical power of computers have become an invaluable part of our lives and research endeavors. Our proof-of-concept study showed that artificial intelligence (AI) algorithms have the potential to detect early changes on optical coherence tomography for prediction of progression that is not readily observed by clinicians. Further research may help establish possible AI models that can assist with early diagnosis or risk stratification in ophthalmology.
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Affiliation(s)
- Anfei Li
- Department of Ophthalmology (AL), New York Presbyterian Hospital, New York, New York; and Department of Ophthalmology (AKT, GS, MJD, CO), Weill Cornell Medicine, New York, New York
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Jiang J, Liu H, He L, Pei M, Lin T, Yang H, Yang J, Gong J, Wei X, Zhu M, Wu G, Li Z. HM_ADET: a hybrid model for automatic detection of eyelid tumors based on photographic images. Biomed Eng Online 2024; 23:25. [PMID: 38419078 PMCID: PMC10903075 DOI: 10.1186/s12938-024-01221-3] [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: 05/05/2023] [Accepted: 02/15/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The accurate detection of eyelid tumors is essential for effective treatment, but it can be challenging due to small and unevenly distributed lesions surrounded by irrelevant noise. Moreover, early symptoms of eyelid tumors are atypical, and some categories of eyelid tumors exhibit similar color and texture features, making it difficult to distinguish between benign and malignant eyelid tumors, particularly for ophthalmologists with limited clinical experience. METHODS We propose a hybrid model, HM_ADET, for automatic detection of eyelid tumors, including YOLOv7_CNFG to locate eyelid tumors and vision transformer (ViT) to classify benign and malignant eyelid tumors. First, the ConvNeXt module with an inverted bottleneck layer in the backbone of YOLOv7_CNFG is employed to prevent information loss of small eyelid tumors. Then, the flexible rectified linear unit (FReLU) is applied to capture multi-scale features such as texture, edge, and shape, thereby improving the localization accuracy of eyelid tumors. In addition, considering the geometric center and area difference between the predicted box (PB) and the ground truth box (GT), the GIoU_loss was utilized to handle cases of eyelid tumors with varying shapes and irregular boundaries. Finally, the multi-head attention (MHA) module is applied in ViT to extract discriminative features of eyelid tumors for benign and malignant classification. RESULTS Experimental results demonstrate that the HM_ADET model achieves excellent performance in the detection of eyelid tumors. In specific, YOLOv7_CNFG outperforms YOLOv7, with AP increasing from 0.763 to 0.893 on the internal test set and from 0.647 to 0.765 on the external test set. ViT achieves AUCs of 0.945 (95% CI 0.894-0.981) and 0.915 (95% CI 0.860-0.955) for the classification of benign and malignant tumors on the internal and external test sets, respectively. CONCLUSIONS Our study provides a promising strategy for the automatic diagnosis of eyelid tumors, which could potentially improve patient outcomes and reduce healthcare costs.
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Affiliation(s)
- Jiewei Jiang
- School of Electronic Engineering, Xi'an University of Posts and Telecommunications, Xi'an, 710121, China
| | - Haiyang Liu
- School of Electronic Engineering, Xi'an University of Posts and Telecommunications, Xi'an, 710121, China
| | - Lang He
- School of Computer Science and Technology, Xi'an University of Posts and Telecommunications, Xi'an, 710121, China
| | - Mengjie Pei
- School of Computer Science and Technology, Xi'an University of Posts and Telecommunications, Xi'an, 710121, China
| | - Tongtong Lin
- School of Electronic Engineering, Xi'an University of Posts and Telecommunications, Xi'an, 710121, China
| | - Hailong Yang
- School of Electronic Engineering, Xi'an University of Posts and Telecommunications, Xi'an, 710121, China
| | - Junhua Yang
- School of Electronic Engineering, Xi'an University of Posts and Telecommunications, Xi'an, 710121, China
| | - Jiamin Gong
- School of Modern Post, Xi'an University of Posts and Telecommunications, Xi'an, 710061, China
| | - Xumeng Wei
- School of Communications and Information Engineering, Xi'an University of Posts and Telecommunications, Xi'an, 710121, China
| | - Mingmin Zhu
- School of Mathematics and Statistics, Xidian University, Xi'an, 710071, China.
| | - Guohai Wu
- Ningbo Eye Hospital, Wenzhou Medical University, Ningbo, 315000, China.
| | - Zhongwen Li
- Ningbo Eye Hospital, Wenzhou Medical University, Ningbo, 315000, China.
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
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Hu P, Zhou H, Yan T, Miu H, Xiao F, Zhu X, Shu L, Yang S, Jin R, Dou W, Ren B, Zhu L, Liu W, Zhang Y, Zeng K, Ye M, Lv S, Wu M, Deng G, Hu R, Zhan R, Chen Q, Zhang D, Zhu X. Deep learning-assisted identification and quantification of aneurysmal subarachnoid hemorrhage in non-contrast CT scans: Development and external validation of Hybrid 2D/3D UNet. Neuroimage 2023; 279:120321. [PMID: 37574119 DOI: 10.1016/j.neuroimage.2023.120321] [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: 06/27/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 08/15/2023] Open
Abstract
Accurate stroke assessment and consequent favorable clinical outcomes rely on the early identification and quantification of aneurysmal subarachnoid hemorrhage (aSAH) in non-contrast computed tomography (NCCT) images. However, hemorrhagic lesions can be complex and difficult to distinguish manually. To solve these problems, here we propose a novel Hybrid 2D/3D UNet deep-learning framework for automatic aSAH identification and quantification in NCCT images. We evaluated 1824 consecutive patients admitted with aSAH to four hospitals in China between June 2018 and May 2022. Accuracy and precision, Dice scores and intersection over union (IoU), and interclass correlation coefficients (ICC) were calculated to assess model performance, segmentation performance, and correlations between automatic and manual segmentation, respectively. A total of 1355 patients with aSAH were enrolled: 931, 101, 179, and 144 in four datasets, of whom 326 were scanned with Siemens, 640 with Philips, and 389 with GE Medical Systems scanners. Our proposed deep-learning method accurately identified (accuracies 0.993-0.999) and segmented (Dice scores 0.550-0.897) hemorrhage in both the internal and external datasets, even combinations of hemorrhage subtypes. We further developed a convenient AI-assisted platform based on our algorithm to assist clinical workflows, whose performance was comparable to manual measurements by experienced neurosurgeons (ICCs 0.815-0.957) but with greater efficiency and reduced cost. While this tool has not yet been prospectively tested in clinical practice, our innovative hybrid network algorithm and platform can accurately identify and quantify aSAH, paving the way for fast and cheap NCCT interpretation and a reliable AI-based approach to expedite clinical decision-making for aSAH patients.
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Affiliation(s)
- Ping Hu
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China; Jiangxi Key Laboratory of Neurological Tumors and Cerebrovascular Diseases, Nanchang, Jiangxi 330006, China; Jiangxi Health Commission Key Laboratory of Neurological Medicine, Nanchang, Jiangxi 330006, China; Institute of Neuroscience, Nanchang University, Nanchang, Jiangxi 330006, China
| | - Haizhu Zhou
- School of Physics and Technology, Wuhan University, Wuhan, Hubei 430060, China
| | - Tengfeng Yan
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China; Jiangxi Key Laboratory of Neurological Tumors and Cerebrovascular Diseases, Nanchang, Jiangxi 330006, China; Jiangxi Health Commission Key Laboratory of Neurological Medicine, Nanchang, Jiangxi 330006, China; Institute of Neuroscience, Nanchang University, Nanchang, Jiangxi 330006, China
| | - Hongping Miu
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Feng Xiao
- Department of Neurosurgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, China
| | - Xinyi Zhu
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| | - Lei Shu
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China; Jiangxi Key Laboratory of Neurological Tumors and Cerebrovascular Diseases, Nanchang, Jiangxi 330006, China; Jiangxi Health Commission Key Laboratory of Neurological Medicine, Nanchang, Jiangxi 330006, China; Institute of Neuroscience, Nanchang University, Nanchang, Jiangxi 330006, China
| | - Shuang Yang
- School of Physics and Technology, Wuhan University, Wuhan, Hubei 430060, China
| | - Ruiyun Jin
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Wenlei Dou
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Baoyu Ren
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Lizhen Zhu
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Wanrong Liu
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Yihan Zhang
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Kaisheng Zeng
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Minhua Ye
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Shigang Lv
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Miaojing Wu
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Gang Deng
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| | - Rong Hu
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Renya Zhan
- Department of Neurosurgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, China
| | - Qianxue Chen
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| | - Dong Zhang
- School of Physics and Technology, Wuhan University, Wuhan, Hubei 430060, China
| | - Xingen Zhu
- Department of Neurosurgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China; Jiangxi Key Laboratory of Neurological Tumors and Cerebrovascular Diseases, Nanchang, Jiangxi 330006, China; Jiangxi Health Commission Key Laboratory of Neurological Medicine, Nanchang, Jiangxi 330006, China; Institute of Neuroscience, Nanchang University, Nanchang, Jiangxi 330006, China.
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Ing EB, Balas M, Nassrallah G, DeAngelis D, Nijhawan N. The Isabel Differential Diagnosis Generator for Orbital Diagnosis. Ophthalmic Plast Reconstr Surg 2023; 39:461-464. [PMID: 36928323 DOI: 10.1097/iop.0000000000002364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
PURPOSE The Isabel differential diagnosis generator is one of the most widely known electronic diagnosis decision support tools. The authors prospectively evaluated the utility of Isabel for orbital disease differential diagnosis. METHODS The terms "proptosis," "lid retraction," "orbit inflammation," "orbit tumour," "orbit tumor, infiltrative" and "orbital tumor, well-circumscribed" were separately input into Isabel and the results were tabulated. Then the clinical details (patient age, gender, signs, symptoms, and imaging findings) of 25 orbital cases from a textbook of orbital surgery were entered into Isabel. The top 10 differential diagnoses generated by Isabel were compared with the correct diagnosis. RESULTS Isabel identified hyperthyroidism and Graves ophthalmopathy as the leading causes of lid retraction, but many common causes of proptosis and orbital tumors were not correctly elucidated. Of the textbook cases, Isabel correctly identified 4/25 (16%) of orbital cases as one of its top 10 differential diagnoses, and the median rank of the correct diagnosis was 6/10. Thirty-two percent of the output diagnoses were unlikely to cause orbital disease. CONCLUSION Isabel is currently of limited value in the mainstream orbital differential diagnosis. The incorporation of anatomic localizations and imaging findings may help increase the accuracy of orbital diagnosis.
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Affiliation(s)
- Edsel B Ing
- Department of Ophthalmology and Vision Science, University of Toronto Temerty Faculty of Medicine, Toronto, Canada
- Department of Ophthalmolgoy and Vision Science, University of Alberta, Edmonton, Canada
| | - Michael Balas
- Department of Ophthalmolgoy and Vision Science, University of Alberta, Edmonton, Canada
| | - Georges Nassrallah
- Department of Ophthalmology and Vision Science, University of Toronto Temerty Faculty of Medicine, Toronto, Canada
| | - Dan DeAngelis
- Department of Ophthalmology and Vision Science, University of Toronto Temerty Faculty of Medicine, Toronto, Canada
| | - Navdeep Nijhawan
- Department of Ophthalmology and Vision Science, University of Toronto Temerty Faculty of Medicine, Toronto, Canada
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Tang J, Liang Y, Jiang Y, Liu J, Zhang R, Huang D, Pang C, Huang C, Luo D, Zhou X, Li R, Zhang K, Xie B, Hu L, Zhu F, Xia H, Lu L, Wang H. A multicenter study on two-stage transfer learning model for duct-dependent CHDs screening in fetal echocardiography. NPJ Digit Med 2023; 6:143. [PMID: 37573426 PMCID: PMC10423245 DOI: 10.1038/s41746-023-00883-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 07/21/2023] [Indexed: 08/14/2023] Open
Abstract
Duct-dependent congenital heart diseases (CHDs) are a serious form of CHD with a low detection rate, especially in underdeveloped countries and areas. Although existing studies have developed models for fetal heart structure identification, there is a lack of comprehensive evaluation of the long axis of the aorta. In this study, a total of 6698 images and 48 videos are collected to develop and test a two-stage deep transfer learning model named DDCHD-DenseNet for screening critical duct-dependent CHDs. The model achieves a sensitivity of 0.973, 0.843, 0.769, and 0.759, and a specificity of 0.985, 0.967, 0.956, and 0.759, respectively, on the four multicenter test sets. It is expected to be employed as a potential automatic screening tool for hierarchical care and computer-aided diagnosis. Our two-stage strategy effectively improves the robustness of the model and can be extended to screen for other fetal heart development defects.
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Affiliation(s)
- Jiajie Tang
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- School of Information Management, Wuhan University, Wuhan, China
| | - Yongen Liang
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yuxuan Jiang
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- School of Information Management, Wuhan University, Wuhan, China
| | - Jinrong Liu
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Rui Zhang
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Danping Huang
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Chengcheng Pang
- Cardiovascular Pediatrics/Guangdong Cardiovascular Institute/Medical Big Data Center, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Chen Huang
- Department of Medical Ultrasonics/Shenzhen Longgang Maternal and Child Health Hospital, Shenzhen, China
| | - Dongni Luo
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xue Zhou
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ruizhuo Li
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- School of Medicine, Southern China University of Technology, Guangzhou, China
| | - Kanghui Zhang
- School of Information Management, Wuhan University, Wuhan, China
| | - Bingbing Xie
- School of Information Management, Wuhan University, Wuhan, China
| | - Lianting Hu
- Cardiovascular Pediatrics/Guangdong Cardiovascular Institute/Medical Big Data Center, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Fanfan Zhu
- School of Information Management, Wuhan University, Wuhan, China
| | - Huimin Xia
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
| | - Long Lu
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
- School of Information Management, Wuhan University, Wuhan, China.
- Center for Healthcare Big Data Research, The Big Data Institute, Wuhan University, Wuhan, China.
- School of Public Health, Wuhan University, Wuhan, China.
| | - Hongying Wang
- Department of Medical Ultrasonics/Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
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10
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Li Z, Wang L, Wu X, Jiang J, Qiang W, Xie H, Zhou H, Wu S, Shao Y, Chen W. Artificial intelligence in ophthalmology: The path to the real-world clinic. Cell Rep Med 2023:101095. [PMID: 37385253 PMCID: PMC10394169 DOI: 10.1016/j.xcrm.2023.101095] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 04/17/2023] [Accepted: 06/07/2023] [Indexed: 07/01/2023]
Abstract
Artificial intelligence (AI) has great potential to transform healthcare by enhancing the workflow and productivity of clinicians, enabling existing staff to serve more patients, improving patient outcomes, and reducing health disparities. In the field of ophthalmology, AI systems have shown performance comparable with or even better than experienced ophthalmologists in tasks such as diabetic retinopathy detection and grading. However, despite these quite good results, very few AI systems have been deployed in real-world clinical settings, challenging the true value of these systems. This review provides an overview of the current main AI applications in ophthalmology, describes the challenges that need to be overcome prior to clinical implementation of the AI systems, and discusses the strategies that may pave the way to the clinical translation of these systems.
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Affiliation(s)
- Zhongwen Li
- Ningbo Eye Hospital, Wenzhou Medical University, Ningbo 315000, China; School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China.
| | - Lei Wang
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Xuefang Wu
- Guizhou Provincial People's Hospital, Guizhou University, Guiyang 550002, China
| | - Jiewei Jiang
- School of Electronic Engineering, Xi'an University of Posts and Telecommunications, Xi'an 710121, China
| | - Wei Qiang
- Ningbo Eye Hospital, Wenzhou Medical University, Ningbo 315000, China
| | - He Xie
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Hongjian Zhou
- Department of Computer Science, University of Oxford, Oxford, Oxfordshire OX1 2JD, UK
| | - Shanjun Wu
- Ningbo Eye Hospital, Wenzhou Medical University, Ningbo 315000, China
| | - Yi Shao
- Department of Ophthalmology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China.
| | - Wei Chen
- Ningbo Eye Hospital, Wenzhou Medical University, Ningbo 315000, China; School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China.
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11
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Li A, Winebrake JP, Kovacs K. Facilitating deep learning through preprocessing of optical coherence tomography images. BMC Ophthalmol 2023; 23:158. [PMID: 37069534 PMCID: PMC10108538 DOI: 10.1186/s12886-023-02916-2] [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: 11/19/2022] [Accepted: 04/10/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND While deep learning has delivered promising results in the field of ophthalmology, the hurdle to complete a deep learning study is high. In this study, we aim to facilitate small scale model trainings by exploring the role of preprocessing to reduce computational burden and accelerate learning. METHODS A small subset of a previously published dataset containing optical coherence tomography images of choroidal neovascularization, drusen, diabetic macula edema, and normal macula was modified using Fourier transformation and bandpass filter, producing high frequency images, original images, and low frequency images. Each set of images was trained with the same model, and their performances were compared. RESULTS Compared to that with the original image dataset, the model trained with the high frequency image dataset achieved an improved final performance and reached maximum performance much earlier (in fewer epochs). The model trained with low frequency images did not achieve a meaningful performance. CONCLUSION Appropriate preprocessing of training images can accelerate the training process and can potentially facilitate modeling using artificial intelligence when limited by sample size or computational power.
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Affiliation(s)
- Anfei Li
- Department of Ophthalmology, New York Presbyterian Hospital, 1305 York Ave 11th floor, New York, NY, 10021, USA.
| | - James P Winebrake
- Department of Ophthalmology, New York Presbyterian Hospital, 1305 York Ave 11th floor, New York, NY, 10021, USA
| | - Kyle Kovacs
- Department of Ophthalmology, Weill Cornell Medicine, 1305 York Ave 11th floor, New York, NY, 10021, USA.
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12
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Tang J, Han J, Xie B, Xue J, Zhou H, Jiang Y, Hu L, Chen C, Zhang K, Zhu F, Lu L. The Two-Stage Ensemble Learning Model Based on Aggregated Facial Features in Screening for Fetal Genetic Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2377. [PMID: 36767743 PMCID: PMC9914999 DOI: 10.3390/ijerph20032377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/18/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
With the advancement of medicine, more and more researchers have turned their attention to the study of fetal genetic diseases in recent years. However, it is still a challenge to detect genetic diseases in the fetus, especially in an area lacking access to healthcare. The existing research primarily focuses on using teenagers' or adults' face information to screen for genetic diseases, but there are no relevant directions on disease detection using fetal facial information. To fill the vacancy, we designed a two-stage ensemble learning model based on sonography, Fgds-EL, to identify genetic diseases with 932 images. Concretely speaking, we use aggregated information of facial regions to detect anomalies, such as the jaw, frontal bone, and nasal bone areas. Our experiments show that our model yields a sensitivity of 0.92 and a specificity of 0.97 in the test set, on par with the senior sonographer, and outperforming other popular deep learning algorithms. Moreover, our model has the potential to be an effective noninvasive screening tool for the early screening of genetic diseases in the fetus.
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Affiliation(s)
- Jiajie Tang
- School of Information Management, Wuhan University, Wuhan 430072, China
- Institute of Pediatrics, Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510180, China
| | - Jin Han
- Institute of Pediatrics, Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510180, China
- Graduate School, Guangzhou Medical University, Guangzhou 511436, China
| | - Bingbing Xie
- School of Information Management, Wuhan University, Wuhan 430072, China
| | - Jiaxin Xue
- Institute of Pediatrics, Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510180, China
- Graduate School, Guangzhou Medical University, Guangzhou 511436, China
| | - Hang Zhou
- Institute of Pediatrics, Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510180, China
- Graduate School, Guangzhou Medical University, Guangzhou 511436, China
| | - Yuxuan Jiang
- Institute of Pediatrics, Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510180, China
| | - Lianting Hu
- Medical Big Data Center, Guangdong Provincial People’s Hospital, Guangzhou 510080, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangzhou 510080, China
| | - Caiyuan Chen
- Institute of Pediatrics, Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510180, China
- Graduate School, Guangzhou Medical University, Guangzhou 511436, China
| | - Kanghui Zhang
- School of Information Management, Wuhan University, Wuhan 430072, China
| | - Fanfan Zhu
- School of Information Management, Wuhan University, Wuhan 430072, China
| | - Long Lu
- School of Information Management, Wuhan University, Wuhan 430072, China
- Institute of Pediatrics, Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510180, China
- Center for Healthcare Big Data Research, The Big Data Institute, Wuhan University, Wuhan 430072, China
- School of Public Health, Wuhan University, Wuhan 430072, China
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13
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Bao XL, Sun YJ, Zhan X, Li GY. Orbital and eyelid diseases: The next breakthrough in artificial intelligence? Front Cell Dev Biol 2022; 10:1069248. [PMID: 36467418 PMCID: PMC9716028 DOI: 10.3389/fcell.2022.1069248] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/08/2022] [Indexed: 12/07/2023] Open
Abstract
Orbital and eyelid disorders affect normal visual functions and facial appearance, and precise oculoplastic and reconstructive surgeries are crucial. Artificial intelligence (AI) network models exhibit a remarkable ability to analyze large sets of medical images to locate lesions. Currently, AI-based technology can automatically diagnose and grade orbital and eyelid diseases, such as thyroid-associated ophthalmopathy (TAO), as well as measure eyelid morphological parameters based on external ocular photographs to assist surgical strategies. The various types of imaging data for orbital and eyelid diseases provide a large amount of training data for network models, which might be the next breakthrough in AI-related research. This paper retrospectively summarizes different imaging data aspects addressed in AI-related research on orbital and eyelid diseases, and discusses the advantages and limitations of this research field.
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Affiliation(s)
- Xiao-Li Bao
- Department of Ophthalmology, Second Hospital of Jilin University, Changchun, China
| | - Ying-Jian Sun
- Department of Ophthalmology, Second Hospital of Jilin University, Changchun, China
| | - Xi Zhan
- Department of Engineering, The Army Engineering University of PLA, Nanjing, China
| | - Guang-Yu Li
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, China
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14
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Cao J, You K, Zhou J, Xu M, Xu P, Wen L, Wang S, Jin K, Lou L, Wang Y, Ye J. A cascade eye diseases screening system with interpretability and expandability in ultra-wide field fundus images: A multicentre diagnostic accuracy study. EClinicalMedicine 2022; 53:101633. [PMID: 36110868 PMCID: PMC9468501 DOI: 10.1016/j.eclinm.2022.101633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/08/2022] [Accepted: 08/08/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Clinical application of artificial intelligence is limited due to the lack of interpretability and expandability in complex clinical settings. We aimed to develop an eye diseases screening system with improved interpretability and expandability based on a lesion-level dissection and tested the clinical expandability and auxiliary ability of the system. METHODS The four-hierarchical interpretable eye diseases screening system (IEDSS) based on a novel structural pattern named lesion atlas was developed to identify 30 eye diseases and conditions using a total of 32,026 ultra-wide field images collected from the Second Affiliated Hospital of Zhejiang University, School of Medicine (SAHZU), the First Affiliated Hospital of University of Science and Technology of China (FAHUSTC), and the Affiliated People's Hospital of Ningbo University (APHNU) in China between November 1, 2016 to February 28, 2022. The performance of IEDSS was compared with ophthalmologists and classic models trained with image-level labels. We further evaluated IEDSS in two external datasets, and tested it in a real-world scenario and an extended dataset with new phenotypes beyond the training categories. The accuracy (ACC), F1 score and confusion matrix were calculated to assess the performance of IEDSS. FINDINGS IEDSS reached average ACCs (aACC) of 0·9781 (95%CI 0·9739-0·9824), 0·9660 (95%CI 0·9591-0·9730) and 0·9709 (95%CI 0·9655-0·9763), frequency-weighted average F1 scores of 0·9042 (95%CI 0·8957-0·9127), 0·8837 (95%CI 0·8714-0·8960) and 0·8874 (95%CI 0·8772-0·8972) in datasets of SAHZU, APHNU and FAHUSTC, respectively. IEDSS reached a higher aACC (0·9781, 95%CI 0·9739-0·9824) compared with a multi-class image-level model (0·9398, 95%CI 0·9329-0·9467), a classic multi-label image-level model (0·9278, 95%CI 0·9189-0·9366), a novel multi-label image-level model (0·9241, 95%CI 0·9151-0·9331) and a lesion-level model without Adaboost (0·9381, 95%CI 0·9299-0·9463). In the real-world scenario, the aACC of IEDSS (0·9872, 95%CI 0·9828-0·9915) was higher than that of the senior ophthalmologist (SO) (0·9413, 95%CI 0·9321-0·9504, p = 0·000) and the junior ophthalmologist (JO) (0·8846, 95%CI 0·8722-0·8971, p = 0·000). IEDSS remained strong performance (ACC = 0·8560, 95%CI 0·8252-0·8868) compared with JO (ACC = 0·784, 95%CI 0·7479-0·8201, p= 0·003) and SO (ACC = 0·8500, 95%CI 0·8187-0·8813, p = 0·789) in the extended dataset. INTERPRETATION IEDSS showed excellent and stable performance in identifying common eye conditions and conditions beyond the training categories. The transparency and expandability of IEDSS could tremendously increase the clinical application range and the practical clinical value of it. It would enhance the efficiency and reliability of clinical practice, especially in remote areas with a lack of experienced specialists. FUNDING National Natural Science Foundation Regional Innovation and Development Joint Fund (U20A20386), Key research and development program of Zhejiang Province (2019C03020), Clinical Medical Research Centre for Eye Diseases of Zhejiang Province (2021E50007).
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Affiliation(s)
- Jing Cao
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Kun You
- Zhejiang Feitu Medical Imaging Co.,LTD, Hangzhou, Zhejiang, China
| | - Jingxin Zhou
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Mingyu Xu
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Peifang Xu
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Lei Wen
- The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, China
| | - Shengzhan Wang
- The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Kai Jin
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Lixia Lou
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Yao Wang
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Juan Ye
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
- Corresponding author at: No. 1 West Lake Avenue, Hangzhou, Zhejiang Province, China, 310009.
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