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Woodward MA, Niziol LM, Ballouz D, Lu MC, Kang L, Thibodeau A, Singh K. Prediction of Visual Acuity in Patients With Microbial Keratitis. Cornea 2023; 42:217-223. [PMID: 36256452 PMCID: PMC9805475 DOI: 10.1097/ico.0000000000003129] [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: 01/31/2022] [Accepted: 07/16/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE The purpose of this study was to predict visual acuity (VA) 90 days after presentation for patients with microbial keratitis (MK) from data at the initial clinical ophthalmic encounter. METHODS Patients with MK were identified in the electronic health record between August 2012 and February 2021. Random forest (RF) models were used to predict 90-day VA < 20/40 [visual impairment (VI)]. Predictors evaluated included age, sex, initial VA, and information documented in notes at presentation. Model diagnostics are reported with 95% confidence intervals (CIs) for area under the curve (AUC), misclassification rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS One thousand seven hundred ninety-one patients were identified. The presenting logMAR VA was on average 0.86 (Snellen equivalent and standard deviation = 20/144 ± 12.6 lines) in the affected or worse eye, and 43.6% with VI. VI at 90-day follow-up was present in the affected eye or worse eye for 26.9% of patients. The RF model for predicting 90-day VI had an AUC of 95% (CI: 93%-97%) and a misclassification rate of 9% (7%-12%). The percent sensitivity, specificity, PPV, and NPV were 86% (80%-91%), 92% (89%-95%), 81% (74%-86%), and 95% (92%-97%), respectively. Older age, worse presenting VA, and more mentions of "penetrating keratoplasty" and "bandage contact lens" were associated with increased probability of 90-day VI, whereas more mentions of "quiet" were associated with decreased probability of 90-day VI. CONCLUSIONS RF modeling yielded good sensitivity and specificity to predict VI at 90 days which could guide clinicians about the risk of poor vision outcomes for patients with MK.
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Affiliation(s)
- Maria A. Woodward
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Leslie M. Niziol
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Dena Ballouz
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Ming-Chen Lu
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Linda Kang
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Alexa Thibodeau
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Karandeep Singh
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Meijome TE, Wozniak R, Kang L, Azzouz L, Niziol LM, Johnson WL, Kriegel M, Woodward MA. Assessment of Keratitis Severity Using Quantitative Image Analysis in an In Vivo Murine Model of Staphylococcus aureus Bacterial Keratitis. Transl Vis Sci Technol 2022; 11:12. [DOI: 10.1167/tvst.11.11.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Tomas E. Meijome
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Rachel Wozniak
- Department of Ophthalmology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Linda Kang
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Lyna Azzouz
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Leslie M. Niziol
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - William L. Johnson
- Department of Ophthalmology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Matthias Kriegel
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
- Augenzentrum am St. Franziskus Hospital, Muenster, Germany
| | - Maria A. Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
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Pedrotti E, Bonacci E, Kilian R, Pagnacco C, Fasolo A, Anastasi M, Manzini G, Bosello F, Marchini G. The Role of Topical Povidone-Iodine in the Management of Infectious Keratitis: A Pilot Study. J Clin Med 2022; 11:jcm11030848. [PMID: 35160298 PMCID: PMC8837158 DOI: 10.3390/jcm11030848] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/29/2022] [Accepted: 02/02/2022] [Indexed: 02/04/2023] Open
Abstract
The aim of this prospective explorative study was to evaluate the safety and the effectiveness of topical polyvinylpyrrolidone-iodine (PVP-I) administered during the time-to-results period for pathogen identification and susceptibility testing in patients with infectious keratitis (IK). A corneal swab (CS) for antimicrobial evaluation was performed at enrollment (T0) and topical 0.66%-PVP-I was administered until the laboratory results were available (T1). Ulcer and infiltrate areas and infiltrate depths were compared between T0 and T1 (i.e., time-to-result period). Patients were then shifted to a specific antimicrobial therapy and followed up until resolution of their infiltrates (Tlast-TL). Twenty-five eyes were enrolled, and none showed clinical worsening leading to protocol withdrawal. At T1, ulcer and infiltrate areas showed significant improvement in Gram-positive IK (n = 13–52%; p = 0.027 and p = 0.019, respectively), remained stable in fungal IK (n = 5–20%; both p = 0.98) and increased in those with Gram-negative bacteria (n = 4–16%; p = 0.58 and p = 0.27). Eyes with negative cultures (n = 3–12%) showed complete resolution at T1 and did not initiate any additional antimicrobial therapy. The administration of 0.66% PVP-I during the time-to-result period seems to be a safe strategy in patients with IK while often sparing broad-spectrum antimicrobial agents. In addition, it showed to be effective in eyes with a Gram-positive bacterial infection.
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Affiliation(s)
- Emilio Pedrotti
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy; (E.P.); (E.B.); (C.P.); (A.F.); (M.A.); (G.M.); (F.B.); (G.M.)
| | - Erika Bonacci
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy; (E.P.); (E.B.); (C.P.); (A.F.); (M.A.); (G.M.); (F.B.); (G.M.)
| | - Raphael Kilian
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy; (E.P.); (E.B.); (C.P.); (A.F.); (M.A.); (G.M.); (F.B.); (G.M.)
- Correspondence:
| | - Camilla Pagnacco
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy; (E.P.); (E.B.); (C.P.); (A.F.); (M.A.); (G.M.); (F.B.); (G.M.)
| | - Adriano Fasolo
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy; (E.P.); (E.B.); (C.P.); (A.F.); (M.A.); (G.M.); (F.B.); (G.M.)
- Research Center, The Veneto Eye Bank Foundation, 30174 Venezia, Italy
| | - Marco Anastasi
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy; (E.P.); (E.B.); (C.P.); (A.F.); (M.A.); (G.M.); (F.B.); (G.M.)
| | - Gessica Manzini
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy; (E.P.); (E.B.); (C.P.); (A.F.); (M.A.); (G.M.); (F.B.); (G.M.)
| | - Francesca Bosello
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy; (E.P.); (E.B.); (C.P.); (A.F.); (M.A.); (G.M.); (F.B.); (G.M.)
| | - Giorgio Marchini
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy; (E.P.); (E.B.); (C.P.); (A.F.); (M.A.); (G.M.); (F.B.); (G.M.)
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Loo J, Woodward MA, Prajna V, Kriegel MF, Pawar M, Khan M, Niziol LM, Farsiu S. Open-Source Automatic Biomarker Measurement on Slit-Lamp Photography to Estimate Visual Acuity in Microbial Keratitis. Transl Vis Sci Technol 2021; 10:2. [PMID: 34605877 PMCID: PMC8496413 DOI: 10.1167/tvst.10.12.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose To assess clinical applicability of automatic image analysis in microbial keratitis (MK) by evaluating the relationship between biomarker measurements on slit-lamp photography (SLP) and best-corrected visual acuity (BCVA). Methods Seventy-six patients with MK with SLP images and same-day logarithm of the minimum angle of resolution (logMAR) BCVA were evaluated. MK biomarkers (stromal infiltrate, white blood cell infiltration, corneal edema, hypopyon, epithelial defect) were segmented manually by ophthalmologists and automatically by a novel, open-source, deep learning–based segmentation algorithm. Five measurements (presence, maximum width, total area, proportion of the corneal limbus area affected, centrality) were calculated. Correlations between the measurements and BCVA were calculated. An automatic regression model estimated BCVA from the measurements. Differences in performance between using manual and automatic measurements were evaluated using William's test (for correlation) and the paired-sample t-test (for absolute error). Results Measurements had high correlations of 0.86 (manual) and 0.84 (automatic) with true BCVA. Estimated BCVA had average (mean ± SD) absolute errors of 0.39 ± 0.27 logMAR (manual, median: 0.30) and 0.35 ± 0.28 logMAR (automatic, median: 0.30) and high correlations of 0.76 (manual) and 0.80 (automatic) with true BCVA. Differences between using manual and automatic measurements were not statistically significant for correlations of measurements with true BCVA (P = .66), absolute errors of estimated BCVA (P = .15), or correlations of estimated BCVA with true BCVA (P = .60). Conclusions The proposed algorithm measured MK biomarkers as accurately as ophthalmologists. Measurements were highly correlated with and estimative of visual acuity. Translational Relevance This study demonstrates the potential of developing fully automatic objective and standardized strategies to aid ophthalmologists in the clinical assessment of MK.
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Affiliation(s)
- Jessica Loo
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Venkatesh Prajna
- Department of Cornea and Refractive Services, Aravind Eye Care System, Madurai, Tamil Nadu, India
| | - Matthias F Kriegel
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA.,Department of Ophthalmology, Augenzentrum am St. Franziskus Hospital Münster, Münster, Germany
| | - Mercy Pawar
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Mariam Khan
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Leslie M Niziol
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| | - Sina Farsiu
- Department of Biomedical Engineering, Duke University, Durham, NC, USA.,Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
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