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Ramamurthy D, Srinivasan S, Chamarty S, Velappan T, Verkicharla PK, Samuel Paulraj AK. Smart Devices in Optometry: Current and Future Perspectives to Clinical Optometry. CLINICAL OPTOMETRY 2024; 16:169-190. [PMID: 39100732 PMCID: PMC11296370 DOI: 10.2147/opto.s447554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 06/18/2024] [Indexed: 08/06/2024]
Abstract
There is a huge unmet need for eye care with more than a hundred million people living without basic eye care services and facilities. There is an exigency to deploy adequate resources in terms of manpower and equipment to address this. The usage of smart devices in optometry and eye care practice has been gaining momentum for last half a decade, due to the COVID-19 pandemic and technological advancements in telemedicine. These smart devices will help facilitate remote monitoring of important visual functions, ocular signs and symptoms, thus providing better eye care services and facilities and promoting outreach services. Smart devices in optometry exist in the form of gadgets that can be worn in the wrist, and spectacle-mounted or head-mounted devices. On the other hand, with the ubiquitous nature of smartphones, a large number of smartphone applications have been developed and tested for advanced optometry and primary eye care practice, which may potentially reduce the burden of inadequate resources and the unmet need for eye care. This article aims to give an overview of the current trends and future perspectives on the application of such smart devices in optometric practice.
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Affiliation(s)
- Dharani Ramamurthy
- Department of Optometry, Faculty of Medical & Health Sciences, SRM Medical College Hospital & Research Centre, SRM Institute of Science and Technology, Chennai, Tamil Nadu, 603203, India
| | | | - Sruthi Chamarty
- Myopia Research Lab, Brien Holden Institute of Optometry and Vision Sciences, Prof Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, 500034, India
| | - Tharaniy Velappan
- Department of Optometry, Faculty of Medical & Health Sciences, SRM Medical College Hospital & Research Centre, SRM Institute of Science and Technology, Chennai, Tamil Nadu, 603203, India
| | - Pavan Kumar Verkicharla
- Myopia Research Lab, Brien Holden Institute of Optometry and Vision Sciences, Prof Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, 500034, India
| | - Angeline Kirubha Samuel Paulraj
- Department. of Biomedical Engineering, College of Engineering & Technology, SRM Institute of Science and Technology, Chennai, Tamil Nadu, 603203, India
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Ehongo A. Understanding Posterior Staphyloma in Pathologic Myopia: Current Overview, New Input, and Perspectives. Clin Ophthalmol 2023; 17:3825-3853. [PMID: 38105912 PMCID: PMC10725704 DOI: 10.2147/opth.s405202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023] Open
Abstract
Posterior staphyloma (PS) is considered the hallmark of pathologic myopia and is defined as an outpouching of a circumscribed portion of the eyeball with a radius of curvature smaller than that of the adjacent zone. Although more common in eyes with high myopia, it can affect those without it. The presence of PS is associated with a structurally and functionally worse course of high myopia that can lead to visual disability. Unfortunately, the pathogenesis of PS is unclear so far. Thus, due to the increasing prevalence of myopia which has been further exacerbated by the advent of COVID-19 lockdown, researchers are eager to elucidate the pathogenesis of pathologic myopia and that of its complications, especially PS, which will allow the development of preventive strategies. The aim of this work was to review the morphological characteristics of PS with emphasis on similarities with peripapillary staphyloma and to discuss the pathogenesis of PS considering recent suggestions about that of peripapillary staphyloma.
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Affiliation(s)
- Adèle Ehongo
- Ophthalmology Department, Erasmus Hospital, Brussels, Belgium
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Harb EN, Sawai ES, Wildsoet CF. Indoor and outdoor human behavior and myopia: an objective and dynamic study. Front Med (Lausanne) 2023; 10:1270454. [PMID: 38020131 PMCID: PMC10643732 DOI: 10.3389/fmed.2023.1270454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Significance Myopia holds significant public health concern given its social, ocular disease and economic burdens. Although environmental factors are primarily to blame for the rapid rise in prevalence, key risk factors remain unresolved. Purpose The aim of this study was to objectively characterize, using a wearable technology, the temporal indoor and outdoor behavioral patterns and associated environmental lighting characteristics of young myopic and nonmyopic University students. Methods Participants were recruited to continuously wear an Actiwatch for 3 weeks, during either or both academic and non-academic periods. The device allows continuous recording of activity and incident light. Recorded illuminance levels were used as a proxy for outdoors (>1,000 lux), with the dynamics (interval frequency and duration) of indoor and outdoor activities, as well as lighting characteristics derived. In addition, participant input regarding near work was obtained daily. Participants were classified by both myopia and axial length status (based on collected refractive error and biometry data) for the purpose of data analysis. Result A total of 55 students, aged 18 to 25 years of age, participated. Overall, the dosing of indoor and outdoor activities was similar across participants, regardless of myopia status, during the academic period. Nonetheless, an apparent difference in the timing of outdoor activities was noted with myopes going outdoors later in the day, particularly during the weekend (p = 0.03). While a trend was observed between increased lighting levels experienced outdoors and shorter axial lengths, there was no significant relationship with myopia status. Noteworthy, participants generally significantly overestimated time spent outdoors, compared to Actiwatch-derived estimates of the same. Conclusion While the findings from this cohort of young adult students did not reveal substantial myopia-related differences in behavior, the power of a more objective and dynamic approach to quantifying behavior cannot be understated, providing argument for general adoption of wearable technologies in future clinical myopia studies.
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Affiliation(s)
- Elise N. Harb
- Herbert Wertheim School of Optometry and Vision Science, University of California at Berkeley, Berkeley, CA, United States
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RaviChandran N, Teo ZL, Ting DSW. Artificial intelligence enabled smart digital eye wearables. Curr Opin Ophthalmol 2023; 34:414-421. [PMID: 37527195 DOI: 10.1097/icu.0000000000000985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
PURPOSE OF REVIEW Smart eyewear is a head-worn wearable device that is evolving as the next phase of ubiquitous wearables. Although their applications in healthcare are being explored, they have the potential to revolutionize teleophthalmology care. This review highlights their applications in ophthalmology care and discusses future scope. RECENT FINDINGS Smart eyewear equips advanced sensors, optical displays, and processing capabilities in a wearable form factor. Rapid technological developments and the integration of artificial intelligence are expanding their reach from consumer space to healthcare applications. This review systematically presents their applications in treating and managing eye-related conditions. This includes remote assessments, real-time monitoring, telehealth consultations, and the facilitation of personalized interventions. They also serve as low-vision assistive devices to help visually impaired, and can aid physicians with operational and surgical tasks. SUMMARY Wearables such as smart eyewear collects rich, continuous, objective, individual-specific data, which is difficult to obtain in a clinical setting. By leveraging sophisticated data processing and artificial intelligence based algorithms, these data can identify at-risk patients, recognize behavioral patterns, and make timely interventions. They promise cost-effective and personalized treatment for vision impairments in an effort to mitigate the global burden of eye-related conditions and aging.
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Affiliation(s)
| | - Zhen Ling Teo
- Singapore National Eye Center, Singapore Eye Research Institute
| | - Daniel S W Ting
- AI and Digital Innovations
- Singapore National Eye Center, Singapore Eye Research Institute
- Duke-NUS Medical School, National University Singapore, Singapore
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Zhang Y, Su M, Sun Y, Qi L, Gao L, Wu X, Li Y, Liu Y, Li W, Jin M. Clouclip combined with a questionnaire on the influence factors of myopia in children. Front Pediatr 2023; 11:1228257. [PMID: 37609361 PMCID: PMC10440742 DOI: 10.3389/fped.2023.1228257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/27/2023] [Indexed: 08/24/2023] Open
Abstract
Purpose To evaluate eye use behavior in myopic and non-myopic children objectively using Clouclip M2 device and subjectively using questionnaire and compare the results. The study also aimed to assess the relationships between ocular biometric parameters and refractive status. Methods Clouclip M2 was used in monitoring eye use behavior and visual environment in children aged 9-11 years. The participants were monitored for 7 days. On the eighth day, data stored in the device were collected, relevant eye examination were conducted and survey questionnaire was administered. The paired sample t-test was used to compare the eye use behavior obtained objectively and subjectively. The relationships between ocular biometric parameters and refractive status were assessed using the Pearson's Correlation analysis. Results Spherical equivalent refraction was significantly correlated with axial length, axial length to corneal radius, anterior chamber depth, lens thickness, and corneal radius (P < 0.05). The average time per day spent on near work, the maximum time for single near work, and the average near working distance were significantly lower, and the average total time spent on outdoor activities was significantly longer as determined by questionnaire method than that found using Clouclip M2. Logistic regression analysis revealed that prolonged near work, shorter working distance, presence of parental myopia, and lesser outdoor activities were significant risk factors for myopia. Conclusions The childhood myopia is influenced by eye use behavior, eye use environment, and parental myopia. Results from this study further support that biometric and optical parameters of the eye determine refractive status. Being an objective method, Clouclip M2 provides an independent eye use behavior data which potentially are more reliable than obtained from subjective method. Our study provided a theoretical basis for myopia prevention and control in clinical practice.
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Affiliation(s)
| | - Ming Su
- Department of Optometry, Shijiazhuang Aier Eye Hospital, Shijiazhuang, China
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Li Y, Yip MYT, Ting DSW, Ang M. Artificial intelligence and digital solutions for myopia. Taiwan J Ophthalmol 2023; 13:142-150. [PMID: 37484621 PMCID: PMC10361438 DOI: 10.4103/tjo.tjo-d-23-00032] [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: 03/12/2023] [Accepted: 03/16/2023] [Indexed: 07/25/2023] Open
Abstract
Myopia as an uncorrected visual impairment is recognized as a global public health issue with an increasing burden on health-care systems. Moreover, high myopia increases one's risk of developing pathologic myopia, which can lead to irreversible visual impairment. Thus, increased resources are needed for the early identification of complications, timely intervention to prevent myopia progression, and treatment of complications. Emerging artificial intelligence (AI) and digital technologies may have the potential to tackle these unmet needs through automated detection for screening and risk stratification, individualized prediction, and prognostication of myopia progression. AI applications in myopia for children and adults have been developed for the detection, diagnosis, and prediction of progression. Novel AI technologies, including multimodal AI, explainable AI, federated learning, automated machine learning, and blockchain, may further improve prediction performance, safety, accessibility, and also circumvent concerns of explainability. Digital technology advancements include digital therapeutics, self-monitoring devices, virtual reality or augmented reality technology, and wearable devices - which provide possible avenues for monitoring myopia progression and control. However, there are challenges in the implementation of these technologies, which include requirements for specific infrastructure and resources, demonstrating clinically acceptable performance and safety of data management. Nonetheless, this remains an evolving field with the potential to address the growing global burden of myopia.
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Affiliation(s)
- Yong Li
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology and Visual Sciences, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Michelle Y. T. Yip
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Daniel S. W. Ting
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology and Visual Sciences, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology and Visual Sciences, Duke-NUS Medical School, National University of Singapore, Singapore
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Seasonal Variations in Ocular Axial Length Increase among Children in the Czech Republic. J Ophthalmol 2023; 2023:2592853. [PMID: 36817325 PMCID: PMC9937750 DOI: 10.1155/2023/2592853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/07/2022] [Accepted: 11/25/2022] [Indexed: 02/12/2023] Open
Abstract
In recent decades, the prevalence of myopia has increased worldwide as well as in European countries, and it has become an important medical and socioeconomic problem. Our prospective single-center study analysed the changes in ocular axial length (AXL) in a population of Central European schoolchildren from 2016 to 2019. The study included 528 eyes of 264 children with a mean age of 12.2 years at the beginning of the study. Visual acuity, ocular AXL, anterior chamber depth, and the questionnaire were examined at 6-month intervals (in spring and autumn, following the winter and summer periods, respectively). The average ocular AXL was 23.329 mm (median: 23.315 mm) at the beginning of the study and 23.525 mm (median: 23.505 mm) at the end of the study. The change in ocular AXL per month was significantly higher (p < 0.0001) during the winter period (average: 0.013 mm, median: 0.011 mm) than during the summer period (average: -0.001 mm, median: 0.000 mm). We observed a significantly higher increase in ocular AXL in a Caucasian population during the winter period (with lower daylight exposure) than the summer period.
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Spitschan M, Smolders K, Vandendriessche B, Bent B, Bakker JP, Rodriguez-Chavez IR, Vetter C. Verification, analytical validation and clinical validation (V3) of wearable dosimeters and light loggers. Digit Health 2022; 8:20552076221144858. [PMID: 36601285 PMCID: PMC9806438 DOI: 10.1177/20552076221144858] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/25/2022] [Indexed: 12/27/2022] Open
Abstract
Background Light exposure is an important driver and modulator of human physiology, behavior and overall health, including the biological clock, sleep-wake cycles, mood and alertness. Light can also be used as a directed intervention, e.g., in the form of light therapy in seasonal affective disorder (SAD), jetlag prevention and treatment, or to treat circadian disorders. Recently, a system of quantities and units related to the physiological effects of light was standardized by the International Commission on Illumination (CIE S 026/E:2018). At the same time, biometric monitoring technologies (BioMeTs) to capture personalized light exposure were developed. However, because there are currently no standard approaches to evaluate the digital dosimeters, the need to provide a firm framework for the characterization, calibration, and reporting for these digital sensors is urgent. Objective This article provides such a framework by applying the principles of verification, analytic validation and clinical validation (V3) as a state-of-the-art approach for tools and standards in digital medicine to light dosimetry. Results This article describes opportunities for the use of digital dosimeters for basic research, for monitoring light exposure, and for measuring adherence in both clinical and non-clinical populations to light-based interventions in clinical trials.
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Affiliation(s)
- Manuel Spitschan
- Translational Sensory & Circadian Neuroscience, Max Planck
Institute for Biological Cybernetics, Tübingen, Germany,Chronobiology & Health, TUM Department of Sport and Health
Sciences (TUM SG), Technical University of
Munich, Munich, Germany,TUM Institute for Advanced Study (TUM-IAS), Technical University of
Munich, Garching, Germany,Manuel Spitschan, Translational Sensory
& Circadian Neuroscience, Max Planck Institute for Biological Cybernetics,
Tübingen, Germany.
| | - Karin Smolders
- Human-Technology Interaction Group, Eindhoven University of
Technology, Eindhoven, The Netherlands
| | - Benjamin Vandendriessche
- Byteflies, Antwerp, Belgium,Department of Electrical, Computer, and Systems Engineering, Case Western Reserve
University, Cleveland, OH, USA
| | | | | | | | - Céline Vetter
- Department of Integrative Physiology, University of Colorado
Boulder, Boulder, CO, USA,Céline Vetter, University of Colorado
Boulder, Boulder, CO, USA.
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Bhandari KR, Ostrin LA. Objective measures of viewing behaviour in children during near tasks. Clin Exp Optom 2022; 105:746-753. [PMID: 34538208 PMCID: PMC8933286 DOI: 10.1080/08164622.2021.1971049] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/04/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022] Open
Abstract
CLINICAL RELEVANCE Objective assessment of near viewing behaviours performed in a laboratory setting showed that children demonstrate differing viewing distances and angles based on the type of task. Findings will contribute to our understanding of how near work influences myopia. BACKGROUND Evidence suggests that near working distance and viewing breaks are associated with myopia. The purpose of this study was to use an objective, continuously measuring range finding device to examine these viewing behaviours in children. METHODS Viewing distance, number of breaks, and head and eye angles were assessed in 16 non-myopic and 19 myopic children (ages 13.38 ± 4.14 years) using the Clouclip, an objective rangefinder, during five 15-minute near tasks, including (a) passive reading and (b) active writing on printed material, (c) passive viewing and (d) active engagement on an iPad, and (e) active engagement on a cell phone. Height and Harmon distance were measured. Viewing behaviours were analysed by task, refractive error group, and gender. RESULTS Mean viewing distances significantly differed by task (P < 0.001) and were highly correlated with children's Harmon distance and height for all near tasks (P < 0.05), except for the active printed task (P > 0.05). Viewing distances did not differ by gender or refractive error group. During each task, mean number of viewing breaks was 2.6 ± 4.1 and did not vary between task (P = 0.92) or refractive error group (P = 0.65). Head declination and total viewing angle varied by type of near task (P < 0.001 for both). CONCLUSION Children demonstrated differing viewing distances and viewing angles based on the type of near task they were performing. Viewing behaviours did not vary between myopic and non-myopic children. Findings will contribute to a better understanding of how near viewing behaviours can be quantified objectively and relationships with myopia.
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Affiliation(s)
- Khob R Bhandari
- University of Houston College of Optometry, 4901 Calhoun Rd, Houston, TX, 77204 USA
| | - Lisa A Ostrin
- University of Houston College of Optometry, 4901 Calhoun Rd, Houston, TX, 77204 USA
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Dhiman R, Rakheja V, Gupta V, Saxena R. Current concepts in the management of childhood myopia. Indian J Ophthalmol 2022; 70:2800-2815. [PMID: 35918919 DOI: 10.4103/ijo.ijo_2098_21] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Myopia or short-sightedness is an emerging pandemic affecting more than 50% population in South-Asian countries. It is associated with several sight-threatening complications, such as retinal detachment and choroidal neovascularization, leading to an increased burden of visual impairment and blindness. The pathophysiology of myopia involves a complex interplay of numerous environmental and genetic factors leading to progressive axial elongation. Environmental factors such as decreased outdoor activity, reduced exposure to ambient light, strenuous near work, and role of family history of myopia have been implicated with increased prevalence of this refractive error. While multiple clinical trials have been undertaken to devise appropriate treatment strategies and target the modifiable risk factors, there is no single treatment modality with ideal results; therefore, formulating a comprehensive approach is required to control the myopia epidemic. This review article summarizes the epidemiology, dynamic concepts of pathophysiology, and evolution of the treatment modalities for myopia such as pharmacological (atropine and other agents) and optical methods (spectacles, contact lenses, and orthokeratology).
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Affiliation(s)
- Rebika Dhiman
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, India
| | - Vaishali Rakheja
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, India
| | - Vinay Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, India
| | - Rohit Saxena
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, India
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Zhang C, Zhao J, Zhu Z, Li Y, Li K, Wang Y, Zheng Y. Applications of Artificial Intelligence in Myopia: Current and Future Directions. Front Med (Lausanne) 2022; 9:840498. [PMID: 35360739 PMCID: PMC8962670 DOI: 10.3389/fmed.2022.840498] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/15/2022] [Indexed: 12/17/2022] Open
Abstract
With the continuous development of computer technology, big data acquisition and imaging methods, the application of artificial intelligence (AI) in medical fields is expanding. The use of machine learning and deep learning in the diagnosis and treatment of ophthalmic diseases is becoming more widespread. As one of the main causes of visual impairment, myopia has a high global prevalence. Early screening or diagnosis of myopia, combined with other effective therapeutic interventions, is very important to maintain a patient's visual function and quality of life. Through the training of fundus photography, optical coherence tomography, and slit lamp images and through platforms provided by telemedicine, AI shows great application potential in the detection, diagnosis, progression prediction and treatment of myopia. In addition, AI models and wearable devices based on other forms of data also perform well in the behavioral intervention of myopia patients. Admittedly, there are still some challenges in the practical application of AI in myopia, such as the standardization of datasets; acceptance attitudes of users; and ethical, legal and regulatory issues. This paper reviews the clinical application status, potential challenges and future directions of AI in myopia and proposes that the establishment of an AI-integrated telemedicine platform will be a new direction for myopia management in the post-COVID-19 period.
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Bhandari KR, Shukla D, Mirhajianmoghadam H, Ostrin LA. Objective Measures of Near Viewing and Light Exposure in Schoolchildren during COVID-19. Optom Vis Sci 2022; 99:241-252. [PMID: 35086121 PMCID: PMC8897254 DOI: 10.1097/opx.0000000000001871] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Wearable sensors provide the opportunity for continuous objective measurement of the visual environment with high resolution. Our findings show that absolute and temporal properties of near viewing and time outdoors vary between myopic and nonmyopic schoolchildren, which are important considerations when studying refractive error pathogenesis. PURPOSE Numerous behavioral factors, including near work, time outdoors, electronic device use, and sleep, have been linked to myopia. The purpose of this study was to assess behaviors using subjective and objective methods in myopic and nonmyopic schoolchildren in the United States. METHODS Forty children (aged 14.6 ± 0.4 years) simultaneously wore two sensors for 1 week, a Clouclip for objective measurement of near viewing and light exposure and an Actiwatch for objective measurement of activity and sleep. Parents completed an activity questionnaire for their child. Near-viewing distance, daily duration, short-duration (>1 minute) and long-duration (>30 minutes) near-viewing episodes, light exposure, time outdoors, electronic device use, and sleep duration were analyzed by refractive error group and day of the week. RESULTS Objectively measured daily near-viewing duration was 6.9 ± 0.3 hours. Myopes spent more time in near + intermediate viewing than nonmyopes (P = .008) and had higher diopter hours (P = .03). Short- and long-duration near-viewing episodes were similar between groups (P < .05 for both). Daily light exposure and time outdoors were significantly lower for myopes (P < .05 for both). Electronic device use (12.0 ± 0.7 hours per day) and sleep duration (8.2 ± 0.2 hours per night) were similar between groups (P > .05 for both). CONCLUSIONS Objective and subjective measures confirm that myopic and nonmyopic schoolchildren exhibit different behaviors. Combining wearable sensors with questionnaires provides a comprehensive description of children's visual environment to better understand factors that contribute to myopia.
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Affiliation(s)
| | - Divya Shukla
- University of Houston College of Optometry, Houston, Texas
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Wearable Sensors for Measurement of Viewing Behavior, Light Exposure, and Sleep. SENSORS 2021; 21:s21217096. [PMID: 34770402 PMCID: PMC8587946 DOI: 10.3390/s21217096] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/29/2021] [Accepted: 10/21/2021] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to compare two wearable sensors to each other and to a questionnaire in an adult population. For one week, participants aged 29.2 ± 5.5 years (n = 25) simultaneously wore a Clouclip, a spectacle-mounted device that records viewing distance and illuminance, and an Actiwatch, a wrist-worn device that measures illuminance and activity. Participants maintained a daily log of activities and completed an activity questionnaire. Objective measures of time outdoors, near (10–< 60 cm) and intermediate (60–100 cm) viewing, and sleep duration were assessed with respect to the daily log and questionnaire. Findings showed that time outdoors per day from the questionnaire (3.2 ± 0.3 h) was significantly greater than the Clouclip (0.9 ± 0.8 h) and Actiwatch (0.7 ± 0.1 h, p < 0.001 for both). Illuminance from the Actiwatch was systematically lower than the Clouclip. Daily near viewing duration was similar between the questionnaire (5.7 ± 0.6 h) and Clouclip (6.1 ± 0.4 h, p = 0.76), while duration of intermediate viewing was significantly different between methods (p < 0.001). In conclusion, self-reported time outdoors and viewing behaviors were different than objective measures. The Actiwatch and Clouclip are valuable tools for studying temporal patterns of behavioral factors such as near work, light exposure, and sleep.
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South J, Roberts P, Gao T, Black J, Collins A. Development of a Spectacle Wear Monitor System: SpecsOn Monitor. Transl Vis Sci Technol 2021; 10:11. [PMID: 34614165 PMCID: PMC8496409 DOI: 10.1167/tvst.10.12.11] [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: 12/23/2022] Open
Abstract
Purpose This study aimed to custom design, build, and test a removable device that accurately and objectively monitors adherence to spectacle wear in preschool children participating in clinical trials. This work will provide researchers with the tools to investigate the effect of adherence to optical treatment in conditions relating to refractive error, such as anisometropia, amblyopia, myopia, and accommodative esotropia, where spectacle wearing behaviors are of interest. Methods Several sensors were considered in the design of the SpecsOn monitor. The final version included two temperature sensors, one that measures skin temperature through an infrared sensor directed at the wearer's temple on the spectacle arm and the other measuring device temperature. The difference between the two temperature readings is used to determine if the spectacles were worn. The SpecsOn monitor was tested in two phases in adult participants (laboratory n = 10 and real world n = 5). Results Results from both phases showed good agreement between the objective measurement of wear based on skin and device temperature differences and participants’ manually logged wear times. The custom built SpecsOn monitor was 99% successful in accurately detecting spectacle wear in our adult cohort. Conclusions The SpecsOn monitor offers a convenient, accurate, and reliable system to monitor spectacle adherence. The devices were comfortable, secure, and unobtrusive to wear, and fitted easily to a variety of frame styles. Translational Relevance Easy access to spectacle compliance information from the SpecsOn monitor during the optical treatment phase will optimize visual outcomes and provide detailed clinical data to support decision making on the need and timing of additional therapies, improving treatment efficiency.
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Affiliation(s)
- Jayshree South
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Paul Roberts
- Medlink Innovation Limited, Auckland, New Zealand, Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Tina Gao
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Joanna Black
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Andrew Collins
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
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Wang X, Yang Y, Wu Y, Wei W, Dong L, Li Y, Tan X, Cao H, Zhang H, Ma X, Jiang Q, Zhou Y, Yang W, Li C, Gu Y, Ding L, Qin Y, Chen Q, Li L, Lian M, Ma J, Cui D, Huang Y, Liu W, Yang X, Yu S, Chen J, Wang D, Lin Z, Yan P, Lin H. The national multi-center artificial intelligent myopia prevention and control project. INTELLIGENT MEDICINE 2021; 1:51-55. [DOI: 10.1016/j.imed.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
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16
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Tseng RMWW, Tham YC, Rim TH, Cheng CY. Emergence of non-artificial intelligence digital health innovations in ophthalmology: A systematic review. Clin Exp Ophthalmol 2021; 49:741-756. [PMID: 34235833 DOI: 10.1111/ceo.13971] [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: 06/30/2021] [Accepted: 07/03/2021] [Indexed: 11/30/2022]
Abstract
The prominent rise of digital health in ophthalmology is evident in the current age of Industry 4.0. Despite the many facets of digital health, there has been a greater slant in interest and focus on artificial intelligence recently. Other major elements of digital health like wearables could also substantially impact patient-focused outcomes but have been relatively less explored and discussed. In this review, we comprehensively evaluate the use of non-artificial intelligence digital health tools in ophthalmology. 53 papers were included in this systematic review - 25 papers discuss virtual or augmented reality, 14 discuss mobile applications and 14 discuss wearables. Most papers focused on the use of technologies to detect or rehabilitate visual impairment, glaucoma and age-related macular degeneration. Overall, the findings on patient-focused outcomes with the adoption of these technologies are encouraging. Further validation, large-scale studies and earlier consideration of real-world barriers are warranted to enable better real-world implementation.
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Affiliation(s)
| | - Yih-Chung Tham
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore
| | - Tyler Hyungtaek Rim
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore
| | - Ching-Yu Cheng
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
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17
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Li L, Wen L, Lan W, Zhu H, Yang Z. A Novel Approach to Quantify Environmental Risk Factors of Myopia: Combination of Wearable Devices and Big Data Science. Transl Vis Sci Technol 2020; 9:17. [PMID: 33344061 PMCID: PMC7735949 DOI: 10.1167/tvst.9.13.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 10/27/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose To develop a practical approach to quantify the exposure to environmental risk factors of myopia. Methods In total, 179 children (age, mean ± standard deviation [SD] 9.17 ± 0.52 years) were requested to wear Clouclip, designed to measure working distance (WD) and light intensity (LI), for a whole week. The spherical equivalent refraction (SER) was determined by cycloplegic autorefraction. The raw data of WD and LI were preprocessed through several steps, including data denoising, constructing a two-dimensional WD-LI space, and data sparseness disposing. Weighted linear regression was used to explore the relationship between WD/LI and SER. A novel parameter visual behaviour index (VBI) was developed to summarize the overall impact of WD/LI on SER. Results The mean ± SD SER of 179 participants was 0.22 ± 1.18 D. WD and LI were positively associated with SER. However, their magnitude of effect on SER varied with the relative level between them. When WD and LI were split up, the detrimental threshold was approximately 40 cm for WD and 6300 lux for LI. VBI was significantly positively associated with SER (β = 0.0623, R2 = 0.031, P < 0.05). Conclusions The current study provides a novel approach to quantify environmental risk factors of myopia. Despite the complexity of the interaction between these risk factors and their impact on SER, this information can be summarized as one single-parameter VBI, which provides a useful tool to investigate the effect of environmental factors on myopia development and progression. Translational Relevance We developed a novel approach to quantify environmental risk factors of myopia.
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Affiliation(s)
- Lei Li
- State Key Laboratory of Software Development Environment, Beihang University, Beijing, China
| | - Longbo Wen
- Aier School of Ophthalmology, Central South University, Hunan, China
| | - Weizhong Lan
- Aier School of Ophthalmology, Central South University, Hunan, China.,Aier School of Optometry and Vision Science, Hubei University of Science and Technology, Xianning, China.,Guangzhou Aier Eye Hospital, Jinan University, Guangzhou, China
| | - Haogang Zhu
- State Key Laboratory of Software Development Environment, Beihang University, Beijing, China.,NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Zhikuan Yang
- Aier School of Ophthalmology, Central South University, Hunan, China.,Aier School of Optometry and Vision Science, Hubei University of Science and Technology, Xianning, China
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Bhandari KR, Ostrin LA. Validation of the Clouclip and utility in measuring viewing distance in adults. Ophthalmic Physiol Opt 2020; 40:801-814. [PMID: 33002229 DOI: 10.1111/opo.12735] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/20/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE To validate the Clouclip, a continuously measuring objective rangefinder, and examine viewing behaviours during various near tasks in non-myopic and myopic adults. METHODS In experiment 1, five Clouclip devices were utilised. An infrared camera was used to visualise and measure infrared beam size and angle. Repeatability for distance tracking was assessed from 5 to 120 cm in 5 cm increments. Accuracy of distance tracking was investigated for paper and iPad targets, spatial integration was calculated, effects of target tilt were determined and light measurements were compared to a lux meter. In experiment 2, viewing behaviour was assessed in 41 subjects (21 non-myopic, 20 myopic) during four 15-min near tasks; (1) passive reading of printed material, (2) active writing on printed material, (3) passive viewing on an electronic device and (4) active engagement on an electronic device. Working distance was compared between tasks and refractive error groups. RESULTS Clouclip distance tracking showed good repeatability, with a mean difference of 0.34 cm and limits of agreement of ±2.0 cm. Clouclip-measured and actual distances were highly correlated for paper and electronic targets from 5 to 120 cm, with mean differences and limits of agreement of 3.96 ± 13.78 cm and 4.48 ± 8.92 cm, respectively; variability increased for distances >100 cm. Tracking ability increased with larger target sizes; tracking was accurate when the target occupied 1.5%-20.3% of tracking beam area, depending on distance and with target tilt up to ±60 degrees. Clouclip- and lux meter-measured ambient illumination were highly correlated for a wide range of intensities (r = 0.96, p < 0.001), but with greater variability for intensities >20 000 lux. The Clouclip infrared beam was measured to have a diameter of 25.6 ± 2.2° and a downward angle of 10.3 ± 0.5°. For subject testing, viewing distance was significantly closer for active and passive printed tasks (29.5 ± 6.7 cm and 33.2 ± 8.8 cm, respectively) than for active and passive electronic tasks (35.4 ± 8.0 cm and 40.8 ± 10.4 cm, respectively), with no differences between refractive error groups (p = 0.88). CONCLUSIONS The Clouclip performed well in measuring near and intermediate distances and could distinguish between indoor (<1000 lux) and outdoor (>1000 lux) illumination. A closer working distance was observed for printed tasks compared to those on an iPad, with no difference in viewing distance between non-myopic and myopic adults.
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Affiliation(s)
| | - Lisa A Ostrin
- University of Houston College of Optometry, Houston, USA
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