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Fantaguzzi F, Servillo A, Sacconi R, Tombolini B, Bandello F, Querques G. Comparison of peripheral extension, acquisition time, and image chromaticity of Optos, Clarus, and EIDON systems. Graefes Arch Clin Exp Ophthalmol 2022; 261:1289-1297. [PMID: 36456861 DOI: 10.1007/s00417-022-05923-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/20/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To evaluate differences in acquisition time, peripheral extension, and chromaticity between 3 different commercialized ultra-wide-field (UWF) fundus cameras. METHODS Patients were prospectively enrolled from 07/2021 to 11/2021. Patients underwent fundus photography with the following scanning protocols: (1) single shot with Silverstone (Optos, California), two-shot montage with Clarus 500 (Carl Zeiss, Dublin, CA), and three-shot montage with iCare EIDON FA with UWF module (CenterVue Spa, a company of iCare Finland Oy; Vantaa, Finland). Acquisition time was calculated as the interval between the beginning and the end of the acquisition. Peripheral extension was quantified as the average ratio between the total retinal pixel area and the optic nerve head (ONH) pixel area. The average chromaticity of all pixels in the red-green-blue (RGB) space was calculated. RESULTS Twenty-three eyes of 13 prospectively enrolled healthy controls were included in the study. Optos Silverstone had a higher total retina area/ONH area ratio (509.1 [480.9;559.3]) compared to Zeiss Clarus (442.0 [431.9;510.5], p = 0.02) and iCare EIDON (369.7 [345.3;387.8], p < 0.0001). Silverstone demonstrated the shortest acquisition time (median [interquartile range]: 32 [20;58.5] s) compared to Zeiss Clarus (42 [28.5;53.5] s, p = 0.6733) and iCare EIDON (72 [68.5;78] s, p = 0.0003). iCare EIDON demonstrated the lowest variability of acquisition time (9.5 s), compared to Zeiss Clarus (25 s) and Optos Silverstone (38.5 s). A statistically significant difference was found in the RGB distribution between each of the 3 devices (p < 0.001). iCare EIDON demonstrated an average barycenter position (RGB = [0.412, 0.314, 0.275]) that represented the best color balance of the image. Zeiss Clarus had a noticeable red shift at the expense of the blue and green channels (RGB = [0.515, 0.294, 0.191]). Optos Silverstone showed an absence of the blue channel (RGB = [0.621, 0.372, 0.007]) which results in a distortion of the color of the image. CONCLUSION Optos Silverstone and Zeiss Clarus required less time than iCare EIDON to acquire a comparable size image and captured larger areas of the retina than iCare EIDON. iCare EIDON provided more color-balanced retinal images with greater richness of color content than the other two devices.
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Affiliation(s)
- Federico Fantaguzzi
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Andrea Servillo
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Riccardo Sacconi
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Beatrice Tombolini
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
- Division of Head and Neck, Ophthalmology Unit, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Giuseppe Querques
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
- Division of Head and Neck, Ophthalmology Unit, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
- Department of Ophthalmology, University Vita-Salute, IRCCS San Raffaele, Milan, Italy.
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Shin Y, Cho H, Shin YU, Seong M, Choi JW, Lee WJ. Comparison between Deep-Learning-Based Ultra-Wide-Field Fundus Imaging and True-Colour Confocal Scanning for Diagnosing Glaucoma. J Clin Med 2022; 11:jcm11113168. [PMID: 35683577 PMCID: PMC9181263 DOI: 10.3390/jcm11113168] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/25/2022] [Accepted: 06/01/2022] [Indexed: 02/05/2023] Open
Abstract
In this retrospective, comparative study, we evaluated and compared the performance of two confocal imaging modalities in detecting glaucoma based on a deep learning (DL) classifier: ultra-wide-field (UWF) fundus imaging and true-colour confocal scanning. A total of 777 eyes, including 273 normal control eyes and 504 glaucomatous eyes, were tested. A convolutional neural network was used for each true-colour confocal scan (Eidon AF™, CenterVue, Padova, Italy) and UWF fundus image (Optomap™, Optos PLC, Dunfermline, UK) to detect glaucoma. The diagnostic model was trained using 545 training and 232 test images. The presence of glaucoma was determined, and the accuracy and area under the receiver operating characteristic curve (AUC) metrics were assessed for diagnostic power comparison. DL-based UWF fundus imaging achieved an AUC of 0.904 (95% confidence interval (CI): 0.861−0.937) and accuracy of 83.62%. In contrast, DL-based true-colour confocal scanning achieved an AUC of 0.868 (95% CI: 0.824−0.912) and accuracy of 81.46%. Both DL-based confocal imaging modalities showed no significant differences in their ability to diagnose glaucoma (p = 0.135) and were comparable to the traditional optical coherence tomography parameter-based methods (all p > 0.005). Therefore, using a DL-based algorithm on true-colour confocal scanning and UWF fundus imaging, we confirmed that both confocal fundus imaging techniques had high value in diagnosing glaucoma.
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Affiliation(s)
- Younji Shin
- Department of Electrical Engineering, Hanyang University, Seoul 04763, Korea;
| | - Hyunsoo Cho
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul 04763, Korea; (H.C.); (Y.U.S.); (M.S.)
| | - Yong Un Shin
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul 04763, Korea; (H.C.); (Y.U.S.); (M.S.)
| | - Mincheol Seong
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul 04763, Korea; (H.C.); (Y.U.S.); (M.S.)
| | - Jun Won Choi
- Department of Electrical Engineering, Hanyang University, Seoul 04763, Korea;
- Correspondence: (J.W.C.); (W.J.L.); Tel.: +82-2-2290-2316 (J.W.C.); +82-2-2290-8570 (W.J.L.)
| | - Won June Lee
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul 04763, Korea; (H.C.); (Y.U.S.); (M.S.)
- Correspondence: (J.W.C.); (W.J.L.); Tel.: +82-2-2290-2316 (J.W.C.); +82-2-2290-8570 (W.J.L.)
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Yao X, Toslak D, Son T, Ma J. Understanding the relationship between visual-angle and eye-angle for reliable determination of the field-of-view in ultra-wide field fundus photography. BIOMEDICAL OPTICS EXPRESS 2021; 12:6651-6659. [PMID: 34745762 PMCID: PMC8547975 DOI: 10.1364/boe.433775] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 05/15/2023]
Abstract
Visual-angle has been used as the conventional unit to determine the field-of-view (FOV) in traditional fundus photography. Recently emerging usage of eye-angle as the unit in wide field fundus photography creates confusion about FOV interpretation in instrumentation design and clinical application. This study aims to systematically derive the relationship between the visual-angle θv and eye-angle θe, and thus to enable reliable determination of the FOV in wide field fundus photography. FOV conversion ratio θe/θv, angular conversion ratio Δθe/Δθv, retinal conversion ratio Δd/Δθv, retinal distance and area are quantitatively evaluated. Systematic analysis indicates that reliable conversion between the θv and θe requires determined nodal point and spherical radius of the eye; and the conversion ratio is not linear from the central field to peripheral region. Based on the eye model with average parameters, both angular conversion (Δθe/Δθv) and retinal conversion (Δd/Δθv) ratios are observed to have a 1.51-fold difference at the central field and far peripheral region. A conversion table, including θe/θv, Δθe/Δθv, Δd/Δθv, retinal area and percentage ratio, is created for reliable assessment of imaging systems with variable FOV.
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Affiliation(s)
- Xincheng Yao
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Devrim Toslak
- Antalya Training and Research Hospital, Department of Ophthalmology, Antalya, 07100, Turkey
| | - Taeyoon Son
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Jiechao Ma
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL 60607, USA
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Olvera-Barrios A, Seltene M, Heeren TFC, Chambers R, Bolter L, Tufail A, Owen CG, Rudnicka AR, Egan C, Anderson J. Effect of ethnicity and other sociodemographic factors on attendance at diabetic eye screening: a 12-month retrospective cohort study. BMJ Open 2021; 11:e046264. [PMID: 34535475 PMCID: PMC8451288 DOI: 10.1136/bmjopen-2020-046264] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To examine the association of sociodemographic characteristics with attendance at diabetic eye screening in a large ethnically diverse urban population. DESIGN Retrospective cohort study. SETTING Screening visits in the North East London Diabetic Eye Screening Programme (NELDESP). PARTICIPANTS 84 449 people with diabetes aged 12 years or older registered in the NELDESP and scheduled for screening between 1 April 2017 and 31 March 2018. MAIN OUTCOME MEASURE Attendance at diabetic eye screening appointments. RESULTS The mean age of people with diabetes was 60 years (SD 14.2 years), 53.4% were men, 41% South Asian, 29% White British and 17% Black; 83.4% attended screening. Black people with diabetes had similar levels of attendance compared with White British people. However, South Asian, Chinese and 'Any other Asian' background ethnicities showed greater odds of attendance compared with White British. When compared with their respective reference group, high levels of deprivation, younger age, longer duration of diabetes and worse visual acuity, were all associated with non-attendance. There was a higher likelihood of attendance per quintile improvement in deprivation (OR, 1.06; 95% CI, 1.03 to 1.08), with increasing age (OR per decade, 1.17; 95% CI, 1.15 to 1.19), with better visual acuity (OR per Bailey-Lovie chart line 1.12; 95% CI, 1.11 to 1.14) and with longer time of NELDESP registration (OR per year, 1.02; 95% CI, 1.01 to 1.03). CONCLUSION Ethnic differences in diabetic eye screening uptake, though small, are evident. Despite preconceptions, a higher likelihood of screening attendance was observed among Asian ethnic groups when compared with the White ethnic group. Poorer socioeconomic profile was associated with higher likelihood of non-attendance for screening. Further work is needed to understand how to target individuals at risk of non-attendance and reduce inequalities.
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Affiliation(s)
- Abraham Olvera-Barrios
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- University College London Institute of Ophthalmology, London, UK
| | - Michael Seltene
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Tjebo F C Heeren
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- University College London Institute of Ophthalmology, London, UK
| | - Ryan Chambers
- Homerton University Hospital NHS Foundation Trust, London, UK
| | - Louis Bolter
- Homerton University Hospital NHS Foundation Trust, London, UK
| | - Adnan Tufail
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- University College London Institute of Ophthalmology, London, UK
| | - Christopher G Owen
- Population Health Research Institute, St George's, University London, London, UK
| | - Alicja R Rudnicka
- Population Health Research Institute, St George's, University London, London, UK
| | - Catherine Egan
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- University College London Institute of Ophthalmology, London, UK
| | - John Anderson
- Homerton University Hospital NHS Foundation Trust, London, UK
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Terasaki H, Sonoda S, Tomita M, Sakamoto T. Recent Advances and Clinical Application of Color Scanning Laser Ophthalmoscope. J Clin Med 2021; 10:jcm10040718. [PMID: 33670287 PMCID: PMC7917686 DOI: 10.3390/jcm10040718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 12/14/2022] Open
Abstract
Scanning laser ophthalmoscopes (SLOs) have been available since the early 1990s, but they were not commonly used because their advantages were not enough to replace conventional color fundus photography. In recent years, color SLOs have improved significantly, and the colored SLO images are obtained by combining multiple SLO images taken by lasers of different wavelengths. A combination of these images of different lasers can create an image that is close to that of the real ocular fundus. One advantage of the advanced SLOs is that they can obtain images with a wider view of the ocular fundus while maintaining a high resolution even through non-dilated eyes. The current SLOs are superior to the conventional fundus photography in their ability to image abnormal alterations of the retina and choroid. Thus, the purpose of this review was to present the characteristics of the current color SLOs and to show how that can help in the diagnosis and the following of changes after treatments. To accomplish these goals, we will present our findings in patients with different types of retinochoroidal disorders.
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Affiliation(s)
- Hiroto Terasaki
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan; (S.S.); (M.T.); (T.S.)
- Correspondence: ; Tel.: +81-99-275-5402; Fax: +81-99-265-4894
| | - Shozo Sonoda
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan; (S.S.); (M.T.); (T.S.)
- Kagoshima Sonoda Eye & Plastic Surgery Clinic, Kagoshima 890-0053, Japan
| | - Masatoshi Tomita
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan; (S.S.); (M.T.); (T.S.)
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8544, Japan; (S.S.); (M.T.); (T.S.)
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Huemer J, Wagner SK, Sim DA. The Evolution of Diabetic Retinopathy Screening Programmes: A Chronology of Retinal Photography from 35 mm Slides to Artificial Intelligence. Clin Ophthalmol 2020; 14:2021-2035. [PMID: 32764868 PMCID: PMC7381763 DOI: 10.2147/opth.s261629] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/01/2020] [Indexed: 12/14/2022] Open
Abstract
As a third of people with diabetes mellitus (DM) will suffer the microvascular complications of diabetic retinopathy (DR) and therapeutic options can effectively prevent visual impairment, systematic screening has substantially reduced disease burden in developed countries. In an effort to tackle the rising incidence of DM, screening programmes have modernized in synchrony with technical and infrastructural advancements. Patient evaluation has shifted from face-to-face ophthalmologist-based review delivered through community grassroots to asynchronous store-and-forward modern telemedicine platforms commissioned on a nationwide scale. First pioneered with primitive 35-mm slide film retinal photography, the last decade has seen an emergence of high resolution and widefield imaging devices, which may reveal extents of DR indiscernible to the clinician but with implications of potential earlier identification. Similar progress has been seen in image analysis approaches - automated image analysis of retinal photographs of DR has evolved from qualitative feature detection to rules-based algorithms to autonomous artificial intelligence-powered classification. Such models have, relatively rapidly, been validated and are now receiving approval from health regulation authorities with deployment into the clinical sphere. In this review, we chart the evolution of global DR screening programmes since their inception highlighting major milestones in healthcare infrastructure, telemedicine approaches and imaging devices that have shaped the robust and effective frameworks recognised today. We also provide an outlook for the future of DR screening in the context of recent technological advancements with respect to their limitations in current times.
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Affiliation(s)
- Josef Huemer
- NIHR Biomedical Research Center at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- Vienna Institute for Research in Ocular Surgery, A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria
| | - Siegfried K Wagner
- NIHR Biomedical Research Center at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Dawn A Sim
- NIHR Biomedical Research Center at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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Olvera-Barrios A, Heeren TF, Balaskas K, Chambers R, Bolter L, Egan C, Tufail A, Anderson J. Diagnostic accuracy of diabetic retinopathy grading by an artificial intelligence-enabled algorithm compared with a human standard for wide-field true-colour confocal scanning and standard digital retinal images. Br J Ophthalmol 2020; 105:265-270. [PMID: 32376611 DOI: 10.1136/bjophthalmol-2019-315394] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/15/2020] [Accepted: 04/04/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Photographic diabetic retinopathy screening requires labour-intensive grading of retinal images by humans. Automated retinal image analysis software (ARIAS) could provide an alternative to human grading. We compare the performance of an ARIAS using true-colour, wide-field confocal scanning images and standard fundus images in the English National Diabetic Eye Screening Programme (NDESP) against human grading. METHODS Cross-sectional study with consecutive recruitment of patients attending annual diabetic eye screening. Imaging with mydriasis was performed (two-field protocol) with the EIDON platform (CenterVue, Padua, Italy) and standard NDESP cameras. Human grading was carried out according to NDESP protocol. Images were processed by EyeArt V.2.1.0 (Eyenuk Inc, Woodland Hills, California). The reference standard for analysis was the human grade of standard NDESP images. RESULTS We included 1257 patients. Sensitivity estimates for retinopathy grades were: EIDON images; 92.27% (95% CI: 88.43% to 94.69%) for any retinopathy, 99% (95% CI: 95.35% to 100%) for vision-threatening retinopathy and 100% (95% CI: 61% to 100%) for proliferative retinopathy. For NDESP images: 92.26% (95% CI: 88.37% to 94.69%) for any retinopathy, 100% (95% CI: 99.53% to 100%) for vision-threatening retinopathy and 100% (95% CI: 61% to 100%) for proliferative retinopathy. One case of vision-threatening retinopathy (R1M1) was missed by the EyeArt when analysing the EIDON images, but identified by the human graders. The EyeArt identified all cases of vision-threatening retinopathy in the standard images. CONCLUSION EyeArt identified diabetic retinopathy in EIDON images with similar sensitivity to standard images in a large-scale screening programme, exceeding the sensitivity threshold recommended for a screening test. Further work to optimise the identification of 'no retinopathy' and to understand the differential lesion detection in the two imaging systems would enhance the use of these two innovative technologies in a diabetic retinopathy screening setting.
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Affiliation(s)
- Abraham Olvera-Barrios
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK .,University College London Institute of Ophthalmology, London, UK
| | - Tjebo Fc Heeren
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,University College London Institute of Ophthalmology, London, UK
| | | | - Ryan Chambers
- Diabetes, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Louis Bolter
- Diabetes, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Catherine Egan
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,University College London Institute of Ophthalmology, London, UK
| | - Adnan Tufail
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,University College London Institute of Ophthalmology, London, UK
| | - John Anderson
- Diabetes, Homerton University Hospital NHS Foundation Trust, London, UK
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