Impact of automated OCT in a high-volume eye urgent care setting

Retinal vascular arcade angle as a biomarker for visual improvement after epiretinal membrane surgery

OBJECTIVES

To investigate the changes in the temporal vascular angles after epiretinal membrane (ERM) surgery and utilize the angles to predict visual outcomes.

METHODS

A total of 168 eyes from 84 patients with unilateral ERM who underwent vitrectomy were enrolled from a single institution. The angles of temporal venous (anglevein) and arterial arcades (angleartery) were measured on fundus photographs. The relationships between the angles and the best-corrected visual acuity (BCVA) were explored and multivariable logistic models and receiver operating characteristic (ROC) curves were analyzed to identify the factors that predicted visual outcomes.

RESULTS

At baseline, both angleartery and anglevein were narrower in the eyes with ERM than the fellow eyes (p < 0.001 and 0.007) but had no correlation with the baseline BCVA (p = 0.754 and 0.804). Postoperatively, the angleartery and anglevein significantly widened (both p < 0.001) and a greater BCVA improvement was associated with a greater widening of the angleartery (p = 0.029) and anglevein (p = 0.050). Multivariable logistic analyses found a narrower baseline angleartery compared to the fellow eye had a higher chance for BCVA improvement ≧ 2 lines (Odds ratio = 0.97; 95% CI, 0.94-0.99; p = 0.016). ROC curve showed the baseline difference in the angleartery between bilateral eyes predicted BCVA improvement ≧ 2 lines (area under the curve = 0.74; p = 0.035), and a 0.73 sensitivity and 0.80 specificity with a cut-off value of -27.19 degrees.

CONCLUSIONS

The retinal vascular angles widened after ERM surgery and the fundus photograph-derived angles may serve as a highly-accessible biomarker to predict postoperative visual outcomes.

Painting unknown worlds

This paper sets out to discover more about the name 'Tarrant' whose ophthalmic paintings have regularly featured in ophthalmic textbooks over the past 50 years. Through a series of telephone calls, I have spoken to Tarrant about his life and work while I research the origins of ophthalmic illustrations charting the story behind this art movement. The paper also explores the eventual decline of retinal painting and the emergence of photography, concluding that due to the continuing advance of technology the ophthalmic photographer may eventually succumb to the same fate as the artist.

Evaluation of an OCT-AI-Based Telemedicine Platform for Retinal Disease Screening and Referral in a Primary Care Setting

Purpose

To evaluate the performance of a telemedicine platform integrated with optical coherence tomography (OCT) and artificial intelligence (AI) techniques for retinal disease screening and referral.

Methods

We constructed an OCT-AI–based telemedicine platform and deployed it at four primary care stations located in Jing'an district, Shanghai, to detect retinal disease cases among aged groups and refer them to Shanghai Tenth People's Hospital (TENTH Hospital). Two ophthalmologists jointly graded the data set collected from this pilot application, and then the performance of this platform was analyzed from multiple aspects.

Results

This study included 1257 participants between July 2020 and September 2020, of whom 394 had retinal pathologies and 146 were even considered urgent cases by the ophthalmologists. The OCT-AI models achieved a sensitivity of 96.6% (95% confidence interval [CI], 91.8%–98.7%) and specificity of 98.8% (95% CI, 98.0%–99.3%) for detecting urgent cases and a sensitivity of 98.5% (95% CI, 96.5%–99.4%) and specificity of 96.2% (95% CI, 94.6%–97.3%) for detecting both urgent and routine cases. Coupled with AI, our platform reduced the workload of human consultation by 96.2% for massive normal cases. The detected disease cases received online medical suggestions at an average time of 21.4 hours via this platform.

Conclusions

This platform can automatically identify patients with retinal disease with high sensitivity and specificity, support timely human consultation, and bring necessary referrals.

Translational Relevance

The OCT-AI–based telemedicine platform shows great practical value for retinal disease screening and referral in a real-world primary care setting.

A Review of Ophthalmic Telemedicine for Emergency Department Settings

BACKGROUND

Patients presenting to emergency departments for ophthalmic emergencies benefit from prompt evaluation. However, Few emergency departments (EDs) have ophthalmologists on call, and eye care provided in EDs without ophthalmic services can be inaccurate.

METHODS

We review the current state of ophthalmic telemedical care in EDs and highlight important considerations when implementing telemedicine in this setting.

RESULTS

Telemedicine allows ophthalmologists to work with on-site emergency care providers to interview and examine patients remotely in EDs, enabling proper assessment of patient history, visual acuity, pupils, intraocular pressure, as well as the anterior and posterior segment. To date, patients' perceptions of this new model of care have been largely positive.

DISCUSSION

The use of telemedical consultations for remote evaluation of patients with ophthalmic complaints stands to improve the quality of care provided to patients and extend the reach of remote ophthalmologists. The onset of the COVID-19 pandemic and the risk of in-person care further highlights the potential for telemedicine to augment existing models of emergency care.