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Singh RK, Smith S, Fingert J, Gordon M, Kass M, Scheetz T, Segrè AV, Wiggs J, Elze T, Zebardast N. Machine Learning-Derived Baseline Visual Field Patterns Predict Future Glaucoma Onset in the Ocular Hypertension Treatment Study. Invest Ophthalmol Vis Sci 2024; 65:35. [PMID: 38393715 PMCID: PMC10901249 DOI: 10.1167/iovs.65.2.35] [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: 08/06/2023] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Purpose The Ocular Hypertension Treatment Study (OHTS) identified risk factors for primary open-angle glaucoma (POAG) in patients with ocular hypertension, including pattern standard deviation (PSD). Archetypal analysis, an unsupervised machine learning method, may offer a more interpretable approach to risk stratification by identifying patterns in baseline visual fields (VFs). Methods There were 3272 eyes available in the OHTS. Archetypal analysis was applied using 24-2 baseline VFs, and model selection was performed with cross-validation. Decomposition coefficients for archetypes (ATs) were calculated. A penalized Cox proportional hazards model was implemented to select discriminative ATs. The AT model was compared to the OHTS model. Associations were identified between ATs with both POAG onset and VF progression, defined by mean deviation change per year. Results We selected 8494 baseline VFs. Optimal AT count was 19. The highest prevalence ATs were AT9, AT11, and AT7. The AT-based prediction model had a C-index of 0.75 for POAG onset. Multivariable models demonstrated that a one-interquartile range increase in the AT5 (hazard ratio [HR] = 1.14; 95% confidence interval [CI], 1.04-1.25), AT8 (HR = 1.22; 95% CI, 1.09-1.37), AT15 (HR = 1.26; 95% CI, 1.12-1.41), and AT17 (HR = 1.17; 95% CI, 1.03-1.31) coefficients conferred increased risk of POAG onset. AT5, AT10, and AT14 were significantly associated with rapid VF progression. In a subgroup analysis by high-risk ATs (>95th percentile or <75th percentile coefficients), PSD lost significance as a predictor of POAG in the low-risk group. Conclusions Baseline VFs, prior to detectable glaucomatous damage, contain occult patterns representing early changes that may increase the risk of POAG onset and VF progression in patients with ocular hypertension. The relationship between PSD and POAG is modified by the presence of high-risk patterns at baseline. An AT-based prediction model for POAG may provide more interpretable glaucoma-specific information in a clinical setting.
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Affiliation(s)
- Rishabh K. Singh
- Department of Ophthalmology, Columbia University Medical Center, New York, New York, United States
- Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts, United States
| | - Sophie Smith
- Tufts University School of Medicine, Boston, Massachusetts, United States
| | - John Fingert
- Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Mae Gordon
- Washington University School of Medicine, St. Louis, Missouri, United States
| | - Michael Kass
- Washington University School of Medicine, St. Louis, Missouri, United States
| | - Todd Scheetz
- Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Ayellet V. Segrè
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
- Ocular Genomics Institute, Massachusetts Eye and Ear, Boston, Massachusetts, United States
| | - Janey Wiggs
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
- Ocular Genomics Institute, Massachusetts Eye and Ear, Boston, Massachusetts, United States
| | - Tobias Elze
- Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts, United States
| | - Nazlee Zebardast
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
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Hussain S, Chua J, Wong D, Lo J, Kadziauskiene A, Asoklis R, Barbastathis G, Schmetterer L, Yong L. Predicting glaucoma progression using deep learning framework guided by generative algorithm. Sci Rep 2023; 13:19960. [PMID: 37968437 PMCID: PMC10651936 DOI: 10.1038/s41598-023-46253-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023] Open
Abstract
Glaucoma is a slowly progressing optic neuropathy that may eventually lead to blindness. To help patients receive customized treatment, predicting how quickly the disease will progress is important. Structural assessment using optical coherence tomography (OCT) can be used to visualize glaucomatous optic nerve and retinal damage, while functional visual field (VF) tests can be used to measure the extent of vision loss. However, VF testing is patient-dependent and highly inconsistent, making it difficult to track glaucoma progression. In this work, we developed a multimodal deep learning model comprising a convolutional neural network (CNN) and a long short-term memory (LSTM) network, for glaucoma progression prediction. We used OCT images, VF values, demographic and clinical data of 86 glaucoma patients with five visits over 12 months. The proposed method was used to predict VF changes 12 months after the first visit by combining past multimodal inputs with synthesized future images generated using generative adversarial network (GAN). The patients were classified into two classes based on their VF mean deviation (MD) decline: slow progressors (< 3 dB) and fast progressors (> 3 dB). We showed that our generative model-based novel approach can achieve the best AUC of 0.83 for predicting the progression 6 months earlier. Further, the use of synthetic future images enabled the model to accurately predict the vision loss even earlier (9 months earlier) with an AUC of 0.81, compared to using only structural (AUC = 0.68) or only functional measures (AUC = 0.72). This study provides valuable insights into the potential of using synthetic follow-up OCT images for early detection of glaucoma progression.
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Affiliation(s)
- Shaista Hussain
- Institute of High Performance Computing, A*STAR, Singapore, Singapore.
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Damon Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE) Program, Singapore, Singapore
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | | | - Aiste Kadziauskiene
- Clinic of Ears, Nose, Throat and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Eye Diseases, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Rimvydas Asoklis
- Clinic of Ears, Nose, Throat and Eye Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Eye Diseases, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - George Barbastathis
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
- Singapore-MIT Alliance for Research and Technology (SMART) Centre, Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland.
- Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore, Singapore.
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.
| | - Liu Yong
- Institute of High Performance Computing, A*STAR, Singapore, Singapore
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Thakur S, Dinh LL, Lavanya R, Quek TC, Liu Y, Cheng CY. Use of artificial intelligence in forecasting glaucoma progression. Taiwan J Ophthalmol 2023; 13:168-183. [PMID: 37484617 PMCID: PMC10361424 DOI: 10.4103/tjo.tjo-d-23-00022] [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: 02/15/2023] [Accepted: 03/03/2023] [Indexed: 07/25/2023] Open
Abstract
Artificial intelligence (AI) has been widely used in ophthalmology for disease detection and monitoring progression. For glaucoma research, AI has been used to understand progression patterns and forecast disease trajectory based on analysis of clinical and imaging data. Techniques such as machine learning, natural language processing, and deep learning have been employed for this purpose. The results from studies using AI for forecasting glaucoma progression however vary considerably due to dataset constraints, lack of a standard progression definition and differences in methodology and approach. While glaucoma detection and screening have been the focus of most research that has been published in the last few years, in this narrative review we focus on studies that specifically address glaucoma progression. We also summarize the current evidence, highlight studies that have translational potential, and provide suggestions on how future research that addresses glaucoma progression can be improved.
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Affiliation(s)
- Sahil Thakur
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Linh Le Dinh
- Institute of High Performance Computing, The Agency for Science, Technology and Research, Singapore
| | - Raghavan Lavanya
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Ten Cheer Quek
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Yong Liu
- Institute of High Performance Computing, The Agency for Science, Technology and Research, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Centre for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore
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Assessment of visual field progression in glaucoma. Curr Opin Ophthalmol 2023; 34:103-108. [PMID: 36378107 DOI: 10.1097/icu.0000000000000932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE OF REVIEW Perimetry plays an important role in the diagnosis and management of glaucoma. This article discusses the assessment of visual field progression in patients with glaucoma. RECENT FINDINGS Selecting the best visual field test strategy and establishing a baseline of visual fields will assist clinicians in the detection of glaucomatous progression. Repeat testing serves to confirm or refute changes on visual field testing. More frequent testing after initial diagnosis is recommended to establish a baseline and to identify patients with rapid progression who may need more aggressive management. Statistically significant changes on event analysis can prompt examination of a patient's trend analysis to determine whether clinically significant deterioration may be occurring. Future applications of machine learning can complement existing methods of visual field interpretation. SUMMARY Many treated patients with glaucoma will experience visual field progression. Optimal utilization of visual field testing strategy and analytical software can help clinicians identify patients with glaucomatous progression likely to cause functional visual disability.
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Gajendran MK, Rohowetz LJ, Koulen P, Mehdizadeh A. Novel Machine-Learning Based Framework Using Electroretinography Data for the Detection of Early-Stage Glaucoma. Front Neurosci 2022; 16:869137. [PMID: 35600610 PMCID: PMC9115110 DOI: 10.3389/fnins.2022.869137] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/28/2022] [Indexed: 01/05/2023] Open
Abstract
PurposeEarly-stage glaucoma diagnosis has been a challenging problem in ophthalmology. The current state-of-the-art glaucoma diagnosis techniques do not completely leverage the functional measures' such as electroretinogram's immense potential; instead, focus is on structural measures like optical coherence tomography. The current study aims to take a foundational step toward the development of a novel and reliable predictive framework for early detection of glaucoma using machine-learning-based algorithm capable of leveraging medically relevant information that ERG signals contain.MethodsERG signals from 60 eyes of DBA/2 mice were grouped for binary classification based on age. The signals were also grouped based on intraocular pressure (IOP) for multiclass classification. Statistical and wavelet-based features were engineered and extracted. Important predictors (ERG tests and features) were determined, and the performance of five machine learning-based methods were evaluated.ResultsRandom forest (bagged trees) ensemble classifier provided the best performance in both binary and multiclass classification of ERG signals. An accuracy of 91.7 and 80% was achieved for binary and multiclass classification, respectively, suggesting that machine-learning-based models can detect subtle changes in ERG signals if trained using advanced features such as those based on wavelet analyses.ConclusionsThe present study describes a novel, machine-learning-based method to analyze ERG signals providing additional information that may be used to detect early-stage glaucoma. Based on promising performance metrics obtained using the proposed machine-learning-based framework leveraging an established ERG data set, we conclude that the novel framework allows for detection of functional deficits of early/various stages of glaucoma in mice.
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Affiliation(s)
- Mohan Kumar Gajendran
- Department of Civil and Mechanical Engineering, School of Computing and Engineering, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Landon J. Rohowetz
- Vision Research Center, Department of Ophthalmology, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Peter Koulen
- Vision Research Center, Department of Ophthalmology, University of Missouri-Kansas City, Kansas City, MO, United States
- Department of Biomedical Sciences, University of Missouri-Kansas City, Kansas City, MO, United States
| | - Amirfarhang Mehdizadeh
- Department of Civil and Mechanical Engineering, School of Computing and Engineering, University of Missouri-Kansas City, Kansas City, MO, United States
- Vision Research Center, Department of Ophthalmology, University of Missouri-Kansas City, Kansas City, MO, United States
- *Correspondence: Amirfarhang Mehdizadeh
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Bunod R, Augstburger E, Brasnu E, Labbe A, Baudouin C. [Artificial intelligence and glaucoma: A literature review]. J Fr Ophtalmol 2022; 45:216-232. [PMID: 34991909 DOI: 10.1016/j.jfo.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/18/2021] [Indexed: 11/26/2022]
Abstract
In recent years, research in artificial intelligence (AI) has experienced an unprecedented surge in the field of ophthalmology, in particular glaucoma. The diagnosis and follow-up of glaucoma is complex and relies on a body of clinical evidence and ancillary tests. This large amount of information from structural and functional testing of the optic nerve and macula makes glaucoma a particularly appropriate field for the application of AI. In this paper, we will review work using AI in the field of glaucoma, whether for screening, diagnosis or detection of progression. Many AI strategies have shown promising results for glaucoma detection using fundus photography, optical coherence tomography, or automated perimetry. The combination of these imaging modalities increases the performance of AI algorithms, with results comparable to those of humans. We will discuss potential applications as well as obstacles and limitations to the deployment and validation of such models. While there is no doubt that AI has the potential to revolutionize glaucoma management and screening, research in the coming years will need to address unavoidable questions regarding the clinical significance of such results and the explicability of the predictions.
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Affiliation(s)
- R Bunod
- Service d'ophtalmologie 3, IHU FOReSIGHT, centre hospitalier national des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France.
| | - E Augstburger
- Service d'ophtalmologie 3, IHU FOReSIGHT, centre hospitalier national des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - E Brasnu
- Service d'ophtalmologie 3, IHU FOReSIGHT, centre hospitalier national des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 17, rue Moreau, 75012 Paris, France; Sorbonne universités, INSERM, CNRS, institut de la Vision, 17, rue Moreau, 75012 Paris, France
| | - A Labbe
- Service d'ophtalmologie 3, IHU FOReSIGHT, centre hospitalier national des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 17, rue Moreau, 75012 Paris, France; Sorbonne universités, INSERM, CNRS, institut de la Vision, 17, rue Moreau, 75012 Paris, France; Service d'ophtalmologie, hôpital Ambroise-Paré, AP-HP, université de Paris Saclay, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - C Baudouin
- Service d'ophtalmologie 3, IHU FOReSIGHT, centre hospitalier national des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 17, rue Moreau, 75012 Paris, France; Sorbonne universités, INSERM, CNRS, institut de la Vision, 17, rue Moreau, 75012 Paris, France; Service d'ophtalmologie, hôpital Ambroise-Paré, AP-HP, université de Paris Saclay, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
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