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Rojas-Carabali W, Cifuentes-González C, Gutierrez-Sinisterra L, Heng LY, Tsui E, Gangaputra S, Sadda S, Nguyen QD, Kempen JH, Pavesio CE, Gupta V, Raman R, Miao C, Lee B, de-la-Torre A, Agrawal R. Managing a patient with uveitis in the era of artificial intelligence: Current approaches, emerging trends, and future perspectives. Asia Pac J Ophthalmol (Phila) 2024; 13:100082. [PMID: 39019261 DOI: 10.1016/j.apjo.2024.100082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 06/30/2024] [Accepted: 07/04/2024] [Indexed: 07/19/2024] Open
Abstract
The integration of artificial intelligence (AI) with healthcare has opened new avenues for diagnosing, treating, and managing medical conditions with remarkable precision. Uveitis, a diverse group of rare eye conditions characterized by inflammation of the uveal tract, exemplifies the complexities in ophthalmology due to its varied causes, clinical presentations, and responses to treatments. Uveitis, if not managed promptly and effectively, can lead to significant visual impairment. However, its management requires specialized knowledge, which is often lacking, particularly in regions with limited access to health services. AI's capabilities in pattern recognition, data analysis, and predictive modelling offer significant potential to revolutionize uveitis management. AI can classify disease etiologies, analyze multimodal imaging data, predict outcomes, and identify new therapeutic targets. However, transforming these AI models into clinical applications and meeting patient expectations involves overcoming challenges like acquiring extensive, annotated datasets, ensuring algorithmic transparency, and validating these models in real-world settings. This review delves into the complexities of uveitis and the current AI landscape, discussing the development, opportunities, and challenges of AI from theoretical models to bedside application. It also examines the epidemiology of uveitis, the global shortage of uveitis specialists, and the disease's socioeconomic impacts, underlining the critical need for AI-driven approaches. Furthermore, it explores the integration of AI in diagnostic imaging and future directions in ophthalmology, aiming to highlight emerging trends that could transform management of a patient with uveitis and suggesting collaborative efforts to enhance AI applications in clinical practice.
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Affiliation(s)
- William Rojas-Carabali
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore.
| | - Carlos Cifuentes-González
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore.
| | - Laura Gutierrez-Sinisterra
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore.
| | - Lim Yuan Heng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
| | - Edmund Tsui
- Stein Eye Institute, David Geffen of Medicine at UCLA, Los Angeles, CA, USA.
| | - Sapna Gangaputra
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Srinivas Sadda
- Doheny Eye Institute, David Geffen of Medicine at UCLA, Los Angeles, CA, USA.
| | | | - John H Kempen
- Department of Ophthalmology, Massachusetts Eye and Ear/Harvard Medical School; and Schepens Eye Research Institute; Boston, MA, USA; Department of Ophthalmology, Myungsung Medical College/MCM Comprehensive Specialized Hospital, Addis Abeba, Ethiopia; Sight for Souls, Bellevue, WA, USA.
| | | | - Vishali Gupta
- Advanced Eye Centre, Post, graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Rajiv Raman
- Department of Ophthalmology, Sankara Nethralaya, Chennai, India.
| | - Chunyan Miao
- School of Computer Science and Engineering at Nanyang Technological University, Singapore.
| | - Bernett Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
| | - Alejandra de-la-Torre
- Neuroscience Research Group (NEUROS), Neurovitae Center for Neuroscience, Institute of Translational Medicine (IMT), Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.
| | - Rupesh Agrawal
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore; Singapore Eye Research Institute, Singapore; Duke NUS Medical School, Singapore.
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2
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Mhibik B, Kouadio D, Jung C, Bchir C, Toutée A, Maestri F, Gulic K, Miere A, Falcione A, Touati M, Monnet D, Bodaghi B, Touhami S. AUTOMATED DETECTION OF VITRITIS USING ULTRAWIDE-FIELD FUNDUS PHOTOGRAPHS AND DEEP LEARNING. Retina 2024; 44:1034-1044. [PMID: 38261816 DOI: 10.1097/iae.0000000000004049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND/PURPOSE Evaluate the performance of a deep learning algorithm for the automated detection and grading of vitritis on ultrawide-field imaging. METHODS Cross-sectional noninterventional study. Ultrawide-field fundus retinophotographs of uveitis patients were used. Vitreous haze was defined according to the six steps of the Standardization of Uveitis Nomenclature classification. The deep learning framework TensorFlow and the DenseNet121 convolutional neural network were used to perform the classification task. The best fitted model was tested in a validation study. RESULTS One thousand one hundred eighty-one images were included. The performance of the model for the detection of vitritis was good with a sensitivity of 91%, a specificity of 89%, an accuracy of 0.90, and an area under the receiver operating characteristics curve of 0.97. When used on an external set of images, the accuracy for the detection of vitritis was 0.78. The accuracy to classify vitritis in one of the six Standardization of Uveitis Nomenclature grades was limited (0.61) but improved to 0.75 when the grades were grouped into three categories. When accepting an error of one grade, the accuracy for the six-class classification increased to 0.90, suggesting the need for a larger sample to improve the model performances. CONCLUSION A new deep learning model based on ultrawide-field fundus imaging that produces an efficient tool for the detection of vitritis was described. The performance of the model for the grading into three categories of increasing vitritis severity was acceptable. The performance for the six-class grading of vitritis was limited but can probably be improved with a larger set of images.
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Affiliation(s)
- Bayram Mhibik
- Department of Ophthalmology, Sorbonne Université, Pitié Salpêtrière University Hospital, Paris, France
| | - Desire Kouadio
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Camille Jung
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Chemsedine Bchir
- Department of Mathematics and Engineering Applications, Sorbonne Université, Paris, France ; and
| | - Adelaide Toutée
- Department of Ophthalmology, Sorbonne Université, Pitié Salpêtrière University Hospital, Paris, France
| | - Federico Maestri
- Department of Ophthalmology, Sorbonne Université, Pitié Salpêtrière University Hospital, Paris, France
| | - Karmen Gulic
- Department of Ophthalmology, Sorbonne Université, Pitié Salpêtrière University Hospital, Paris, France
| | - Alexandra Miere
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Alessandro Falcione
- Department of Ophthalmology, Sorbonne Université, Pitié Salpêtrière University Hospital, Paris, France
| | - Myriam Touati
- Department of Ophthalmology, Sorbonne Université, Pitié Salpêtrière University Hospital, Paris, France
| | - Dominique Monnet
- Department of Ophthalmology, Université de Paris, Cochin University Hospital, Paris, France
| | - Bahram Bodaghi
- Department of Ophthalmology, Sorbonne Université, Pitié Salpêtrière University Hospital, Paris, France
| | - Sara Touhami
- Department of Ophthalmology, Sorbonne Université, Pitié Salpêtrière University Hospital, Paris, France
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Jacquot R, Sève P, Jackson TL, Wang T, Duclos A, Stanescu-Segall D. Diagnosis, Classification, and Assessment of the Underlying Etiology of Uveitis by Artificial Intelligence: A Systematic Review. J Clin Med 2023; 12:jcm12113746. [PMID: 37297939 DOI: 10.3390/jcm12113746] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/26/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023] Open
Abstract
Recent years have seen the emergence and application of artificial intelligence (AI) in diagnostic decision support systems. There are approximately 80 etiologies that can underly uveitis, some very rare, and AI may lend itself to their detection. This synthesis of the literature selected articles that focused on the use of AI in determining the diagnosis, classification, and underlying etiology of uveitis. The AI-based systems demonstrated relatively good performance, with a classification accuracy of 93-99% and a sensitivity of at least 80% for identifying the two most probable etiologies underlying uveitis. However, there were limitations to the evidence. Firstly, most data were collected retrospectively with missing data. Secondly, ophthalmic, demographic, clinical, and ancillary tests were not reliably integrated into the algorithms' dataset. Thirdly, patient numbers were small, which is problematic when aiming to discriminate rare and complex diagnoses. In conclusion, the data indicate that AI has potential as a diagnostic decision support system, but clinical applicability is not yet established. Future studies and technologies need to incorporate more comprehensive clinical data and larger patient populations. In time, these should improve AI-based diagnostic tools and help clinicians diagnose, classify, and manage patients with uveitis.
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Affiliation(s)
- Robin Jacquot
- Department of Internal Medicine, Croix-Rousse Hospital, Hospices Civils de Lyon, Claude Bernard-Lyon 1 University, F-69004 Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Claude Bernard Lyon 1 University, F-69000 Lyon, France
| | - Pascal Sève
- Department of Internal Medicine, Croix-Rousse Hospital, Hospices Civils de Lyon, Claude Bernard-Lyon 1 University, F-69004 Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Claude Bernard Lyon 1 University, F-69000 Lyon, France
| | - Timothy L Jackson
- Department of Ophthalmology, King's College Hospital, London SE5 9RS, UK
- Faculty of Life Science and Medicine, King's College London, London SE5 9RS, UK
| | - Tao Wang
- DISP UR4570, Jean Monnet Saint-Etienne University, F-42300 Roanne, France
| | - Antoine Duclos
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Claude Bernard Lyon 1 University, F-69000 Lyon, France
| | - Dinu Stanescu-Segall
- Department of Ophthalmology, La Pitié-Salpêtrière Hospital, APHP, F-75013 Paris, France
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Artificial intelligence in uveitis: A comprehensive review. Surv Ophthalmol 2023:S0039-6257(23)00044-9. [PMID: 36878360 DOI: 10.1016/j.survophthal.2023.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
Uveitis is a disease complex characterized by intraocular inflammation of the uvea that is an important cause of blindness and social morbidity. With the dawn of artificial intelligence (AI) and machine learning integration in healthcare, their application in uveitis creates an avenue to improve screening and diagnosis. Our review identified the use of artificial intelligence in studies of uveitis and classified them as diagnosis support, finding detection, screening, and standardization of uveitis nomenclature. The overall performance of models is poor, with limited datasets and a lack of validation studies and publicly available data and codes. We conclude that AI holds great promise to assist with the diagnosis and detection of ocular findings of uveitis, but further studies and large representative datasets are needed to guarantee generalizability and fairness.
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Kale AU, Serrano A, Liu X, Balasubramaniam B, Keane PA, Moore DJ, Llorenç V, Denniston AK. Measuring Inflammation in the Vitreous and Retina: A Narrative Review. Ocul Immunol Inflamm 2022; 31:768-777. [PMID: 35412855 DOI: 10.1080/09273948.2022.2049316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Uveitis consists of a group of syndromes characterised by intraocular inflammation, accounting for up to 15% of visual loss in the western world and 10% worldwide. Assessment of intraocular inflammation has been limited to clinician-dependent, subjective grading. Developments in imaging technology, such as optical coherence tomography (OCT), have enabled the development of objective, quantitative measures of inflammatory activity. Important quantitative metrics including central macular thickness and vitreous signal intensity allow longitudinal monitoring of disease activity and can be used in conjunction with other imaging modalities enabling holistic assessment of ocular inflammation. Ongoing work into the validation of instrument-based measures alongside development of core outcome sets is crucial for standardisation of clinical trial endpoints and developing guidance for quantitative multi-modal imaging approaches. This review outlines methods of grading inflammation in the vitreous and retina, with a focus on the use of OCT as an objective measure of disease activity.
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Affiliation(s)
- Aditya U Kale
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alba Serrano
- Ocular Infection & Inflammation, Clínic Institute of Ophthalmology Clínic Hospital of Barcelona, Barcelona, Spain
| | - Xiaoxuan Liu
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Centre for Regulatory Science and Innovation, Birmingham Health Partners, Birmingham, UK
| | - Balini Balasubramaniam
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Pearse A Keane
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - David J Moore
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Victor Llorenç
- Ocular Infection & Inflammation, Clínic Institute of Ophthalmology Clínic Hospital of Barcelona, Barcelona, Spain.,Biomedical Research Institute August Pi i Sunyer, Clínic Hospital of Barcelona, Barcelona, Spain
| | - Alastair K Denniston
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Centre for Regulatory Science and Innovation, Birmingham Health Partners, Birmingham, UK.,NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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6
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Abellanas M, Elena MJ, Keane PA, Balaskas K, Grewal DS, Carreño E. Artificial Intelligence and Imaging Processing in Optical Coherence Tomography and Digital Images in Uveitis. Ocul Immunol Inflamm 2022; 30:675-681. [PMID: 35412935 DOI: 10.1080/09273948.2022.2054433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Computer vision, understood as the area of science that trains computers to interpret digital images through both artificial intelligence (AI) and classical algorithms, has significantly advanced the analysis and interpretation of optical coherence tomography (OCT) in retina research. The aim of this review is to summarise the recent advances of computer vision in imaging processing in uveitis, with a particular focus in optical coherence tomography images. MATERIAL AND METHODS Literature review. RESULTS The development of computer vision to assist uveitis diagnosis and prognosis is still undergoing, but important efforts have been made in the field. CONCLUSION The automatising of image processing in uveitis could be fundamental to establish objective and standardised outcomes for future clinical trials. In addition, it could help to better understand the disease and its progression.
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Affiliation(s)
- María Abellanas
- Department of Ophthalmology, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | - María José Elena
- Department of Ophthalmology, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
| | - Pearse A Keane
- Moorfields Eye Hospital NHS Foundation Trust, UK and University College London (UCL) Institute of Ophthalmology, UK
| | - Konstantinos Balaskas
- Moorfields Eye Hospital NHS Foundation Trust, UK and University College London (UCL) Institute of Ophthalmology, UK
| | - Dilraj S Grewal
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, USA
| | - Ester Carreño
- Department of Ophthalmology, Fundacion Jimenez Diaz University Hospital, Madrid, Spain
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7
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Liu X, Hui BTK, Way C, Beese S, Adriano A, Keane PA, Moore DJ, Denniston AK. Noninvasive Instrument-based Tests for Detecting and Measuring Vitreous Inflammation in Uveitis: A Systematic Review. Ocul Immunol Inflamm 2022; 30:137-148. [PMID: 33021418 PMCID: PMC8935946 DOI: 10.1080/09273948.2020.1799038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/01/2020] [Accepted: 07/17/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE This systematic review aims to identify instrument-based tests for quantifying vitreous inflammation in uveitis, report the test reliability and the level of correlation with clinician grading. METHODS Studies describing instrument-based tests for detecting vitreous inflammation were identified by searching bibliographic databases and trials registers. Test reliability measures and level of correlation with clinician vitreous haze grading are extracted. RESULTS Twelve studies describing ultrasound, optical coherence tomography (OCT), and retinal photography for detecting vitreous inflammation were included: Ultrasound was used for detection of disease features, whereas OCT and retinal photography provided quantifiable measurements. Correlation with clinician grading for OCT was 0.53-0.60 (three studies) and for retinal photography was 0.51 (1 study). Both instruments showed high inter- and intra-observer reliability (>0.70 intraclass correlation and Cohen's kappa), where reported in four studies. CONCLUSION Retinal photography and OCT are able to detect and measure vitreous inflammation. Both techniques are reliable, automatable, and warrant further evaluation.
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Affiliation(s)
- Xiaoxuan Liu
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, BirminghamUK
- Health Data Research UK, London, UK
| | - Benjamin TK Hui
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Christopher Way
- Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Sophie Beese
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, BirminghamUK
| | - Ada Adriano
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, BirminghamUK
| | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, UK
| | - David J Moore
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, BirminghamUK
| | - Alastair K Denniston
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, BirminghamUK
- Health Data Research UK, London, UK
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, UK
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8
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Bradley LJ, Ward A, Hsue MCY, Liu J, Copland DA, Dick AD, Nicholson LB. Quantitative Assessment of Experimental Ocular Inflammatory Disease. Front Immunol 2021; 12:630022. [PMID: 34220797 PMCID: PMC8250853 DOI: 10.3389/fimmu.2021.630022] [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: 11/17/2020] [Accepted: 05/28/2021] [Indexed: 11/25/2022] Open
Abstract
Ocular inflammation imposes a high medical burden on patients and substantial costs on the health-care systems that mange these often chronic and debilitating diseases. Many clinical phenotypes are recognized and classifying the severity of inflammation in an eye with uveitis is an ongoing challenge. With the widespread application of optical coherence tomography in the clinic has come the impetus for more robust methods to compare disease between different patients and different treatment centers. Models can recapitulate many of the features seen in the clinic, but until recently the quality of imaging available has lagged that applied in humans. In the model experimental autoimmune uveitis (EAU), we highlight three linked clinical states that produce retinal vulnerability to inflammation, all different from healthy tissue, but distinct from each other. Deploying longitudinal, multimodal imaging approaches can be coupled to analysis in the tissue of changes in architecture, cell content and function. This can enrich our understanding of pathology, increase the sensitivity with which the impacts of therapeutic interventions are assessed and address questions of tissue regeneration and repair. Modern image processing, including the application of artificial intelligence, in the context of such models of disease can lay a foundation for new approaches to monitoring tissue health.
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Affiliation(s)
- Lydia J Bradley
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
| | - Amy Ward
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
| | - Madeleine C Y Hsue
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
| | - Jian Liu
- Academic Unit of Ophthalmology, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - David A Copland
- Academic Unit of Ophthalmology, Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Andrew D Dick
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom.,Academic Unit of Ophthalmology, Translational Health Sciences, University of Bristol, Bristol, United Kingdom.,University College London, Institute of Ophthalmology, London, United Kingdom
| | - Lindsay B Nicholson
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
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9
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Wintergerst MWM, Liu X, Terheyden JH, Pohlmann D, Li JQ, Montesano G, Ometto G, Holz FG, Crabb DP, Pleyer U, Heinz C, Denniston AK, Finger RP. Structural Endpoints and Outcome Measures in Uveitis. Ophthalmologica 2021; 244:465-479. [PMID: 34062542 DOI: 10.1159/000517521] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 05/20/2021] [Indexed: 11/19/2022]
Abstract
Most uveitis entities are rare diseases but, taken together, are responsible for 5-10% of worldwide visual impairment which largely affects persons of working age. As with many rare diseases, there is a lack of high-level evidence regarding its clinical management, partly due to a dearth of reliable and objective quantitative endpoints for clinical trials. This review provides an overview of available structural outcome measures for uveitis disease activity and damage in an anatomical order from the anterior to the posterior segment of the eye. While there is a multitude of available structural outcome measures, not all might qualify as endpoints for clinical uveitis trials, and thorough testing of applicability is warranted. Furthermore, a consensus on endpoint definition, standardization, and "core outcomes" is required. As stipulated by regulatory agencies, endpoints should be precisely defined, clinically important, internally consistent, reliable, responsive to treatment, and relevant for the respective subtype of uveitis. Out of all modalities used for assessment of the reviewed structural outcome measures, optical coherence tomography, color fundus photography, fundus autofluorescence, and fluorescein/indocyanine green angiography represent current "core modalities" for reliable and objective quantification of uveitis outcome measures, based on their practical availability and the evidence provided so far.
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Affiliation(s)
| | - Xiaoxuan Liu
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- Health Data Research UK, London, United Kingdom
| | - Jan H Terheyden
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Dominika Pohlmann
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jeany Q Li
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Giovanni Montesano
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, United Kingdom
| | - Giovanni Ometto
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, United Kingdom
| | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - David P Crabb
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, United Kingdom
| | - Uwe Pleyer
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Carsten Heinz
- Department of Ophthalmology, St. Franziskus-Hospital Münster, Münster, Germany
- Department of Ophthalmology, University Duisburg-Essen, Essen, Germany
| | - Alastair K Denniston
- Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- Health Data Research UK, London, United Kingdom
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
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10
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Multimodal imaging in infectious and noninfectious intermediate, posterior and panuveitis. Curr Opin Ophthalmol 2021; 32:169-182. [PMID: 33710009 DOI: 10.1097/icu.0000000000000762] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE OF REVIEW Given the heterogeneity of uveitis, markers of inflammation vary from patient to patient. Multimodal imaging has proven itself to be critical for accurate evaluation for disease activity and treatment response in uveitis. RECENT FINDINGS Ultra-widefield (UWF) fluorescein angiography and autofluorescence (AF) as well as optical coherence tomography angiography (OCTA) have provided insights into disease pathogenesis and monitoring not previously appreciated. In addition to structural retinal imaging, OCT can be used to assess the choroid, the posterior cortical vitreous and the retinal vasculature in eyes with uveitis. SUMMARY Multimodal ocular imaging in eyes with uveitis is critical for disease diagnosis and assessing response to treatment. UWF fluorescein angiography can detect retinal vasculitis even in the absence of overt vascular sheathing. UWF AF can help detect more chorioretinal lesions than clinically visible. OCT can be used to assess the posterior cortical vitreous, retina, large retinal vessels and choroid in uveitis. The use of multimodal imaging will likely be needed to determine clinical trial endpoints in studies evaluating therapeutics for uveitis.
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