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Cathomas M, Saad B, Taha-Mehlitz S, Vankayalapati DK, Ghazal NE, Mourad MM, Ortlieb N, Than CA, Burri E, Glaser C, Heigl A, Neumann K, Honaker MD, Taha A, Rosenberg R. Safety and effectivity of Kono-S anastomosis in Crohn's patients: a systematic review and Meta-analysis. Langenbecks Arch Surg 2024; 409:227. [PMID: 39037448 PMCID: PMC11263246 DOI: 10.1007/s00423-024-03412-x] [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: 05/20/2024] [Accepted: 07/08/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE Kono-S anastomosis, an antimesenteric, functional, end-to-end handsewn anastomosis, was introduced in 2011. The aim of this meta-analysis is to evaluate the safety and effectivity of the Kono-S technique. METHODS A comprehensive search of MEDLINE (PubMed), Embase (Elsevier), Scopus (Elsevier), and Cochrane Central (Ovid) from inception to August 24th, 2023, was conducted. Studies reporting outcomes of adults with Crohn's disease undergoing ileocolic resection with subsequent Kono-S anastomosis were included. PRISMA and Cochrane guidelines were used to screen, extract and synthesize data. Primary outcomes assessed were endoscopic, surgical and clinical recurrence rates, as well as complication rates. Data were pooled using random-effects models, and heterogeneity was assessed with I² statistics. ROBINS-I and ROB2 tools were used for quality assessment. RESULTS 12 studies involving 820 patients met the eligibility criteria. A pooled mean follow-up time of 22.8 months (95% CI: 15.8, 29.9; I2 = 99.8%) was completed in 98.3% of patients. Pooled endoscopic recurrence was reported in 24.1% of patients (95% CI: 9.4, 49.3; I2 = 93.43%), pooled surgical recurrence in 3.9% of patients (95% CI: 2.2, 6.9; I2 = 25.97%), and pooled clinical recurrence in 26.8% of patients (95% CI: 14, 45.1; I2 = 84.87%). The pooled complication rate was 33.7%. The most common complications were infection (11.5%) and ileus (10.9%). Pooled anastomosis leakage rate was 2.9%. CONCLUSIONS Despite limited and heterogenous data, patients undergoing Kono-S anastomosis had low rates of surgical recurrence and anastomotic leakage with moderate rates of endoscopic recurrence, clinical recurrence and complications rate.
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Affiliation(s)
- Marionna Cathomas
- Department of Surgery, Cantonal Hospital Baselland, Rheinstrasse 26, Liestal, 4410, Switzerland
| | - Baraa Saad
- School of Medicine, St George's University of London, London, SW17 0RE, UK
| | - Stephanie Taha-Mehlitz
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Dilip K Vankayalapati
- Stoke Mandeville Hospital, Buckinghamshire NHS Trust, Oxford Thames Valley, Aylesbury, UK
| | - Nour El Ghazal
- School of Medicine, St George's University of London, London, SW17 0RE, UK
| | | | - Niklas Ortlieb
- Medoc Swiss GMBH, Healthcare management, Basel, Switzerland
| | - Christian A Than
- School of Biomedical Sciences, The University of Queensland, St Lucia, Brisbane, 4072, Australia
| | - Emanuel Burri
- Department of Gastroenterology and Hepatology, Medical University Clinic, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Christine Glaser
- Department of Surgery, Cantonal Hospital Baselland, Rheinstrasse 26, Liestal, 4410, Switzerland
| | - Andres Heigl
- Department of Surgery, Cantonal Hospital Baselland, Rheinstrasse 26, Liestal, 4410, Switzerland
| | - Katerina Neumann
- Division of General Surgery, Dalhousie University, Nova scotia, Halifax, Canada
| | - Michael D Honaker
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Anas Taha
- Department of Surgery, Cantonal Hospital Baselland, Rheinstrasse 26, Liestal, 4410, Switzerland.
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
- Faculty of medicine, University of Basel, Basel, Switzerland.
| | - Robert Rosenberg
- Department of Surgery, Cantonal Hospital Baselland, Rheinstrasse 26, Liestal, 4410, Switzerland
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2
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Ni S, Liang GB, Ng R, Ostmo S, Jia Y, Chiang MF, Huang D, Skalet AH, Young BK, Campbell JP, Jian Y. Panretinal handheld OCT angiography for pediatric retinal imaging. BIOMEDICAL OPTICS EXPRESS 2024; 15:3412-3424. [PMID: 38855676 PMCID: PMC11161374 DOI: 10.1364/boe.520739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 06/11/2024]
Abstract
Comprehensive visualization of retina morphology is essential in the diagnosis and management of retinal diseases in pediatric populations. Conventional imaging techniques often face challenges in effectively capturing the peripheral retina, primarily due to the limitations in current optical designs, which lack the necessary field of view to characterize the far periphery. To address this gap, our study introduces a novel ultra-widefield optical coherence tomography angiography (OCTA) system. This system, specifically tailored for pediatric applications, incorporates an ultrahigh-speed 800 kHz swept-source laser. The system's innovative design achieves a 140° field of view while maintaining excellent optical performance. Over the last 15 months, we have conducted 379 eye examinations on 96 babies using this system. It demonstrates marked efficacy in the diagnosis of retinopathy of prematurity, providing detailed and comprehensive peripheral retinal angiography. The capabilities of the ultra-widefield handheld OCTA system in enhancing the clarity and thoroughness of retina vascularization assessments have significantly improved the precision of diagnoses and the customization of treatment strategies. Our findings underscore the system's potential to advance pediatric ophthalmology and broaden the scope of retinal imaging.
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Affiliation(s)
- Shuibin Ni
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR 97239, USA
| | - Guangru Ben Liang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR 97239, USA
| | - Ringo Ng
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Susan Ostmo
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR 97239, USA
| | - Michael F. Chiang
- National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA
- National Library of Medicine, National Institutes of Health, Bethesda, MD 20892, USA
| | - David Huang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR 97239, USA
| | - Alison H. Skalet
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Radiation Medicine, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Dermatology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Benjamin K. Young
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - J. Peter Campbell
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Yifan Jian
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR 97239, USA
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3
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El Habib Daho M, Li Y, Zeghlache R, Boité HL, Deman P, Borderie L, Ren H, Mannivanan N, Lepicard C, Cochener B, Couturier A, Tadayoni R, Conze PH, Lamard M, Quellec G. DISCOVER: 2-D multiview summarization of Optical Coherence Tomography Angiography for automatic diabetic retinopathy diagnosis. Artif Intell Med 2024; 149:102803. [PMID: 38462293 DOI: 10.1016/j.artmed.2024.102803] [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: 08/24/2023] [Revised: 12/19/2023] [Accepted: 02/03/2024] [Indexed: 03/12/2024]
Abstract
Diabetic Retinopathy (DR), an ocular complication of diabetes, is a leading cause of blindness worldwide. Traditionally, DR is monitored using Color Fundus Photography (CFP), a widespread 2-D imaging modality. However, DR classifications based on CFP have poor predictive power, resulting in suboptimal DR management. Optical Coherence Tomography Angiography (OCTA) is a recent 3-D imaging modality offering enhanced structural and functional information (blood flow) with a wider field of view. This paper investigates automatic DR severity assessment using 3-D OCTA. A straightforward solution to this task is a 3-D neural network classifier. However, 3-D architectures have numerous parameters and typically require many training samples. A lighter solution consists in using 2-D neural network classifiers processing 2-D en-face (or frontal) projections and/or 2-D cross-sectional slices. Such an approach mimics the way ophthalmologists analyze OCTA acquisitions: (1) en-face flow maps are often used to detect avascular zones and neovascularization, and (2) cross-sectional slices are commonly analyzed to detect macular edemas, for instance. However, arbitrary data reduction or selection might result in information loss. Two complementary strategies are thus proposed to optimally summarize OCTA volumes with 2-D images: (1) a parametric en-face projection optimized through deep learning and (2) a cross-sectional slice selection process controlled through gradient-based attribution. The full summarization and DR classification pipeline is trained from end to end. The automatic 2-D summary can be displayed in a viewer or printed in a report to support the decision. We show that the proposed 2-D summarization and classification pipeline outperforms direct 3-D classification with the advantage of improved interpretability.
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Affiliation(s)
- Mostafa El Habib Daho
- Univ Bretagne Occidentale, Brest, F-29200, France; Inserm, UMR 1101, Brest, F-29200, France
| | - Yihao Li
- Univ Bretagne Occidentale, Brest, F-29200, France; Inserm, UMR 1101, Brest, F-29200, France
| | - Rachid Zeghlache
- Univ Bretagne Occidentale, Brest, F-29200, France; Inserm, UMR 1101, Brest, F-29200, France
| | - Hugo Le Boité
- Sorbonne University, Paris, F-75006, France; Service d'Ophtalmologie, Hôpital Lariboisière, APHP, Paris, F-75475, France
| | - Pierre Deman
- ADCIS, Saint-Contest, F-14280, France; Evolucare Technologies, Le Pecq, F-78230, France
| | | | - Hugang Ren
- Carl Zeiss Meditec, Dublin, CA 94568, USA
| | | | - Capucine Lepicard
- Service d'Ophtalmologie, Hôpital Lariboisière, APHP, Paris, F-75475, France
| | - Béatrice Cochener
- Univ Bretagne Occidentale, Brest, F-29200, France; Inserm, UMR 1101, Brest, F-29200, France; Service d'Ophtalmologie, CHRU Brest, Brest, F-29200, France
| | - Aude Couturier
- Service d'Ophtalmologie, Hôpital Lariboisière, APHP, Paris, F-75475, France
| | - Ramin Tadayoni
- Service d'Ophtalmologie, Hôpital Lariboisière, APHP, Paris, F-75475, France; Paris Cité University, Paris, F-75006, France
| | - Pierre-Henri Conze
- Inserm, UMR 1101, Brest, F-29200, France; IMT Atlantique, Brest, F-29200, France
| | - Mathieu Lamard
- Univ Bretagne Occidentale, Brest, F-29200, France; Inserm, UMR 1101, Brest, F-29200, France
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4
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Sun J, Zhao F, Zhu L, Liu B, Fei P. Optical projection tomography reconstruction with few views using highly-generalizable deep learning at sinogram domain. BIOMEDICAL OPTICS EXPRESS 2023; 14:6260-6270. [PMID: 38420331 PMCID: PMC10898583 DOI: 10.1364/boe.500152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 03/02/2024]
Abstract
Optical projection tomography (OPT) reconstruction using a minimal number of measured views offers the potential to significantly reduce excitation dosage and greatly enhance temporal resolution in biomedical imaging. However, traditional algorithms for tomographic reconstruction exhibit severe quality degradation, e.g., presence of streak artifacts, when the number of views is reduced. In this study, we introduce a novel domain evaluation method which can evaluate the domain complexity, and thereby validate that the sinogram domain exhibits lower complexity as compared to the conventional spatial domain. Then we achieve robust deep-learning-based reconstruction with a feedback-based data initialization method at sinogram domain, which shows strong generalization ability that notably improves the overall performance for OPT image reconstruction. This learning-based approach, termed SinNet, enables 4-view OPT reconstructions of diverse biological samples showing robust generalization ability. It surpasses the conventional OPT reconstruction approaches in terms of peak-signal-to-noise ratio (PSNR) and structural similarity (SSIM) metrics, showing its potential for the augment of widely-used OPT techniques.
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Affiliation(s)
- Jiahao Sun
- School of Optical and Electronic Information-Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Fang Zhao
- School of Optical and Electronic Information-Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Lanxin Zhu
- School of Optical and Electronic Information-Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - BinBing Liu
- School of Optical and Electronic Information-Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Peng Fei
- School of Optical and Electronic Information-Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, 430074, China
- Advanced Biomedical Imaging Facility, Huazhong University of Science and Technology, Wuhan, 430074, China
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5
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Murata T, Hirano T, Mizobe H, Toba S. OCT-angiography based artificial intelligence-inferred fluorescein angiography for leakage detection in retina [Invited]. BIOMEDICAL OPTICS EXPRESS 2023; 14:5851-5860. [PMID: 38021144 PMCID: PMC10659810 DOI: 10.1364/boe.506467] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023]
Abstract
Optical coherence tomography angiography (OCTA) covers most functions of fluorescein angiography (FA) when imaging the retina but lacks the ability to depict vascular leakage. Based on OCTA, we developed artificial intelligence-inferred-FA (AI-FA) to delineate leakage in eyes with diabetic retinopathy (DR). Training data of 19,648 still FA images were prepared from FA-photo and videos of 43 DR eyes. AI-FA images were generated using a convolutional neural network. AI-FA images achieved a structural similarity index of 0.91 with corresponding real FA images in DR. The AI-FA generated from OCTA correctly depicted vascular occlusion and associated leakage with enough quality, enabling precise DR diagnosis and treatment planning. A combination of OCT, OCTA, and AI-FA yields more information than real FA with reduced acquisition time without risk of allergic reactions.
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Affiliation(s)
- Toshinori Murata
- Department of Ophthalmology, School of Medicine, Shinshu University, 3-1-1 Asahi Matsumoto, Nagano, 390-8621, Japan
| | - Takao Hirano
- Department of Ophthalmology, School of Medicine, Shinshu University, 3-1-1 Asahi Matsumoto, Nagano, 390-8621, Japan
| | - Hideaki Mizobe
- Canon Inc. 30-2, Shimomaruko 3-chome, Ohta-ku, Tokyo 146-8501, Japan
| | - Shuhei Toba
- Canon Inc. 30-2, Shimomaruko 3-chome, Ohta-ku, Tokyo 146-8501, Japan
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6
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Liang GB, Hormel TT, Wei X, Guo Y, Wang J, Hwang T, Jia Y. Single-shot OCT and OCT angiography for slab-specific detection of diabetic retinopathy. BIOMEDICAL OPTICS EXPRESS 2023; 14:5682-5695. [PMID: 38021127 PMCID: PMC10659794 DOI: 10.1364/boe.503476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 12/01/2023]
Abstract
In this study, we present an optical coherence tomographic angiography (OCTA) prototype using a 500 kHz high-speed swept-source laser. This system can generate a 75-degree field of view with a 10.4 µm lateral resolution with a single acquisition. With this prototype we acquired detailed, wide-field, and plexus-specific images throughout the retina and choroid in eyes with diabetic retinopathy, detecting early retinal neovascularization and locating pathology within specific retinal slabs. Our device could also visualize choroidal flow and identify signs of key biomarkers in diabetic retinopathy.
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Affiliation(s)
- Guangru B. Liang
- Department of Biomedical Engineering, Oregon Health & Science University, 3303 S.W. Bond Avenue, Portland, OR 97239, USA
- Casey Eye Institute, Oregon Health & Science University, 515 S.W. Campus Drive, Portland, OR 97239, USA
| | - Tristan T. Hormel
- Casey Eye Institute, Oregon Health & Science University, 515 S.W. Campus Drive, Portland, OR 97239, USA
| | - Xiang Wei
- Department of Biomedical Engineering, Oregon Health & Science University, 3303 S.W. Bond Avenue, Portland, OR 97239, USA
- Casey Eye Institute, Oregon Health & Science University, 515 S.W. Campus Drive, Portland, OR 97239, USA
| | - Yukun Guo
- Department of Biomedical Engineering, Oregon Health & Science University, 3303 S.W. Bond Avenue, Portland, OR 97239, USA
- Casey Eye Institute, Oregon Health & Science University, 515 S.W. Campus Drive, Portland, OR 97239, USA
| | - Jie Wang
- Department of Biomedical Engineering, Oregon Health & Science University, 3303 S.W. Bond Avenue, Portland, OR 97239, USA
- Casey Eye Institute, Oregon Health & Science University, 515 S.W. Campus Drive, Portland, OR 97239, USA
| | - Thomas Hwang
- Casey Eye Institute, Oregon Health & Science University, 515 S.W. Campus Drive, Portland, OR 97239, USA
| | - Yali Jia
- Department of Biomedical Engineering, Oregon Health & Science University, 3303 S.W. Bond Avenue, Portland, OR 97239, USA
- Casey Eye Institute, Oregon Health & Science University, 515 S.W. Campus Drive, Portland, OR 97239, USA
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7
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Transformer and convolutional based dual branch network for retinal vessel segmentation in OCTA images. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Deep Learning in Optical Coherence Tomography Angiography: Current Progress, Challenges, and Future Directions. Diagnostics (Basel) 2023; 13:diagnostics13020326. [PMID: 36673135 PMCID: PMC9857993 DOI: 10.3390/diagnostics13020326] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Optical coherence tomography angiography (OCT-A) provides depth-resolved visualization of the retinal microvasculature without intravenous dye injection. It facilitates investigations of various retinal vascular diseases and glaucoma by assessment of qualitative and quantitative microvascular changes in the different retinal layers and radial peripapillary layer non-invasively, individually, and efficiently. Deep learning (DL), a subset of artificial intelligence (AI) based on deep neural networks, has been applied in OCT-A image analysis in recent years and achieved good performance for different tasks, such as image quality control, segmentation, and classification. DL technologies have further facilitated the potential implementation of OCT-A in eye clinics in an automated and efficient manner and enhanced its clinical values for detecting and evaluating various vascular retinopathies. Nevertheless, the deployment of this combination in real-world clinics is still in the "proof-of-concept" stage due to several limitations, such as small training sample size, lack of standardized data preprocessing, insufficient testing in external datasets, and absence of standardized results interpretation. In this review, we introduce the existing applications of DL in OCT-A, summarize the potential challenges of the clinical deployment, and discuss future research directions.
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Ma D, Pasquale LR, Girard MJA, Leung CKS, Jia Y, Sarunic MV, Sappington RM, Chan KC. Reverse translation of artificial intelligence in glaucoma: Connecting basic science with clinical applications. FRONTIERS IN OPHTHALMOLOGY 2023; 2:1057896. [PMID: 36866233 PMCID: PMC9976697 DOI: 10.3389/fopht.2022.1057896] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/05/2022] [Indexed: 04/16/2023]
Abstract
Artificial intelligence (AI) has been approved for biomedical research in diverse areas from bedside clinical studies to benchtop basic scientific research. For ophthalmic research, in particular glaucoma, AI applications are rapidly growing for potential clinical translation given the vast data available and the introduction of federated learning. Conversely, AI for basic science remains limited despite its useful power in providing mechanistic insight. In this perspective, we discuss recent progress, opportunities, and challenges in the application of AI in glaucoma for scientific discoveries. Specifically, we focus on the research paradigm of reverse translation, in which clinical data are first used for patient-centered hypothesis generation followed by transitioning into basic science studies for hypothesis validation. We elaborate on several distinctive areas of research opportunities for reverse translation of AI in glaucoma including disease risk and progression prediction, pathology characterization, and sub-phenotype identification. We conclude with current challenges and future opportunities for AI research in basic science for glaucoma such as inter-species diversity, AI model generalizability and explainability, as well as AI applications using advanced ocular imaging and genomic data.
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Affiliation(s)
- Da Ma
- School of Medicine, Wake Forest University, Winston-Salem, NC, United States
- Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
- School of Engineering Science, Simon Fraser University, Burnaby, BC, Canada
| | - Louis R. Pasquale
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Michaël J. A. Girard
- Ophthalmic Engineering & Innovation Laboratory (OEIL), Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Institute for Molecular and Clinical Ophthalmology, Basel, Switzerland
| | | | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, Portland, OR, United States
| | - Marinko V. Sarunic
- School of Engineering Science, Simon Fraser University, Burnaby, BC, Canada
- Institute of Ophthalmology, University College London, London, United Kingdom
| | - Rebecca M. Sappington
- School of Medicine, Wake Forest University, Winston-Salem, NC, United States
- Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Kevin C. Chan
- Departments of Ophthalmology and Radiology, Neuroscience Institute, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, NY, United States
- Department of Biomedical Engineering, Tandon School of Engineering, New York University, New York, NY, United States
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Hao J, Shen T, Zhu X, Liu Y, Behera A, Zhang D, Chen B, Liu J, Zhang J, Zhao Y. Retinal Structure Detection in OCTA Image via Voting-Based Multitask Learning. IEEE TRANSACTIONS ON MEDICAL IMAGING 2022; 41:3969-3980. [PMID: 36044489 DOI: 10.1109/tmi.2022.3202183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Automated detection of retinal structures, such as retinal vessels (RV), the foveal avascular zone (FAZ), and retinal vascular junctions (RVJ), are of great importance for understanding diseases of the eye and clinical decision-making. In this paper, we propose a novel Voting-based Adaptive Feature Fusion multi-task network (VAFF-Net) for joint segmentation, detection, and classification of RV, FAZ, and RVJ in optical coherence tomography angiography (OCTA). A task-specific voting gate module is proposed to adaptively extract and fuse different features for specific tasks at two levels: features at different spatial positions from a single encoder, and features from multiple encoders. In particular, since the complexity of the microvasculature in OCTA images makes simultaneous precise localization and classification of retinal vascular junctions into bifurcation/crossing a challenging task, we specifically design a task head by combining the heatmap regression and grid classification. We take advantage of three different en face angiograms from various retinal layers, rather than following existing methods that use only a single en face. We carry out extensive experiments on three OCTA datasets acquired using different imaging devices, and the results demonstrate that the proposed method performs on the whole better than either the state-of-the-art single-purpose methods or existing multi-task learning solutions. We also demonstrate that our multi-task learning method generalizes across other imaging modalities, such as color fundus photography, and may potentially be used as a general multi-task learning tool. We also construct three datasets for multiple structure detection, and part of these datasets with the source code and evaluation benchmark have been released for public access.
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11
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Tsuboi K, You QS, Guo Y, Wang J, Flaxel CJ, Bailey ST, Huang D, Jia Y, Hwang TS. Association Between Fluid Volume in Inner Nuclear Layer and Visual Acuity in Diabetic Macular Edema. Am J Ophthalmol 2022; 237:164-172. [PMID: 34942107 PMCID: PMC9035073 DOI: 10.1016/j.ajo.2021.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/30/2021] [Accepted: 12/09/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE In diabetic macular edema (DME), the correlation between visual acuity (VA) and central subfield thickness (CST) is weak. We hypothesize that fluid volume (FV) in the inner nuclear layer (INL) may correlate more strongly with VA. DESIGN Retrospective, cross-sectional study. METHODS One eye each of diabetic patients with DME was included. We measured intraretinal fluid volume that was detected by automated fluid detection algorithm on 3- × 3-mm optical coherence tomography angiogram volume scans. The detected fluid was subdivided into inner FV, bounded by the INL, and outer FV, the fluid between the outer border of INL to the ellipsoid zone. RESULTS We enrolled 125 patients with DME (60 women; mean age, 61 years). The mean detected inner FV was 0.013 mm3 in 109 eyes (87%). The mean detected outer FV was 0.042 mm3 in 124 eyes (99%). Univariate analysis demonstrated that the VA significantly correlated with the inner FV (P < .0001), whole macular FV (P = .010), and CST (P = .036). Multivariate analysis demonstrated that the inner FV was the only significant factor (β = -0.41, P = .004). These correlations were consistent when the treatment-naïve group (n = 33) and the eyes without previous laser treatments (n = 93) were analyzed separately. The area under the receiver operating characteristic curve of inner FV for VA of 20/32 or worse was significantly higher than that for CST (0.66 vs 0.54, P = .018). CONCLUSIONS The inner FV has a stronger association with VA than other OCT biomarkers in DME and may be more clinically useful.
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