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Poh SSJ, Sia JT, Yip MYT, Tsai ASH, Lee SY, Tan GSW, Weng CY, Kadonosono K, Kim M, Yonekawa Y, Ho AC, Toth CA, Ting DSW. Artificial Intelligence, Digital Imaging, and Robotics Technologies for Surgical Vitreoretinal Diseases. Ophthalmol Retina 2024; 8:633-645. [PMID: 38280425 DOI: 10.1016/j.oret.2024.01.018] [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: 10/17/2023] [Revised: 01/14/2024] [Accepted: 01/19/2024] [Indexed: 01/29/2024]
Abstract
OBJECTIVE To review recent technological advancement in imaging, surgical visualization, robotics technology, and the use of artificial intelligence in surgical vitreoretinal (VR) diseases. BACKGROUND Technological advancements in imaging enhance both preoperative and intraoperative management of surgical VR diseases. Widefield imaging in fundal photography and OCT can improve assessment of peripheral retinal disorders such as retinal detachments, degeneration, and tumors. OCT angiography provides a rapid and noninvasive imaging of the retinal and choroidal vasculature. Surgical visualization has also improved with intraoperative OCT providing a detailed real-time assessment of retinal layers to guide surgical decisions. Heads-up display and head-mounted display utilize 3-dimensional technology to provide surgeons with enhanced visual guidance and improved ergonomics during surgery. Intraocular robotics technology allows for greater surgical precision and is shown to be useful in retinal vein cannulation and subretinal drug delivery. In addition, deep learning techniques leverage on diverse data including widefield retinal photography and OCT for better predictive accuracy in classification, segmentation, and prognostication of many surgical VR diseases. CONCLUSION This review article summarized the latest updates in these areas and highlights the importance of continuous innovation and improvement in technology within the field. These advancements have the potential to reshape management of surgical VR diseases in the very near future and to ultimately improve patient care. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Stanley S J Poh
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Josh T Sia
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Michelle Y T Yip
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Andrew S H Tsai
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Shu Yen Lee
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Gavin S W Tan
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Christina Y Weng
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | | | - Min Kim
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Allen C Ho
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Cynthia A Toth
- Departments of Ophthalmology and Biomedical Engineering, Duke University, Durham, North Carolina
| | - Daniel S W Ting
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore; Byers Eye Institute, Stanford University, Palo Alto, California.
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Mariotti C, Mangoni L, Iorio S, Lombardo V, Fruttini D, Rizzo C, Chhablani J, Midena E, Lupidi M. Novel Artificial Intelligence-Based Assessment of Imaging Biomarkers in Full-Thickness Macular Holes: Preliminary Data from a Pivotal Trial. J Clin Med 2024; 13:628. [PMID: 38276134 PMCID: PMC10816123 DOI: 10.3390/jcm13020628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
Artificial intelligence (AI)- and deep learning (DL)-based systems have shown significant progress in the field of macular disorders, demonstrating high performance in detecting retinal fluid and assessing anatomical changes during disease progression. This study aimed to validate an AI algorithm for identifying and quantifying prognostic factors in visual recovery after macular hole (MH) surgery by analyzing major optical coherence tomography (OCT) biomarkers. This study included 20 patients who underwent vitrectomy for a full-thickness macular hole (FTMH). The mean diameter of the FTMH was measured at 285.36 ± 97.4 μm. The preoperative best-corrected visual acuity (BCVA) was 0.76 ± 0.06 logMAR, improving to 0.38 ± 0.16 postoperatively, with a statistically significant difference (p = 0.001). AI software was utilized to assess biomarkers, such as intraretinal fluid (IRF) and subretinal fluid (SRF) volume, external limiting membrane (ELM) and ellipsoid zone (EZ) integrity, and retinal hyperreflective foci (HRF). The AI analysis showed a significant decrease in IRF volume, from 0.08 ± 0.12 mm3 preoperatively to 0.01 ± 0.01 mm3 postoperatively. ELM interruption improved from 79% ± 18% to 34% ± 37% after surgery (p = 0.006), whereas EZ interruption improved from 80% ± 22% to 40% ± 36% (p = 0.007) postoperatively. Additionally, the study revealed a negative correlation between preoperative IRF volume and postoperative BCVA recovery, suggesting that greater preoperative fluid volumes may hinder visual improvement. The integrity of the ELM and EZ was found to be essential for postoperative visual acuity improvement, with their disruption negatively impacting visual recovery. The study highlights the potential of AI in quantifying OCT biomarkers for managing MHs and improving patient care.
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Affiliation(s)
- Cesare Mariotti
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60131 Ancona, Italy (S.I.)
| | - Lorenzo Mangoni
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60131 Ancona, Italy (S.I.)
| | - Silvia Iorio
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60131 Ancona, Italy (S.I.)
| | - Veronica Lombardo
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60131 Ancona, Italy (S.I.)
| | - Daniela Fruttini
- Department of Medicine and Surgery, University of Perugia, S. Maria della Misericordia Hospital, 06123 Perugia, Italy
| | - Clara Rizzo
- Ophthalmic Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, 37129 Verona, Italy
| | - Jay Chhablani
- Department of Ophthalmology, UPMC Eye Center, University of Pittsburgh, Pittsburgh, PA 15213, USA;
| | - Edoardo Midena
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy;
- IRCCS—Fondazione Bietti, 00198 Rome, Italy
| | - Marco Lupidi
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60131 Ancona, Italy (S.I.)
- Fondazione per la Macula Onlus, Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), University Eye Clinic, 16132 Genova, Italy
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Chen JZ, Li CC, Li SH, Su YT, Zhang T, Wang YS, Dou GR, Chen T, Wang XC, Zhang ZM. A feasibility study for objective evaluation of visual acuity based on pattern-reversal visual evoked potentials and other related visual parameters with machine learning algorithm. BMC Ophthalmol 2023; 23:293. [PMID: 37369996 DOI: 10.1186/s12886-023-03044-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND To develop machine learning models for objectively evaluating visual acuity (VA) based on pattern-reversal visual evoked potentials (PRVEPs) and other related visual parameters. METHODS Twenty-four volunteers were recruited and forty-eight eyes were divided into four groups of 1.0, 0.8, 0.6, and 0.4 (decimal vision). The relationship between VA, peak time, or amplitude of P100 recorded at 5.7°, 2.6°, 1°, 34', 15', and 7' check sizes were analyzed using repeated-measures analysis of variance. Correlations between VA and P100, contrast sensitivity (CS), refractive error, wavefront aberrations, and visual field were analyzed by rank correlation. Based on meaningful P100 peak time, P100 amplitude, and other related visual parameters, four machine learning algorithms and an ensemble classification algorithm were used to construct objective assessment models for VA. Receiver operating characteristic (ROC) curves were used to compare the efficacy of different models by repeated sampling comparisons and ten-fold cross-validation. RESULTS The main effects of P100 peak time and amplitude between different VA and check sizes were statistically significant (all P < 0.05). Except amplitude at 2.6° and 5.7°, VA was negatively correlated with peak time and positively correlated with amplitude. The peak time initially shortened with increasing check size and gradually lengthened after the minimum value was reached at 1°. At the 1° check size, there were statistically significant differences when comparing the peak times between the vision groups with each other (all P < 0.05), and the amplitudes of the vision reduction groups were significantly lower than that of the 1.0 vision group (all P < 0.01). The correlations between peak time, amplitude, and visual acuity were all highest at 1° (rs = - 0.740, 0.438). VA positively correlated with CS and spherical equivalent (all P < 0.001). There was a negative correlation between VA and coma aberrations (P < 0.05). For different binarization classifications of VA, the classifier models with the best assessment efficacy all had the mean area under the ROC curves (AUC) above 0.95 for 500 replicate samples and above 0.84 for ten-fold cross-validation. CONCLUSIONS Machine learning models established by meaning visual parameters related to visual acuity can assist in the objective evaluation of VA.
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Affiliation(s)
- Jian Zheng Chen
- Ministry-of-Education Key Laboratory of Aerospace Medicine, School of Aerospace Medicine, Air Force Medical University, Xi'an, Shaanxi Province, China
- Qingdao Special Servicemen Recuperation Center of PLA Navy, Qingdao, Shandong Province, China
| | - Cong Cong Li
- Ministry-of-Education Key Laboratory of Aerospace Medicine, School of Aerospace Medicine, Air Force Medical University, Xi'an, Shaanxi Province, China
| | - Shao Heng Li
- Ministry-of-Education Key Laboratory of Aerospace Medicine, School of Aerospace Medicine, Air Force Medical University, Xi'an, Shaanxi Province, China
- Department of Ophthalmology, The First Affiliated Hospital, Air Force Medical University, Xi'an, Shaanxi Province, China
| | - Yu Ting Su
- Ministry-of-Education Key Laboratory of Aerospace Medicine, School of Aerospace Medicine, Air Force Medical University, Xi'an, Shaanxi Province, China
| | - Tao Zhang
- School of Biomedical Engineering, Air Force Medical University, Xi'an, Shaanxi Province, China
| | - Yu Sheng Wang
- Department of Ophthalmology, The First Affiliated Hospital, Air Force Medical University, Xi'an, Shaanxi Province, China
| | - Guo Rui Dou
- Department of Ophthalmology, The First Affiliated Hospital, Air Force Medical University, Xi'an, Shaanxi Province, China
| | - Tao Chen
- Ministry-of-Education Key Laboratory of Aerospace Medicine, School of Aerospace Medicine, Air Force Medical University, Xi'an, Shaanxi Province, China.
- Department of Aviation Medicine, The First Affiliated Hospital, Air Force Medical University, Xi'an, Shaanxi Province, China.
| | - Xiao Cheng Wang
- Ministry-of-Education Key Laboratory of Aerospace Medicine, School of Aerospace Medicine, Air Force Medical University, Xi'an, Shaanxi Province, China.
- Department of Aviation Medicine, The First Affiliated Hospital, Air Force Medical University, Xi'an, Shaanxi Province, China.
| | - Zuo Ming Zhang
- Ministry-of-Education Key Laboratory of Aerospace Medicine, School of Aerospace Medicine, Air Force Medical University, Xi'an, Shaanxi Province, China.
- Department of Aviation Medicine, The First Affiliated Hospital, Air Force Medical University, Xi'an, Shaanxi Province, China.
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Ozturk Y, Ağın A, Kockar N, Ay N, Imamoglu S, Ozcelik Kose A, Kugu S. The Importance of Anatomic Configuration and Cystic Changes in Macular Hole: Predicting Surgical Success with a Different Approach. Curr Eye Res 2022; 47:1436-1443. [PMID: 35770860 DOI: 10.1080/02713683.2022.2096908] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE This study aimed to define a novel metric for the area of the macular hole (MH) and cysts located around the hole using an optical coherence tomography (OCT) device. METHODS This study was conducted with 58 eyes of 56 patients. The patients were divided into two groups according to anatomic closure after surgery. Using the metrics of macular hole index (MHI), tractional hole index (THI), hole forming factor (HFF), macular hole area (HA), the cystoid space areas in the inner retinal layers (CA), and our novel metric, the cyst hole area index (CHAI) was calculated. The correlation of the CA, the HA, and the CHAI with other indexes were assessed. Receiver operating characteristic (ROC) curves and cut-off values were derived for indexes predicting type 1 or type 2 closures. RESULTS The CA showed a strong positive correlation with the base MH size and the maximum MH height (r = 0.624, p < 0.001; r = 0.722, p < 0.001, respectively). The HA showed a strong positive correlation with basal MH size and minimum MH size (r = 0.934, p < 0.001; r = 0.765, p < 0.001). The HA showed a moderate positive correlation with maximum MH height (r = 0.483, p < 0.001, respectively). CHAI showed a moderate positive correlation with minimum MH size (r = 0.297, p = 0.02). CHAI and HA showed a moderate negative correlation with post-operative BCVA (r = -0.39, p = 0.003; r = -0.357, p = 0.006; respectively). ROC curve analysis showed that MHI (0.823), THI (0.750), and HFF (0.722) predicted type 1 closure and that CHAI (0.769) and HA (0.709) predicted type 2 closures. CONCLUSION MHI and our novel index CHAI, which can be calculated without any additional software, could successfully predict type 1 and type 2 closures, respectively.
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Affiliation(s)
- Yucel Ozturk
- Department of Ophthalmology, Haydarpaşa Numune Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Abdullah Ağın
- Department of Ophthalmology, Haseki Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Nadir Kockar
- Department of Ophthalmology, Haydarpaşa Numune Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Nevzat Ay
- Department of Ophthalmology, Haydarpaşa Numune Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Serhat Imamoglu
- Department of Ophthalmology, Haydarpaşa Numune Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Alev Ozcelik Kose
- Department of Ophthalmology, Haydarpaşa Numune Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Suleyman Kugu
- Department of Ophthalmology, Haydarpaşa Numune Training and Research Hospital, University of Health Science, Istanbul, Turkey
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Lachance A, Godbout M, Antaki F, Hébert M, Bourgault S, Caissie M, Tourville É, Durand A, Dirani A. Predicting Visual Improvement After Macular Hole Surgery: A Combined Model Using Deep Learning and Clinical Features. Transl Vis Sci Technol 2022; 11:6. [PMID: 35385045 PMCID: PMC8994199 DOI: 10.1167/tvst.11.4.6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose The purpose of this study was to assess the feasibility of deep learning (DL) methods to enhance the prediction of visual acuity (VA) improvement after macular hole (MH) surgery from a combined model using DL on high-definition optical coherence tomography (HD-OCT) B-scans and clinical features. Methods We trained a DL convolutional neural network (CNN) using pre-operative HD-OCT B-scans of the macula and combined with a logistic regression model of pre-operative clinical features to predict VA increase ≥15 Early Treatment Diabetic Retinopathy Study (ETDRS) letters at 6 months post-vitrectomy in closed MHs. A total of 121 MHs with 242 HD-OCT B-scans and 484 clinical data points were used to train, validate, and test the model. Prediction of VA increase was evaluated using the area under the receiver operating characteristic curve (AUROC) and F1 scores. We also extracted the weight of each input feature in the hybrid model. Results All performances are reported on the held-out test set, matching results obtained with cross-validation. Using a regression on clinical features, the AUROC was 80.6, with an F1 score of 79.7. For the CNN, relying solely on the HD-OCT B-scans, the AUROC was 72.8 ± 14.6, with an F1 score of 61.5 ± 23.7. For our hybrid regression model using clinical features and CNN prediction, the AUROC was 81.9 ± 5.2, with an F1 score of 80.4 ± 7.7. In the hybrid model, the baseline VA was the most important feature (weight = 59.1 ± 6.9%), while the weight of HD-OCT prediction was 9.6 ± 4.2%. Conclusions Both the clinical data and HD-OCT models can predict postoperative VA improvement in patients undergoing vitrectomy for a MH with good discriminative performances. Combining them into a hybrid model did not significantly improve performance. Translational Relevance OCT-based DL models can predict postoperative VA improvement following vitrectomy for MH but fusing those models with clinical data might not provide improved predictive performance.
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Affiliation(s)
- Alexandre Lachance
- Faculté de Médecine, Université Laval, Québec, QC, Canada.,Département d'Ophtalmologie et d'oto-Rhino-Laryngologie - Chirurgie Cervico-Faciale, Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Québec, QC, Canada
| | - Mathieu Godbout
- Département d'informatique et de Génie Logiciel, Université Laval, Québec, QC, Canada
| | - Fares Antaki
- Département d'ophtalmologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, QC, Canada
| | - Mélanie Hébert
- Faculté de Médecine, Université Laval, Québec, QC, Canada.,Département d'Ophtalmologie et d'oto-Rhino-Laryngologie - Chirurgie Cervico-Faciale, Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Québec, QC, Canada
| | - Serge Bourgault
- Faculté de Médecine, Université Laval, Québec, QC, Canada.,Département d'Ophtalmologie et d'oto-Rhino-Laryngologie - Chirurgie Cervico-Faciale, Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Québec, QC, Canada
| | - Mathieu Caissie
- Faculté de Médecine, Université Laval, Québec, QC, Canada.,Département d'Ophtalmologie et d'oto-Rhino-Laryngologie - Chirurgie Cervico-Faciale, Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Québec, QC, Canada
| | - Éric Tourville
- Faculté de Médecine, Université Laval, Québec, QC, Canada.,Département d'Ophtalmologie et d'oto-Rhino-Laryngologie - Chirurgie Cervico-Faciale, Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Québec, QC, Canada
| | - Audrey Durand
- Département d'informatique et de Génie Logiciel, Université Laval, Québec, QC, Canada.,Département de Génie Électrique et de Génie Informatique, Université Laval, Québec, QC, Canada
| | - Ali Dirani
- Faculté de Médecine, Université Laval, Québec, QC, Canada.,Département d'Ophtalmologie et d'oto-Rhino-Laryngologie - Chirurgie Cervico-Faciale, Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec - Université Laval, Québec, QC, Canada
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