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Keel S, Li Z, Scheetz J, Robman L, Phung J, Makeyeva G, Aung K, Liu C, Yan X, Meng W, Guymer R, Chang R, He M. Development and validation of a deep-learning algorithm for the detection of neovascular age-related macular degeneration from colour fundus photographs. Clin Exp Ophthalmol 2019; 47:1009-1018. [PMID: 31215760 DOI: 10.1111/ceo.13575] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/24/2019] [Accepted: 06/13/2019] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Detection of early onset neovascular age-related macular degeneration (AMD) is critical to protecting vision. BACKGROUND To describe the development and validation of a deep-learning algorithm (DLA) for the detection of neovascular age-related macular degeneration. DESIGN Development and validation of a DLA using retrospective datasets. PARTICIPANTS We developed and trained the DLA using 56 113 retinal images and an additional 86 162 images from an independent dataset to externally validate the DLA. All images were non-stereoscopic and retrospectively collected. METHODS The internal validation dataset was derived from real-world clinical settings in China. Gold standard grading was assigned when consensus was reached by three individual ophthalmologists. The DLA classified 31 247 images as gradable and 24 866 as ungradable (poor quality or poor field definition). These ungradable images were used to create a classification model for image quality. Efficiency and diagnostic accuracy were tested using 86 162 images derived from the Melbourne Collaborative Cohort Study. Neovascular AMD and/or ungradable outcome in one or both eyes was considered referable. MAIN OUTCOME MEASURES Area under the receiver operating characteristic curve (AUC), sensitivity and specificity. RESULTS In the internal validation dataset, the AUC, sensitivity and specificity of the DLA for neovascular AMD was 0.995, 96.7%, 96.4%, respectively. Testing against the independent external dataset achieved an AUC, sensitivity and specificity of 0.967, 100% and 93.4%, respectively. More than 60% of false positive cases displayed other macular pathologies. Amongst the false negative cases (internal validation dataset only), over half (57.2%) proved to be undetected detachment of the neurosensory retina or RPE layer. CONCLUSIONS AND RELEVANCE This DLA shows robust performance for the detection of neovascular AMD amongst retinal images from a multi-ethnic sample and under different imaging protocols. Further research is warranted to investigate where this technology could be best utilized within screening and research settings.
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Affiliation(s)
- Stuart Keel
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Zhixi Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Jane Scheetz
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Liubov Robman
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Monash University Melbourne, Melbourne, Victoria, Australia
| | - James Phung
- Monash University Melbourne, Melbourne, Victoria, Australia
| | - Galina Makeyeva
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - KhinZaw Aung
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Chi Liu
- Healgoo Interactive Medical Technology Co. Ltd., Guangzhou, China
| | - Xixi Yan
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Wei Meng
- Healgoo Interactive Medical Technology Co. Ltd., Guangzhou, China
| | - Robyn Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Robert Chang
- Department of Ophthalmology, Byers Eye Institute at Stanford University, Palo Alto, California
| | - Mingguang He
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia.,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
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Guymer RH, Wu Z, Hodgson LA, Caruso E, Brassington KH, Tindill N, Aung KZ, McGuinness MB, Fletcher EL, Chen FK, Chakravarthy U, Arnold JJ, Heriot WJ, Durkin SR, Lek JJ, Harper CA, Wickremasinghe SS, Sandhu SS, Baglin EK, Sharangan P, Braat S, Luu CD. Subthreshold Nanosecond Laser Intervention in Age-Related Macular Degeneration. Ophthalmology 2019; 126:829-838. [DOI: 10.1016/j.ophtha.2018.09.015] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/11/2018] [Accepted: 09/11/2018] [Indexed: 01/12/2023] Open
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Adaptive optics ophthalmoscopy: Application to age-related macular degeneration and vascular diseases. Prog Retin Eye Res 2018; 66:1-16. [DOI: 10.1016/j.preteyeres.2018.07.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 07/12/2018] [Accepted: 07/12/2018] [Indexed: 12/11/2022]
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Fenwick EK, Man REK, Cheung CMG, Sabanayagam C, Cheng CY, Neelam K, Chua J, Gan ATL, Mitchell P, Wong TY, Lamoureux EL. Ethnic Differences in the Association Between Age-Related Macular Degeneration and Vision-Specific Functioning. JAMA Ophthalmol 2017; 135:469-476. [PMID: 28358956 DOI: 10.1001/jamaophthalmol.2017.0266] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Importance Understanding the link between ethnicity and health is critical to making appropriate public policy decisions. Few population-level data are available about this connection, however, including the influence of ethnicity on the association between age-related macular degeneration (AMD) and vision-specific functioning (VSF). Objective To identify the influence of ethnicity on VSF among Chinese, Malay, and Indian patients with AMD. Design, Setting, and Participants This cross-sectional, population-based study relied on patients and their data from 3 population-based studies in 3 ethnic groups: Chinese, Malay and Indian. Of 10 033 Chinese, Malay, and Indian adults who participated in the study, 9962 (99.3%) who had gradable fundus images and Visual Function Index (VF-11) data available were included in the analyses for the present study. Uniocular presenting distance visual acuity was measured using the logMAR chart. Separate multiple linear regression models examined the association between AMD and VSF in the 3 ethnic groups, adjusting for age, sex, presenting visual acuity in the better-seeing eye, educational level, income, smoking status, hypertension, diabetes, cardiovascular disease, total cholesterol level, and other eye conditions. Data were collected between January 20, 2004, and December 19, 2011; data analysis was conducted between November 12, 2015, and December 28, 2016. Exposures Age-related macular degeneration according to fundus photographs graded using a modified Wisconsin Age-Related Maculopathy Grading System. Main Outcomes and Measures Rasch analysis was used to convert VF-11 questionnaire scores to estimated interval measures of VSF. Results Of the 9962 participants, the mean (SD) age was 58.8 (10.4) years; 4909 (49.3%) were male; 590 (5.9%) had early AMD (241 Chinese, 161 Malays, and 188 Indians) and 60 (0.6%) had late AMD (25 Chinese, 21 Malays, and 14 Indians). In the adjusted models, compared with no AMD, early AMD was associated with a small reduction in VSF (2.9%; β = -0.12; 95% CI, -0.23 to -0.00; P = .046) in the Chinese group but not in the Indian and Malay groups. Moreover, Chinese participants with late AMD had a clinically significant 19.1% loss of VSF (β = -0.78; 95% CI, -1.13 to -0.43, P < .001). In the Malay group, those with late AMD had a 13.5% drop in VSF (β = -0.49; 95% CI, -1.01 to 0.04; P = .07) compared with their counterparts without AMD. Similarly, late AMD was not associated with VSF in the Indian group. Conclusions and Relevance Early and late AMD negatively affected VSF in Chinese but not in Indian and Malay participants. This finding suggests that there is an independent ethnic influence in the association of the disease with VSF in multiethnic Asian populations, thus warranting ethnicity-based strategies to delay the onset or progression of AMD.
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Affiliation(s)
- Eva K Fenwick
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore2Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia3Duke-NUS Medical School, National University of Singapore, Singapore
| | - Ryan E K Man
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore3Duke-NUS Medical School, National University of Singapore, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore3Duke-NUS Medical School, National University of Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore3Duke-NUS Medical School, National University of Singapore, Singapore
| | - Kumari Neelam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore3Duke-NUS Medical School, National University of Singapore, Singapore
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore3Duke-NUS Medical School, National University of Singapore, Singapore
| | - Alfred T L Gan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology and the Westmead Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore3Duke-NUS Medical School, National University of Singapore, Singapore
| | - Ecosse L Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore3Duke-NUS Medical School, National University of Singapore, Singapore
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Skalicky SE, Fenwick E, Martin KR, Crowston J, Goldberg I, McCluskey P. Impact of age-related macular degeneration in patients with glaucoma: understanding the patients' perspective. Clin Exp Ophthalmol 2016; 44:377-87. [DOI: 10.1111/ceo.12672] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 08/03/2015] [Accepted: 10/12/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Simon E Skalicky
- Discipline of Ophthalmology; University of Sydney; Sydney New South Wales Australia
- Ophthalmology Department; Addenbrookes Hospital; Cambridge UK
- Departments of Ophthalmology and Surgery, Royal Melbourne Hospital; University of Melbourne; Melbourne Victoria Australia
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital; University of Melbourne; Melbourne Victoria Australia
| | - Eva Fenwick
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital; University of Melbourne; Melbourne Victoria Australia
| | - Keith R Martin
- Ophthalmology Department; Addenbrookes Hospital; Cambridge UK
- Cambridge NIHR Biomedical Research Centre; University of Cambridge; Cambridge UK
| | - Jonathan Crowston
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital; University of Melbourne; Melbourne Victoria Australia
| | - Ivan Goldberg
- Discipline of Ophthalmology; University of Sydney; Sydney New South Wales Australia
- Eye Associates; Sydney New South Wales Australia
- Sydney Eye Hospital; Sydney New South Wales Australia
| | - Peter McCluskey
- Discipline of Ophthalmology; University of Sydney; Sydney New South Wales Australia
- Sydney Eye Hospital; Sydney New South Wales Australia
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Finger RP, Chong E, McGuinness MB, Robman LD, Aung KZ, Giles G, Baird PN, Guymer RH. Reticular Pseudodrusen and Their Association with Age-Related Macular Degeneration: The Melbourne Collaborative Cohort Study. Ophthalmology 2015; 123:599-608. [PMID: 26681391 DOI: 10.1016/j.ophtha.2015.10.029] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/15/2015] [Accepted: 10/16/2015] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To determine the prevalence of reticular pseudodrusen (RPD) and its association with age-related macular degeneration (AMD) and AMD risk factors in a large sample. DESIGN Community-based cohort study in Melbourne, Victoria, Australia. PARTICIPANTS A total of 21,130 participants 48 to 86 years of age available for ophthalmic assessment at follow-up from 2003 through 2007. METHODS Lifestyle, diet, and anthropometric measurements were obtained at baseline and follow-up. At follow-up, digital macular color photographs were graded for early, intermediate, and late AMD as well as the presence of RPD. Data were analyzed using multinomial logistic regression controlling for age, gender, smoking, country of birth, and diet. MAIN OUTCOME MEASURES Detection of RPD based on color fundus photographs. RESULTS Prevalence of RPD was 0.41% (87 of 21,130 participants), with 51% having bilateral RPD. Patients with RPD were older compared with patients with large drusen (>125 μm; 76±4 vs. 68±9 years; P < 0.001). Increasing age, female gender, being a current smoker, as well as focal pigmentary abnormalities and large drusen (>125 μm) were associated with a higher prevalence of RPD. Presence of geographic atrophy (GA) was associated with the highest odds of having RPD (odds ratio [OR], 153; 95% confidence interval [CI], 53-442), followed by choroidal neovascularization (CNV; OR, 90; 95% CI, 26-310), intermediate AMD (OR, 33; 95% CI, 14-77), and early AMD (OR, 12; 95% CI, 5-31) compared with those with no AMD. The ARMS2 single nucleotide polymorphism (SNP) rs10490924, HTRA1 SNPs rs11200638 and rs3793917, and CFH SNPs rs393955, rs1061170, and rs2274700 were associated with increased prevalence of RPD (all P < 0.05). CONCLUSIONS Reticular pseudodrusen are highly concurrent with AMD and have similar associations with known AMD risk factors such as age, gender, smoking, and genetic risk factors. Reticular pseudodrusen are associated more strongly with GA than with CNV. Although RPD are not specific to AMD, they are likely to be a strong risk factor for progression to late-stage AMD, similar to focal pigmentary abnormalities and large drusen.
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Affiliation(s)
- Robert P Finger
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia.
| | - Elaine Chong
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
| | - Myra B McGuinness
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
| | - Luba D Robman
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
| | - Khin Zaw Aung
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
| | - Graham Giles
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
| | - Paul N Baird
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
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