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Balas M, Micieli JA, Wong J. Integrating AI with tele-ophthalmology in Canada: a review. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00259-X. [PMID: 39255951 DOI: 10.1016/j.jcjo.2024.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 05/21/2024] [Accepted: 08/18/2024] [Indexed: 09/12/2024]
Abstract
The field of ophthalmology is rapidly advancing, with technological innovations enhancing the diagnosis and management of eye diseases. Tele-ophthalmology, or the use of telemedicine for ophthalmology, has emerged as a promising solution to improve access to eye care services, particularly for patients in remote or underserved areas. Despite its potential benefits, tele-ophthalmology faces significant challenges, including the need for high volumes of medical images to be analyzed and interpreted by trained clinicians. Artificial intelligence (AI) has emerged as a powerful tool in ophthalmology, capable of assisting clinicians in diagnosing and treating a variety of conditions. Integrating AI models into existing tele-ophthalmology infrastructure has the potential to revolutionize eye care services by reducing costs, improving efficiency, and increasing access to specialized care. By automating the analysis and interpretation of clinical data and medical images, AI models can reduce the burden on human clinicians, allowing them to focus on patient care and disease management. Available literature on the current status of tele-ophthalmology in Canada and successful AI models in ophthalmology was acquired and examined using the Arksey and O'Malley framework. This review covers literature up to 2022 and is split into 3 sections: 1) existing Canadian tele-ophthalmology infrastructure, with its benefits and drawbacks; 2) preeminent AI models in ophthalmology, across a variety of ocular conditions; and 3) bridging the gap between Canadian tele-ophthalmology and AI in a safe and effective manner.
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Affiliation(s)
- Michael Balas
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan A Micieli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jovi Wong
- Department of Ophthalmology and Vision Sciences, University of Toronto, Ontario, Canada.
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Chen Y, Hu X, Zhu Y, Liu X, Yi B. Real-time non-invasive hemoglobin prediction using deep learning-enabled smartphone imaging. BMC Med Inform Decis Mak 2024; 24:187. [PMID: 38951831 PMCID: PMC11218390 DOI: 10.1186/s12911-024-02585-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/24/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Accurate measurement of hemoglobin concentration is essential for various medical scenarios, including preoperative evaluations and determining blood loss. Traditional invasive methods are inconvenient and not suitable for rapid, point-of-care testing. Moreover, current models, due to their complex parameters, are not well-suited for mobile medical settings, which limits the ability to conduct frequent and rapid testing. This study aims to introduce a novel, compact, and efficient system that leverages deep learning and smartphone technology to accurately estimate hemoglobin levels, thereby facilitating rapid and accessible medical assessments. METHODS The study employed a smartphone application to capture images of the eye, which were subsequently analyzed by a deep neural network trained on data from invasive blood test data. Specifically, the EGE-Unet model was utilized for eyelid segmentation, while the DHA(C3AE) model was employed for hemoglobin level prediction. The performance of the EGE-Unet was evaluated using statistical metrics including mean intersection over union (MIOU), F1 Score, accuracy, specificity, and sensitivity. The DHA(C3AE) model's performance was assessed using mean absolute error (MAE), mean-square error (MSE), root mean square error (RMSE), and R^2. RESULTS The EGE-Unet model demonstrated robust performance in eyelid segmentation, achieving an MIOU of 0.78, an F1 Score of 0.87, an accuracy of 0.97, a specificity of 0.98, and a sensitivity of 0.86. The DHA(C3AE) model for hemoglobin level prediction yielded promising outcomes with an MAE of 1.34, an MSE of 2.85, an RMSE of 1.69, and an R^2 of 0.34. The overall size of the model is modest at 1.08 M, with a computational complexity of 0.12 FLOPs (G). CONCLUSIONS This system presents a groundbreaking approach that eliminates the need for supplementary devices, providing a cost-effective, swift, and accurate method for healthcare professionals to enhance treatment planning and improve patient care in perioperative environments. The proposed system has the potential to enable frequent and rapid testing of hemoglobin levels, which can be particularly beneficial in mobile medical settings. TRIAL REGISTRATION The clinical trial was registered on the Chinese Clinical Trial Registry (No. ChiCTR2100044138) on 20/02/2021.
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Affiliation(s)
- Yuwen Chen
- Chongqing Institute of Green and Intelligent Technology, Chinese Academy of Sciences, Chongqing, 400714, China
| | - Xiaoyan Hu
- Department of Anaesthesiology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Yiziting Zhu
- Department of Anaesthesiology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Xiang Liu
- Department of Anaesthesiology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Bin Yi
- Department of Anaesthesiology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.
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Tang QQ, Yang XG, Wang HQ, Wu DW, Zhang MX. Applications of deep learning for detecting ophthalmic diseases with ultrawide-field fundus images. Int J Ophthalmol 2024; 17:188-200. [PMID: 38239939 PMCID: PMC10754665 DOI: 10.18240/ijo.2024.01.24] [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: 03/04/2023] [Accepted: 11/07/2023] [Indexed: 01/22/2024] Open
Abstract
AIM To summarize the application of deep learning in detecting ophthalmic disease with ultrawide-field fundus images and analyze the advantages, limitations, and possible solutions common to all tasks. METHODS We searched three academic databases, including PubMed, Web of Science, and Ovid, with the date of August 2022. We matched and screened according to the target keywords and publication year and retrieved a total of 4358 research papers according to the keywords, of which 23 studies were retrieved on applying deep learning in diagnosing ophthalmic disease with ultrawide-field images. RESULTS Deep learning in ultrawide-field images can detect various ophthalmic diseases and achieve great performance, including diabetic retinopathy, glaucoma, age-related macular degeneration, retinal vein occlusions, retinal detachment, and other peripheral retinal diseases. Compared to fundus images, the ultrawide-field fundus scanning laser ophthalmoscopy enables the capture of the ocular fundus up to 200° in a single exposure, which can observe more areas of the retina. CONCLUSION The combination of ultrawide-field fundus images and artificial intelligence will achieve great performance in diagnosing multiple ophthalmic diseases in the future.
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Affiliation(s)
- Qing-Qing Tang
- Department of Ophthalmology and Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xiang-Gang Yang
- Department of Ophthalmology and Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hong-Qiu Wang
- Hong Kong University of Science and Technology (Guangzhou), Guangzhou 511400, Guangdong Province, China
| | - Da-Wen Wu
- Department of Ophthalmology and Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Mei-Xia Zhang
- Department of Ophthalmology and Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Zhang J, Zou H. Insights into artificial intelligence in myopia management: from a data perspective. Graefes Arch Clin Exp Ophthalmol 2024; 262:3-17. [PMID: 37231280 PMCID: PMC10212230 DOI: 10.1007/s00417-023-06101-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 03/23/2023] [Accepted: 05/06/2023] [Indexed: 05/27/2023] Open
Abstract
Given the high incidence and prevalence of myopia, the current healthcare system is struggling to handle the task of myopia management, which is worsened by home quarantine during the ongoing COVID-19 pandemic. The utilization of artificial intelligence (AI) in ophthalmology is thriving, yet not enough in myopia. AI can serve as a solution for the myopia pandemic, with application potential in early identification, risk stratification, progression prediction, and timely intervention. The datasets used for developing AI models are the foundation and determine the upper limit of performance. Data generated from clinical practice in managing myopia can be categorized into clinical data and imaging data, and different AI methods can be used for analysis. In this review, we comprehensively review the current application status of AI in myopia with an emphasis on data modalities used for developing AI models. We propose that establishing large public datasets with high quality, enhancing the model's capability of handling multimodal input, and exploring novel data modalities could be of great significance for the further application of AI for myopia.
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Affiliation(s)
- Juzhao Zhang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haidong Zou
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Shanghai Eye Diseases Prevention & Treatment Center, Shanghai Eye Hospital, Shanghai, China.
- National Clinical Research Center for Eye Diseases, Shanghai, China.
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China.
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Chikumba S, Hu Y, Luo J. Deep learning-based fundus image analysis for cardiovascular disease: a review. Ther Adv Chronic Dis 2023; 14:20406223231209895. [PMID: 38028950 PMCID: PMC10657535 DOI: 10.1177/20406223231209895] [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: 11/02/2022] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
It is well established that the retina provides insights beyond the eye. Through observation of retinal microvascular changes, studies have shown that the retina contains information related to cardiovascular disease. Despite the tremendous efforts toward reducing the effects of cardiovascular diseases, they remain a global challenge and a significant public health concern. Conventionally, predicting the risk of cardiovascular disease involves the assessment of preclinical features, risk factors, or biomarkers. However, they are associated with cost implications, and tests to acquire predictive parameters are invasive. Artificial intelligence systems, particularly deep learning (DL) methods applied to fundus images have been generating significant interest as an adjunct assessment tool with the potential of enhancing efforts to prevent cardiovascular disease mortality. Risk factors such as age, gender, smoking status, hypertension, and diabetes can be predicted from fundus images using DL applications with comparable performance to human beings. A clinical change to incorporate DL systems for the analysis of fundus images as an equally good test over more expensive and invasive procedures may require conducting prospective clinical trials to mitigate all the possible ethical challenges and medicolegal implications. This review presents current evidence regarding the use of DL applications on fundus images to predict cardiovascular disease.
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Affiliation(s)
- Symon Chikumba
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Department of Optometry, Faculty of Healthy Sciences, Mzuzu University, Luwinga, Mzuzu, Malawi
| | - Yuqian Hu
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jing Luo
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, 139 Middle Renmin RD, Changsha, Hunan, China
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Mahmud S, Mansour M, Donmez TB, Kutlu M, Freeman C. Non-invasive detection of anemia using lip mucosa images transfer learning convolutional neural networks. Front Big Data 2023; 6:1291329. [PMID: 38025943 PMCID: PMC10655138 DOI: 10.3389/fdata.2023.1291329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Anemia is defined as a drop in the number of erythrocytes or hemoglobin concentration below normal levels in healthy people. The increase in paleness of the skin might vary based on the color of the skin, although there is currently no quantifiable measurement. The pallor of the skin is best visible in locations where the cuticle is thin, such as the interior of the mouth, lips, or conjunctiva. This work focuses on anemia-related pallors and their relationship to blood count values and artificial intelligence. In this study, a deep learning approach using transfer learning and Convolutional Neural Networks (CNN) was implemented in which VGG16, Xception, MobileNet, and ResNet50 architectures, were pre-trained to predict anemia using lip mucous images. A total of 138 volunteers (100 women and 38 men) participated in the work to develop the dataset that contains two image classes: healthy and anemic. Image processing was first performed on a single frame with only the mouth area visible, data argumentation was preformed, and then CNN models were applied to classify the dataset lip images. Statistical metrics were employed to discriminate the performance of the models in terms of Accuracy, Precision, Recal, and F1 Score. Among the CNN algorithms used, Xception was found to categorize the lip images with 99.28% accuracy, providing the best results. The other CNN architectures had accuracies of 96.38% for MobileNet, 95.65% for ResNet %, and 92.39% for VGG16. Our findings show that anemia may be diagnosed using deep learning approaches from a single lip image. This data set will be enhanced in the future to allow for real-time classification.
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Affiliation(s)
- Shekhar Mahmud
- Department of Systems Engineering, Military Technological College, Muscat, Oman
| | - Mohammed Mansour
- Mechatronics Engineering Department, Sakarya University of Applied Sciences, Serdivan, Sakarya, Türkiye
| | - Turker Berk Donmez
- Biomedical Engineering Department, Sakarya University of Applied Sciences, Serdivan, Sakarya, Türkiye
| | - Mustafa Kutlu
- Mechatronics Engineering Department, Sakarya University of Applied Sciences, Serdivan, Sakarya, Türkiye
| | - Chris Freeman
- Electronics and Computer Science, University of Southampton, Southampton, United Kingdom
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Li H, Cao J, Grzybowski A, Jin K, Lou L, Ye J. Diagnosing Systemic Disorders with AI Algorithms Based on Ocular Images. Healthcare (Basel) 2023; 11:1739. [PMID: 37372857 DOI: 10.3390/healthcare11121739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
The advent of artificial intelligence (AI), especially the state-of-the-art deep learning frameworks, has begun a silent revolution in all medical subfields, including ophthalmology. Due to their specific microvascular and neural structures, the eyes are anatomically associated with the rest of the body. Hence, ocular image-based AI technology may be a useful alternative or additional screening strategy for systemic diseases, especially where resources are scarce. This review summarizes the current applications of AI related to the prediction of systemic diseases from multimodal ocular images, including cardiovascular diseases, dementia, chronic kidney diseases, and anemia. Finally, we also discuss the current predicaments and future directions of these applications.
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Affiliation(s)
- Huimin Li
- Eye Center, The Second Affiliated Hospital School of Medicine Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou 310009, China
| | - Jing Cao
- Eye Center, The Second Affiliated Hospital School of Medicine Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou 310009, China
| | - Andrzej Grzybowski
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, 60-836 Poznan, Poland
| | - Kai Jin
- Eye Center, The Second Affiliated Hospital School of Medicine Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou 310009, China
| | - Lixia Lou
- Eye Center, The Second Affiliated Hospital School of Medicine Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou 310009, China
| | - Juan Ye
- Eye Center, The Second Affiliated Hospital School of Medicine Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou 310009, China
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Wen J, Liu D, Wu Q, Zhao L, Iao WC, Lin H. Retinal image‐based artificial intelligence in detecting and predicting kidney diseases: Current advances and future perspectives. VIEW 2023. [DOI: 10.1002/viw.20220070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Affiliation(s)
- Jingyi Wen
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease GuangzhouChina
| | - Dong Liu
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease GuangzhouChina
| | - Qianni Wu
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease GuangzhouChina
| | - Lanqin Zhao
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease GuangzhouChina
| | - Wai Cheng Iao
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease GuangzhouChina
| | - Haotian Lin
- State Key Laboratory of OphthalmologyZhongshan Ophthalmic CenterSun Yat‐sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease GuangzhouChina
- Center for Precision Medicine and Department of Genetics and Biomedical Informatics Zhongshan School of Medicine Sun Yat‐sen University Guangzhou China
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Iao WC, Zhang W, Wang X, Wu Y, Lin D, Lin H. Deep Learning Algorithms for Screening and Diagnosis of Systemic Diseases Based on Ophthalmic Manifestations: A Systematic Review. Diagnostics (Basel) 2023; 13:diagnostics13050900. [PMID: 36900043 PMCID: PMC10001234 DOI: 10.3390/diagnostics13050900] [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: 11/04/2022] [Revised: 02/16/2023] [Accepted: 02/18/2023] [Indexed: 03/06/2023] Open
Abstract
Deep learning (DL) is the new high-profile technology in medical artificial intelligence (AI) for building screening and diagnosing algorithms for various diseases. The eye provides a window for observing neurovascular pathophysiological changes. Previous studies have proposed that ocular manifestations indicate systemic conditions, revealing a new route in disease screening and management. There have been multiple DL models developed for identifying systemic diseases based on ocular data. However, the methods and results varied immensely across studies. This systematic review aims to summarize the existing studies and provide an overview of the present and future aspects of DL-based algorithms for screening systemic diseases based on ophthalmic examinations. We performed a thorough search in PubMed®, Embase, and Web of Science for English-language articles published until August 2022. Among the 2873 articles collected, 62 were included for analysis and quality assessment. The selected studies mainly utilized eye appearance, retinal data, and eye movements as model input and covered a wide range of systemic diseases such as cardiovascular diseases, neurodegenerative diseases, and systemic health features. Despite the decent performance reported, most models lack disease specificity and public generalizability for real-world application. This review concludes the pros and cons and discusses the prospect of implementing AI based on ocular data in real-world clinical scenarios.
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Affiliation(s)
- Wai Cheng Iao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Weixing Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Xun Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Yuxuan Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Duoru Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Haikou 570311, China
- Center for Precision Medicine and Department of Genetics and Biomedical Informatics, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510060, China
- Correspondence:
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