Combining Optical Coherence Tomography and Fundus Photography to Improve Glaucoma Screening

Comparative Evaluation of Fundus Image Interpretation Accuracy in Glaucoma Screening Among Different Physician Groups

Purpose

To examine the variability in glaucoma screening using fundus images among physicians, including non-ophthalmologists.

Patients and Methods

Sixty-nine eyes from 69 patients, including 25 eyes with glaucoma, were included from the Jikei University Hospital from July 2019 to December 2022. Fundus images were captured using TRC-NW8 (Topcon Corporation, Tokyo, Japan), and were interpreted by 10 non-ophthalmologists, 10 non-specialist ophthalmologists, and 9 specialists for diagnostic accuracy. We analyzed differences in diagnostic accuracy among the three groups. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Kappa coefficient were compared, using the Kruskal-Wallis test followed by a post hoc Dunn's test.

Results

The sensitivity and specificity were 0.22 and 0.92 for non-ophthalmologists, 0.49 and 0.83 for non-specialist ophthalmologists, and 0.68 and 0.87 for specialists, respectively. Both specialists and non-specialist ophthalmologists showed significantly higher sensitivity than non-ophthalmologists (Dunn's test, P<0.001 and P=0.031). There was no significant difference in specificity among the three groups (Kruskal-Wallis test, P=0.086). The PPV did not differ significantly between the groups (Kruskal-Wallis test, P=0.108), while the NPV was significantly higher in specialists compared to non-ophthalmologists (Dunn's test, P<0.001). Specialists also had a significantly higher Kappa coefficient than non-ophthalmologists and non-specialist ophthalmologists (Dunn's test, P<0.001 and P=0.024).

Conclusion

Diagnostic accuracy varied significantly based on the physician's background.

Innovations in Diabetic Macular Edema Management: A Comprehensive Review of Automated Quantification and Anti-vascular Endothelial Growth Factor Intervention

Diabetic macular edema (DME) poses a significant threat to the vision and quality of life of individuals with diabetes. This comprehensive review explores recent advancements in DME management, focusing on integrating automated quantification techniques and anti-vascular endothelial growth factor (anti-VEGF) interventions. The review begins with an overview of DME, emphasizing its prevalence, impact on diabetic patients, and current challenges in management. It then delves into the potential of automated quantification, leveraging machine learning and artificial intelligence to improve early detection and monitoring. Concurrently, the role of anti-VEGF therapies in addressing the underlying vascular abnormalities in DME is scrutinized. The review synthesizes vital findings, highlighting the implications for the future of DME management. Promising outcomes from recent clinical trials and case studies are discussed, providing insights into the evolving landscape of personalized medicine approaches. The conclusion underscores the transformative potential of these innovations, calling for continued research, collaboration, and integration of these advancements into clinical practice. This review aims to serve as a roadmap for researchers, clinicians, and industry stakeholders, fostering a collective effort to enhance the precision and efficacy of DME management.

Applications of Artificial Intelligence and Deep Learning in Glaucoma

Diagnosis and detection of progression of glaucoma remains challenging. Artificial intelligence-based tools have the potential to improve and standardize the assessment of glaucoma but development of these algorithms is difficult given the multimodal and variable nature of the diagnosis. Currently, most algorithms are focused on a single imaging modality, specifically screening and diagnosis based on fundus photos or optical coherence tomography images. Use of anterior segment optical coherence tomography and goniophotographs is limited. The majority of algorithms designed for disease progression prediction are based on visual fields. No studies in our literature search assessed the use of artificial intelligence for treatment response prediction and no studies conducted prospective testing of their algorithms. Additional challenges to the development of artificial intelligence-based tools include scarcity of data and a lack of consensus in diagnostic criteria. Although research in the use of artificial intelligence for glaucoma is promising, additional work is needed to develop clinically usable tools.