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Hosseini F, Asadi F, Rabiei R, Kiani F, Harari RE. Applications of artificial intelligence in diagnosis of uncommon cystoid macular edema using optical coherence tomography imaging: A systematic review. Surv Ophthalmol 2024:S0039-6257(24)00073-0. [PMID: 38942125 DOI: 10.1016/j.survophthal.2024.06.005] [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: 03/07/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 06/30/2024]
Abstract
Cystoid macular edema (CME) is a sight-threatening condition often associated with inflammatory and diabetic diseases. Early detection is crucial to prevent irreversible vision loss. Artificial intelligence (AI) has shown promise in automating CME diagnosis through optical coherence tomography (OCT) imaging, but its utility needs critical evaluation. This systematic review assesses the application of AI to diagnosis CME, specifically focusing on disorders like postoperative CME (Irvine Gass syndrome) and retinitis pigmentosa without obvious vasculopathy, using OCT imaging. A comprehensive search was conducted across 6 databases (PubMed, Scopus, Web of Science, Wiley, ScienceDirect, and IEEE) from 2018 to November, 2023. Twenty-three articles met the inclusion criteria and were selected for in-depth analysis. We evaluate AI's role in CME diagnosis and its performance in "detection", "classification" and "segmentation" of OCT retinal images. We found that convolutional neural network (CNN)-based methods consistently outperformed other machine learning techniques, achieving an average accuracy of over 96% in detecting and identifying CME from OCT images. Despite certain limitations such as dataset size and ethical concerns, the synergy between AI and OCT, particularly through CNNs, holds promise for significantly advancing CME diagnostics.
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Affiliation(s)
- Farhang Hosseini
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Farkhondeh Asadi
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Reza Rabiei
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fatemeh Kiani
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Rayan Ebnali Harari
- STRATUS Center for Medical Simulation, Harvard Medical School, Boston, MA, USA.
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2
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Driban M, Yan A, Selvam A, Ong J, Vupparaboina KK, Chhablani J. Artificial intelligence in chorioretinal pathology through fundoscopy: a comprehensive review. Int J Retina Vitreous 2024; 10:36. [PMID: 38654344 PMCID: PMC11036694 DOI: 10.1186/s40942-024-00554-4] [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: 03/04/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Applications for artificial intelligence (AI) in ophthalmology are continually evolving. Fundoscopy is one of the oldest ocular imaging techniques but remains a mainstay in posterior segment imaging due to its prevalence, ease of use, and ongoing technological advancement. AI has been leveraged for fundoscopy to accomplish core tasks including segmentation, classification, and prediction. MAIN BODY In this article we provide a review of AI in fundoscopy applied to representative chorioretinal pathologies, including diabetic retinopathy and age-related macular degeneration, among others. We conclude with a discussion of future directions and current limitations. SHORT CONCLUSION As AI evolves, it will become increasingly essential for the modern ophthalmologist to understand its applications and limitations to improve patient outcomes and continue to innovate.
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Affiliation(s)
- Matthew Driban
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Audrey Yan
- Department of Medicine, West Virginia School of Osteopathic Medicine, Lewisburg, WV, USA
| | - Amrish Selvam
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joshua Ong
- Michigan Medicine, University of Michigan, Ann Arbor, USA
| | | | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Manikandan S, Raman R, Rajalakshmi R, Tamilselvi S, Surya RJ. Deep learning-based detection of diabetic macular edema using optical coherence tomography and fundus images: A meta-analysis. Indian J Ophthalmol 2023; 71:1783-1796. [PMID: 37203031 PMCID: PMC10391382 DOI: 10.4103/ijo.ijo_2614_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Diabetic macular edema (DME) is an important cause of visual impairment in the working-age group. Deep learning methods have been developed to detect DME from two-dimensional retinal images and also from optical coherence tomography (OCT) images. The performances of these algorithms vary and often create doubt regarding their clinical utility. In resource-constrained health-care systems, these algorithms may play an important role in determining referral and treatment. The survey provides a diversified overview of macular edema detection methods, including cutting-edge research, with the objective of providing pertinent information to research groups, health-care professionals, and diabetic patients about the applications of deep learning in retinal image detection and classification process. Electronic databases such as PubMed, IEEE Explore, BioMed, and Google Scholar were searched from inception to March 31, 2022, and the reference lists of published papers were also searched. The study followed the preferred reporting items for systematic review and meta-analysis (PRISMA) reporting guidelines. Examination of various deep learning models and their exhibition regarding precision, epochs, their capacity to detect anomalies for less training data, concepts, and challenges that go deep into the applications were analyzed. A total of 53 studies were included that evaluated the performance of deep learning models in a total of 1,414,169°CT volumes, B-scans, patients, and 472,328 fundus images. The overall area under the receiver operating characteristic curve (AUROC) was 0.9727. The overall sensitivity for detecting DME using OCT images was 96% (95% confidence interval [CI]: 0.94-0.98). The overall sensitivity for detecting DME using fundus images was 94% (95% CI: 0.90-0.96).
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Affiliation(s)
- Suchetha Manikandan
- Professor & Deputy Director, Centre for Healthcare Advancement, Innovation ! Research, Vellore Institute of Technology, Chennai, Tamil Nadu, India
| | - Rajiv Raman
- Senior Consultant, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Ramachandran Rajalakshmi
- Head Medical Retina, Dr. Mohan's Diabetes Specialties Centre and Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - S Tamilselvi
- Junior Research Fellow, Centre for Healthcare Advancement, Innovation & Research, Vellore Institute of Technology, Chennai, Tamil Nadu, India
| | - R Janani Surya
- Research Associate, Vision Research Foundation, Chennai, Tamil Nadu, India
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Moradi M, Chen Y, Du X, Seddon JM. Deep ensemble learning for automated non-advanced AMD classification using optimized retinal layer segmentation and SD-OCT scans. Comput Biol Med 2023; 154:106512. [PMID: 36701964 DOI: 10.1016/j.compbiomed.2022.106512] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/30/2022] [Accepted: 12/31/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Accurate retinal layer segmentation in optical coherence tomography (OCT) images is crucial for quantitatively analyzing age-related macular degeneration (AMD) and monitoring its progression. However, previous retinal segmentation models depend on experienced experts and manually annotating retinal layers is time-consuming. On the other hand, accuracy of AMD diagnosis is directly related to the segmentation model's performance. To address these issues, we aimed to improve AMD detection using optimized retinal layer segmentation and deep ensemble learning. METHOD We integrated a graph-cut algorithm with a cubic spline to automatically annotate 11 retinal boundaries. The refined images were fed into a deep ensemble mechanism that combined a Bagged Tree and end-to-end deep learning classifiers. We tested the developed deep ensemble model on internal and external datasets. RESULTS The total error rates for our segmentation model using the boundary refinement approach was significantly lower than OCT Explorer segmentations (1.7% vs. 7.8%, p-value = 0.03). We utilized the refinement approach to quantify 169 imaging features using Zeiss SD-OCT volume scans. The presence of drusen and thickness of total retina, neurosensory retina, and ellipsoid zone to inner-outer segment (EZ-ISOS) thickness had higher contributions to AMD classification compared to other features. The developed ensemble learning model obtained a higher diagnostic accuracy in a shorter time compared with two human graders. The area under the curve (AUC) for normal vs. early AMD was 99.4%. CONCLUSION Testing results showed that the developed framework is repeatable and effective as a potentially valuable tool in retinal imaging research.
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Affiliation(s)
- Mousa Moradi
- Department of Biomedical Engineering, University of Massachusetts, Amherst, MA, United States
| | - Yu Chen
- Department of Biomedical Engineering, University of Massachusetts, Amherst, MA, United States.
| | - Xian Du
- Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, MA, United States.
| | - Johanna M Seddon
- Department of Ophthalmology & Visual Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States.
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Pavithra K, Kumar P, Geetha M, Bhandary SV. Computer aided diagnosis of diabetic macular edema in retinal fundus and OCT images: A review. Biocybern Biomed Eng 2023. [DOI: 10.1016/j.bbe.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Alexopoulos P, Madu C, Wollstein G, Schuman JS. The Development and Clinical Application of Innovative Optical Ophthalmic Imaging Techniques. Front Med (Lausanne) 2022; 9:891369. [PMID: 35847772 PMCID: PMC9279625 DOI: 10.3389/fmed.2022.891369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/23/2022] [Indexed: 11/22/2022] Open
Abstract
The field of ophthalmic imaging has grown substantially over the last years. Massive improvements in image processing and computer hardware have allowed the emergence of multiple imaging techniques of the eye that can transform patient care. The purpose of this review is to describe the most recent advances in eye imaging and explain how new technologies and imaging methods can be utilized in a clinical setting. The introduction of optical coherence tomography (OCT) was a revolution in eye imaging and has since become the standard of care for a plethora of conditions. Its most recent iterations, OCT angiography, and visible light OCT, as well as imaging modalities, such as fluorescent lifetime imaging ophthalmoscopy, would allow a more thorough evaluation of patients and provide additional information on disease processes. Toward that goal, the application of adaptive optics (AO) and full-field scanning to a variety of eye imaging techniques has further allowed the histologic study of single cells in the retina and anterior segment. Toward the goal of remote eye care and more accessible eye imaging, methods such as handheld OCT devices and imaging through smartphones, have emerged. Finally, incorporating artificial intelligence (AI) in eye images has the potential to become a new milestone for eye imaging while also contributing in social aspects of eye care.
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Affiliation(s)
- Palaiologos Alexopoulos
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Chisom Madu
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Gadi Wollstein
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, United States
- Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, NY, United States
- Center for Neural Science, College of Arts & Science, New York University, New York, NY, United States
| | - Joel S. Schuman
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY, United States
- Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, NY, United States
- Center for Neural Science, College of Arts & Science, New York University, New York, NY, United States
- Department of Electrical and Computer Engineering, NYU Tandon School of Engineering, Brooklyn, NY, United States
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Continual Learning Objective for Analyzing Complex Knowledge Representations. SENSORS 2022; 22:s22041667. [PMID: 35214568 PMCID: PMC8879446 DOI: 10.3390/s22041667] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/11/2022] [Accepted: 02/11/2022] [Indexed: 02/04/2023]
Abstract
Human beings tend to incrementally learn from the rapidly changing environment without comprising or forgetting the already learned representations. Although deep learning also has the potential to mimic such human behaviors to some extent, it suffers from catastrophic forgetting due to which its performance on already learned tasks drastically decreases while learning about newer knowledge. Many researchers have proposed promising solutions to eliminate such catastrophic forgetting during the knowledge distillation process. However, to our best knowledge, there is no literature available to date that exploits the complex relationships between these solutions and utilizes them for the effective learning that spans over multiple datasets and even multiple domains. In this paper, we propose a continual learning objective that encompasses mutual distillation loss to understand such complex relationships and allows deep learning models to effectively retain the prior knowledge while adapting to the new classes, new datasets, and even new applications. The proposed objective was rigorously tested on nine publicly available, multi-vendor, and multimodal datasets that span over three applications, and it achieved the top-1 accuracy of 0.9863% and an F1-score of 0.9930.
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8
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CDC-Net: Cascaded decoupled convolutional network for lesion-assisted detection and grading of retinopathy using optical coherence tomography (OCT) scans. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.103030] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Benet D, Pellicer-Valero OJ. Artificial Intelligence: the unstoppable revolution in ophthalmology. Surv Ophthalmol 2021; 67:252-270. [PMID: 33741420 DOI: 10.1016/j.survophthal.2021.03.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 01/31/2021] [Accepted: 03/08/2021] [Indexed: 12/18/2022]
Abstract
Artificial Intelligence (AI) is an unstoppable force that is starting to permeate all aspects of our society as part of the revolution being brought into our lives (and into medicine) by the digital era, and accelerated by the current COVID-19 pandemic. As the population ages and developing countries move forward, AI-based systems may be a key asset in streamlining the screening, staging, and treatment planning of sight-threatening eye conditions, offloading the most tedious tasks from the experts, allowing for a greater population coverage, and bringing the best possible care to every patient. This paper presents a review of the state of the art of AI in the field of ophthalmology, focusing on the strengths and weaknesses of current systems, and defining the vision that will enable us to advance scientifically in this digital era. It starts with a thorough yet accessible introduction to the algorithms underlying all modern AI applications. Then, a critical review of the main AI applications in ophthalmology is presented, including Diabetic Retinopathy, Age-Related Macular Degeneration, Retinopathy of Prematurity, Glaucoma, and other AI-related topics such as image enhancement. The review finishes with a brief discussion on the opportunities and challenges that the future of this field might hold.
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Affiliation(s)
| | - Oscar J Pellicer-Valero
- Intelligent Data Analysis Laboratory, Department of Electronic Engineering, ETSE (Engineering School), Universitat de València (UV), Valencia, Spain
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11
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Hassan T, Akram MU, Werghi N, Nazir MN. RAG-FW: A Hybrid Convolutional Framework for the Automated Extraction of Retinal Lesions and Lesion-Influenced Grading of Human Retinal Pathology. IEEE J Biomed Health Inform 2021; 25:108-120. [PMID: 32224467 DOI: 10.1109/jbhi.2020.2982914] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The identification of retinal lesions plays a vital role in accurately classifying and grading retinopathy. Many researchers have presented studies on optical coherence tomography (OCT) based retinal image analysis over the past. However, to the best of our knowledge, there is no framework yet available that can extract retinal lesions from multi-vendor OCT scans and utilize them for the intuitive severity grading of the human retina. To cater this lack, we propose a deep retinal analysis and grading framework (RAG-FW). RAG-FW is a hybrid convolutional framework that extracts multiple retinal lesions from OCT scans and utilizes them for lesion-influenced grading of retinopathy as per the clinical standards. RAG-FW has been rigorously tested on 43,613 scans from five highly complex publicly available datasets, containing multi-vendor scans, where it achieved the mean intersection-over-union score of 0.8055 for extracting the retinal lesions and the accuracy of 98.70% for the correct severity grading of retinopathy.
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12
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Accelerating ophthalmic artificial intelligence research: the role of an open access data repository. Curr Opin Ophthalmol 2020; 31:337-350. [PMID: 32740059 DOI: 10.1097/icu.0000000000000678] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW Artificial intelligence has already provided multiple clinically relevant applications in ophthalmology. Yet, the explosion of nonstandardized reporting of high-performing algorithms are rendered useless without robust and streamlined implementation guidelines. The development of protocols and checklists will accelerate the translation of research publications to impact on patient care. RECENT FINDINGS Beyond technological scepticism, we lack uniformity in analysing algorithmic performance generalizability, and benchmarking impacts across clinical settings. No regulatory guardrails have been set to minimize bias or optimize interpretability; no consensus clinical acceptability thresholds or systematized postdeployment monitoring has been set. Moreover, stakeholders with misaligned incentives deepen the landscape complexity especially when it comes to the requisite data integration and harmonization to advance the field. Therefore, despite increasing algorithmic accuracy and commoditization, the infamous 'implementation gap' persists. Open clinical data repositories have been shown to rapidly accelerate research, minimize redundancies and disseminate the expertise and knowledge required to overcome existing barriers. Drawing upon the longstanding success of existing governance frameworks and robust data use and sharing agreements, the ophthalmic community has tremendous opportunity in ushering artificial intelligence into medicine. By collaboratively building a powerful resource of open, anonymized multimodal ophthalmic data, the next generation of clinicians can advance data-driven eye care in unprecedented ways. SUMMARY This piece demonstrates that with readily accessible data, immense progress can be achieved clinically and methodologically to realize artificial intelligence's impact on clinical care. Exponentially progressive network effects can be seen by consolidating, curating and distributing data amongst both clinicians and data scientists.
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Automatic Identification and Intuitive Map Representation of the Epiretinal Membrane Presence in 3D OCT Volumes. SENSORS 2019; 19:s19235269. [PMID: 31795480 PMCID: PMC6929067 DOI: 10.3390/s19235269] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 01/27/2023]
Abstract
Optical Coherence Tomography (OCT) is a medical image modality providing high-resolution cross-sectional visualizations of the retinal tissues without any invasive procedure, commonly used in the analysis of retinal diseases such as diabetic retinopathy or retinal detachment. Early identification of the epiretinal membrane (ERM) facilitates ERM surgical removal operations. Moreover, presence of the ERM is linked to other retinal pathologies, such as macular edemas, being among the main causes of vision loss. In this work, we propose an automatic method for the characterization and visualization of the ERM's presence using 3D OCT volumes. A set of 452 features is refined using the Spatial Uniform ReliefF (SURF) selection strategy to identify the most relevant ones. Afterwards, a set of representative classifiers is trained, selecting the most proficient model, generating a 2D reconstruction of the ERM's presence. Finally, a post-processing stage using a set of morphological operators is performed to improve the quality of the generated maps. To verify the proposed methodology, we used 20 3D OCT volumes, both with and without the ERM's presence, totalling 2428 OCT images manually labeled by a specialist. The most optimal classifier in the training stage achieved a mean accuracy of 91 . 9 % . Regarding the post-processing stage, mean specificity values of 91 . 9 % and 99 . 0 % were obtained from volumes with and without the ERM's presence, respectively.
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Cabaleiro P, de Moura J, Novo J, Charlón P, Ortega M. Automatic Identification and Representation of the Cornea-Contact Lens Relationship Using AS-OCT Images. SENSORS (BASEL, SWITZERLAND) 2019; 19:s19235087. [PMID: 31766394 PMCID: PMC6929080 DOI: 10.3390/s19235087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 06/10/2023]
Abstract
The clinical study of the cornea-contact lens relationship is widely used in the process of adaptation of the scleral contact lens (SCL) to the ocular morphology of patients. In that sense, the measurement of the adjustment between the SCL and the cornea can be used to study the comfort or potential damage that the lens may produce in the eye. The current analysis procedure implies the manual inspection of optical coherence tomography of the anterior segment images (AS-OCT) by the clinical experts. This process presents several limitations such as the inability to obtain complex metrics, the inaccuracies of the manual measurements or the requirement of a time-consuming process by the expert in a tedious process, among others. This work proposes a fully-automatic methodology for the extraction of the areas of interest in the study of the cornea-contact lens relationship and the measurement of representative metrics that allow the clinicians to measure quantitatively the adjustment between the lens and the eye. In particular, three distance metrics are herein proposed: Vertical, normal to the tangent of the region of interest and by the nearest point. Moreover, the images are classified to characterize the analysis as belonging to the central cornea, peripheral cornea, limbus or sclera (regions where the inner layer of the lens has already joined the cornea). Finally, the methodology graphically presents the results of the identified segmentations using an intuitive visualization that facilitates the analysis and diagnosis of the patients by the clinical experts.
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Affiliation(s)
- Pablo Cabaleiro
- Centro de investigación CITIC, Universidade da Coruña, 15071 A Coruña, Spain; (P.C.); (J.N.); (M.O.)
- VARPA, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, 15006 A Coruña, Spain
| | - Joaquim de Moura
- Centro de investigación CITIC, Universidade da Coruña, 15071 A Coruña, Spain; (P.C.); (J.N.); (M.O.)
- VARPA, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, 15006 A Coruña, Spain
| | - Jorge Novo
- Centro de investigación CITIC, Universidade da Coruña, 15071 A Coruña, Spain; (P.C.); (J.N.); (M.O.)
- VARPA, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, 15006 A Coruña, Spain
| | - Pablo Charlón
- Instituto Oftalmológico Victoria de Rojas, 15009 A Coruña, Spain;
- Hospital HM Rosaleda, 15701 Santiago de Compostela, Spain
| | - Marcos Ortega
- Centro de investigación CITIC, Universidade da Coruña, 15071 A Coruña, Spain; (P.C.); (J.N.); (M.O.)
- VARPA, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, 15006 A Coruña, Spain
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