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Larsen TJ, Pettersen MB, Nygaard Jensen H, Lynge Pedersen M, Lund-Andersen H, Jørgensen ME, Byberg S. The use of artificial intelligence to assess diabetic eye disease among the Greenlandic population. Int J Circumpolar Health 2024; 83:2314802. [PMID: 38359160 PMCID: PMC10877649 DOI: 10.1080/22423982.2024.2314802] [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: 08/02/2023] [Accepted: 02/01/2024] [Indexed: 02/17/2024] Open
Abstract
Background: Retina fundus images conducted in Greenland are telemedically assessed for diabetic retinopathy by ophthalmological nurses in Denmark. Applying an AI grading solution, in a Greenlandic setting, could potentially improve the efficiency and cost-effectiveness of DR screening.Method: We developed an AI model using retina fundus photos, performed on persons registered with diabetes in Greenland and Denmark, using Optos® ultra wide-field scanning laser ophthalmoscope, graded according to ICDR.Using the ResNet50 network we compared the model's ability to distinguish between different images of ICDR severity levels in a confusion matrix.Results: Comparing images with ICDR level 0 to images of ICDR level 4 resulted in an accuracy of 0.9655, AUC of 0.9905, sensitivity and specificity of 96.6%.Comparing ICDR levels 0,1,2 with ICDR levels 3,4, we achieved a performance with an accuracy of 0.8077, an AUC of 0.8728, a sensitivity of 84.6% and a specificity of 78.8%. For the other comparisons, we achieved a modest performance.Conclusion: We developed an AI model using Greenlandic data, to automatically detect DR on Optos retina fundus images. The sensitivity and specificity were too low for our model to be applied directly in a clinical setting, thus optimising the model should be prioritised.
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Affiliation(s)
- Trine Jul Larsen
- Greenland Center of Health Research, Institute of Nursing and Health Science, University of Greenland, Nuuk, Greenland
| | | | | | - Michael Lynge Pedersen
- Greenland Center of Health Research, Institute of Nursing and Health Science, University of Greenland, Nuuk, Greenland
- Rigshospitalet-Glostrup University Hospital, Glostrup, Denmark
| | - Henrik Lund-Andersen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
- Rigshospitalet-Glostrup University Hospital, Glostrup, Denmark
| | | | - Stine Byberg
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
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Gende M, Castelo L, de Moura J, Novo J, Ortega M. Intra- and Inter-expert Validation of an Automatic Segmentation Method for Fluid Regions Associated with Central Serous Chorioretinopathy in OCT Images. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024; 37:107-122. [PMID: 38343245 DOI: 10.1007/s10278-023-00926-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 03/02/2024]
Abstract
Central Serous Chorioretinopathy (CSC) is a retinal disorder caused by the accumulation of fluid, resulting in vision distortion. The diagnosis of this disease is typically performed through Optical Coherence Tomography (OCT) imaging, which displays any fluid buildup between the retinal layers. Currently, these fluid regions are manually detected by visual inspection a time-consuming and subjective process that can be prone to errors. A series of six deep learning-based automatic segmentation architectural configurations of different levels of complexity were trained and compared in order to determine the best model intended for the automatic segmentation of CSC-related lesions in OCT images. The best performing models were then evaluated in an external validation study. Furthermore, an intra- and inter-expert analysis was conducted in order to compare the manual segmentation performed by expert ophthalmologists with the automatic segmentation provided by the models. Test results of the best performing configuration achieved a mean Dice of 0.868 ± 0.056 in the internal dataset. In the external validation set, these models achieved a level of agreement with human experts of up to 0.960 in terms of Kappa coefficient, contrasting with a value of 0.951 for agreement between human experts. Overall, the models reached a better agreement with either of the human experts than these experts with each other, suggesting that automatic segmentation models for the detection of CSC-related lesions in OCT imaging can be useful tools for assessing this disease, reducing the workload of manual inspection and leading to a more robust and objective diagnosis method.
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Affiliation(s)
- Mateo Gende
- Grupo, VARPA, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, Xubias de Arriba, 84, 15006, A Coruña, Spain
- Centro de investigación, CITIC, Universidade da Coruña, Campus de Elviña s/n, 15071, A Coruña, Spain
| | - Lúa Castelo
- Grupo, VARPA, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, Xubias de Arriba, 84, 15006, A Coruña, Spain
- Centro de investigación, CITIC, Universidade da Coruña, Campus de Elviña s/n, 15071, A Coruña, Spain
| | - Joaquim de Moura
- Grupo, VARPA, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, Xubias de Arriba, 84, 15006, A Coruña, Spain.
- Centro de investigación, CITIC, Universidade da Coruña, Campus de Elviña s/n, 15071, A Coruña, Spain.
| | - Jorge Novo
- Grupo, VARPA, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, Xubias de Arriba, 84, 15006, A Coruña, Spain
- Centro de investigación, CITIC, Universidade da Coruña, Campus de Elviña s/n, 15071, A Coruña, Spain
| | - Marcos Ortega
- Grupo, VARPA, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, Xubias de Arriba, 84, 15006, A Coruña, Spain
- Centro de investigación, CITIC, Universidade da Coruña, Campus de Elviña s/n, 15071, A Coruña, Spain
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Teoh CS, Wong KH, Xiao D, Wong HC, Zhao P, Chan HW, Yuen YS, Naing T, Yogesan K, Koh VTC. Variability in Grading Diabetic Retinopathy Using Retinal Photography and Its Comparison with an Automated Deep Learning Diabetic Retinopathy Screening Software. Healthcare (Basel) 2023; 11:1697. [PMID: 37372815 DOI: 10.3390/healthcare11121697] [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: 03/19/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) screening using colour retinal photographs is cost-effective and time-efficient. In real-world clinical settings, DR severity is frequently graded by individuals of different expertise levels. We aim to determine the agreement in DR severity grading between human graders of varying expertise and an automated deep learning DR screening software (ADLS). METHODS Using the International Clinical DR Disease Severity Scale, two hundred macula-centred fundus photographs were graded by retinal specialists, ophthalmology residents, family medicine physicians, medical students, and the ADLS. Based on referral urgency, referral grading was divided into no referral, non-urgent referral, and urgent referral to an ophthalmologist. Inter-observer and intra-group variations were analysed using Gwet's agreement coefficient, and the performance of ADLS was evaluated using sensitivity and specificity. RESULTS The agreement coefficient for inter-observer and intra-group variability ranged from fair to very good, and moderate to good, respectively. The ADLS showed a high area under curve of 0.879, 0.714, and 0.836 for non-referable DR, non-urgent referable DR, and urgent referable DR, respectively, with varying sensitivity and specificity values. CONCLUSION Inter-observer and intra-group agreements among human graders vary widely, but ADLS is a reliable and reasonably sensitive tool for mass screening to detect referable DR and urgent referable DR.
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Affiliation(s)
- Chin Sheng Teoh
- Department of Ophthalmology, National University Health System, Singapore 119228, Singapore
| | - Kah Hie Wong
- Department of Ophthalmology, National University Health System, Singapore 119228, Singapore
| | - Di Xiao
- Commonwealth Scientific and Industrial Research Organisation, Urrbrae 5064, Australia
| | - Hung Chew Wong
- Medicine Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Paul Zhao
- Department of Ophthalmology, National University Health System, Singapore 119228, Singapore
| | - Hwei Wuen Chan
- Department of Ophthalmology, National University Health System, Singapore 119228, Singapore
| | - Yew Sen Yuen
- Department of Ophthalmology, National University Health System, Singapore 119228, Singapore
| | - Thet Naing
- Department of Ophthalmology, National University Health System, Singapore 119228, Singapore
| | | | - Victor Teck Chang Koh
- Department of Ophthalmology, National University Health System, Singapore 119228, Singapore
- Centre for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
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Deep Learning and Medical Image Processing Techniques for Diabetic Retinopathy: A Survey of Applications, Challenges, and Future Trends. JOURNAL OF HEALTHCARE ENGINEERING 2023; 2023:2728719. [PMID: 36776951 PMCID: PMC9911247 DOI: 10.1155/2023/2728719] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/28/2022] [Accepted: 11/25/2022] [Indexed: 02/05/2023]
Abstract
Diabetic retinopathy (DR) is a common eye retinal disease that is widely spread all over the world. It leads to the complete loss of vision based on the level of severity. It damages both retinal blood vessels and the eye's microscopic interior layers. To avoid such issues, early detection of DR is essential in association with routine screening methods to discover mild causes in manual initiation. But these diagnostic procedures are extremely difficult and expensive. The unique contributions of the study include the following: first, providing detailed background of the DR disease and the traditional detection techniques. Second, the various imaging techniques and deep learning applications in DR are presented. Third, the different use cases and real-life scenarios are explored relevant to DR detection wherein deep learning techniques have been implemented. The study finally highlights the potential research opportunities for researchers to explore and deliver effective performance results in diabetic retinopathy detection.
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Stuermer L, Martin R. Characterization of technologies in digital health applied in vision care. JOURNAL OF OPTOMETRY 2022; 15 Suppl 1:S70-S81. [PMID: 36661275 PMCID: PMC9732480 DOI: 10.1016/j.optom.2022.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 06/17/2023]
Abstract
Digital health technology is increasingly becoming part of the evolution of health services, not only for the innovation of equipment but also in support of health processes. Eye health is one of the areas that most explores this field, being a reference in different segments of digital health and the use of applied technological resources. Thus, the purpose of this review was to analyse and characterize the development of research in digital health applied to vision sciences in the last decade. An exploratory-quantitative review of the research based on studies indexed in the SCOPUS database in the last 10 years, which related aspects of digital health technologies with their use within the vision sciences, was conducted. The research results were filtered, including journal articles and excluding those not directly related to vision. The final sample was categorized and classified according to the technology used, the relationship with eye/visual health and its practical applications. A total of 1069 reports were identified (32.09% published since 2021). "Artificial Intelligence" (77.74%) was the most frequent technological tool cited, and posterior segment (68.10%) most eye structure studied, being diabetic retinopathy (27.88%) the main studied disease. The vast majority have potential for clinical use (93.73%), especially those aimed at supporting decision-making. Technologies in digital health in the vision sciences have had a huge growth in recent years, with emphasis on artificial intelligence applied to the posterior segment, but with a low development of studies aimed at using this technology in primary visual care.
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Affiliation(s)
- Leandro Stuermer
- Department of Optometry, University of Contestado, Canoinhas Brazil; Optometry Research Group, IOBA Eye Institute. School of Optometry, University of Valladolid, 47011 Valladolid, Spain
| | - Raul Martin
- Optometry Research Group, IOBA Eye Institute. School of Optometry, University of Valladolid, 47011 Valladolid, Spain; Universidad de Valladolid. Departamento de Física Teórica, Atómica y Óptica. Paseo de Belén, 7 - Campus Miguel Delibes, 47011 Valladolid, Spain.
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Morya AK, Janti SS, Sisodiya P, Tejaswini A, Prasad R, Mali KR, Gurnani B. Everything real about unreal artificial intelligence in diabetic retinopathy and in ocular pathologies. World J Diabetes 2022; 13:822-834. [PMID: 36311999 PMCID: PMC9606792 DOI: 10.4239/wjd.v13.i10.822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/11/2022] [Accepted: 09/10/2022] [Indexed: 02/05/2023] Open
Abstract
Artificial Intelligence is a multidisciplinary field with the aim of building platforms that can make machines act, perceive, reason intelligently and whose goal is to automate activities that presently require human intelligence. From the cornea to the retina, artificial intelligence (AI) is expected to help ophthalmologists diagnose and treat ocular diseases. In ophthalmology, computerized analytics are being viewed as efficient and more objective ways to interpret the series of images and come to a conclusion. AI can be used to diagnose and grade diabetic retinopathy, glaucoma, age-related macular degeneration, cataracts, IOL power calculation, retinopathy of prematurity and keratoconus. This review article intends to discuss various aspects of artificial intelligence in ophthalmology.
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Affiliation(s)
- Arvind Kumar Morya
- Department of Ophthalmology, All India Institute of Medical Sciences Bibinagar, Hyderabad 508126, Telangana, India
| | - Siddharam S Janti
- Department of Ophthalmology, All India Institute of Medical Sciences Bibinagar, Hyderabad 508126, Telangana, India
| | - Priya Sisodiya
- Department of Ophthalmology, Sadguru Netra Chikitsalaya, Chitrakoot 485001, Madhya Pradesh, India
| | - Antervedi Tejaswini
- Department of Ophthalmology, All India Institute of Medical Sciences Bibinagar, Hyderabad 508126, Telangana, India
| | - Rajendra Prasad
- Department of Ophthalmology, R P Eye Institute, New Delhi 110001, New Delhi, India
| | - Kalpana R Mali
- Department of Pharmacology, All India Institute of Medical Sciences, Bibinagar, Hyderabad 508126, Telangana, India
| | - Bharat Gurnani
- Department of Ophthalmology, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry 605007, Pondicherry, India
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Automatic detection of microaneurysms in optical coherence tomography images of retina using convolutional neural networks and transfer learning. Sci Rep 2022; 12:13975. [PMID: 35978087 PMCID: PMC9385621 DOI: 10.1038/s41598-022-18206-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 08/08/2022] [Indexed: 11/15/2022] Open
Abstract
Microaneurysms (MAs) are pathognomonic signs that help clinicians to detect diabetic retinopathy (DR) in the early stages. Automatic detection of MA in retinal images is an active area of research due to its application in screening processes for DR which is one of the main reasons of blindness amongst the working-age population. The focus of these works is on the automatic detection of MAs in en face retinal images like fundus color and Fluorescein Angiography (FA). On the other hand, detection of MAs from Optical Coherence Tomography (OCT) images has 2 main advantages: first, OCT is a non-invasive imaging technique that does not require injection, therefore is safer. Secondly, because of the proven application of OCT in detection of Age-Related Macular Degeneration, Diabetic Macular Edema, and normal cases, thanks to detecting MAs in OCT, extensive information is obtained by using this imaging technique. In this research, the concentration is on the diagnosis of MAs using deep learning in the OCT images which represent in-depth structure of retinal layers. To this end, OCT B-scans should be divided into strips and MA patterns should be searched in the resulted strips. Since we need a dataset comprising OCT image strips with suitable labels and such large labelled datasets are not yet available, we have created it. For this purpose, an exact registration method is utilized to align OCT images with FA photographs. Then, with the help of corresponding FA images, OCT image strips are created from OCT B-scans in four labels, namely MA, normal, abnormal, and vessel. Once the dataset of image strips is prepared, a stacked generalization (stacking) ensemble of four fine-tuned, pre-trained convolutional neural networks is trained to classify the strips of OCT images into the mentioned classes. FA images are used once to create OCT strips for training process and they are no longer needed for subsequent steps. Once the stacking ensemble model is obtained, it will be used to classify the OCT strips in the test process. The results demonstrate that the proposed framework classifies overall OCT image strips and OCT strips containing MAs with accuracy scores of 0.982 and 0.987, respectively.
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Bortoli JQ, Silber PC, Picetti E, Silva CFD, Pakter HM. Retinografia como forma de rastreio de retinopatia diabética em hospital terciário do Sistema Único de Saúde. REVISTA BRASILEIRA DE OFTALMOLOGIA 2022. [DOI: 10.37039/1982.8551.20220057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Li J, Zhao D, Deng Q, Hao Y, Wang M, Sun J, Liu J, Ren G, Li H, Qi Y, Liu J. Reduced serum calcium is associated with a higher risk of retinopathy in non-diabetic individuals: The Chinese Multi-provincial Cohort Study. Front Endocrinol (Lausanne) 2022; 13:973078. [PMID: 36531449 PMCID: PMC9747923 DOI: 10.3389/fendo.2022.973078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 11/16/2022] [Indexed: 12/02/2022] Open
Abstract
AIMS As a common micro-vascular disease, retinopathy can also present in non-diabetic individuals and increase the risk of clinical cardiovascular disease. Understanding the relationship between serum calcium and retinopathy would contribute to etiological study and disease prevention. METHODS A total of 1836 participants (aged 55-84 years and diabetes-free) from the Chinese Multi-Provincial Cohort Study-Beijing Project in 2012 were included for analyzing the relation between serum calcium level and retinopathy prevalence. Of these, 1407 non-diabetic participants with data on serum calcium in both the 2007 and 2012 surveys were included for analyzing the association of five-year changes in serum calcium with retinopathy risk. The retinopathy was determined from retinal images by ophthalmologists and a computer-aided system using convolutional neural network (CNN). The association between serum calcium and retinopathy risk was assessed by multivariate logistic regression. RESULTS Among the 1836 participants (male, 42.5%), 330 (18.0%) had retinopathy determined by CNN. After multivariate adjustment, the odds ratio (OR) comparing the lowest quartiles (serum calcium < 2.38 mmol/L) to the highest quartiles (serum calcium ≥ 2.50 mmol/L) for the prevalence of retinopathy determined by CNN was 1.58 (95% confidence interval [CI]: 1.10 - 2.27). The findings were consistent with the result discerned by ophthalmologists, and either by CNN or ophthalmologists. These relationships are preserved even in those without metabolic risk factors, including hypertension, high hemoglobin A1c, high fasting blood glucose, or high low-density lipoprotein cholesterol. Over 5 years, participants with the sustainably low levels of serum calcium (OR: 1.58; 95%CI: 1.05 - 2.39) and those who experienced a decrease in serum calcium (OR: 1.56; 95%CI: 1.04 - 2.35) had an increased risk of retinopathy than those with the sustainably high level of serum calcium. CONCLUSIONS Reduced serum calcium was independently associated with an increased risk of retinopathy in non-diabetic individuals. Moreover, reduction of serum calcium could further increase the risk of retinopathy even in the absence of hypertension, high glucose, or high cholesterol. This study suggested that maintaining a high level of serum calcium may be recommended for reducing the growing burden of retinopathy. Further large prospective studies will allow more detailed information.
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Affiliation(s)
- Jiangtao Li
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China
- Beijing Municipal Key laboratory of Clinical Epidemiology, Beijing, China
| | - Dong Zhao
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China
- Beijing Municipal Key laboratory of Clinical Epidemiology, Beijing, China
| | - Qiuju Deng
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China
- Beijing Municipal Key laboratory of Clinical Epidemiology, Beijing, China
| | - Yongchen Hao
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China
- Beijing Municipal Key laboratory of Clinical Epidemiology, Beijing, China
| | - Miao Wang
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China
- Beijing Municipal Key laboratory of Clinical Epidemiology, Beijing, China
| | - Jiayi Sun
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China
- Beijing Municipal Key laboratory of Clinical Epidemiology, Beijing, China
| | - Jun Liu
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China
- Beijing Municipal Key laboratory of Clinical Epidemiology, Beijing, China
| | - Guandi Ren
- School of Information and Electronics, Beijing Institute of Technology, Beijing, China
| | - Huiqi Li
- School of Information and Electronics, Beijing Institute of Technology, Beijing, China
| | - Yue Qi
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China
- Beijing Municipal Key laboratory of Clinical Epidemiology, Beijing, China
- *Correspondence: Yue Qi, ; ; Jing Liu,
| | - Jing Liu
- Center for Clinical and Epidemiologic Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing, China
- Beijing Municipal Key laboratory of Clinical Epidemiology, Beijing, China
- *Correspondence: Yue Qi, ; ; Jing Liu,
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Pereira AMP, da Silva Laureano RM, de Lima Neto FB. Five regions, five retinopathy screening programmes: a systematic review of how Portugal addresses the challenge. BMC Health Serv Res 2021; 21:756. [PMID: 34330280 PMCID: PMC8325279 DOI: 10.1186/s12913-021-06776-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The implementation of a population-based screening programme for diabetic retinopathy involves several challenges, often leading to postponements and setbacks at high human and material costs. Thus, it is of the utmost importance to promote the sharing of experiences, successes, and difficulties. However, factors such as the existence of regional programmes, specificities of each country's health systems, organisational and even linguistic barriers, make it difficult to create a solid framework that can be used as a basis for future projects. METHODS Web of Science and PubMed platforms were searched using appropriate key words. The review process resulted in 423 articles adherent to the search criteria, 28 of which were accepted and analysed. Web sites of all Portuguese governmental and non-governmental organisations, with a relevant role on the research topic, were inspected and 75 official documents were retrieved and analysed. RESULTS Since 2001, five regional screening programmes were gradually implemented under the guidelines of Portuguese General Health Department. However, complete population coverage was still not achieved. Among the main difficulties reported are the complex articulation between different levels of care providers, the low number of orthoptic technician in the national health system, the high burden that images grading, and treatment of positive cases represents for hospitals ophthalmology services, and low adherence rates. Yet, the comparison between strategies adopted in the different regions allowed the identification of potential solutions: hire orthoptic technician for primary health care units, eliminating the dependence of hospital professionals; use artificial intelligence algorithms for automatic retinographies grading, avoiding ophthalmologists overload; adoption of proximity strategies, as the use of portable retinographers, to promote adherence to screening. CONCLUSION Access to diabetic retinopathy screening remains remarkably variable in Portugal and needs urgent attention. However, several characteristics of effective screening programmes were found in Portuguese screening programmes, what seems to point toward promising outcomes, especially if each other highlights are considered. The findings of this research could be very useful for the other countries with similar socio-political characteristics. TRIAL REGISTRATION PROSPERO registration ID CRD42020200115 .
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Affiliation(s)
| | - Raul Manuel da Silva Laureano
- Instituto Universitário de Lisboa (ISCTE-IUL), Business Research Unit (BRU-IUL) and ISTAR-IUL, Av. das Forças Armadas, 1649-026 Lisbon, Portugal
| | - Fernando Buarque de Lima Neto
- Escola Politécnica, Computer Engineering (POLI/PPG-EC), Universidade de Pernambuco (UPE), Rua Benfica, 455 - Bloco ‘C’, Recife, 50720-001 Brazil
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Sarao V, Veritti D, Lanzetta P. Automated diabetic retinopathy detection with two different retinal imaging devices using artificial intelligence: a comparison study. Graefes Arch Clin Exp Ophthalmol 2020; 258:2647-2654. [DOI: 10.1007/s00417-020-04853-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/12/2020] [Accepted: 07/14/2020] [Indexed: 12/14/2022] Open
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Lanzetta P, Sarao V, Scanlon PH, Barratt J, Porta M, Bandello F, Loewenstein A. Fundamental principles of an effective diabetic retinopathy screening program. Acta Diabetol 2020; 57:785-798. [PMID: 32222818 PMCID: PMC7311555 DOI: 10.1007/s00592-020-01506-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/14/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Diabetic retinopathy (DR) is the leading cause of blindness among working-age adults worldwide. Early detection and treatment are necessary to forestall vision loss from DR. METHODS A working group of ophthalmic and diabetes experts was established to develop a consensus on the key principles of an effective DR screening program. Recommendations are based on analysis of a structured literature review. RESULTS The recommendations for implementing an effective DR screening program are: (1) Examination methods must be suitable for the screening region, and DR classification/grading systems must be systematic and uniformly applied. Two-field retinal imaging is sufficient for DR screening and is preferable to seven-field imaging, and referable DR should be well defined and reliably identifiable by qualified screening staff; (2) in many countries/regions, screening can and should take place outside the ophthalmology clinic; (3) screening staff should be accredited and show evidence of ongoing training; (4) screening programs should adhere to relevant national quality assurance standards; (5) studies that use uniform definitions of risk to determine optimum risk-based screening intervals are required; (6) technology infrastructure should be in place to ensure that high-quality images can be stored securely to protect patient information; (7) although screening for diabetic macular edema (DME) in conjunction with DR evaluations may have merit, there is currently insufficient evidence to support implementation of programs solely for DME screening. CONCLUSION Use of these recommendations may yield more effective DR screening programs that reduce the risk of vision loss worldwide.
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Affiliation(s)
- Paolo Lanzetta
- Department of Medicine - Ophthalmology, University of Udine, Piazzale S. Maria della Misericordia, 33100, Udine, Italy.
- Istituto Europeo di Microchirurgia Oculare (IEMO), Udine, Italy.
| | - Valentina Sarao
- Department of Medicine - Ophthalmology, University of Udine, Piazzale S. Maria della Misericordia, 33100, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare (IEMO), Udine, Italy
| | - Peter H Scanlon
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Jane Barratt
- International Federation on Ageing, Toronto, Canada
| | - Massimo Porta
- Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Anat Loewenstein
- Department of Ophthalmology Tel Aviv Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Aharony O, Gal-Or O, Polat A, Nahum Y, Weinberger D, Zimmer Y. Automatic Characterization of Retinal Blood Flow Using OCT Angiograms. Transl Vis Sci Technol 2019; 8:6. [PMID: 31338254 PMCID: PMC6632182 DOI: 10.1167/tvst.8.4.6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 05/21/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To quantitatively characterize the retinal vascular network in healthy and pathological cases using optical coherence tomography angiography (OCTA) images. Methods The study included 56 eyes of 28 patients as follows: 26 healthy, 20 with diabetic retinopathy (DR), 6 with age-related macular degeneration (AMD), and 4 with retinal vein occlusion (RVO). For 33 eyes (16 healthy and 17 with DR), vessel density maps were provided by the OCTA machine. An automatic algorithm classified the image (as healthy, DR, AMD, or RVO) and provided quantitative information obtained from the angiograms, including global vessel density, global fractal dimension, and fovea avascular zone (FAZ) area. Classification results were compared with the diagnosis made by a retina specialist. The quantitative values were compared with the literature and to values provided by the OCTA machine. Results The success rate of classification was 83.9%. Vessel densities obtained by our algorithm (in healthy and DR cases) were significantly lower than the values reported in previous studies using OCTA. Similarly, they were much lower than the values provided by the OCTA machine. However, vessel densities in the healthy cases were similar to or higher than (depending on the retinal layer) the recently published values that may be considered as gold standard. Our values of fractal dimension were similar to those previously reported. Conclusions Our algorithm provides significantly improved vessel density values compared with previous studies. We believe our algorithm successfully omits false vessels. Translational Relevance Accurately assessing retinal vessel density enables better evaluation of retinal disorders.
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Affiliation(s)
- Omer Aharony
- School of Medical Engineering, Afeka College of Engineering, Tel Aviv, Israel
| | - Orly Gal-Or
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Polat
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Nahum
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dov Weinberger
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Zimmer
- School of Medical Engineering, Afeka College of Engineering, Tel Aviv, Israel
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Dietzel A, Schanner C, Falck A, Hautala N. Automatic detection of diabetic retinopathy and its progression in sequential fundus images of patients with diabetes. Acta Ophthalmol 2019; 97:e667-e669. [PMID: 30450774 DOI: 10.1111/aos.13976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Alexander Dietzel
- Institute of Biomedical Engineering and Informatics Technische Universität Ilmenau Ilmenau Germany
| | - Carolin Schanner
- Department of Ophthalmology PEDEGO Research Unit University of Oulu Oulu Finland
| | - Aura Falck
- Department of Ophthalmology PEDEGO Research Unit University of Oulu Oulu Finland
- Department of Ophthalmology Oulu University Hospital Oulu Finland
| | - Nina Hautala
- Department of Ophthalmology PEDEGO Research Unit University of Oulu Oulu Finland
- Department of Ophthalmology Oulu University Hospital Oulu Finland
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Romero-Aroca P, Valls A, Moreno A, Sagarra-Alamo R, Basora-Gallisa J, Saleh E, Baget-Bernaldiz M, Puig D. A Clinical Decision Support System for Diabetic Retinopathy Screening: Creating a Clinical Support Application. Telemed J E Health 2019; 25:31-40. [PMID: 29466097 PMCID: PMC6352499 DOI: 10.1089/tmj.2017.0282] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/10/2017] [Accepted: 01/10/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The aim of this study was to build a clinical decision support system (CDSS) in diabetic retinopathy (DR), based on type 2 diabetes mellitus (DM) patients. METHOD We built a CDSS from a sample of 2,323 patients, divided into a training set of 1,212 patients, and a testing set of 1,111 patients. The CDSS is based on a fuzzy random forest, which is a set of fuzzy decision trees. A fuzzy decision tree is a hierarchical data structure that classifies a patient into several classes to some level, depending on the values that the patient presents in the attributes related to the DR risk factors. Each node of the tree is an attribute, and each branch of the node is related to a possible value of the attribute. The leaves of the tree link the patient to a particular class (DR, no DR). RESULTS A CDSS was built with 200 trees in the forest and three variables at each node. Accuracy of the CDSS was 80.76%, sensitivity was 80.67%, and specificity was 85.96%. Applied variables were current age, gender, DM duration and treatment, arterial hypertension, body mass index, HbA1c, estimated glomerular filtration rate, and microalbuminuria. DISCUSSION Some studies concluded that screening every 3 years was cost effective, but did not personalize risk factors. In this study, the random forest test using fuzzy rules permit us to build a personalized CDSS. CONCLUSIONS We have developed a CDSS that can help in screening diabetic retinopathy programs, despite our results more testing is essential.
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Affiliation(s)
- Pedro Romero-Aroca
- Ophthalmology Service, Hospital Universitat Sant Joan, Institut de Investigacio Sanitaria Pere Virgili (IISPV), Universitat Rovira i Virgili, Reus, Spain
| | - Aida Valls
- Department of Computer Engineering and Mathematics, Universitat Rovira i Virgili, Reus, Spain
| | - Antonio Moreno
- Department of Computer Engineering and Mathematics, Universitat Rovira i Virgili, Reus, Spain
| | - Ramon Sagarra-Alamo
- Reus-Priorat Health Care Area, Institut Catala de la Salut (ICS), Institut de Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, Reus, Spain
| | - Josep Basora-Gallisa
- Reus-Priorat Health Care Area, Institut Catala de la Salut (ICS), Institut de Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, Reus, Spain
| | - Emran Saleh
- Department of Computer Engineering and Mathematics, Universitat Rovira i Virgili, Reus, Spain
| | - Marc Baget-Bernaldiz
- Ophthalmology Service, Hospital Universitat Sant Joan, Institut de Investigacio Sanitaria Pere Virgili (IISPV), Universitat Rovira i Virgili, Reus, Spain
| | - Domenec Puig
- Department of Computer Engineering and Mathematics, Universitat Rovira i Virgili, Reus, Spain
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17
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Diabetic Retinopathy Diagnosis from Retinal Images Using Modified Hopfield Neural Network. J Med Syst 2018; 42:247. [DOI: 10.1007/s10916-018-1111-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 10/24/2018] [Indexed: 12/26/2022]
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18
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Shahsuvaryan M. Millennial-minded approach for the management of diabetic retinopathy. QJM 2018; 111:277. [PMID: 29149284 DOI: 10.1093/qjmed/hcx218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Shahsuvaryan
- From the Department of Ophthalmology, Yerevan State Medical University, 26 Sayat-Nova Av., Yerevan, 0001, Republic of Armenia
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19
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van der Heijden AA, Abramoff MD, Verbraak F, van Hecke MV, Liem A, Nijpels G. Validation of automated screening for referable diabetic retinopathy with the IDx-DR device in the Hoorn Diabetes Care System. Acta Ophthalmol 2018; 96:63-68. [PMID: 29178249 PMCID: PMC5814834 DOI: 10.1111/aos.13613] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 09/05/2017] [Indexed: 12/17/2022]
Abstract
Purpose To increase the efficiency of retinal image grading, algorithms for automated grading have been developed, such as the IDx‐DR 2.0 device. We aimed to determine the ability of this device, incorporated in clinical work flow, to detect retinopathy in persons with type 2 diabetes. Methods Retinal images of persons treated by the Hoorn Diabetes Care System (DCS) were graded by the IDx‐DR device and independently by three retinal specialists using the International Clinical Diabetic Retinopathy severity scale (ICDR) and EURODIAB criteria. Agreement between specialists was calculated. Results of the IDx‐DR device and experts were compared using sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), distinguishing between referable diabetic retinopathy (RDR) and vision‐threatening retinopathy (VTDR). Area under the receiver operating characteristic curve (AUC) was calculated. Results Of the included 1415 persons, 898 (63.5%) had images of sufficient quality according to the experts and the IDx‐DR device. Referable diabetic retinopathy (RDR) was diagnosed in 22 persons (2.4%) using EURODIAB and 73 persons (8.1%) using ICDR classification. Specific intergrader agreement ranged from 40% to 61%. Sensitivity, specificity, PPV and NPV of IDx‐DR to detect RDR were 91% (95% CI: 0.69–0.98), 84% (95% CI: 0.81–0.86), 12% (95% CI: 0.08–0.18) and 100% (95% CI: 0.99–1.00; EURODIAB) and 68% (95% CI: 0.56–0.79), 86% (95% CI: 0.84–0.88), 30% (95% CI: 0.24–0.38) and 97% (95% CI: 0.95–0.98; ICDR). The AUC was 0.94 (95% CI: 0.88–1.00; EURODIAB) and 0.87 (95% CI: 0.83–0.92; ICDR). For detection of VTDR, sensitivity was lower and specificity was higher compared to RDR. AUC's were comparable. Conclusion Automated grading using the IDx‐DR device for RDR detection is a valid method and can be used in primary care, decreasing the demand on ophthalmologists.
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Affiliation(s)
- Amber A van der Heijden
- Department of General Practice and Elderly Care Medicine; VU University Medical Centre; Amsterdam the Netherlands
- Amsterdam Public Health Research Institute; VU University Medical Centre; Amsterdam the Netherlands
| | - Michael D Abramoff
- Department of Ophthalmology and Visual Sciences; University of Iowa Hospital and Clinics; Iowa City IA USA
- VA Medical Center; Iowa City IA USA
- IDx LLC; Iowa City IA USA
| | - Frank Verbraak
- Department of Ophthalmology; VU University Medical Centre; Amsterdam the Netherlands
| | - Manon V van Hecke
- Department of Ophthalmology; Elisabeth-Tweestedenziekenhuis; Tilburg the Netherlands
| | - Albert Liem
- Department of Ophthalmology; University Medical Centre Utrecht; Utrecht the Netherlands
| | - Giel Nijpels
- Department of General Practice and Elderly Care Medicine; VU University Medical Centre; Amsterdam the Netherlands
- Amsterdam Public Health Research Institute; VU University Medical Centre; Amsterdam the Netherlands
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Nørgaard MF, Grauslund J. Automated Screening for Diabetic Retinopathy - A Systematic Review. Ophthalmic Res 2018; 60:9-17. [PMID: 29339646 DOI: 10.1159/000486284] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/12/2017] [Indexed: 12/26/2022]
Abstract
PURPOSE Worldwide ophthalmologists are challenged by the rapid rise in the prevalence of diabetes. Diabetic retinopathy (DR) is the most common complication in diabetes, and possible consequences range from mild visual impairment to blindness. Repetitive screening for DR is cost-effective, but it is also a costly and strenuous affair. Several studies have examined the application of automated image analysis to solve this problem. Large populations are needed to assess the efficacy of such programs, and a standardized and rigorous methodology is important to give an indication of system performance in actual clinical settings. METHODS In a systematic review, we aimed to identify studies with methodology and design that are similar or replicate actual screening scenarios. A total of 1,231 publications were identified through PubMed, Cochrane Library, and Embase searches. Three manual search strategies were carried out to identify publications missed in the primary search. Four levels of screening identified 7 studies applicable for inclusion. RESULTS Seven studies were included. The detection of DR had high sensitivities (87.0-95.2%) but lower specificities (49.6-68.8%). False-negative results were related to mild DR with a low risk of progression within 1 year. Several studies reported missed cases of diabetic macular edema. A meta-analysis was not conducted as studies were not suitable for direct comparison or statistical analysis. CONCLUSION The study demonstrates that despite limited specificity, automated retinal image analysis may potentially be valuable in different DR screening scenarios with a relatively high sensitivity and a substantial workload reduction.
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Affiliation(s)
- Mads Fonager Nørgaard
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Research Unit of Ophthalmology, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Research Unit of Ophthalmology, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Xu K, Feng D, Mi H. Deep Convolutional Neural Network-Based Early Automated Detection of Diabetic Retinopathy Using Fundus Image. Molecules 2017; 22:molecules22122054. [PMID: 29168750 PMCID: PMC6149821 DOI: 10.3390/molecules22122054] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 12/26/2022] Open
Abstract
The automatic detection of diabetic retinopathy is of vital importance, as it is the main cause of irreversible vision loss in the working-age population in the developed world. The early detection of diabetic retinopathy occurrence can be very helpful for clinical treatment; although several different feature extraction approaches have been proposed, the classification task for retinal images is still tedious even for those trained clinicians. Recently, deep convolutional neural networks have manifested superior performance in image classification compared to previous handcrafted feature-based image classification methods. Thus, in this paper, we explored the use of deep convolutional neural network methodology for the automatic classification of diabetic retinopathy using color fundus image, and obtained an accuracy of 94.5% on our dataset, outperforming the results obtained by using classical approaches.
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Affiliation(s)
- Kele Xu
- School of Information and Communication, National University of Defense Technology, Wuhan 430019, China.
| | - Dawei Feng
- School of Computer, National University of Defense Technology, Changsha 410073, China.
| | - Haibo Mi
- School of Computer, National University of Defense Technology, Changsha 410073, China.
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