Prognostic indicators of corneal ulcer clinical outcomes at a tertiary care center in the Bronx, New York

PURPOSE

Corneal ulcers frequently result in ocular morbidity and may lead to permanent visual impairment if severe or untreated. This study aims to evaluate the association of patient factors and ocular exam findings on clinical outcomes for patients diagnosed with a corneal ulcer at a tertiary care center in the Bronx, New York.

METHODS

A retrospective chart review was conducted on all ambulatory and admitted patients diagnosed with a corneal ulcer (identified using ICD-10 code H16.0) at Montefiore Medical Center, Bronx, NY between 2016-2022. Patient demographics, presence of known risk factors, characteristics of subsequent clinical course, and microbiological studies were noted. Clinical outcomes following treatment were longitudinally evaluated and categorized based upon the following criteria: 1) 'No Surgical Intervention': No severe complications or surgery required after presentation, 2) 'Surgical Intervention': Decline in BCVA with surgery required for a severe complication.

RESULTS

The search criteria identified 205 patients (205 eyes) with the diagnosis of a corneal ulcer. Mean age was 55.3 ± 21.1 years (mean ± SD). Mean ulcer area at presentation was 7 ± 10.5 mm2. Mean LogMAR at presentation was 1.2 ± 1, and following treatment, improved to 1.0 ± 1. 'Surgical Intervention' outcome was associated with advanced age (p = 0.005), presence of ocular surface disease (p = 0.008), central location of ulcer (p = 0.014), greater ulcer area at presentation (p = 0.003), worse visual acuity at presentation (p < 0.001), and isolation of fungi (p = 0.004).

CONCLUSION

Identification of risk factors associated with a poor clinical prognosis can guide treatment and inform expectations for patients diagnosed with a corneal ulcer. Our study highlights the importance of timely diagnosis, work-up, and initiation of appropriate management, particularly in vulnerable populations where access to specialty care is logistically challenging.

Socioeconomic Disparities Associated with Access to Oculofacial Plastic Surgeons: A Cross-Sectional Analysis of US County Demographics

PURPOSE

To compare population demographics with the geographic distribution of oculofacial plastic surgeons (OPSs) in the United States.

DESIGN

A cross-sectional study design was used to investigate demographic differences between counties with 1 or more OPSs and counties with zero OPSs.

PARTICIPANTS

The number of OPSs were identified in each US county using online public databases: American Society of Ophthalmic Plastic and Reconstructive Surgeons and American Academy of Ophthalmology. Counties were categorized into 2 groups: 1 or more OPSs and zero OPSs. Demographic characteristics at the county level were obtained from the 2021 US Census Bureau Population Estimates and the American Community Survey. Cost of living was collected from the 2022 Economic Policy Institute Family Budget Calculator.

MAIN OUTCOME MEASURES

Socioeconomic demographics of the US population as related to geographic OPS distribution.

RESULTS

A total of 1238 OPSs were identified. States with the most OPSs per million were Hawaii (6.2), D.C. (6.0), Connecticut (5.8), Utah (5.1), and Maryland (5.0). Among 3143 counties, 2725 (86.7%) had zero OPSs and 418 (13.3%) had 1 or more OPSs. Counties with 1 or more OPSs had a higher median (standard deviation) household income versus counties with zero OPSs ($72 471 [$19 152] vs. $56 152 [$13 675]; difference $16 319; 95% confidence interval [CI], $14 300-$18 338; P < 0.001). The annual cost of living per person (standard deviation) was higher in counties with 1 or more OPSs versus counties with zero OPSs ($39 238 [$6992] vs. $36 227 [$3516]; difference $3011; 95% CI, $2328-$3694; P < 0.001). Counties with zero OPSs versus counties with 1 or more OPSs had higher proportions of persons with only Medicaid (15.6% vs. 13.6%; difference 2.0%; 95% CI, 1.4%-2.5%; P < 0.001), no health insurance (9.9% vs. 8.0%; difference 1.9%; 95% CI, 1.5%-2.4%; P < 0.001), no household internet access (17.2% vs. 9.6%; difference 7.6%; 95% CI, 7.1%-8.0%; P < 0.001), and higher proportions of persons aged 65 years or older (20.0% vs. 17.0%; difference 3.0%; 95% CI, 2.5%-3.5%; P < 0.001).

CONCLUSIONS

This cross-sectional analysis of all US counties revealed socioeconomic disparities associated with access to OPSs.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Electrodermal Activity of Auricular Acupoints in Pediatric Patients With Functional Abdominal Pain Disorders

OBJECTIVES

Functional abdominal pain disorders (FAPD) affect approximately 13.5% of children. Pharmacotherapy is often ineffective, leaving providers, and families seeking adjunctive therapies. Auriculotherapy provides treatment for pain and other symptoms, without a defined protocol for FAPD. A handheld point-finder device measuring transdermal electrical current determines active acupoints, with a higher current indicating a more active acupoint. Our objectives were to determine auricular acupoint (AA) activity in FAPD and to assess participants' attitudes towards auriculotherapy.

METHODS

This is a prospective double-blind study evaluating the electrodermal activity of AAs in pediatric-aged female participants with FAPD compared to healthy controls (HC). Participants completed surveys regarding demographics and interest in auriculotherapy. The electrodermal assessment evaluated 20 AAs per ear using a point-finder device. Each AA current measurement was analyzed by average relative rank and median, with a median current measurement ≥50 μA considered active.

RESULTS

We enrolled 46 female participants, 22 FAPD (mean age 15.8 years) and 24 HC (mean age 15.4 years). In FAPD, 12 of 40 AAs were active, of which only six were also active in HC. Comparison of median current and average ranking between participants demonstrated consistency. In the post-assessment survey, 86.4% of FAPD expressed interest in receiving auricular acupressure and 68.2% would travel to the clinic solely for treatment.

CONCLUSIONS

Based on electrodermal measurements, we propose a treatment protocol using auriculotherapy for FAPD symptom-management. We demonstrated there is considerable patient interest in auriculotherapy. Further studies are needed to confirm the findings in a larger sample size and validate the efficacy of this treatment protocol.

Deep learning-level melanoma detection by interpretable machine learning and imaging biomarker cues

SIGNIFICANCE

Melanoma is a deadly cancer that physicians struggle to diagnose early because they lack the knowledge to differentiate benign from malignant lesions. Deep machine learning approaches to image analysis offer promise but lack the transparency to be widely adopted as stand-alone diagnostics.

AIM

We aimed to create a transparent machine learning technology (i.e., not deep learning) to discriminate melanomas from nevi in dermoscopy images and an interface for sensory cue integration.

APPROACH

Imaging biomarker cues (IBCs) fed ensemble machine learning classifier (Eclass) training while raw images fed deep learning classifier training. We compared the areas under the diagnostic receiver operator curves.

RESULTS

Our interpretable machine learning algorithm outperformed the leading deep-learning approach 75% of the time. The user interface displayed only the diagnostic imaging biomarkers as IBCs.

CONCLUSIONS

From a translational perspective, Eclass is better than convolutional machine learning diagnosis in that physicians can embrace it faster than black box outputs. Imaging biomarkers cues may be used during sensory cue integration in clinical screening. Our method may be applied to other image-based diagnostic analyses, including pathology and radiology.

Hyperspectral imaging in automated digital dermoscopy screening for melanoma

Objectives

Early melanoma detection decreases morbidity and mortality. Early detection classically involves dermoscopy to identify suspicious lesions for which biopsy is indicated. Biopsy and histological examination then diagnose benign nevi, atypical nevi, or cancerous growths. With current methods, a considerable number of unnecessary biopsies are performed as only 11% of all biopsied, suspicious lesions are actually melanomas. Thus, there is a need for more advanced noninvasive diagnostics to guide the decision of whether or not to biopsy. Artificial intelligence can generate screening algorithms that transform a set of imaging biomarkers into a risk score that can be used to classify a lesion as a melanoma or a nevus by comparing the score to a classification threshold. Melanoma imaging biomarkers have been shown to be spectrally dependent in Red, Green, Blue (RGB) color channels, and hyperspectral imaging may further enhance diagnostic power. The purpose of this study was to use the same melanoma imaging biomarkers previously described, but over a wider range of wavelengths to determine if, in combination with machine learning algorithms, this could result in enhanced melanoma detection.

Methods

We used the melanoma advanced imaging dermatoscope (mAID) to image pigmented lesions assessed by dermatologists as requiring a biopsy. The mAID is a 21‐wavelength imaging device in the 350–950 nm range. We then generated imaging biomarkers from these hyperspectral dermoscopy images, and, with the help of artificial intelligence algorithms, generated a melanoma Q‐score for each lesion (0 = nevus, 1 = melanoma). The Q‐score was then compared to the histopathologic diagnosis.

Results

The overall sensitivity and specificity of hyperspectral dermoscopy in detecting melanoma when evaluated in a set of lesions selected by dermatologists as requiring biopsy was 100% and 36%, respectively.

Conclusion

With widespread application, and if validated in larger clinical trials, this non‐invasive methodology could decrease unnecessary biopsies and potentially increase life‐saving early detection events. Lasers Surg. Med. 51:214–222, 2019. © 2019 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.