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Eppenberger LS, Grzybowski A, Schmetterer L, Ang M. Myopia Control: Are We Ready for an Evidence Based Approach? Ophthalmol Ther 2024:10.1007/s40123-024-00951-w. [PMID: 38710983 DOI: 10.1007/s40123-024-00951-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/11/2024] [Indexed: 05/08/2024] Open
Abstract
INTRODUCTION Myopia and its vision-threatening complications present a significant public health problem. This review aims to provide an updated overview of the multitude of known and emerging interventions to control myopia, including their potential effect, safety, and costs. METHODS A systematic literature search of three databases was conducted. Interventions were grouped into four categories: environmental/behavioral (outdoor time, near work), pharmacological (e.g., atropine), optical interventions (spectacles and contact lenses), and novel approaches such as red-light (RLRL) therapies. Review articles and original articles on randomized controlled trials (RCT) were selected. RESULTS From the initial 3224 retrieved records, 18 reviews and 41 original articles reporting results from RCTs were included. While there is more evidence supporting the efficacy of low-dose atropine and certain myopia-controlling contact lenses in slowing myopia progression, the evidence about the efficacy of the newer interventions, such as spectacle lenses (e.g., defocus incorporated multiple segments and highly aspheric lenslets) is more limited. Behavioral interventions, i.e., increased outdoor time, seem effective for preventing the onset of myopia if implemented successfully in schools and homes. While environmental interventions and spectacles are regarded as generally safe, pharmacological interventions, contact lenses, and RLRL may be associated with adverse effects. All interventions, except for behavioral change, are tied to moderate to high expenditures. CONCLUSION Our review suggests that myopia control interventions are recommended and prescribed on the basis of accessibility and clinical practice patterns, which vary widely around the world. Clinical trials indicate short- to medium-term efficacy in reducing myopia progression for various interventions, but none have demonstrated long-term effectiveness in preventing high myopia and potential complications in adulthood. There is an unmet need for a unified consensus for strategies that balance risk and effectiveness for these methods for personalized myopia management.
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Affiliation(s)
- Leila Sara Eppenberger
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Andrzej Grzybowski
- University of Warmia and Mazury, Olsztyn, Poland
- Institute for Research in Ophthalmology, Poznan, Poland
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology and Visual Sciences Department, Duke-NUS Medical School, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- School of Chemical and Biological Engineering, Nanyang Technological University, Singapore, Singapore
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
- Ophthalmology and Visual Sciences Department, Duke-NUS Medical School, Singapore, Singapore.
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Teo ZL, Ang M. Femtosecond laser-assisted in situ keratomileusis versus small-incision lenticule extraction: current approach based on evidence. Curr Opin Ophthalmol 2024:00055735-990000000-00166. [PMID: 38700941 DOI: 10.1097/icu.0000000000001060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
PURPOSE OF REVIEW Laser keratorefractive surgery achieves excellent visual outcomes for refractive error correction. With femtosecond laser, small incision lenticule extraction (SMILE) is an increasingly viable alternative to laser-assisted in situ keratomileusis (LASIK). Comparative studies demonstrate similar efficacy and predictability between SMILE and LASIK, making it difficult for clinicians to choose which to use. This review thus compares femtosecond-LASIK (FS-LASK) and SMILE in various scenarios, to assist clinicians in deciding which refractive surgery procedure to recommend. RECENT FINDINGS SMILE may be superior for highly myopic eyes due to a smaller decrease in functional optical zone. SMILE further induces less spherical aberration and less overall higher order aberrations in mesopic conditions. SMIILE also has less postoperative dry eye, making it suitable those with preexisting dry eye. For low to moderate myopic astigmatism correction, FS-LASIK has less undercorrection compared to SMILE. Lastly, SMILE has not yet received Food and Drug Administration or Conformité Européenne approval for hyperopic correction, rendering FS-LASIK the choice of procedure for hyperopic correction. SUMMARY Both FS-LASIK and SMILE demonstrate good efficacy and predictability. Understanding specific clinical scenarios where one may be superior to the other will aid clinicians in choosing the most suitable procedure for personalized care.
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Affiliation(s)
- Zhen Ling Teo
- Singapore National Eye Centre, Singapore Eye Research Institute
| | - Marcus Ang
- Singapore National Eye Centre, Singapore Eye Research Institute
- Department of Cornea and External Eye Disease, Refractive Surgery, Singapore National Eye Centre
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
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Liu C, Lin MTY, Lee IXY, Wong JHF, Lu D, Lam TC, Zhou L, Mehta JS, Ong HS, Ang M, Tong L, Liu YC. Neuropathic corneal pain: Tear proteomic and neuromediator profiles, imaging features, and clinical manifestations. Am J Ophthalmol 2024:S0002-9394(24)00117-X. [PMID: 38521157 DOI: 10.1016/j.ajo.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/05/2024] [Accepted: 03/15/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE To investigate the tear proteomic and neuromediator profiles, in vivo confocal microscopy (IVCM) imaging features, and clinical manifestations in neuropathic corneal pain (NCP) patients. DESIGN Cross-sectional study. METHODS Twenty NCP patients and twenty age-matched controls were recruited. All subjects were evaluated by corneal sensitivity, Schirmer's test, tear break-up time, corneal and ocular surface staining, Ocular Surface Disease Index and Ocular Pain Assessment Survey questionnaires, as well as IVCM examinations for corneal nerves, microneruomas, epithelial and dendritic cells. Tears were collected for neuromediator and proteomic analysis using enzyme-linked immunosorbent assay and data-independent acquisition mass spectrometry. RESULTS Burning and sensitivity to light were the two most common symptoms in NCP. A total of 188 significantly dysregulated proteins, such as elevated metallothionein-2, creatine kinases B-type, vesicle-associated membrane protein 2, neurofilament light polypeptide, and myelin basic protein, were identified in the NCP patients. The top 10 dysregulated biological pathways in NCP include neurotoxicity, axonal signaling, wound healing, neutrophil degradation, apoptosis, thrombin signaling mitochondrial dysfunction, RHOGDI and P70S6K signaling pathways. Compared to controls, the NCP cohort presented with significantly decreased corneal sensitivity (P<0.001), decreased corneal nerve fiber length (P=0.003), corneal nerve fiber density (P=0.006), nerve fiber fractal dimension (P=0.033), as well as increased in corneal nerve fiber width (P=0.002), increased length, total area and perimeter of microneuromas (P<0.001, P<0.001, P=0.019), smaller corneal epithelial size (P=0.017), and higher nerve growth factor level in tears (p=0.006). CONCLUSIONS These clinical manifestations, imaging features, and molecular characterizations would contribute to the diagnostics and potential therapeutic targets for NCP.
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Affiliation(s)
- Chang Liu
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore; Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore
| | - Molly Tzu-Yu Lin
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore
| | - Isabelle Xin Yu Lee
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore
| | | | - Daqian Lu
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong
| | - Thomas Chuen Lam
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong; Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong
| | - Lei Zhou
- Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong; School of Optometry; Department of Applied Biology and Chemical Technology; Research Centre for SHARP Vision (RCSV); The Hong Kong Polytechnic University, Hong Kong
| | - Jodhbir S Mehta
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore; Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore; Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Hon Shing Ong
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore; Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore; Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Marcus Ang
- Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Louis Tong
- Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore; Ocular Surface Research Group, Singapore Eye Research Institute, Singapore; Eye Academic Clinical Program, Duke-NUS Medical School, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore
| | - Yu-Chi Liu
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore; Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore; Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore; Department of Ophthalmology, National Taiwan University, Taiwan.
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Foo VHX, Lim GYS, Liu YC, Ong HS, Wong E, Chan S, Wong J, Mehta JS, Ting DSW, Ang M. Deep learning for detection of Fuchs endothelial dystrophy from widefield specular microscopy imaging: a pilot study. Eye Vis (Lond) 2024; 11:11. [PMID: 38494521 PMCID: PMC10946096 DOI: 10.1186/s40662-024-00378-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/18/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND To describe the diagnostic performance of a deep learning (DL) algorithm in detecting Fuchs endothelial corneal dystrophy (FECD) based on specular microscopy (SM) and to reliably detect widefield peripheral SM images with an endothelial cell density (ECD) > 1000 cells/mm2. METHODS Five hundred and forty-seven subjects had SM imaging performed for the central cornea endothelium. One hundred and seventy-three images had FECD, while 602 images had other diagnoses. Using fivefold cross-validation on the dataset containing 775 central SM images combined with ECD, coefficient of variation (CV) and hexagonal endothelial cell ratio (HEX), the first DL model was trained to discriminate FECD from other images and was further tested on an external set of 180 images. In eyes with FECD, a separate DL model was trained with 753 central/paracentral SM images to detect SM with ECD > 1000 cells/mm2 and tested on 557 peripheral SM images. Area under curve (AUC), sensitivity and specificity were evaluated. RESULTS The first model achieved an AUC of 0.96 with 0.91 sensitivity and 0.91 specificity in detecting FECD from other images. With an external validation set, the model achieved an AUC of 0.77, with a sensitivity of 0.69 and specificity of 0.68 in differentiating FECD from other diagnoses. The second model achieved an AUC of 0.88 with 0.79 sensitivity and 0.78 specificity in detecting peripheral SM images with ECD > 1000 cells/mm2. CONCLUSIONS Our pilot study developed a DL model that could reliably detect FECD from other SM images and identify widefield SM images with ECD > 1000 cells/mm2 in eyes with FECD. This could be the foundation for future DL models to track progression of eyes with FECD and identify candidates suitable for therapies such as Descemet stripping only.
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Affiliation(s)
- Valencia Hui Xian Foo
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
| | | | - Yu-Chi Liu
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Ophthalmology and Visual Science Academic Clinical Research Program, Singapore, Singapore
| | - Hon Shing Ong
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Ophthalmology and Visual Science Academic Clinical Research Program, Singapore, Singapore
| | - Evan Wong
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
| | - Stacy Chan
- Singapore Eye Research Institute, Singapore, Singapore
| | - Jipson Wong
- Singapore Eye Research Institute, Singapore, Singapore
| | - Jodhbir S Mehta
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Ophthalmology and Visual Science Academic Clinical Research Program, Singapore, Singapore
| | - Daniel S W Ting
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Ophthalmology and Visual Science Academic Clinical Research Program, Singapore, Singapore
| | - Marcus Ang
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore, 168751, Singapore.
- Singapore Eye Research Institute, Singapore, Singapore.
- Duke-NUS Medical School, Ophthalmology and Visual Science Academic Clinical Research Program, Singapore, Singapore.
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Tey KY, Cheong EZK, Ang M. Potential applications of artificial intelligence in image analysis in cornea diseases: a review. Eye Vis (Lond) 2024; 11:10. [PMID: 38448961 PMCID: PMC10919022 DOI: 10.1186/s40662-024-00376-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024]
Abstract
Artificial intelligence (AI) is an emerging field which could make an intelligent healthcare model a reality and has been garnering traction in the field of medicine, with promising results. There have been recent developments in machine learning and/or deep learning algorithms for applications in ophthalmology-primarily for diabetic retinopathy, and age-related macular degeneration. However, AI research in the field of cornea diseases is relatively new. Algorithms have been described to assist clinicians in diagnosis or detection of cornea conditions such as keratoconus, infectious keratitis and dry eye disease. AI may also be used for segmentation and analysis of cornea imaging or tomography as an adjunctive tool. Despite the potential advantages that these new technologies offer, there are challenges that need to be addressed before they can be integrated into clinical practice. In this review, we aim to summarize current literature and provide an update regarding recent advances in AI technologies pertaining to corneal diseases, and its potential future application, in particular pertaining to image analysis.
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Affiliation(s)
- Kai Yuan Tey
- Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
| | | | - Marcus Ang
- Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore.
- Singapore Eye Research Institute, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
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Li J, Dan YS, Chua SQ, Wong QY, Chong RS, Ang M, Wong CW, Hoang QV. Pathologic myopia in highly myopic patients with high axial anisomyopia. Br J Ophthalmol 2024; 108:411-416. [PMID: 36690422 DOI: 10.1136/bjo-2022-322285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/06/2023] [Indexed: 01/25/2023]
Abstract
PURPOSE To determine prevalence of anisomyopia (axial length (AL) difference ≥2.5 mm) among high myopes ((HMs), defined by spherical equivalent of ≤6.0 diopters or AL ≥ 26.5 mm). To characterise the shorter anisomyopic eye (SAE) and evaluate if pathologic myopia (PM) in the longer anisomyopic eye (LAE) was associated with increased risk of PM in the SAE. METHODS 1168 HMs were recruited from Singapore National Eye Centre clinic for this cross-sectional study. Biometry, fundus photography and swept-source optical coherence tomography were performed. Patients with high axial anisomyopia were identified. Structural characteristics and presence of PM were described. Stepwise multivariate regression explored associations between PM in the LAE and pathology in the SAE, controlling for confounding variables. RESULTS Prevalence of anisomyopia was 15.8% (184 of 1168 patients). Anisomyopic patients (age 65.8±13.5 years) had mean AL of 30.6±2.0 mm and 26.2±2.3 mm in the LAE and SAE, respectively. 52.7% of SAEs had AL < 26.5 mm. Prevalence of myopic macular degeneration, macula-involving posterior staphyloma (PS), myopic traction maculopathy (MTM) and myopic choroidal neovascularisation (mCNV) in the SAE was 52.2%, 36.5%, 13.0% and 8.2%, respectively. Macular hole in the LAE was associated with increased risk of MTM in the SAE (OR=4.88, p=0.01). mCNV in the LAE was associated with mCNV in the SAE (OR=3.57, p=0.02). PS in the LAE was associated with PS in the SAE (OR=4.03, p<0.001). CONCLUSIONS Even when controlled for AL, PM complications in the LAE predict similar PM complications in the SAE. Patients with high axial anisometropia with PM in the LAE should be monitored carefully for complications in the SAE.
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Affiliation(s)
- Jonathan Li
- Department of Ophthalmology, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
| | | | - Si Qi Chua
- Singapore Eye Research Institute, Singapore
| | | | - Rachel S Chong
- Department of Ophthalmology, Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
| | - Marcus Ang
- Department of Ophthalmology, Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
| | - Chee Wai Wong
- Department of Ophthalmology, Singapore National Eye Centre, Singapore
| | - Quan V Hoang
- Department of Ophthalmology, Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Duke-NUS Medical School, Singapore
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Ting DSJ, Gatinel D, Ang M. Cataract surgery after corneal refractive surgery: preoperative considerations and management. Curr Opin Ophthalmol 2024; 35:4-10. [PMID: 37962882 DOI: 10.1097/icu.0000000000001006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
PURPOSE OF REVIEW Corneal refractive surgery (CRS) is one of the most popular eye procedures, with more than 40 million cases performed globally. As CRS-treated patients age and develop cataract, the number of cases that require additional preoperative considerations and management will increase around the world. Thus, we provide an up-to-date, concise overview of the considerations and outcomes of cataract surgery in eyes with previous CRS, including surface ablation, laser in-situ keratomileusis (LASIK), and small-incision lenticule extraction (SMILE). RECENT FINDINGS Challenges associated with accurate biometry in eyes with CRS have been mitigated recently through total keratometry, ray tracing, intraoperative aberrometry, and machine learning assisted intraocular lens (IOL) power calculation formulas to improve prediction. Emerging studies have highlighted the superior performance of ray tracing and/or total keratometry-based formulas for IOL power calculation in eyes with previous SMILE. Dry eye remains a common side effect after cataract surgery, especially in eyes with CRS, though the risk appears to be lower after SMILE than LASIK (in the short-term). Recent presbyopia-correcting IOL designs such as extended depth of focus (EDOF) IOLs may be suitable in carefully selected eyes with previous CRS. SUMMARY Ophthalmologists will increasingly face challenges associated with the surgical management of cataract in patients with prior CRS. Careful preoperative assessment of the ocular surface, appropriate use of IOL power calculation formulas, and strategies for presbyopia correction are key to achieve good clinical and refractive outcomes and patient satisfaction. Recent advances in CRS techniques, such as SMILE, may pose new challenges for such eyes in the future.
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Affiliation(s)
- Darren S J Ting
- Birmingham and Midland Eye Centre, Birmingham
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Damien Gatinel
- Department of Anterior Segment and Refractive Surgery, Rothschild Foundation Hospital, Paris, France
| | - Marcus Ang
- Singapore National Eye Centre, Singapore Eye Research Institute
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
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Li Y, Yip M, Ning Y, Chung J, Toh A, Leow C, Liu N, Ting D, Schmetterer L, Saw SM, Jonas JB, Chia A, Ang M. Topical Atropine for Childhood Myopia Control: The Atropine Treatment Long-Term Assessment Study. JAMA Ophthalmol 2024; 142:15-23. [PMID: 38019503 PMCID: PMC10690578 DOI: 10.1001/jamaophthalmol.2023.5467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/05/2023] [Indexed: 11/30/2023]
Abstract
Importance Clinical trial results of topical atropine eye drops for childhood myopia control have shown inconsistent outcomes across short-term studies, with little long-term safety or other outcomes reported. Objective To report the long-term safety and outcomes of topical atropine for childhood myopia control. Design, Setting, and Participants This prospective, double-masked observational study of the Atropine for the Treatment of Myopia (ATOM) 1 and ATOM2 randomized clinical trials took place at 2 single centers and included adults reviewed in 2021 through 2022 from the ATOM1 study (atropine 1% vs placebo; 1999 through 2003) and the ATOM2 study (atropine 0.01% vs 0.1% vs 0.5%; 2006 through 2012). Main Outcome Measures Change in cycloplegic spherical equivalent (SE) with axial length (AL); incidence of ocular complications. Results Among the original 400 participants in each original cohort, the study team evaluated 71 of 400 ATOM1 adult participants (17.8% of original cohort; study age, mean [SD] 30.5 [1.2] years; 40.6% female) and 158 of 400 ATOM2 adult participants (39.5% of original cohort; study age, mean [SD], 24.5 [1.5] years; 42.9% female) whose baseline characteristics (SE and AL) were representative of the original cohort. In this study, evaluating ATOM1 participants, the mean (SD) SE and AL were -5.20 (2.46) diopters (D), 25.87 (1.23) mm and -6.00 (1.63) D, 25.90 (1.21) mm in the 1% atropine-treated and placebo groups, respectively (difference of SE, 0.80 D; 95% CI, -0.25 to 1.85 D; P = .13; difference of AL, -0.03 mm; 95% CI, -0.65 to 0.58 mm; P = .92). In ATOM2 participants, the mean (SD) SE and AL was -6.40 (2.21) D; 26.25 (1.34) mm; -6.81 (1.92) D, 26.28 (0.99) mm; and -7.19 (2.87) D, 26.31 (1.31) mm in the 0.01%, 0.1%, and 0.5% atropine groups, respectively. There was no difference in the 20-year incidence of cataract/lens opacities, myopic macular degeneration, or parapapillary atrophy (β/γ zone) comparing the 1% atropine-treated group vs the placebo group. Conclusions and Relevance Among approximately one-quarter of the original participants, use of short-term topical atropine eye drops ranging from 0.01% to 1.0% for a duration of 2 to 4 years during childhood was not associated with differences in final refractive errors 10 to 20 years after treatment. There was no increased incidence of treatment or myopia-related ocular complications in the 1% atropine-treated group vs the placebo group. These findings may affect the design of future clinical trials, as further studies are required to investigate the duration and concentration of atropine for childhood myopia control.
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Affiliation(s)
- Yong Li
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Michelle Yip
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Yilin Ning
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Joey Chung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Angeline Toh
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Cheryl Leow
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Nan Liu
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Daniel Ting
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Jost B. Jonas
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Audrey Chia
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
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Li YT, Wu WY, Li JY, Chan SY, Ang M, Feng Y. Types of Descemet Membrane Detachment After Ocular Surface Burns: The Factor Long Been Ignored. Cornea 2023; 42:1426-1431. [PMID: 36729715 PMCID: PMC10538613 DOI: 10.1097/ico.0000000000003210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to explore types of Descemet membrane detachment (DMD) after ocular surface burns by anterior segment optical coherence tomography. METHODS This is a pilot, case series, observational study. Patients with DMD after ocular surface burns were enrolled. Ophthalmologic examinations were performed in all patients including slit-lamp photography and anterior segment optical coherence tomography. RESULTS Three types of DMDs in 9 eyes of 9 patients with ocular surface burns were identified depending on the detachment components involved with the pre-Descemet layer (PDL). Type A was referred as a taut chord that the PDL and Descemet membrane (DM) detached simultaneously but were remained attached to each other, while type B was identified as a wavy line separated from the stroma by a dark slit that demonstrated the detachment of DM from the PDL and stroma. Type C was defined as the DM detached with or without PDL but they were separated from each other. We found that DM and PDL were detached simultaneously in most condition, with type A in 4 cases, type C in 5 cases, and type B in only 1 case. CONCLUSIONS Our study demonstrated 3 types of DMDs after ocular surface burns and revealed that the limbal involvement and retrocorneal exudations may give clues to DMD in the corresponding areas. DMDs may be neglected for long in patients with extensive limbal involvement in early stages and also play an important role in unstable ocular surface condition until the late stages of conjunctivalization after ocular surface burns.
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Affiliation(s)
- Yuan-Ting Li
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China; and
| | - Wen-Yu Wu
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China; and
| | - Jing-Yi Li
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China; and
| | - Szy-Yann Chan
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China; and
| | - Marcus Ang
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore.
| | - Yun Feng
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China; and
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Foo LL, Xu L, Sabanayagam C, Htoon HM, Ang M, Zhang J, Ohno-Matsui K, Cheng CY, Hoang QV, Tan CS, Saw SM, Wong CW. Predictors of myopic macular degeneration in a 12-year longitudinal study of Singapore adults with myopia. Br J Ophthalmol 2023; 107:1363-1368. [PMID: 35534177 DOI: 10.1136/bjophthalmol-2021-321046] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/24/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate the predictive factors for myopic macular degeneration (MMD) and progression in adults with myopia. METHODS We examined 828 Malay and Indian adults (1579 myopic eyes) with myopia (spherical equivalent (SE) ≤-0.5 dioptres) at baseline who participated in both baseline and 12-year follow-up visits of the Singapore Malay Eye Study and the Singapore Indian Eye Study. Eye examinations, including subjective refraction and axial length (AL) measurements, were performed. MMD was graded from fundus photographs following the Meta-Analysis for Pathologic Myopia classification. The predictive factors for MMD development and progression were assessed in adults without and with MMD at baseline, respectively as risk ratios (RR) using multivariable modified Poisson regression models. The receiver operating characteristic curve was used to visualise the performance of the predictive models for the development of MMD, with performance quantified by the area under the curve (AUC). RESULTS The 12-year cumulative MMD incidence was 10.3% (95% CI 8.9% to 12.0%) among 1504 myopic eyes without MMD at baseline. Tessellated fundus was a major predictor of MMD (RR=2.50, p<0.001), among other factors including age, worse SE and longer AL (all p<0.001). The AUC for prediction of MMD development was found to be 0.78 (95% CI 0.76 to 0.80) for tessellated fundus and increased significantly to an AUC of 0.86 (95% CI 0.84 to 0.88) with the combination of tessellated fundus with age, race, gender and SE (p<0.001). Older age (p=0.02), worse SE (p<0.001) and longer AL (p<0.001) were found to be predictors of MMD progression. CONCLUSIONS In adults with myopia without MMD, tessellated fundus, age, SE and AL had good predictive value for incident MMD. In adults with MMD, 1 in 10 eyes experienced progression over the same period. Older age, more severe myopia and longer AL were independent risk factors for progression.
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Affiliation(s)
- Li Lian Foo
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | | | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | | | - Marcus Ang
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Jingwen Zhang
- GKT School of Medicine, King's College London, London, UK
| | - Kyoko Ohno-Matsui
- Ophthalmology and Visual Science, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Ching Yu Cheng
- Singapore Eye Research Institute, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Quan V Hoang
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
- Dept. of Ophthalmology, Columbia University, New York, New York, USA
| | - Chuen-Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Chee Wai Wong
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
- Asia Pacific Eye Centre, Gleneagles Hospital, Singapore
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11
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Tan TF, Thirunavukarasu AJ, Jin L, Lim J, Poh S, Teo ZL, Ang M, Chan RVP, Ong J, Turner A, Karlström J, Wong TY, Stern J, Ting DSW. Artificial intelligence and digital health in global eye health: opportunities and challenges. Lancet Glob Health 2023; 11:e1432-e1443. [PMID: 37591589 DOI: 10.1016/s2214-109x(23)00323-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/26/2023] [Accepted: 07/04/2023] [Indexed: 08/19/2023]
Abstract
Global eye health is defined as the degree to which vision, ocular health, and function are maximised worldwide, thereby optimising overall wellbeing and quality of life. Improving eye health is a global priority as a key to unlocking human potential by reducing the morbidity burden of disease, increasing productivity, and supporting access to education. Although extraordinary progress fuelled by global eye health initiatives has been made over the last decade, there remain substantial challenges impeding further progress. The accelerated development of digital health and artificial intelligence (AI) applications provides an opportunity to transform eye health, from facilitating and increasing access to eye care to supporting clinical decision making with an objective, data-driven approach. Here, we explore the opportunities and challenges presented by digital health and AI in global eye health and describe how these technologies could be leveraged to improve global eye health. AI, telehealth, and emerging technologies have great potential, but require specific work to overcome barriers to implementation. We suggest that a global digital eye health task force could facilitate coordination of funding, infrastructural development, and democratisation of AI and digital health to drive progress forwards in this domain.
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Affiliation(s)
- Ting Fang Tan
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Singapore National Eye Centre, Singapore General Hospital, Singapore
| | - Arun J Thirunavukarasu
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Corpus Christi College, University of Cambridge, Cambridge, UK; School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Liyuan Jin
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - Joshua Lim
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Singapore National Eye Centre, Singapore General Hospital, Singapore
| | - Stanley Poh
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Singapore National Eye Centre, Singapore General Hospital, Singapore
| | - Zhen Ling Teo
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Singapore National Eye Centre, Singapore General Hospital, Singapore
| | - Marcus Ang
- Singapore National Eye Centre, Singapore General Hospital, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore
| | - R V Paul Chan
- Illinois Eye and Ear Infirmary, University of Illinois College of Medicine, Urbana-Champaign, IL, USA
| | - Jasmine Ong
- Pharmacy Department, Singapore General Hospital, Singapore
| | - Angus Turner
- Lions Eye Institute, University of Western Australia, Nedlands, WA, Australia
| | - Jonas Karlström
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore National Eye Centre, Singapore General Hospital, Singapore; Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Jude Stern
- The International Agency for the Prevention of Blindness, London, UK
| | - Daniel Shu-Wei Ting
- Artificial Intelligence and Digital Innovation Research Group, Singapore Eye Research Institute, Singapore; Singapore National Eye Centre, Singapore General Hospital, Singapore; Duke-NUS Medical School, National University of Singapore, Singapore.
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12
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Liu X, Jiang L, Ke M, Sigal IA, Chua J, Hoang QV, Chia AW, Najjar RP, Tan B, Cheong J, Bellemo V, Chong RS, Girard MJA, Ang M, Liu M, Garhöfer G, Barathi VA, Saw SM, Villiger M, Schmetterer L. Posterior scleral birefringence measured by triple-input polarization-sensitive imaging as a biomarker of myopia progression. Nat Biomed Eng 2023; 7:986-1000. [PMID: 37365268 PMCID: PMC10427432 DOI: 10.1038/s41551-023-01062-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/30/2023] [Indexed: 06/28/2023]
Abstract
In myopic eyes, pathological remodelling of collagen in the posterior sclera has mostly been observed ex vivo. Here we report the development of triple-input polarization-sensitive optical coherence tomography (OCT) for measuring posterior scleral birefringence. In guinea pigs and humans, the technique offers superior imaging sensitivities and accuracies than dual-input polarization-sensitive OCT. In 8-week-long studies with young guinea pigs, scleral birefringence was positively correlated with spherical equivalent refractive errors and predicted the onset of myopia. In a cross-sectional study involving adult individuals, scleral birefringence was associated with myopia status and negatively correlated with refractive errors. Triple-input polarization-sensitive OCT may help establish posterior scleral birefringence as a non-invasive biomarker for assessing the progression of myopia.
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Affiliation(s)
- Xinyu Liu
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE) programme, Singapore, Singapore
| | - Liqin Jiang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Mengyuan Ke
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Ian A Sigal
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE) programme, Singapore, Singapore
| | - Quan V Hoang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine National University of Singapore, Singapore, Singapore
- Department of Ophthalmology, Columbia University, New York, NY, USA
| | - Audrey Wi Chia
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Raymond P Najjar
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine National University of Singapore, Singapore, Singapore
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE) programme, Singapore, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore, Singapore
| | - Jocelyn Cheong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Valentina Bellemo
- SERI-NTU Advanced Ocular Engineering (STANCE) programme, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Rachel S Chong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Michaël J A Girard
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Mengyang Liu
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Veluchamy A Barathi
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine National University of Singapore, Singapore, Singapore
- Translational Pre-Clinical Model Platform, Singapore Eye Research Institute, Singapore, Singapore
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Saw Swee Hock School of Public Health, ,National University of Singapore, National University Health System, Singapore, Singapore
| | - Martin Villiger
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
- Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
- SERI-NTU Advanced Ocular Engineering (STANCE) programme, Singapore, Singapore.
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland.
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.
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13
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Deshmukh R, Ong ZZ, Rampat R, Alió del Barrio JL, Barua A, Ang M, Mehta JS, Said DG, Dua HS, Ambrósio R, Ting DSJ. Management of keratoconus: an updated review. Front Med (Lausanne) 2023; 10:1212314. [PMID: 37409272 PMCID: PMC10318194 DOI: 10.3389/fmed.2023.1212314] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/30/2023] [Indexed: 07/07/2023] Open
Abstract
Keratoconus is the most common corneal ectatic disorder. It is characterized by progressive corneal thinning with resultant irregular astigmatism and myopia. Its prevalence has been estimated at 1:375 to 1:2,000 people globally, with a considerably higher rate in the younger populations. Over the past two decades, there was a paradigm shift in the management of keratoconus. The treatment has expanded significantly from conservative management (e.g., spectacles and contact lenses wear) and penetrating keratoplasty to many other therapeutic and refractive modalities, including corneal cross-linking (with various protocols/techniques), combined CXL-keratorefractive surgeries, intracorneal ring segments, anterior lamellar keratoplasty, and more recently, Bowman's layer transplantation, stromal keratophakia, and stromal regeneration. Several recent large genome-wide association studies (GWAS) have identified important genetic mutations relevant to keratoconus, facilitating the development of potential gene therapy targeting keratoconus and halting the disease progression. In addition, attempts have been made to leverage the power of artificial intelligence-assisted algorithms in enabling earlier detection and progression prediction in keratoconus. In this review, we provide a comprehensive overview of the current and emerging treatment of keratoconus and propose a treatment algorithm for systematically guiding the management of this common clinical entity.
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Affiliation(s)
- Rashmi Deshmukh
- Department of Cornea and Refractive Surgery, LV Prasad Eye Institute, Hyderabad, India
| | - Zun Zheng Ong
- Department of Ophthalmology, Queen’s Medical Centre, Nottingham, United Kingdom
| | - Radhika Rampat
- Department of Ophthalmology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Jorge L. Alió del Barrio
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
- Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain
| | - Ankur Barua
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom
| | - Marcus Ang
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Jodhbir S. Mehta
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Dalia G. Said
- Department of Ophthalmology, Queen’s Medical Centre, Nottingham, United Kingdom
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Harminder S. Dua
- Department of Ophthalmology, Queen’s Medical Centre, Nottingham, United Kingdom
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Renato Ambrósio
- Department of Cornea and Refractive Surgery, Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil
- Department of Ophthalmology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Darren Shu Jeng Ting
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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14
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Man REK, Goh KJL, Lee EPX, Lim JHX, Ang M, Hoang QV, Wong CW, Saw SM, Fenwick EK, Lamoureux EL. Identifying Content for an Item Bank to Measure the Quality-of-Life Impact of Myopia Refractive Interventions. Transl Vis Sci Technol 2023; 12:27. [PMID: 37227748 DOI: 10.1167/tvst.12.5.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Purpose To report on the content generation and item refinement phases for a myopia refractive intervention-specific quality-of-life (QoL) item bank that will be operationalized using computerized adaptive testing. Methods Myopia refractive intervention-specific QoL domains and items were generated from (1) a literature search of existing refractive-intervention QoL questionnaires; (2) semistructured interviews with myopic patients corrected using spectacles, contact lenses and/or refractive surgery (n = 32); (3) and myopia experts (n = 9) recruited from the Singapore National Eye Centre. After a thematic analysis, items were systematically refined and tested using cognitive interviews with 24 additional patients with corrected myopia. Results Of the 32 participants with myopia interviewed (mean ± standard deviation age, 35.6 ± 9.0 years; 71.9% female; 78.1% Chinese), 12 (37.5%) wore spectacles, 7 (21.9%) used contact lenses, and 20 (62.5%) had undergone laser refractive surgery. Initially, 912 items within 7 independent QoL domains were identified. After refinement, 204 items were retained, including those relating to mobility challenges and work-related difficulties that are not well-represented in current refractive intervention-specific questionnaires. Conclusions Through a rigorous item generation and selection process, we have developed a 204-item and 7-domain myopia refractive intervention-specific item bank that will now undergo rigorous psychometric testing to generate item calibrations for the validation of a novel computerized adaptive testing instrument designed for use in research and routine clinical practice. Translational Relevance Once psychometrically validated and operationalized using computerized adaptive testing, this myopia refractive intervention-specific instrument will enable researchers and clinicians to quickly and comprehensively assess the impact of myopic refractive interventions across seven QoL domains.
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Affiliation(s)
- Ryan E K Man
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
| | - Kodi J L Goh
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Ester P X Lee
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Joshua H X Lim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
| | - Quan V Hoang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
- Department of Ophthalmology, Columbia University, New York, NY, USA
- Department Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chee Wai Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
| | - Seang Mei Saw
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Eva K Fenwick
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
| | - Ecosse L Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- https://orcid.org/0000-0001-8674-5705
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15
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Li Y, Yip MYT, Ting DSW, Ang M. Artificial intelligence and digital solutions for myopia. Taiwan J Ophthalmol 2023; 13:142-150. [PMID: 37484621 PMCID: PMC10361438 DOI: 10.4103/tjo.tjo-d-23-00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 03/16/2023] [Indexed: 07/25/2023] Open
Abstract
Myopia as an uncorrected visual impairment is recognized as a global public health issue with an increasing burden on health-care systems. Moreover, high myopia increases one's risk of developing pathologic myopia, which can lead to irreversible visual impairment. Thus, increased resources are needed for the early identification of complications, timely intervention to prevent myopia progression, and treatment of complications. Emerging artificial intelligence (AI) and digital technologies may have the potential to tackle these unmet needs through automated detection for screening and risk stratification, individualized prediction, and prognostication of myopia progression. AI applications in myopia for children and adults have been developed for the detection, diagnosis, and prediction of progression. Novel AI technologies, including multimodal AI, explainable AI, federated learning, automated machine learning, and blockchain, may further improve prediction performance, safety, accessibility, and also circumvent concerns of explainability. Digital technology advancements include digital therapeutics, self-monitoring devices, virtual reality or augmented reality technology, and wearable devices - which provide possible avenues for monitoring myopia progression and control. However, there are challenges in the implementation of these technologies, which include requirements for specific infrastructure and resources, demonstrating clinically acceptable performance and safety of data management. Nonetheless, this remains an evolving field with the potential to address the growing global burden of myopia.
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Affiliation(s)
- Yong Li
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology and Visual Sciences, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Michelle Y. T. Yip
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Daniel S. W. Ting
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology and Visual Sciences, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology and Visual Sciences, Duke-NUS Medical School, National University of Singapore, Singapore
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16
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Gan ATL, Fenwick EK, Ang M, Mehta JS, Lamoureux EL. Bilateral sequential small-incision lenticule extraction and LASIK result in similar short-term quality-of-life outcomes. J Cataract Refract Surg 2023; 49:305-311. [PMID: 36730347 DOI: 10.1097/j.jcrs.0000000000001103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 11/16/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE To compare quality of life (QoL) between patients who receive bilateral small-incision lenticule extraction (SMILE) or laser in situ keratomileusis (LASIK) vs bilateral sequential SMILE-LASIK (BSSL) surgery. SETTING Singapore National Eye Centre, Singapore. DESIGN Retrospective cohort study. METHODS 2 patient cohorts were recruited (2010-2012; 2014-2016). The bilateral SMILE (BS) and bilateral LASIK (BL) groups comprised patients (mean ± SD age: 30.3 ± 6.5, 50% male) from a prospective nonrandomized study who chose SMILE and LASIK, respectively. The BSSL group comprised patients (mean ± SD age: 28.6 ± 6.2, 64.3% male) randomized to receive SMILE in 1 eye and LASIK in the other. Rasch-scaled scores of the QoL Impact of Refractive Correction questionnaire between groups postoperatively at 1 and 3 months were compared. RESULTS At month 1, scores on 3 QoL without emotional well-being items were worse in the BSSL (n = 70) compared with the BL group (n = 25), specficially, "using sunglasses" (β: -20.6, 95% CI, -34.3 to -6.9), "reliance on refractive correction" (-23.1, 95% CI, -40.9 to -5.4), and "medical complications from optical correction" (β: -14.8, 95% CI, -27.9 to -1.7). Emotional well-being (overall), and items "feeling able to do things" (β: 11.0, 95% CI, 1.6-20.4) and "feeling eager to try new things" (β: 14.1, 95% CI, 3.6-24.6) were better in the BSSL compared with the BS group (n = 25). No substantive differences were observed at month 3. CONCLUSIONS Refractive correction-related QoL differences at month 1 between BSSL and BS/BL patients attenuated by month 3. Bilateral sequential SMILE-LASIK surgery appeared unlikely to negatively affect QoL beyond 3 months.
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Affiliation(s)
- Alfred T L Gan
- From the Singapore Eye Research Institute and Singapore National Eye Centre, Singapore (Gan, Fenwick, Ang, Mehta, Lamoureux); Duke-NUS Medical School, Singapore (Fenwick, Ang, Mehta, Lamoureux); National University of Singapore, Singapore (Lamoureux); Faculty of Medicine, Dentistry and Health Sciences University of Melbourne, Australia (Lamoureux)
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17
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Ting DSJ, Deshmukh R, Ting DSW, Ang M. Big data in corneal diseases and cataract: Current applications and future directions. Front Big Data 2023; 6:1017420. [PMID: 36818823 PMCID: PMC9929069 DOI: 10.3389/fdata.2023.1017420] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
The accelerated growth in electronic health records (EHR), Internet-of-Things, mHealth, telemedicine, and artificial intelligence (AI) in the recent years have significantly fuelled the interest and development in big data research. Big data refer to complex datasets that are characterized by the attributes of "5 Vs"-variety, volume, velocity, veracity, and value. Big data analytics research has so far benefitted many fields of medicine, including ophthalmology. The availability of these big data not only allow for comprehensive and timely examinations of the epidemiology, trends, characteristics, outcomes, and prognostic factors of many diseases, but also enable the development of highly accurate AI algorithms in diagnosing a wide range of medical diseases as well as discovering new patterns or associations of diseases that are previously unknown to clinicians and researchers. Within the field of ophthalmology, there is a rapidly expanding pool of large clinical registries, epidemiological studies, omics studies, and biobanks through which big data can be accessed. National corneal transplant registries, genome-wide association studies, national cataract databases, and large ophthalmology-related EHR-based registries (e.g., AAO IRIS Registry) are some of the key resources. In this review, we aim to provide a succinct overview of the availability and clinical applicability of big data in ophthalmology, particularly from the perspective of corneal diseases and cataract, the synergistic potential of big data, AI technologies, internet of things, mHealth, and wearable smart devices, and the potential barriers for realizing the clinical and research potential of big data in this field.
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Affiliation(s)
- Darren S. J. Ting
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom,Birmingham and Midland Eye Centre, Birmingham, United Kingdom,Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, United Kingdom,*Correspondence: Darren S. J. Ting ✉
| | - Rashmi Deshmukh
- Department of Cornea and Refractive Surgery, LV Prasad Eye Institute, Hyderabad, India
| | - Daniel S. W. Ting
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore,Department of Ophthalmology and Visual Sciences, Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Marcus Ang
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore,Department of Ophthalmology and Visual Sciences, Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
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18
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Foo LL, Lim GYS, Lanca C, Wong CW, Hoang QV, Zhang XJ, Yam JC, Schmetterer L, Chia A, Wong TY, Ting DSW, Saw SM, Ang M. Deep learning system to predict the 5-year risk of high myopia using fundus imaging in children. NPJ Digit Med 2023; 6:10. [PMID: 36702878 PMCID: PMC9879938 DOI: 10.1038/s41746-023-00752-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/10/2023] [Indexed: 01/27/2023] Open
Abstract
Our study aims to identify children at risk of developing high myopia for timely assessment and intervention, preventing myopia progression and complications in adulthood through the development of a deep learning system (DLS). Using a school-based cohort in Singapore comprising of 998 children (aged 6-12 years old), we train and perform primary validation of the DLS using 7456 baseline fundus images of 1878 eyes; with external validation using an independent test dataset of 821 baseline fundus images of 189 eyes together with clinical data (age, gender, race, parental myopia, and baseline spherical equivalent (SE)). We derive three distinct algorithms - image, clinical and mix (image + clinical) models to predict high myopia development (SE ≤ -6.00 diopter) during teenage years (5 years later, age 11-17). Model performance is evaluated using area under the receiver operating curve (AUC). Our image models (Primary dataset AUC 0.93-0.95; Test dataset 0.91-0.93), clinical models (Primary dataset AUC 0.90-0.97; Test dataset 0.93-0.94) and mixed (image + clinical) models (Primary dataset AUC 0.97; Test dataset 0.97-0.98) achieve clinically acceptable performance. The addition of 1 year SE progression variable has minimal impact on the DLS performance (clinical model AUC 0.98 versus 0.97 in primary dataset, 0.97 versus 0.94 in test dataset; mixed model AUC 0.99 versus 0.97 in primary dataset, 0.95 versus 0.98 in test dataset). Thus, our DLS allows prediction of the development of high myopia by teenage years amongst school-going children. This has potential utility as a clinical-decision support tool to identify "at-risk" children for early intervention.
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Affiliation(s)
- Li Lian Foo
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Gilbert Yong San Lim
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Carla Lanca
- grid.418858.80000 0000 9084 0599Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL), Instituto Politécnico de Lisboa, Lisboa, Portugal ,grid.10772.330000000121511713Comprehensive Health Research Center (CHRC), Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Chee Wai Wong
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore ,grid.415572.00000 0004 0620 9577Asia Pacific Eye Centre, Gleneagles Hospital, Singapore, Singapore
| | - Quan V. Hoang
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore ,grid.21729.3f0000000419368729Dept. of Ophthalmology, Columbia University, Columbia, SC USA
| | - Xiu Juan Zhang
- grid.10784.3a0000 0004 1937 0482Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Jason C. Yam
- grid.10784.3a0000 0004 1937 0482Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China ,grid.490089.c0000 0004 1803 8779Hong Kong Eye Hospital, Hong Kong, China ,grid.415197.f0000 0004 1764 7206Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China ,grid.10784.3a0000 0004 1937 0482Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China ,Department of Ophthalmology, Hong Kong Children’s Hospital, Hong Kong, China
| | - Leopold Schmetterer
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Audrey Chia
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Tien Yin Wong
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Daniel S. W. Ting
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Seang-Mei Saw
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Marcus Ang
- grid.272555.20000 0001 0706 4670Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore ,grid.4280.e0000 0001 2180 6431Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
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19
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Keel S, Lingham G, Misra N, Block S, Bourne R, Calonge M, Cheng CY, Friedman DS, Furtado JM, Khanna R, Mariotti S, Mathenge W, Matoto E, Müeller A, Rabiu M, Rasengane T, Resnikoff S, Wormald R, Yasmin S, Zhao J, Evans JR, Cieza A, Chan VF, Chen Y, Chinnery H, Dodson S, Downie L, Gordon I, Ghadiri N, Govender Poonsamy P, Han X, Hui F, Jackson ML, Lawrenson J, Ning Lee C, McGuinness M, Murray C, Newsham D, van Nispen R, Prictor M, Puri L, Ramke J, Reekie I, Safi S, Scheetz J, Shen S, Silveira S, Thakur S, Virgili G, Yong AC, Zhang J, Ziaei M, Ali MA, AlObaida IA, AlShamlan FT, Alsulaiman SM, Amissah-Arthur KN, Ang M, Azad R, Bell K, Bharadwaj SR, Booysen DJ, Branchevski S, Bosch V, Brossard-Barbosa N, Chen Y, Craig JP, Dada T, Dichoso CA, Duerksen R, Ebri A, Erdmann I, Freddo T, Flanagan J, Gammoh Y, Gupta N, Hendicott P, Husni MA, Jonathan Jackson A, Jadoon MZ, Januleviciene I, Jeeva I, Jimenez MSS, Kocur I, Kreis A, Kyei S, Lan W, Loy MJV, Marmamula S, Minto LH, Muhit M, Nsubuga NH, Ogundipe A, Okonkwo ON, Olawoye OO, Ouertani AM, Ovenseri-Ogbomo G, Özkan SB, Patel B, Paula JS, Rahi JS, Ravilla RD, Senanayake NS, Sil AK, Solebo AL, Sousa RARC, Tennant MTS, van Staden DB, Wazir JF, Webber AL, Yorston D, Zin A, Faal HB, Keeffe J, McGrath CE. Toward Universal Eye Health Coverage-Key Outcomes of the World Health Organization Package of Eye Care Interventions: A Systematic Review. JAMA Ophthalmol 2022; 140:1229-1238. [PMID: 36394836 DOI: 10.1001/jamaophthalmol.2022.4716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Importance Despite persistent inequalities in access to eye care services globally, guidance on a set of recommended, evidence-based eye care interventions to support country health care planning has not been available. To overcome this barrier, the World Health Organization (WHO) Package of Eye Care Interventions (PECI) has been developed. Objective To describe the key outcomes of the PECI development. Evidence Review A standardized stepwise approach that included the following stages: (1) selection of priority eye conditions by an expert panel after reviewing epidemiological evidence and health facility data; (2) identification of interventions and related evidence for the selected eye conditions from a systematic review of clinical practice guidelines (CPGs); stage 2 included a systematic literature search, screening of title and abstracts (excluding articles that were not relevant CPGs), full-text review to assess disclosure of conflicts of interest and affiliations, quality appraisal, and data extraction; (3) expert review of the evidence extracted in stage 2, identification of missed interventions, and agreement on the inclusion of essential interventions suitable for implementation in low- and middle-income resource settings; and (4) peer review. Findings Fifteen priority eye conditions were chosen. The literature search identified 3601 articles. Of these, 469 passed title and abstract screening, 151 passed full-text screening, 98 passed quality appraisal, and 87 were selected for data extraction. Little evidence (≤1 CPG identified) was available for pterygium, keratoconus, congenital eyelid disorders, vision rehabilitation, myopic macular degeneration, ptosis, entropion, and ectropion. In stage 3, domain-specific expert groups voted to include 135 interventions (57%) of a potential 235 interventions collated from stage 2. After synthesis across all interventions and eye conditions, 64 interventions (13 health promotion and education, 6 screening and prevention, 38 treatment, and 7 rehabilitation) were included in the PECI. Conclusions and Relevance This systematic review of CPGs for priority eye conditions, followed by an expert consensus procedure, identified 64 essential, evidence-based, eye care interventions that are required to achieve universal eye health coverage. The review identified some important gaps, including a paucity of high-quality, English-language CPGs, for several eye diseases and a dearth of evidence-based recommendations on eye health promotion and prevention within existing CPGs.
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Affiliation(s)
- Stuart Keel
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Gareth Lingham
- Centre for Eye Research Ireland, Technological University Dublin, Dublin, Ireland.,Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), University of Western Australia, Perth, Australia
| | - Neha Misra
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | | | - Rupert Bourne
- Cambridge University Hospitals, Cambridge, United Kingdom.,Vision & Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
| | - Margarita Calonge
- Institute of Applied OphthalmoBiology, Universidad de Valladolid, Valladolid, Spain.,CIBER-BBN (Biomedical Research Networking Center Bioengineering, Biomaterials and Nanomedicine), Carlos III National Institute of Health, Valladolid, Spain
| | - Ching-Yu Cheng
- Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | | | - João M Furtado
- Division of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Rohit Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India
| | - Silvio Mariotti
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | | | | | - Andreas Müeller
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Mansur Rabiu
- Noor Dubai Foundation, Dubai Health Authority, Dubai, United Arab Emirates
| | - Tuwani Rasengane
- Department of Optometry, University of the Free State, Bloemfontein, South Africa.,Universitas Hospital, Bloemfontein, South Africa
| | - Serge Resnikoff
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Brien Holden Vision Institute, Sydney, Australia.,Organisation pour la Prévention de la Cécité, Paris, France
| | - Richard Wormald
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom.,Cochrane Eyes and Vision, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | | | - Jialiang Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Eye Research Center Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Cochrane Eyes and Vision, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Alarcos Cieza
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | | | - Ving Fai Chan
- for the Package of Eye Care Interventions Development Group
| | - Yanxian Chen
- for the Package of Eye Care Interventions Development Group
| | - Holly Chinnery
- for the Package of Eye Care Interventions Development Group
| | - Sarity Dodson
- for the Package of Eye Care Interventions Development Group
| | - Laura Downie
- for the Package of Eye Care Interventions Development Group
| | - Iris Gordon
- for the Package of Eye Care Interventions Development Group
| | - Nima Ghadiri
- for the Package of Eye Care Interventions Development Group
| | | | - Xiaotong Han
- for the Package of Eye Care Interventions Development Group
| | - Flora Hui
- for the Package of Eye Care Interventions Development Group
| | | | - John Lawrenson
- for the Package of Eye Care Interventions Development Group
| | - Chan Ning Lee
- for the Package of Eye Care Interventions Development Group
| | | | - Craig Murray
- for the Package of Eye Care Interventions Development Group
| | - David Newsham
- for the Package of Eye Care Interventions Development Group
| | | | - Megan Prictor
- for the Package of Eye Care Interventions Development Group
| | - Lila Puri
- for the Package of Eye Care Interventions Development Group
| | | | - Ian Reekie
- for the Package of Eye Care Interventions Development Group
| | - Sare Safi
- for the Package of Eye Care Interventions Development Group
| | - Jane Scheetz
- for the Package of Eye Care Interventions Development Group
| | - Sunny Shen
- for the Package of Eye Care Interventions Development Group
| | - Sue Silveira
- for the Package of Eye Care Interventions Development Group
| | - Sahil Thakur
- for the Package of Eye Care Interventions Development Group
| | - Gianni Virgili
- for the Package of Eye Care Interventions Development Group
| | - Ai Chee Yong
- for the Package of Eye Care Interventions Development Group
| | - Justine Zhang
- for the Package of Eye Care Interventions Development Group
| | - Mohammed Ziaei
- for the Package of Eye Care Interventions Development Group
| | | | | | | | | | | | - Marcus Ang
- for the Package of Eye Care Interventions Development Group
| | | | - Kristin Bell
- for the Package of Eye Care Interventions Development Group
| | | | - Dirk J Booysen
- for the Package of Eye Care Interventions Development Group
| | | | - Vanessa Bosch
- for the Package of Eye Care Interventions Development Group
| | | | - Yi Chen
- for the Package of Eye Care Interventions Development Group
| | | | - Tanuj Dada
- for the Package of Eye Care Interventions Development Group
| | | | | | - Anne Ebri
- for the Package of Eye Care Interventions Development Group
| | - Irmela Erdmann
- for the Package of Eye Care Interventions Development Group
| | - Thomas Freddo
- for the Package of Eye Care Interventions Development Group
| | - John Flanagan
- for the Package of Eye Care Interventions Development Group
| | - Yazan Gammoh
- for the Package of Eye Care Interventions Development Group
| | - Neeru Gupta
- for the Package of Eye Care Interventions Development Group
| | | | | | | | | | | | - Irfan Jeeva
- for the Package of Eye Care Interventions Development Group
| | | | - Ivo Kocur
- for the Package of Eye Care Interventions Development Group
| | - Andreas Kreis
- for the Package of Eye Care Interventions Development Group
| | - Samuel Kyei
- for the Package of Eye Care Interventions Development Group
| | - Weizhong Lan
- for the Package of Eye Care Interventions Development Group
| | | | | | | | - Mohammad Muhit
- for the Package of Eye Care Interventions Development Group
| | | | | | | | | | | | | | - Seyhan B Özkan
- for the Package of Eye Care Interventions Development Group
| | - Bina Patel
- for the Package of Eye Care Interventions Development Group
| | - Jayter S Paula
- for the Package of Eye Care Interventions Development Group
| | - Jugnoo S Rahi
- for the Package of Eye Care Interventions Development Group
| | | | | | - Asim Kumar Sil
- for the Package of Eye Care Interventions Development Group
| | | | - Raúl ARC Sousa
- for the Package of Eye Care Interventions Development Group
| | | | | | | | - Ann L Webber
- for the Package of Eye Care Interventions Development Group
| | - David Yorston
- for the Package of Eye Care Interventions Development Group
| | - Andrea Zin
- for the Package of Eye Care Interventions Development Group
| | - Hannah B Faal
- for the Package of Eye Care Interventions Development Group
| | - Jill Keeffe
- for the Package of Eye Care Interventions Development Group
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20
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Williams CK, McCarver GA, Chaturvedi A, Sinha S, Ang M, Vogiatzis KD, Jiang J“J. Electrocatalytic Hydrogen Evolution Using A Molecular Antimony Complex under Aqueous Conditions: An Experimental and Computational Study on Main‐Group Element Catalysis. Chemistry 2022; 28:e202201323. [DOI: 10.1002/chem.202201323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Caroline K. Williams
- Department of Chemistry University of Cincinnati P.O. Box 210172 Cincinnati Ohio 45221 USA
| | - Gavin A. McCarver
- Department of Chemistry University of Tennessee Knoxville Tennessee 37996-1600 USA
| | - Ashwin Chaturvedi
- Department of Chemistry University of Cincinnati P.O. Box 210172 Cincinnati Ohio 45221 USA
| | - Soumalya Sinha
- Department of Chemistry University of Cincinnati P.O. Box 210172 Cincinnati Ohio 45221 USA
| | - Marcus Ang
- Department of Chemistry University of Cincinnati P.O. Box 210172 Cincinnati Ohio 45221 USA
| | | | - Jianbing “Jimmy” Jiang
- Department of Chemistry University of Cincinnati P.O. Box 210172 Cincinnati Ohio 45221 USA
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21
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Tsai ASH, Yeo BSY, Anaya Alaminos R, Wong CW, Tham CC, Fang SK, Lam DSC, González-Andrades M, Ang M. Survey of Ophthalmology Training Experiences Among Young Ophthalmologists in the Asia-Pacific. Asia Pac J Ophthalmol (Phila) 2022; 11:434-440. [PMID: 36102646 DOI: 10.1097/apo.0000000000000556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 07/06/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To describe ophthalmology training experiences across the Asia-Pacific (APAC). DESIGN Survey study. METHODS We utilized an anonymous online survey, which was previously validated and conducted in Europe, through Young Ophthalmologist leaders from the national member societies of the Asia-Pacific Academy of Ophthalmology (APAO) from September 2019 to July 2021. Responses were based on a 5-point Likert scale (where applicable) and data were analyzed using Microsoft Excel. Our main outcome measures were differences between regions, that is, Southeast Asia (SEA) and Western Pacific (WP); and seniority, that is, trainees/junior ophthalmologists and senior ophthalmologists. RESULTS We collated 130 responses representing 20 regions in the APAC region. The year of completion of ophthalmic training ranged from 1999 to 2024. The mean duration of training was 3.7±1.0 years. Most (98/130, 75%) indicated an interest for a common training standard across the APAC. Comparing SEA and WP trainees, both regions had similar working environments, but those in SEA reported significantly lower remuneration than their counterparts in WP ($600 vs $3000, P <0.05). WP trainees performed more phacoemulsification surgeries (76 WP vs 19 SEA), while SEA trainees conducted more manual small incision cataract surgeries (157 WP vs 1.5 SEA per duration of training). Senior ophthalmologists performed more cataract surgeries (210.9 senior ophthalmologists vs 40.1 junior ophthalmologists). Trainees had less confidence in medical competency areas such as interpreting an electroretinogram/visual evoked potential/electrooculogram (SEA=1.8, WP=2.1) and conducting an angiography (SEA=2.8, WP=3.4). CONCLUSIONS Our study highlighted heterogeneity among ophthalmology training experiences in the APAC region, with the majority indicating an interest in a common training standard.
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Affiliation(s)
- Andrew S H Tsai
- Singapore National Eye Centre, Singapore, Singapore
- DUKE NUS Medical School, Singapore, Singapore
| | - Brian S Y Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Roberto Anaya Alaminos
- Department of Ophthalmology, Hospital Universitario San Cecilio, VISIÓON Ophthalmic Clinic, Granada, Spain
| | - Chee Wai Wong
- Singapore National Eye Centre, Singapore, Singapore
- DUKE NUS Medical School, Singapore, Singapore
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Dennis S C Lam
- C-MER International Eye Research Center of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China
- C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China
| | - Miguel González-Andrades
- Department of Ophthalmology, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital and University of Cordoba, Cordoba, Spain
| | - Marcus Ang
- Singapore National Eye Centre, Singapore, Singapore
- DUKE NUS Medical School, Singapore, Singapore
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22
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Ong J, Tan G, Ang M, Chhablani J. Digital Advancements in Retinal Models of Care in the Post-COVID-19 Lockdown Era. Asia Pac J Ophthalmol (Phila) 2022; 11:403-407. [PMID: 36094383 DOI: 10.1097/apo.0000000000000533] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
The coronavirus disease-2019 (COVID-19) pandemic introduced unique barriers to retinal care including limited access to imaging modalities, ophthalmic clinicians, and direct medical interventions. These unprecedented barriers were met with the robust implementation of digital advances to aid in monitoring and efficiency of retinal care while taking into the account of public safety. Many of these innovations have been successful in maintaining efficiency and patient satisfaction and are likely to stay to help preserve vision in the future. In this article we highlight these advances implemented during the pandemic including telescreening triage, virtual retinal imaging clinics, at-home optical coherence tomography, mobile phone self-monitoring, and virtual reality monitoring technology. We also discuss advancing innovations including Internet of Things and Blockchain technology that will be critical for further implementation and security of these digital advancements.
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Affiliation(s)
- Joshua Ong
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Gavin Tan
- Surgical Retinal Department of the Singapore National Eye Centre, Singapore
- Clinician Scientist, Singapore Eye Research Institute, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Marcus Ang
- Duke-NUS Department of Ophthalmology and Visual Sciences, Singapore
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA
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23
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Ang M, He F, Lang S, Sabanayagam C, Cheng CY, Arundhati A, Mehta JS. Machine Learning to Analyze Factors Associated With Ten-Year Graft Survival of Keratoplasty for Cornea Endothelial Disease. Front Med (Lausanne) 2022; 9:831352. [PMID: 35721073 PMCID: PMC9200960 DOI: 10.3389/fmed.2022.831352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/28/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Machine learning analysis of factors associated with 10-year graft survival of Descemet stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK) in Asian eyes. Methods Prospective study of donor characteristics, clinical outcomes and complications from consecutive patients (n = 1,335) who underwent DSAEK (946 eyes) or PK (389 eyes) for Fuchs’ endothelial dystrophy (FED) or bullous keratopathy (BK) were analyzed. Random survival forests (RSF) analysis using the highest variable importance (VIMP) factors were determined to develop the optimal Cox proportional hazards regression model. Main outcome measure was 10-year graft survival with RSF analysis of factors associated with graft failure. Results Mean age was 68 ± 11 years, 47.6% male, in our predominantly Chinese (76.6%) Asian cohort, with more BK compared to FED (62.2 vs. 37.8%, P < 0.001). Overall 10-year survival for DSAEK was superior to PK (73.6 vs. 50.9%, log-rank P < 0.001). RSF based on VIMP (best Harrell C statistic: 0.701) with multivariable modeling revealed that BK (HR:2.84, 95%CI:1.89–4.26; P < 0.001), PK (HR: 1.64, 95%CI:1.19–2.27; P = 0.002), male recipients (HR:1.75, 95%CI:1.31–2.34; P < 0.001) and poor pre-operative visual acuity (HR: 1.60, 95%CI:1.15–2.22, P = 0.005) were associated with graft failure. Ten-year cumulative incidence of complications such as immune-mediated graft rejection (P < 0.001), epitheliopathy (P < 0.001), and wound dehiscence (P = 0.002) were greater in the PK compared to the DSAEK group. Conclusion In our study, RSF combined with Cox regression was superior to traditional regression techniques alone in analyzing a large number of high-dimensional factors associated with 10-year corneal graft survival in Asian eyes with cornea endothelial disease.
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Affiliation(s)
- Marcus Ang
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Department of Ophthalmology and Visual Sciences, Duke-NUS Medical School, Singapore, Singapore
| | - Feng He
- Singapore Eye Research Institute, Singapore, Singapore
| | | | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore, Singapore.,Department of Ophthalmology and Visual Sciences, Duke-NUS Medical School, Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore, Singapore.,Department of Ophthalmology and Visual Sciences, Duke-NUS Medical School, Singapore, Singapore
| | - Anshu Arundhati
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Department of Ophthalmology and Visual Sciences, Duke-NUS Medical School, Singapore, Singapore
| | - Jodhbir S Mehta
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Department of Ophthalmology and Visual Sciences, Duke-NUS Medical School, Singapore, Singapore
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24
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Ong HS, Htoon HM, Ang M, Mehta JS. “Endothelium-Out” and “Endothelium-In” Descemet Membrane Endothelial Keratoplasty (DMEK) Graft Insertion Techniques: A Systematic Review With Meta-Analysis. Front Med (Lausanne) 2022; 9:868533. [PMID: 35775001 PMCID: PMC9237218 DOI: 10.3389/fmed.2022.868533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background We evaluated the visual outcomes and complications of “endothelium-out” and “endothelium-in” Descemet membrane endothelial keratoplasty (DMEK) graft insertion techniques. Materials and Methods Electronic searches were conducted in CENTRAL, Cochrane databases, PubMed, EMBASE, ClinicalTrials.gov. Study designs included clinical trials, comparative observational studies, and large case series (≥25 eyes). PRISMA guidelines were used for abstracting data and synthesis. Random-effects models were employed for meta-analyses. Results 21,323 eyes (95 studies) were included. Eighty-six studies reported on “endothelium-out” techniques; eight studies reported on “endothelium-in” techniques. One study compared “endothelium-out” to “endothelium-in” techniques. Eighteen “endothelium-out” studies reported that 42.5–85% of eyes achieved best-corrected visual acuity (BCVA) ≥20/25 at 6 months; pooled proportion of eyes achieving BCVA ≥20/25 at 6 months was 58.7% (95% CI 49.4–67.7%,15 studies). Three “endothelium-in” studies reported that 44.7–87.5% of eyes achieved BCVA of ≥20/25 at 6 months; pooled proportion of eyes achieving BCVA ≥20/25 at 6 months was 62.4% (95% CI 33.9–86.9%). Pooled mean endothelial cell loss was lower in the “endothelium-in” studies (28.1 ± 1.3%, 7 studies) compared to “endothelium-out” studies (36.3 ± 6.9%,10 studies) at 6 months (p = 0.018). Graft re-bubbling rates were higher in the “endothelium-out” studies (26.2%, 95% CI 21.9–30.9%, 74 studies) compared to “endothelium-in” studies (16.5%, 95% CI 8.5–26.4%, 6 studies), although statistical significance was not reached (p = 0.440). Primary graft failure rates were comparable between the two groups (p = 0.552). Quality of evidence was considered low and significant heterogeneity existed amongst the studies. Conclusion Reported rates of endothelial cell loss were lower in “endothelium-in” DMEK studies at 6 months compared to “endothelium-out” studies. Outcomes of “endothelium-in” techniques were otherwise comparable to those reported in “endothelium-out” studies. Given the technical challenges encountered in “endothelium-out” procedures, surgeons may consider “endothelium-in” techniques designed for easier intra-operative DMEK graft unfolding. “Endothelium-in” studies evaluating outcomes at longer time points are required before conclusive comparisons between the two techniques can be drawn.
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Affiliation(s)
- Hon Shing Ong
- Department of Corneal & External Eye Diseases, Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Hon Shing Ong,
| | - Hla M. Htoon
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Marcus Ang
- Department of Corneal & External Eye Diseases, Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Jodhbir S. Mehta
- Department of Corneal & External Eye Diseases, Singapore National Eye Centre, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- School of Materials Science and Engineering, Nanyang Technological University, Singapore, Singapore
- *Correspondence: Jodhbir S. Mehta,
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Li Y, Zheng F, Foo LL, Wong QY, Ting D, Hoang QV, Chong R, Ang M, Wong CW. Advances in OCT Imaging in Myopia and Pathologic Myopia. Diagnostics (Basel) 2022; 12:diagnostics12061418. [PMID: 35741230 PMCID: PMC9221645 DOI: 10.3390/diagnostics12061418] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
Advances in imaging with optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) technology, including the development of swept source OCT/OCTA, widefield or ultra-widefield systems, have greatly improved the understanding, diagnosis, and treatment of myopia and myopia-related complications. Anterior segment OCT is useful for imaging the anterior segment of myopes, providing the basis for implantable collamer lens optimization, or detecting intraocular lens decentration in high myopic patients. OCT has enhanced imaging of vitreous properties, and measurement of choroidal thickness in myopic eyes. Widefield OCT systems have greatly improved the visualization of peripheral retinal lesions and have enabled the evaluation of wide staphyloma and ocular curvature. Based on OCT imaging, a new classification system and guidelines for the management of myopic traction maculopathy have been proposed; different dome-shaped macula morphologies have been described; and myopia-related abnormalities in the optic nerve and peripapillary region have been demonstrated. OCTA can quantitatively evaluate the retinal microvasculature and choriocapillaris, which is useful for the early detection of myopic choroidal neovascularization and the evaluation of anti-vascular endothelial growth factor therapy in these patients. In addition, the application of artificial intelligence in OCT/OCTA imaging in myopia has achieved promising results.
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Affiliation(s)
- Yong Li
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.L.); (F.Z.); (L.L.F.); (Q.Y.W.); (D.T.); (Q.V.H.); (R.C.); (M.A.)
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Feihui Zheng
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.L.); (F.Z.); (L.L.F.); (Q.Y.W.); (D.T.); (Q.V.H.); (R.C.); (M.A.)
| | - Li Lian Foo
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.L.); (F.Z.); (L.L.F.); (Q.Y.W.); (D.T.); (Q.V.H.); (R.C.); (M.A.)
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Qiu Ying Wong
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.L.); (F.Z.); (L.L.F.); (Q.Y.W.); (D.T.); (Q.V.H.); (R.C.); (M.A.)
| | - Daniel Ting
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.L.); (F.Z.); (L.L.F.); (Q.Y.W.); (D.T.); (Q.V.H.); (R.C.); (M.A.)
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Quan V. Hoang
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.L.); (F.Z.); (L.L.F.); (Q.Y.W.); (D.T.); (Q.V.H.); (R.C.); (M.A.)
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
- Department of Ophthalmology, Columbia University, New York, NY 10027, USA
| | - Rachel Chong
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.L.); (F.Z.); (L.L.F.); (Q.Y.W.); (D.T.); (Q.V.H.); (R.C.); (M.A.)
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Marcus Ang
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.L.); (F.Z.); (L.L.F.); (Q.Y.W.); (D.T.); (Q.V.H.); (R.C.); (M.A.)
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Chee Wai Wong
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore 169856, Singapore; (Y.L.); (F.Z.); (L.L.F.); (Q.Y.W.); (D.T.); (Q.V.H.); (R.C.); (M.A.)
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
- Correspondence:
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Ting DSJ, Deshmukh R, Ting DSW, Ang M. Corneal Disorders. Ophthalmic Epidemiol 2022. [DOI: 10.1201/9781315146737-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Tey KY, Tan SY, Ting DSJ, Mehta JS, Ang M. Effects of Combined Cataract Surgery on Outcomes of Descemet's Membrane Endothelial Keratoplasty: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:857200. [PMID: 35425783 PMCID: PMC9002009 DOI: 10.3389/fmed.2022.857200] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
Objective A systematic review and meta-analysis of literature-to-date regarding the effects of combined cataract surgery on outcomes of DMEK. Methods Multiple electronic databases were searched, including Cochrane Library databases, PubMed, Web of Science, and ClinicalTrials.gov. The final search was updated on 10th February 2022. We included randomized controlled trials (RCTs), non-randomized studies and large case series (≥25 eyes) of DMEK (pseudophakic/phakic) and “triple DMEK”. A total of 36 studies were included in this study. Meta-analyses were done with risk differences (RD) computed for dichotomous data and the mean difference (MD) for continuous data via random-effects model. Primary outcome measure: postoperative re-bubbling rate; secondary outcome measures: complete/partial graft detachment rate, best-corrected visual acuity (BCVA), endothelial cell loss (ECL), primary graft failure, and cystoid macular edema (CMO). Results A total of 11,401 eyes were included in this review. Based on non-randomized studies, triple DMEK demonstrated a better BCVA at 1-month postoperative than DMEK alone (MD 0.10 logMAR; 95% CI: 0.07–0.13; p < 0.001), though not statistically significant at 3–6 months postoperative (MD 0.07 logMAR; 95% CI: −0.01 to 0.15; p = 0.08). There was no significant difference in rebubbling, ECL, graft failures, and CMO postoperatively between the two groups (p = 0.07, p = 0.40, 0.06, and 0.54 respectively). Conclusion Our review suggests that DMEK has a similar post-operative complication risk compared to “triple DMEK” (low-quality evidence), with comparable visual outcome and graft survival rate at 6 months postoperative. High-quality RCTs specifically studying the outcomes of combined vs. staged DMEK are still warranted. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020173760, identifier: CRD42020173760.
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Affiliation(s)
- Kai Yuan Tey
- Singapore Eye Research Institute, Singapore, Singapore.,Tasmanian Medical School, University of Tasmania, Hobart, TAS, Australia
| | - Sarah Yingli Tan
- Tasmanian Medical School, University of Tasmania, Hobart, TAS, Australia
| | - Darren S J Ting
- Academic Ophthalmology, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom.,Department of Ophthalmology, Queen's Medical Centre, Nottingham, United Kingdom
| | - Jodhbir S Mehta
- Singapore Eye Research Institute, Singapore, Singapore.,Singapore National Eye Center, Singapore, Singapore.,Duke-National University Singapore Graduate Medical School, Singapore, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore, Singapore.,Singapore National Eye Center, Singapore, Singapore.,Duke-National University Singapore Graduate Medical School, Singapore, Singapore
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Li M, Tan CS, Xu L, Foo LL, Yap F, Sun CH, Tham EKH, Cai S, Ang M, Saw SM, Sabanayagam C. Sleep Patterns and Myopia Among School-Aged Children in Singapore. Front Public Health 2022; 10:828298. [PMID: 35400064 PMCID: PMC8990958 DOI: 10.3389/fpubh.2022.828298] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/28/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate the associations of sleep factors with myopia, spherical equivalent (SE), and axial length (AL) in elementary school-aged children from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort. Methods This cross-sectional study included multi-ethnic children who participated in the GUSTO prospective birth cohort and were delivered in two major tertiary hospitals in Singapore (2009–2010). Sleep factors and myopia outcomes were assessed at the 8- and 9-year study visits, respectively. Parent-reported sleep quality was assessed with the Children's Sleep Habits Questionnaire (CSHQ) total scores. Additionally, each child's sleep duration, timing (bedtime; waketime), and the consistency of sleep duration or timing (i.e., the difference between weekends and weekdays) were parent-reported. Outcomes included cycloplegic SE, myopia (SE ≤ −0.5 D) and AL. Eye measurements from both eyes were included in the analyses. Multivariable linear or logistic regression with Generalized Estimating Equations were used to account for the correlation between paired eyes and confounders in the associations of sleep factors at age 8 and myopia at age 9. Results A total of 572 multi-ethnic children (49.5% boys; 56.1% Chinese) aged 9 years were included in the analyses. Overall, 37.3% of eyes were myopic. Children reported a mean total CSHQ score of 46 [standard deviation (SD) = 6]. The mean duration of sleep was 9.2 (SD = 1.0) hours per day (h/day), with 59.9% of children reporting sufficient sleep (≥9 h/day) based on guidelines recommended by the National Sleep Foundation, USA. The mean bedtime and wake time were 22:00 (SD = 00:53) and 07:08 (SD = 00:55), respectively. In multivariable regression models, total CSHQ scores, the duration of sleep, bedtime and wake time were not significantly associated with myopia, SE, or AL (p ≥ 0.05 for all), adjusting for gender, ethnicity, time outdoors, near-work, parental myopia, maternal education levels (and additionally the child's height when the outcome was AL). Similarly, the consistency of both the duration and timing of sleep (across weekends and weekdays) were not significantly associated with myopia, SE, or AL (p ≥ 0.05 for all). Conclusion In this cross-sectional study, sleep quality, duration, timing, and the consistency of specific sleep factors were not independently associated with myopia, SE, or AL among elementary school-aged children in Singapore. Large longitudinal studies are warranted to corroborate these results.
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Affiliation(s)
- Mijie Li
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Chuen-Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Lingqian Xu
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Li-Lian Foo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS (National University of Singapore) Medical School, Singapore, Singapore
| | - Fabian Yap
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Chen-Hsin Sun
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Elaine K. H. Tham
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| | - Shirong Cai
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS (National University of Singapore) Medical School, Singapore, Singapore
| | - Seang-Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS (National University of Singapore) Medical School, Singapore, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS (National University of Singapore) Medical School, Singapore, Singapore
- *Correspondence: Charumathi Sabanayagam
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Li Y, Foo LL, Wong CW, Li J, Hoang QV, Schmetterer L, Ting DSW, Ang M. Pathologic myopia: advances in imaging and the potential role of artificial intelligence. Br J Ophthalmol 2022; 107:600-606. [PMID: 35288438 DOI: 10.1136/bjophthalmol-2021-320926] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/17/2022] [Indexed: 11/04/2022]
Abstract
Pathologic myopia is a severe form of myopia that can lead to permanent visual impairment. The recent global increase in the prevalence of myopia has been projected to lead to a higher incidence of pathologic myopia in the future. Thus, imaging myopic eyes to detect early pathological changes, or predict myopia progression to allow for early intervention, has become a key priority. Recent advances in optical coherence tomography (OCT) have contributed to the new grading system for myopic maculopathy and myopic traction maculopathy, which may improve phenotyping and thus, clinical management. Widefield fundus and OCT imaging has improved the detection of posterior staphyloma. Non-invasive OCT angiography has enabled depth-resolved imaging for myopic choroidal neovascularisation. Artificial intelligence (AI) has shown great performance in detecting pathologic myopia and the identification of myopia-associated complications. These advances in imaging with adjunctive AI analysis may lead to improvements in monitoring disease progression or guiding treatments. In this review, we provide an update on the classification of pathologic myopia, how imaging has improved clinical evaluation and management of myopia-associated complications, and the recent development of AI algorithms to aid the detection and classification of pathologic myopia.
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Affiliation(s)
- Yong Li
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Department, Duke-NUS Medical School, Singapore
| | - Li-Lian Foo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Department, Duke-NUS Medical School, Singapore
| | - Chee Wai Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Department, Duke-NUS Medical School, Singapore
| | - Jonathan Li
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Quan V Hoang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Department, Duke-NUS Medical School, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Ophthalmology, Columbia University, New York City, New York, USA
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Department, Duke-NUS Medical School, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE), Singapore.,School of Chemical and Biological Engineering, Nanyang Technological University, Singapore.,Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria.,Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria.,Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Daniel S W Ting
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,Ophthalmology and Visual Sciences Department, Duke-NUS Medical School, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore .,Ophthalmology and Visual Sciences Department, Duke-NUS Medical School, Singapore
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Gan J, Sng CCA, Ke M, Chieh CS, Tan B, Schmetterer L, Ang M. Anterior Segment Optical Coherence Tomography Angiography Following Trabecular Bypass Minimally Invasive Glaucoma Surgery. Front Med (Lausanne) 2022; 9:830678. [PMID: 35321475 PMCID: PMC8936187 DOI: 10.3389/fmed.2022.830678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo assess anterior segment optical coherence tomography angiography (AS-OCTA) imaging of the episcleral vessels before and after trabecular bypass minimally invasive glaucoma surgery (MIGS).DesignA prospective, clinical, single-centre, single-arm pilot feasibility study conducted at National University Hospital, Singapore.SubjectsPatients with primary glaucomatous optic neuropathy undergoing Hydrus Microstent (Ivantis Inc., Irvine, CA, USA) implantation, who require at least one intra-ocular pressure-lowering medication. One or two eyes per patient may be enrolled.MethodsWe performed AS-OCTA (Nidek RS-3000 Advance 2, Gamagori, Japan) pre- and up to 6 months post-MIGS implantation using a standard protocol in all cornealimbal quadrants, to derive episcleral vessel densities (VD) using a previously described technique.Main Outcome MeasuresEpiscleral VD pre- and post-surgery, in sectors with and without the implant.ResultsWe obtained serial AS-OCTA images in 25 eyes undergoing MIGS implantation (23 subjects, mean age 70.3 ± 1.5, 61% female) with mean preoperative intraocular pressure (IOP) of 15.5 mmHg ± 4.0. We observed reductions in postoperative episcleral VD compared to preoperative VD at month 1 (mean difference −3.2, p = 0.001), month 3 (mean difference −2.94, p = 0.004) and month 6 (mean difference −2.19, p = 0.039) in sectors with implants (overall 6 month follow-up, p = 0.011). No significant changes were detected in episcleral VD in the sectors without implants (p = 0.910).ConclusionIn our pilot study, AS-OCTA was able to detect changes in the episcleral VD following trabecular bypass MIGS, which may be a useful modality to evaluate surgical outcomes if validated in future studies.
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Affiliation(s)
- Jinyuan Gan
- Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Chelvin C. A. Sng
- Singapore National Eye Centre, Singhealth, Singapore Eye Research Institute, Singapore, Singapore
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | - Mengyuan Ke
- Singapore National Eye Centre, Singhealth, Singapore Eye Research Institute, Singapore, Singapore
| | - Chew Shi Chieh
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | - Bingyao Tan
- Singapore National Eye Centre, Singhealth, Singapore Eye Research Institute, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore
| | - Leopold Schmetterer
- Duke-NUS Graduate Medical School, Singapore, Singapore
- Singapore National Eye Centre, Singhealth, Singapore Eye Research Institute, Singapore, Singapore
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Marcus Ang
- Duke-NUS Graduate Medical School, Singapore, Singapore
- Singapore National Eye Centre, Singhealth, Singapore Eye Research Institute, Singapore, Singapore
- *Correspondence: Marcus Ang
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Abstract
PURPOSE OF REVIEW Minimally invasive glaucoma surgery (MIGS) represents a safer, albeit moderately effective surgical option for intraocular pressure control. However, the CyPass Micro-Stent (Alcon Laboratories) was withdrawn from the market in 2018 as the COMPASS-XT study demonstrated greater cornea endothelial cell (CEC) loss in patients who received the CyPass Micro-Stent with phacoemulsification compared with phacoemulsification alone. This led to the increased attention on MIGS-associated CEC loss and thus, this review will summarise the recent, available evidence on MIGS-associated CEC loss. RECENT FINDINGS Prospective clinical trials and retrospective observational studies published between 2011 and 2021 reported a wide range of 12 month CEC loss from 'insignificant', and up to 14.6%, for phacoemulsification combined with various MIGS procedures. Recent clinical trials over the same time period reported CEC loss of 12.8-15.2% associated with phacoemulsification alone. SUMMARY Apart from the CyPass Micro-Stent clinical trial, no other studies on combined phacoemulsification with MIGS that is 'phaco-plus' procedures have reported a higher short-term CEC loss compared with phacoemulsification alone. However, studies that specifically examine postprocedural CEC loss following phacoemulsification compared to 'phaco-plus' procedures over a longer follow-up period are required.
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Affiliation(s)
- Ivan Seah
- Department of Ophthalmology, National University of Singapore
| | - Chelvin C A Sng
- Department of Ophthalmology, National University of Singapore
- Department of Ophthalmology, National University Hospital
- Singapore Eye Research Institute (SERI)
| | - Marcus Ang
- Singapore Eye Research Institute (SERI)
- Singapore National Eye Center
- Ophthalmology and Visual Sciences, DUKE-National University of Singapore, Singapore, Singapore
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Tey KY, Hoang QV, Loh IQ, Dan YS, Wong QY, Yu DJG, Yandri VR, Ang M, Cheung GCM, Lee SY, Wong TY, Chong RS, Wong CW. Multimodal Imaging-Based Phenotyping of a Singaporean Hospital-Based Cohort of High Myopia Patients. Front Med (Lausanne) 2022; 8:670229. [PMID: 35059405 PMCID: PMC8764286 DOI: 10.3389/fmed.2021.670229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 11/22/2021] [Indexed: 11/08/2022] Open
Abstract
Purpose: To assess the effect of axial length (AL) on the prevalence of pathologic myopia (PM) and associated myopic features in a Singaporean hospital-based cohort of patient with high myopia (HM). Methods: In total, 923 HM eyes from 495 individuals were recruited from the Myopic and Pathologic Eyes in Singapore (MyoPES) cohort and underwent ocular biometry, fundus photography, fundus autofluorescence, and swept-source optical coherence tomography (SS-OCT). Images were analyzed for the presence of myopic macular degeneration (MMD), myopic choroidal neovascularization (mCNV), myopic traction maculopathy (MTM), peripapillary atrophy (PPA), myopic tilted disc, posterior staphyloma (PS), dome-shaped macula (DSM), vitremacular adhesions (VMA), and the epiretinal membrane (ERM). Eyes were stratified into quartiles based on ALs to determine cut-off values to perform comparisons between shorter-length and longer-length groups. A χ2-test was done to determine the difference in the prevalence of pathologies between groups. Results: Overall, mean AL was 29.2 ± 2.2 mm (range 25.0-36.7 mm). Myopic macular degeneration, PPA, myopic tilted disc, and ERM have AL threshold of ≥27.5 mm, whereas MTM has an AL threshold of ≥29.0 mm. We found that there was a significantly higher prevalence of MMD (88.2 vs. 49.4%; p < 0.001), PPA (98.1 vs. 80.1%; p < 0.001), myopic tilted disc (72.7 vs. 50.2%; p < 0.001), and ERM (81.4 vs. 17.3%; p = 0.003) in eyes with AL ≥ 27.5 mm vs. eyes without AL <27.5 mm. Prevalence of MTM (34.7 vs. 32.1%; p < 0.001), mCNV (17.4 vs. 12.1%; p = 0.03), PS (43.4 vs. 34.7%; p = 0.012), DSM (21.3 vs. 13.2%; p = 0.002), and VMA (5.9 vs. 2.6%; p = 0.014) in eyes with AL ≥ 29.0 mm compared with AL < 29.0 mm. Conclusion: Our study describes the overall prevalence of PM and related pathologies among patients with HM in our hospital-based cohort. Longer eyes even among HM eyes had a significantly higher prevalence of PM-associated pathologies studied. This supports the premise that eyes with longer AL, even among HM eyes may be at greater risk of vision-threatening changes and therefore merit regular follow-up.
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Affiliation(s)
- Kai Yuan Tey
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Quan V. Hoang
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore, Singapore,Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, NY, United States,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,*Correspondence: Quan V. Hoang
| | - Isabella Q. Loh
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Yee Shan Dan
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Qiu Ying Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Daryle Jason G. Yu
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Vivi R. Yandri
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Gemmy C. M. Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Shu Yen Lee
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore, Singapore
| | | | - Rachel S. Chong
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Chee Wai Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, Singapore, Singapore
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Gunasekeran DV, Zheng F, Lim GYS, Chong CCY, Zhang S, Ng WY, Keel S, Xiang Y, Park KH, Park SJ, Chandra A, Wu L, Campbel JP, Lee AY, Keane PA, Denniston A, Lam DSC, Fung AT, Chan PRV, Sadda SR, Loewenstein A, Grzybowski A, Fong KCS, Wu WC, Bachmann LM, Zhang X, Yam JC, Cheung CY, Pongsachareonnont P, Ruamviboonsuk P, Raman R, Sakamoto T, Habash R, Girard M, Milea D, Ang M, Tan GSW, Schmetterer L, Cheng CY, Lamoureux E, Lin H, van Wijngaarden P, Wong TY, Ting DSW. Acceptance and Perception of Artificial Intelligence Usability in Eye Care (APPRAISE) for Ophthalmologists: A Multinational Perspective. Front Med (Lausanne) 2022; 9:875242. [PMID: 36314006 PMCID: PMC9612721 DOI: 10.3389/fmed.2022.875242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Many artificial intelligence (AI) studies have focused on development of AI models, novel techniques, and reporting guidelines. However, little is understood about clinicians' perspectives of AI applications in medical fields including ophthalmology, particularly in light of recent regulatory guidelines. The aim for this study was to evaluate the perspectives of ophthalmologists regarding AI in 4 major eye conditions: diabetic retinopathy (DR), glaucoma, age-related macular degeneration (AMD) and cataract. Methods This was a multi-national survey of ophthalmologists between March 1st, 2020 to February 29th, 2021 disseminated via the major global ophthalmology societies. The survey was designed based on microsystem, mesosystem and macrosystem questions, and the software as a medical device (SaMD) regulatory framework chaired by the Food and Drug Administration (FDA). Factors associated with AI adoption for ophthalmology analyzed with multivariable logistic regression random forest machine learning. Results One thousand one hundred seventy-six ophthalmologists from 70 countries participated with a response rate ranging from 78.8 to 85.8% per question. Ophthalmologists were more willing to use AI as clinical assistive tools (88.1%, n = 890/1,010) especially those with over 20 years' experience (OR 3.70, 95% CI: 1.10-12.5, p = 0.035), as compared to clinical decision support tools (78.8%, n = 796/1,010) or diagnostic tools (64.5%, n = 651). A majority of Ophthalmologists felt that AI is most relevant to DR (78.2%), followed by glaucoma (70.7%), AMD (66.8%), and cataract (51.4%) detection. Many participants were confident their roles will not be replaced (68.2%, n = 632/927), and felt COVID-19 catalyzed willingness to adopt AI (80.9%, n = 750/927). Common barriers to implementation include medical liability from errors (72.5%, n = 672/927) whereas enablers include improving access (94.5%, n = 876/927). Machine learning modeling predicted acceptance from participant demographics with moderate to high accuracy, and area under the receiver operating curves of 0.63-0.83. Conclusion Ophthalmologists are receptive to adopting AI as assistive tools for DR, glaucoma, and AMD. Furthermore, ML is a useful method that can be applied to evaluate predictive factors on clinical qualitative questionnaires. This study outlines actionable insights for future research and facilitation interventions to drive adoption and operationalization of AI tools for Ophthalmology.
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Affiliation(s)
- Dinesh V Gunasekeran
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Feihui Zheng
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore
| | - Gilbert Y S Lim
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Crystal C Y Chong
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore
| | - Shihao Zhang
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore
| | - Wei Yan Ng
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore
| | - Stuart Keel
- Department of Ophthalmology, University of Melbourne, Melbourne, VIC, Australia
| | - Yifan Xiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center (ZOC), Sun Yat-sen University, Guangzhou, China
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Aman Chandra
- Department of Ophthalmology, Southend University Hospital, Southend-on-Sea, United Kingdom
| | - Lihteh Wu
- Asociados de Macula, Vitreo y Retina de Costa Rica, San José, Costa Rica
| | - J Peter Campbel
- Casey Eye Institute, Oregon Health and Science, Portland, OR, United States
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, United States
| | | | - Alastair Denniston
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.,Institute of Ophthalmology, University College London (UCL), London, United Kingdom
| | - Dennis S C Lam
- International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), Shenzhen, China.,C-MER International Eye Research Center of the Chinese University of Hong Kong (Shenzhen), Shenzhen, China
| | - Adrian T Fung
- Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia.,Department of Ophthalmology, Faculty of Medicine, Health and Human Sciences, Macquarie University Hospital, Sydney, NSW, Australia
| | - Paul R V Chan
- Department of Ophthalmology, University of Illinois College of Medicine, Chicago, IL, United States
| | - SriniVas R Sadda
- Department of Ophthalmology, Doheny Eye Institute, Los Angeles, CA, United States
| | - Anat Loewenstein
- Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Ponzan, Poland
| | | | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center (ZOC), Sun Yat-sen University, Guangzhou, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong (CUHK), Hong Kong, Hong Kong SAR, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong (CUHK), Hong Kong, Hong Kong SAR, China
| | - Pear Pongsachareonnont
- Vitreoretinal Research Unit, Department of Ophthalmology, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Paisan Ruamviboonsuk
- Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand
| | - Rajiv Raman
- Vitreo-Retinal Department, Sankara Nethralaya, Chennai, India
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University, Kagoshima, Japan
| | - Ranya Habash
- Bascom Palmar Eye Institute, Miami, FL, United States
| | - Michael Girard
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Dan Milea
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,Copenhagen University Hospital, Copenhagen, Denmark
| | - Marcus Ang
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Gavin S W Tan
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center (ZOC), Sun Yat-sen University, Guangzhou, China
| | | | - Tien Y Wong
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Daniel S W Ting
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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Foo LL, Lanca C, Wong CW, Ting D, Lamoureux E, Saw SM, Ang M. Cost of Myopia Correction: A Systematic Review. Front Med (Lausanne) 2021; 8:718724. [PMID: 34926485 PMCID: PMC8677936 DOI: 10.3389/fmed.2021.718724] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022] Open
Abstract
Myopia is one of the leading causes of visual impairment globally. Despite increasing prevalence and incidence, the associated cost of treatment remains unclear. Health care spending is a major concern in many countries and understanding the cost of myopia correction is the first step eluding to the overall cost of myopia treatment. As cost of treatment will reduce the burden of cost of illness, this will aid in future cost-benefit analysis and the allocation of healthcare resources, including considerations in integrating eye care (refractive correction with spectacles) into universal health coverage (UHC). We performed a systematic review to determine the economic costs of myopia correction. However, there were few studies for direct comparison. Costs related to myopia correction were mainly direct with few indirect costs. Annual prevalence-based direct costs for myopia ranged from $14-26 (USA), $56 (Iran) and $199 (Singapore) per capita, respectively (population: 274.63 million, 75.15 million and 3.79 million, respectively). Annually, the direct costs of contact lens were $198.30-$378.10 while spectacles and refractive surgeries were $342.50 and $19.10, respectively. This review provides an insight to the cost of myopia correction. Myopia costs are high from nation-wide perspectives because of the high prevalence of myopia, with contact lenses being the more expensive option. Without further interventions, the burden of illness of myopia will increase substantially with the projected increase in prevalence worldwide. Future studies will be necessary to generate more homogenous cost data and provide a complete picture of the global economic cost of myopia.
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Affiliation(s)
- Li Lian Foo
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Carla Lanca
- Singapore Eye Research Institute, Singapore, Singapore.,Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL), Instituto Politécnico de Lisboa, Lisboa, Portugal.,Comprehensive Health Research Center (CHRC), Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Chee Wai Wong
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Daniel Ting
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.,NUS Saw Swee Hock School of Public Health, Singapore, Singapore
| | - Marcus Ang
- Singapore National Eye Centre, Singapore, Singapore.,Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
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35
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Cahyo DAY, Yow AP, Saw SM, Ang M, Girard M, Schmetterer L, Wong D. Multi-task learning approach for volumetric segmentation and reconstruction in 3D OCT images. Biomed Opt Express 2021; 12:7348-7360. [PMID: 35003838 PMCID: PMC8713660 DOI: 10.1364/boe.428140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/11/2021] [Accepted: 08/27/2021] [Indexed: 06/14/2023]
Abstract
The choroid is the vascular layer of the eye that supplies photoreceptors with oxygen. Changes in the choroid are associated with many pathologies including myopia where the choroid progressively thins due to axial elongation. To quantize these changes, there is a need to automatically and accurately segment the choroidal layer from optical coherence tomography (OCT) images. In this paper, we propose a multi-task learning approach to segment the choroid from three-dimensional OCT images. Our proposed architecture aggregates the spatial context from adjacent cross-sectional slices to reconstruct the central slice. Spatial context learned by this reconstruction mechanism is then fused with a U-Net based architecture for segmentation. The proposed approach was evaluated on volumetric OCT scans of 166 myopic eyes acquired with a commercial OCT system, and achieved a cross-validation Intersection over Union (IoU) score of 94.69% which significantly outperformed (p<0.001) the other state-of-the-art methods on the same data set. Choroidal thickness maps generated by our approach also achieved a better structural similarity index (SSIM) of 72.11% with respect to the groundtruth. In particular, our approach performs well for highly challenging eyes with thinner choroids. Compared to other methods, our proposed approach also requires lesser processing time and has lower computational requirements. The results suggest that our proposed approach could potentially be used as a fast and reliable method for automated choroidal segmentation.
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Affiliation(s)
- Dheo A. Y. Cahyo
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Ai Ping Yow
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Singapore Centre for Environmental Life Sciences Engineering (SCELSE), Singapore
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Michael Girard
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Leopold Schmetterer
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Damon Wong
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
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36
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Tan A, Lai G, Saw S, Chua K, Takano A, Ong B, Koh T, Jain A, Tan W, Ng Q, Kanesvaran R, Rajasekaran T, Kalshnikova E, Shchegrova S, H. -Ta, Lin J, Renner D, Sethi H, Zimmermann B, Aleshin A, Lim W, Tan E, Skanderup A, Ang M, Tan D. MA07.06 Circulating Tumor DNA for Monitoring Minimal Residual Disease and Early Detection of Recurrence in Early Stage Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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37
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Tan B, McNabb RP, Zheng F, Sim YC, Yao X, Chua J, Ang M, Hoang QV, Kuo AN, Schmetterer L. Ultrawide field, distortion-corrected ocular shape estimation with MHz optical coherence tomography (OCT). Biomed Opt Express 2021; 12:5770-5781. [PMID: 34692214 PMCID: PMC8515957 DOI: 10.1364/boe.428430] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/08/2021] [Accepted: 07/08/2021] [Indexed: 05/06/2023]
Abstract
Ocular deformation may be associated with biomechanical alterations in the structures of the eye, especially the cornea and sclera in conditions such as keratoconus, congenital glaucoma, and pathological myopia. Here, we propose a method to estimate ocular shape using an ultra-wide field MHz swept-source optical coherence tomography (SS-OCT) with a Fourier Domain Mode-Locked (FDML) laser and distortion correction of the images. The ocular biometrics for distortion correction was collected by an IOLMaster 700, and localized Gaussian curvature was proposed to quantify the ocular curvature covering a field-of-view up to 65°×62°. We achieved repeatable curvature shape measurements (intraclass coefficient = 0.88 ± 0.06) and demonstrated its applicability in a pilot study with individuals (N = 11) with various degrees of myopia.
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Affiliation(s)
- Bingyao Tan
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore
- Authors contributed equally to the study
| | - Ryan P McNabb
- Duke University Medical Center, Durham, NC 27607, USA
- Authors contributed equally to the study
| | - Feihui Zheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Yin Ci Sim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Xinwen Yao
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore
| | - Jacqueline Chua
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Department of Ophthalmology, Duke-NUS Medical School, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Department of Ophthalmology, Duke-NUS Medical School, Singapore
| | - Quan V Hoang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Department of Ophthalmology, Duke-NUS Medical School, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia College of Physicians and Surgeons, New York, NY 10032, USA
| | - Anthony N Kuo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke University Medical Center, Durham, NC 27607, USA
| | - Leopold Schmetterer
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore
- Department of Ophthalmology, Duke-NUS Medical School, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
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38
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Abstract
PURPOSE OF REVIEW Myopia is one of the leading causes of visual impairment, with a projected increase in prevalence globally. One potential approach to address myopia and its complications is early detection and treatment. However, current healthcare systems may not be able to cope with the growing burden. Digital technological solutions such as artificial intelligence (AI) have emerged as a potential adjunct for myopia management. RECENT FINDINGS There are currently four significant domains of AI in myopia, including machine learning (ML), deep learning (DL), genetics and natural language processing (NLP). ML has been demonstrated to be a useful adjunctive for myopia prediction and biometry for cataract surgery in highly myopic individuals. DL techniques, particularly convoluted neural networks, have been applied to various image-related diagnostic and predictive solutions. Applications of AI in genomics and NLP appear to be at a nascent stage. SUMMARY Current AI research is mainly focused on disease classification and prediction in myopia. Through greater collaborative research, we envision AI will play an increasingly critical role in big data analysis by aggregating a greater variety of parameters including genomics and environmental factors. This may enable the development of generalizable adjunctive DL systems that could help realize predictive and individualized precision medicine for myopic patients.
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Affiliation(s)
- Li Lian Foo
- Singapore National Eye Centre, Singapore Eye Research Institute
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Wei Yan Ng
- Singapore National Eye Centre, Singapore Eye Research Institute
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | | | - Tien-En Tan
- Singapore National Eye Centre, Singapore Eye Research Institute
| | - Marcus Ang
- Singapore National Eye Centre, Singapore Eye Research Institute
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Daniel Shu Wei Ting
- Singapore National Eye Centre, Singapore Eye Research Institute
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
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Tey KY, Gan J, Foo V, Tan B, Ke MY, Schmetterer L, Mehta JS, Ang M. Role of anterior segment optical coherence tomography angiography in the assessment of acute chemical ocular injury: a pilot animal model study. Sci Rep 2021; 11:16625. [PMID: 34404833 PMCID: PMC8371111 DOI: 10.1038/s41598-021-96086-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/21/2021] [Indexed: 11/28/2022] Open
Abstract
To examine the use of anterior segment-optical coherence tomography angiography (AS-OCTA) in the assessment of limbal ischemia in an animal model chemical ocular injury. We conducted a prospective study using an established chemical ocular injury model in 6 rabbits (12 eyes), dividing the cornea limbus into 4 quadrants. Chemical injury grade was induced based on extent of limbal injury (0 to 360 degrees) and all eyes underwent serial slit-lamp with AS-OCTA imaging up to one month. Main outcome measure was changes in AS-OCTA vessel density (VD) comparing injured and control cornea limbal quadrants within 24 h and at one month. AS-OCTA was able to detect differences in limbal VD reduction comparing injured (3.3 ± 2.4%) and control quadrants (7.6 ± 2.3%; p < 0.001) within 24 h of ocular chemical injury. We also observed that AS-OCTA VD reduction was highly correlated with the number of quadrants injured (r = − 0.89; p < 0.001; 95% CI − 5.65 to − 1.87). Corneal vascularization was detected by AS-OCTA in injured compared to control quadrants (10.1 ± 4.3% vs 7.0 ± 1.2%; p = 0.025) at 1 month. Our animal pilot study suggests that AS-OCTA was able to detect limbal vessel disruption from various severities of acute chemical insult, and in the future, could potentially serve as an adjunct in providing objective grading of acute ocular chemical injury once validated in a clinical trial.
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Affiliation(s)
- Kai Yuan Tey
- Singapore Eye Research Institute, Singapore, Singapore
| | - Jinyuan Gan
- Duke-NUS Medical School, Singapore, Singapore
| | - Valencia Foo
- Singapore National Eye Centre, 20 College Rd, Singapore, 169856, Singapore
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE) Program, Nanyang Technological University, Singapore, Singapore
| | - Meng Yuan Ke
- Singapore Eye Research Institute, Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,SERI-NTU Advanced Ocular Engineering (STANCE) Program, Nanyang Technological University, Singapore, Singapore.,School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore.,Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Jodhbir S Mehta
- Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Singapore National Eye Centre, 20 College Rd, Singapore, 169856, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore, Singapore. .,Duke-NUS Medical School, Singapore, Singapore. .,Singapore National Eye Centre, 20 College Rd, Singapore, 169856, Singapore.
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40
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Lanca C, Kassam I, Patasova K, Foo LL, Li J, Ang M, Hoang QV, Teo YY, Hysi PG, Saw SM. New Polygenic Risk Score to Predict High Myopia in Singapore Chinese Children. Transl Vis Sci Technol 2021; 10:26. [PMID: 34319387 PMCID: PMC8322707 DOI: 10.1167/tvst.10.8.26] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose The purpose of this study was to develop an Asian polygenic risk score (PRS) to predict high myopia (HM) in Chinese children in the Singapore Cohort of Risk factors for Myopia (SCORM) cohort. Methods We included children followed from 6 to 11 years old until teenage years (12–18 years old). Cycloplegic autorefraction, ultrasound biometry, Illumina HumanHap 550, or 550 Duo Beadarrays, demographics, and environmental factors data were obtained. The PRS was generated from the Consortium for Refractive Error and Myopia genomewide association study (n = 542,934) and the Strabismus, Amblyopia, and Refractive Error in Singapore children Study (n = 500). The Growing Up in Singapore Towards healthy Outcomes Cohort study (n = 339) was the replication cohort. The outcome was teenage HM (≤ −5.00 D) with predictive performance assessed using the area under the curve (AUC). Results Mean baseline age ± SD was 7.85 ± 0.84 (n = 1004) and 571 attended the teenage visit; 23.3% had HM. In multivariate analysis, the PRS was associated with a myopic spherical equivalent with an incremental R2 of 0.041 (95% confidence interval [CI] = 0.010, 0.073; P < 0.001). AUC for HM (0.77 [95% CI = 0.71–0.83]) performed better (P = 0.02) with the PRS compared with a model without (0.72 [95% CI = 0.65, 0.78]). Children at the top 25% PRS risk had a 2.34-fold-greater risk of HM (95% CI = 1.53, 3.55; P < 0.001). Conclusions The new Asian PRS improved the predictive performance to detect children at risk of HM. Translational Relevance Clinicians may use the PRS with other predictive factors to identify high risk children and guide interventions to reduce the risk of HM later in life.
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Affiliation(s)
- Carla Lanca
- Singapore Eye Research Institute, Singapore.,Comprehensive Health Research Center (CHRC), Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal.,Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL), Instituto Politécnico de Lisboa, Lisboa, Portugal
| | - Irfahan Kassam
- Saw Swee Hock School of Public Health, National University of Singapore.,Life Sciences Institute, National University of Singapore
| | - Karina Patasova
- Section of Ophthalmology, School of Life Course Sciences, King's College London, United Kingdom Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, UK
| | - Li-Lian Foo
- Singapore Eye Research Institute, Singapore.,Singapore National Eye Centre, Singapore.,Duke-NUS Medical School, Singapore
| | - Jonathan Li
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore.,Singapore National Eye Centre, Singapore.,Duke-NUS Medical School, Singapore
| | - Quan V Hoang
- Singapore Eye Research Institute, Singapore.,Singapore National Eye Centre, Singapore.,Duke-NUS Medical School, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yik-Ying Teo
- Saw Swee Hock School of Public Health, National University of Singapore
| | - Pirro G Hysi
- Section of Ophthalmology, School of Life Course Sciences, King's College London, United Kingdom Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, King's College London, UK.,UCL Great Ormond Street Hospital Institute of Child Health, University College London, UK
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore.,Duke-NUS Medical School, Singapore
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41
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Saxena A, Yao X, Wong D, Chua J, Ang M, Hoang QV, Agrawal R, Girard M, Cheung G, Schmetterer L, Tan B. Framework for quantitative three-dimensional choroidal vasculature analysis using optical coherence tomography. Biomed Opt Express 2021; 12:4982-4996. [PMID: 34513237 PMCID: PMC8407849 DOI: 10.1364/boe.426093] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/20/2021] [Accepted: 05/27/2021] [Indexed: 05/25/2023]
Abstract
Choroidal vasculature plays an important role in the pathogenesis of retinal diseases, such as myopic maculopathy, age-related macular degeneration, diabetic retinopathy, central serous chorioretinopathy, and ocular inflammatory diseases. Current optical coherence tomography (OCT) technology provides three-dimensional visualization of the choroidal angioarchitecture; however, quantitative measures remain challenging. Here, we propose and validate a framework to segment and quantify the choroidal vasculature from a prototype swept-source OCT (PLEX Elite 9000, Carl Zeiss Meditec, USA) using a 3×3 mm scan protocol centered on the macula. Enface images referenced from the retinal pigment epithelium were reconstructed from the volumetric data. The boundaries of the choroidal volume were automatically identified by tracking the choroidal vessel feature structure over the depth, and a selective sliding window was applied for segmenting the vessels adaptively from attenuation-corrected enface images. We achieved a segmentation accuracy of 96% ± 1% as compared with manual annotation, and a dice coefficient of 0.83 ± 0.04 for repeatability. Using this framework on both control (0.00 D to -2.00 D) and highly myopic (-8.00 D to -11.00 D) eyes, we report a decrease in choroidal vessel volume (p<0.001) in eyes with high myopia.
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Affiliation(s)
- Ashish Saxena
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
| | - Xinwen Yao
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- NTU Institute for Health Technologies, Singapore
| | - Damon Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- NTU Institute for Health Technologies, Singapore
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Department of Ophthalmology, Duke-NUS Medical School, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Duke-NUS Medical School, Singapore
| | - Quan V. Hoang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Duke-NUS Medical School, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Ophthalmology, Columbia University College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032, USA
| | - Rupesh Agrawal
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Duke-NUS Medical School, Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Michael Girard
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Duke-NUS Medical School, Singapore
- Institute of Molecular and Clinical Ophthalmology, 4031 Basel, Switzerland
| | - Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- NTU Institute for Health Technologies, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- NTU Institute for Health Technologies, Singapore
- Department of Ophthalmology, Duke-NUS Medical School, Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, 4031 Basel, Switzerland
| | - Bingyao Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- NTU Institute for Health Technologies, Singapore
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42
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Foo VHX, Ke M, Tan CQL, Schmetterer L, Mehta JS, Ang M. Anterior Segment Optical Coherence Tomography Angiography Assessment of Corneal Vascularisation After Combined Fine-Needle Diathermy with Subconjunctival Ranibizumab: A Pilot Study. Adv Ther 2021; 38:4333-4343. [PMID: 34241779 DOI: 10.1007/s12325-021-01849-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/25/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To describe anterior segment optical coherence tomography angiography (AS-OCTA) imaging to monitor corneal vascularisation (CoNV) and scar reduction after combined fine-needle diathermy (FND) with subconjunctival ranibizumab. METHODS Prospective clinical study of six eyes from six subjects with corneal scar and CoNV which underwent combined FND with subconjunctival ranibizumab. All eyes were imaged using slit-lamp photography (SLP) and AS-OCTA (Optovue, Inc., Fremont, CA, wavelength: 840 nm) before and after the operation, with two independent masked assessors analysing all images. Main outcome measures were changes in median corneal scar area and vessel density (AS-OCTA) comparing pre- and postoperative imaging up to month 3 and 6. RESULTS The mean age of the subjects was 60 ± 23 years, with three males and three females. CoNV and corneal scarring involving the visual axis were present in all eyes, secondary to previous infective keratitis (n = 3), severe blepharokeratoconjunctivitis (n = 2), or chemical injury (n = 1). Follow-up time frame ranged from 2 to 6 months postoperation. There was a reduction in median corneal scar area from 30.2 mm2 (IQR 18.7-38.5) before surgery to 14.8 mm2 (IQR 7.1-19.6) after surgery, with a median reduction of 37.1% (IQR = - 3.1-86.9, p = 0.046). There was also a reduction in median cornea vessel density (AS-OCTA) from 20.8% (IQR 16.1-20.8) before surgery to 17.6% (IQR 14.0-17.6) after surgery, with a median reduction of 15.1% (IQR 13.2-15.1, p < 0.001). CONCLUSIONS Combined imaging of SLP and AS-OCTA is useful for monitoring treatment response of corneal scarring and CoNV after combined FND with subconjunctival Ranibizumab.
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Affiliation(s)
- Valencia Hui Xian Foo
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Mengyuan Ke
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Chelsea Qiu Lin Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Leopold Schmetterer
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
- Department of Ophthalmology and Visual Science, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore
- SERI-NTU Advanced Ocular Engineering (STANCE), 50 Nanyang Drive, Singapore, 637553, Singapore
- Institute for Health Technologies, Nanyang Technological University, 50 Nanyang Drive, Singapore, 637553, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Institute of Clinical and Experimental Ophthalmology, Klybeckstrasse 141, WKL 420, 4057, Basel, Switzerland
| | - Jodhbir S Mehta
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
- Department of Ophthalmology and Visual Science, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Marcus Ang
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore.
- Department of Ophthalmology and Visual Science, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.
- Department of Ophthalmology and Visual Sciences, Duke-NUS Medical School, Cornea and Refractive Service, Singapore National Eye Center, 11 Third Hospital Avenue, Singapore, 168751, Singapore.
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43
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Song A, Deshmukh R, Lin H, Ang M, Mehta JS, Chodosh J, Said DG, Dua HS, Ting DSJ. Post-keratoplasty Infectious Keratitis: Epidemiology, Risk Factors, Management, and Outcomes. Front Med (Lausanne) 2021; 8:707242. [PMID: 34307431 PMCID: PMC8292647 DOI: 10.3389/fmed.2021.707242] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 06/09/2021] [Indexed: 12/26/2022] Open
Abstract
Post-keratoplasty infectious keratitis (PKIK) represents a unique clinical entity that often poses significant diagnostic and therapeutic challenges. It carries a high risk of serious complications such as graft rejection and failure, and less commonly endophthalmitis. Topical corticosteroids are often required to reduce the risk of graft rejection but their use in PKIK may act as a double-edged sword, particularly in fungal infection. The increased uptake in lamellar keratoplasty in the recent years has also led to complications such as graft-host interface infectious keratitis (IIK), which is particularly difficult to manage. The reported incidence of PKIK differs considerably across different countries, with a higher incidence observed in developing countries (9.2-11.9%) than developed countries (0.02-7.9%). Common risk factors for PKIK include the use of topical corticosteroids, suture-related problems, ocular surface diseases and previous corneal infection. PKIK after penetrating keratoplasty or (deep) anterior lamellar keratoplasty is most commonly caused by ocular surface commensals, particularly Gramme-positive bacteria, whereas PKIK after endothelial keratoplasty is usually caused by Candida spp. Empirical broad-spectrum antimicrobial treatment is the mainstay of treatment for both PKIK, though surgical interventions are required in medically refractory cases (during the acute phase) and those affected by visually significant scarring (during the late phase). In this paper, we aim to provide a comprehensive overview on PKIK, encompassing the epidemiology, risk factors, causes, management and outcomes, and to propose a treatment algorithm for systematically managing this challenging condition.
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Affiliation(s)
- Anna Song
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rashmi Deshmukh
- Department of Ophthalmology, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Marcus Ang
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Jodhbir S. Mehta
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - James Chodosh
- Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, United States
| | - Dalia G. Said
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, United Kingdom
| | - Harminder S. Dua
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, United Kingdom
| | - Darren S. J. Ting
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Department of Ophthalmology, Queen's Medical Centre, Nottingham, United Kingdom
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44
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Yao X, Tan B, Ho Y, Liu X, Wong D, Chua J, Wong TT, Perera S, Ang M, Werkmeister RM, Schmetterer L. Full circumferential morphological analysis of Schlemm's canal in human eyes using megahertz swept source OCT. Biomed Opt Express 2021; 12:3865-3877. [PMID: 34457385 PMCID: PMC8367246 DOI: 10.1364/boe.426218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 05/16/2023]
Abstract
We performed full circumferential imaging of the Schlemm's canal (SC) of two human eyes using a Fourier domain mode-lock laser (FDML) based 1.66-MHz SS-OCT prototype at 1060 nm. Eight volumes with overlapping margins were acquired around the limbal area with customized raster scanning patterns designed to fully cover the SC while minimizing motion artifacts. The SC was segmented from the volumes using a semi-automated active contour segmentation algorithm, whose mean dice similarity coefficient was 0.76 compared to the manual segmentation results. We also reconstructed three-dimensional (3D) renderings of the 360° SC by stitching the segmented SCs from the volumetric datasets. Quantitative metrics of the full circumferential SC were provided, including the mean and standard deviation (SD) of the cross-sectional area (CSA), the maximum CSA, the minimum and maximum SC opening width, and the number of collector channels (CC) stemming from the SC.
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Affiliation(s)
- Xinwen Yao
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Bingyao Tan
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Yijie Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xinyu Liu
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Damon Wong
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Jacqueline Chua
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Tina T. Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Shamira Perera
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - René M. Werkmeister
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Leopold Schmetterer
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
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45
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Tey KY, Wong QY, Dan YS, Tsai ASH, Ting DSW, Ang M, Cheung GCM, Lee SY, Wong TY, Hoang QV, Wong CW. Association of Aberrant Posterior Vitreous Detachment and Pathologic Tractional Forces With Myopic Macular Degeneration. Invest Ophthalmol Vis Sci 2021; 62:7. [PMID: 34096974 PMCID: PMC8185394 DOI: 10.1167/iovs.62.7.7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose The purpose of this study was to assess whether the tractional elements of pathologic myopia (PM; e.g. myopic traction maculopathy [MTM], posterior staphyloma [PS], and aberrant posterior vitreous detachment [PVD]) are associated with myopic macular degeneration (MMD) independent of age and axial length, among highly myopic (HM) eyes. Methods One hundred twenty-nine individuals with 239 HM eyes from the Myopic and Pathologic Eyes in Singapore (MyoPES) cohort underwent ocular biometry, fundus photography, swept-source optical coherence tomography, and ocular B-scan ultrasound. Images were analyzed for PVD grade, and presence of MTM, PS, and MMD. The χ² test was done to determine the difference in prevalence of MMD between eyes with and without PVD, PS, and MTM. Multivariate probit regression analyses were performed to ascertain the relationship between the potential predictors (PVD, PS, and MTM) and outcome variable (MMD), after accounting for possible confounders (e.g. age and axial length). Marginal effects were reported. Results Controlling for potential confounders, eyes with MTM have a 29.92 percentage point higher likelihood of having MMD (P = 0.003), and eyes with PS have a 25.72 percentage point higher likelihood of having MMD (P = 0.002). The likelihood of MMD increases by 10.61 percentage points per 1 mm increase in axial length (P < 0.001). Subanalysis revealed that eyes with incomplete PVD have a 22.54 percentage point higher likelihood of having MMD than eyes with early PVD (P = 0.04). Conclusions Our study demonstrated an association between tractional (MTM, PS, and persistently incomplete PVD) and degenerative elements of PM independent of age and axial length. These data provide further insights into the pathogenesis of MMD.
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Affiliation(s)
- Kai Yuan Tey
- Singapore Eye Research Institute, Singapore.,Tasmanian School of Medicine, Tasmania, Australia
| | | | | | - Andrew S H Tsai
- Singapore National Eye Centre, Duke-NUS Medical School, Singapore
| | - Daniel S W Ting
- Singapore Eye Research Institute, Singapore.,Singapore National Eye Centre, Duke-NUS Medical School, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore.,Singapore National Eye Centre, Duke-NUS Medical School, Singapore
| | - Gemmy Chiu Ming Cheung
- Singapore Eye Research Institute, Singapore.,Singapore National Eye Centre, Duke-NUS Medical School, Singapore
| | - Shu Yen Lee
- Singapore National Eye Centre, Duke-NUS Medical School, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore.,Singapore National Eye Centre, Duke-NUS Medical School, Singapore
| | - Quan V Hoang
- Singapore Eye Research Institute, Singapore.,Singapore National Eye Centre, Duke-NUS Medical School, Singapore.,Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Chee Wai Wong
- Singapore Eye Research Institute, Singapore.,Singapore National Eye Centre, Duke-NUS Medical School, Singapore
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Wong CW, Matsumura S, Htoon HM, Tan S, Tan CS, Ang M, Wong YL, Agrawal R, Sabanayagam C, Saw SM. Assessment of the Macular Microvasculature in High Myopes With Swept Source Optical Coherence Tomographic Angiography. Front Med (Lausanne) 2021; 8:619767. [PMID: 34079808 PMCID: PMC8165745 DOI: 10.3389/fmed.2021.619767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/20/2021] [Indexed: 11/21/2022] Open
Abstract
Background: The risk of pathologic myopia (PM) increases with worsening myopia and may be related to retinal microvasculature alterations. To evaluate this, we analyzed the macular microvasculature of myopes with swept source-optical coherence tomographic angiography (SS-OCTA) in adolescent and young adult Singaporeans. Methods: This is a prevalent case-control study including 93 young Chinese from the Strabismus, Amblyopia and Refractive error in Singaporean children (STARS, N = 45) study and the Singapore Cohort Study of Risk Factors for Myopia (SCORM, N = 48) studies. Macular vessel density (VD) measurements were obtained from 3 × 3 mm SS-OCTA scans and independently assessed using ImageJ. These measurements were compared between individuals with non-high myopia [non-HM, N = 40; SE >-5.0 diopter (D)] and HM (SE ≤-5.0D, N = 53). Results: The mean macular VD was 40.9 ± 0.6% and 38.2 ± 0.5% in the non-HM and HM, groups, respectively (p = 0.01 adjusted for age and gender). Mean FAZ area in the superficial layer was 0.22 ± 0.02 mm2 in the HM group, which was smaller compared to non-HM group (0.32 ± 0.03 mm2, p = 0.04). Mean deep FAZ area was similar between the two groups (0.45 ± 0.03 mm2 and 0.48 ± 0.04 mm2 in the HM and non-HM groups, respectively, p = 0.70). Conclusions: VD was lower and superficial FAZ area was smaller, in adolescents and young adults with HM compared to non-HM. These findings require validation in prospective studies to assess their impact on the subsequent development of PM.
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Affiliation(s)
- Chee-Wai Wong
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Saiko Matsumura
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Hla Myint Htoon
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Shoun Tan
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Colin S Tan
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Marcus Ang
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Yee-Ling Wong
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,R&D Vision Sciences Asia, Middle East, Russia and Africa (AMERA), Essilor International, Singapore, Singapore
| | - Rupesh Agrawal
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Charumati Sabanayagam
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Seang-Mei Saw
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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47
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Tan TE, Anees A, Chen C, Li S, Xu X, Li Z, Xiao Z, Yang Y, Lei X, Ang M, Chia A, Lee SY, Wong EYM, Yeo IYS, Wong YL, Hoang QV, Wang YX, Bikbov MM, Nangia V, Jonas JB, Chen YP, Wu WC, Ohno-Matsui K, Rim TH, Tham YC, Goh RSM, Lin H, Liu H, Wang N, Yu W, Tan DTH, Schmetterer L, Cheng CY, Chen Y, Wong CW, Cheung GCM, Saw SM, Wong TY, Liu Y, Ting DSW. Retinal photograph-based deep learning algorithms for myopia and a blockchain platform to facilitate artificial intelligence medical research: a retrospective multicohort study. Lancet Digit Health 2021; 3:e317-e329. [PMID: 33890579 DOI: 10.1016/s2589-7500(21)00055-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/28/2021] [Accepted: 03/09/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND By 2050, almost 5 billion people globally are projected to have myopia, of whom 20% are likely to have high myopia with clinically significant risk of sight-threatening complications such as myopic macular degeneration. These are diagnoses that typically require specialist assessment or measurement with multiple unconnected pieces of equipment. Artificial intelligence (AI) approaches might be effective for risk stratification and to identify individuals at highest risk of visual loss. However, unresolved challenges for AI medical studies remain, including paucity of transparency, auditability, and traceability. METHODS In this retrospective multicohort study, we developed and tested retinal photograph-based deep learning algorithms for detection of myopic macular degeneration and high myopia, using a total of 226 686 retinal images. First we trained and internally validated the algorithms on datasets from Singapore, and then externally tested them on datasets from China, Taiwan, India, Russia, and the UK. We also compared the performance of the deep learning algorithms against six human experts in the grading of a randomly selected dataset of 400 images from the external datasets. As proof of concept, we used a blockchain-based AI platform to demonstrate the real-world application of secure data transfer, model transfer, and model testing across three sites in Singapore and China. FINDINGS The deep learning algorithms showed robust diagnostic performance with areas under the receiver operating characteristic curves [AUC] of 0·969 (95% CI 0·959-0·977) or higher for myopic macular degeneration and 0·913 (0·906-0·920) or higher for high myopia across the external testing datasets with available data. In the randomly selected dataset, the deep learning algorithms outperformed all six expert graders in detection of each condition (AUC of 0·978 [0·957-0·994] for myopic macular degeneration and 0·973 [0·941-0·995] for high myopia). We also successfully used blockchain technology for data transfer, model transfer, and model testing between sites and across two countries. INTERPRETATION Deep learning algorithms can be effective tools for risk stratification and screening of myopic macular degeneration and high myopia among the large global population with myopia. The blockchain platform developed here could potentially serve as a trusted platform for performance testing of future AI models in medicine. FUNDING None.
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Affiliation(s)
- Tien-En Tan
- Singapore Eye Research Institute, Singapore, Singapore National Eye Centre, Singapore; Duke-National University of Singapore Medical School, Singapore
| | - Ayesha Anees
- Institute of High Performance Computing, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Cheng Chen
- Institute of High Performance Computing, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Shaohua Li
- Institute of High Performance Computing, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Xinxing Xu
- Institute of High Performance Computing, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Zengxiang Li
- Institute of High Performance Computing, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Zhe Xiao
- Institute of High Performance Computing, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Yechao Yang
- Institute of High Performance Computing, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Xiaofeng Lei
- Institute of High Performance Computing, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore, Singapore National Eye Centre, Singapore; Duke-National University of Singapore Medical School, Singapore
| | - Audrey Chia
- Singapore Eye Research Institute, Singapore, Singapore National Eye Centre, Singapore; Duke-National University of Singapore Medical School, Singapore
| | - Shu Yen Lee
- Singapore Eye Research Institute, Singapore, Singapore National Eye Centre, Singapore; Duke-National University of Singapore Medical School, Singapore
| | - Edmund Yick Mun Wong
- Singapore Eye Research Institute, Singapore, Singapore National Eye Centre, Singapore; Duke-National University of Singapore Medical School, Singapore
| | - Ian Yew San Yeo
- Singapore Eye Research Institute, Singapore, Singapore National Eye Centre, Singapore; Duke-National University of Singapore Medical School, Singapore
| | - Yee Ling Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Essilor International, Singapore
| | - Quan V Hoang
- Singapore Eye Research Institute, Singapore, Singapore National Eye Centre, Singapore; Duke-National University of Singapore Medical School, Singapore; Department of Ophthalmology, Columbia University, New York, NY, USA; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ya Xing Wang
- Ufa Eye Research Institute, Ufa, Bashkortostan, Russia
| | | | | | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Yen-Po Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tyler Hyungtaek Rim
- Singapore Eye Research Institute, Singapore, Singapore National Eye Centre, Singapore; Duke-National University of Singapore Medical School, Singapore
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore, Singapore National Eye Centre, Singapore
| | - Rick Siow Mong Goh
- Institute of High Performance Computing, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Haotian Lin
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Hanruo Liu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Weihong Yu
- Peking Union Medical College Hospital, Beijing, China
| | - Donald Tiang Hwee Tan
- Singapore Eye Research Institute, Singapore, Singapore National Eye Centre, Singapore; Duke-National University of Singapore Medical School, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute, Singapore, Singapore National Eye Centre, Singapore; Duke-National University of Singapore Medical School, Singapore; Department of Clinical Pharmacology and Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Austria; Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore, Singapore National Eye Centre, Singapore; Duke-National University of Singapore Medical School, Singapore
| | - Youxin Chen
- Peking Union Medical College Hospital, Beijing, China
| | - Chee Wai Wong
- Singapore Eye Research Institute, Singapore, Singapore National Eye Centre, Singapore; Duke-National University of Singapore Medical School, Singapore
| | - Gemmy Chui Ming Cheung
- Singapore Eye Research Institute, Singapore, Singapore National Eye Centre, Singapore; Duke-National University of Singapore Medical School, Singapore
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore, Singapore National Eye Centre, Singapore; Duke-National University of Singapore Medical School, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore, Singapore National Eye Centre, Singapore; Duke-National University of Singapore Medical School, Singapore
| | - Yong Liu
- Institute of High Performance Computing, Agency for Science, Technology and Research (A*STAR), Singapore
| | - Daniel Shu Wei Ting
- Singapore Eye Research Institute, Singapore, Singapore National Eye Centre, Singapore; Duke-National University of Singapore Medical School, Singapore.
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48
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Jonas JB, Ang M, Cho P, Guggenheim JA, He MG, Jong M, Logan NS, Liu M, Morgan I, Ohno-Matsui K, Pärssinen O, Resnikoff S, Sankaridurg P, Saw SM, Smith EL, Tan DTH, Walline JJ, Wildsoet CF, Wu PC, Zhu X, Wolffsohn JS. IMI Prevention of Myopia and Its Progression. Invest Ophthalmol Vis Sci 2021; 62:6. [PMID: 33909032 PMCID: PMC8083117 DOI: 10.1167/iovs.62.5.6] [Citation(s) in RCA: 123] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The prevalence of myopia has markedly increased in East and Southeast Asia, and pathologic consequences of myopia, including myopic maculopathy and high myopia-associated optic neuropathy, are now some of the most common causes of irreversible blindness. Hence, strategies are warranted to reduce the prevalence of myopia and the progression to high myopia because this is the main modifiable risk factor for pathologic myopia. On the basis of published population-based and interventional studies, an important strategy to reduce the development of myopia is encouraging schoolchildren to spend more time outdoors. As compared with other measures, spending more time outdoors is the safest strategy and aligns with other existing health initiatives, such as obesity prevention, by promoting a healthier lifestyle for children and adolescents. Useful clinical measures to reduce or slow the progression of myopia include the daily application of low-dose atropine eye drops, in concentrations ranging between 0.01% and 0.05%, despite the side effects of a slightly reduced amplitude of accommodation, slight mydriasis, and risk of an allergic reaction; multifocal spectacle design; contact lenses that have power profiles that produce peripheral myopic defocus; and orthokeratology using corneal gas-permeable contact lenses that are designed to flatten the central cornea, leading to midperipheral steeping and peripheral myopic defocus, during overnight wear to eliminate daytime myopia. The risk-to-benefit ratio needs to be weighed up for the individual on the basis of their age, health, and lifestyle. The measures listed above are not mutually exclusive and are beginning to be examined in combination.
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Affiliation(s)
- Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Department of Ophthalmology and Visual Science, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Pauline Cho
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jeremy A Guggenheim
- School of Optometry & Vision Sciences, Cardiff University, Cardiff, United Kingdom
| | - Ming Guang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yatsen University, Guangzhou, China.,Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Monica Jong
- Brien Holden Vision Institute, Sydney, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.,Discipline of Optometry and Vision Science, University of Canberra, Australia
| | - Nicola S Logan
- School of Optometry, Aston University, Birmingham, United Kingdom
| | - Maria Liu
- School of Optometry, University of California, Berkeley, Berkeley, California, United States
| | - Ian Morgan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yatsen University, Guangzhou, China.,Research School of Biology, College of Medicine, Biology and Environment, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Olavi Pärssinen
- Department of Ophthalmology, Central Hospital of Central Finland, Jyväskylä, Finland.,Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Serge Resnikoff
- Brien Holden Vision Institute, Sydney, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Padmaja Sankaridurg
- Brien Holden Vision Institute, Sydney, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Seang-Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Eye & Retina Surgeons, Singapore, Singapore.,Duke-NUS Medical School, Singapore
| | - Earl L Smith
- Brien Holden Vision Institute, Sydney, Australia.,College of Optometry, University of Houston, Houston, Texas, United States
| | - Donald T H Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Department of Ophthalmology and Visual Science, Duke-NUS Graduate Medical School, Singapore, Singapore.,Eye & Retina Surgeons, Singapore, Singapore
| | - Jeffrey J Walline
- The Ohio State University College of Optometry, Columbus, Ohio, United States
| | - Christine F Wildsoet
- School of Optometry, University of California, Berkeley, Berkeley, California, United States
| | - Pei-Chang Wu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Xiaoying Zhu
- Biological and Vision Sciences, State University of New York, College of Optometry, New York, New York, United States
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49
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Lanca C, Foo LL, Ang M, Tan CS, Kathrani B, Htoon HM, Tan D, Hoang QV, Brennan N, Saw SM, Sabanayagam C. Rapid Myopic Progression in Childhood Is Associated With Teenage High Myopia. Invest Ophthalmol Vis Sci 2021; 62:17. [PMID: 33851974 PMCID: PMC8054625 DOI: 10.1167/iovs.62.4.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Purpose The purpose of this study was to evaluate the association of childhood progression of spherical equivalent (SE) with high myopia (HM) in teenagers in the Singapore Cohort of Risk factors for Myopia (SCORM). Methods We included 928 SCORM children followed over a mean follow-up of 6.9 ± 1.0 years from baseline (6–11 years old) until their teenage years (12–19 years old). Cycloplegic autorefraction and axial length (AL) measurements were performed yearly. The outcomes in teenagers were HM (SE ≤ −5 diopter [D)], AL ≥ 25 mm, SE and AL. Three-year SE and AL progression in childhood and baseline SE and AL with outcomes were evaluated using multivariable logistic or linear regression models, with predictive performance of risk factors assessed using the area under the curve (AUC). Results At the last visit, 9.8% of teenagers developed HM and 22.7% developed AL ≥ 25 mm. In multivariate regression analyses, every −0.3 D/year increase in 3-year SE progression and every 0.2 mm/year increase in 3-year AL progression were associated with a −1.14 D greater teenage SE and 0.52 mm greater teenage AL (P values < 0.001). The AUC (95% confidence interval [CI]) of a combination of 3-year SE progression and baseline SE for teenage HM was 0.97 (95% CI = 0.95 – 0.98). The AUC of 3-year AL progression and baseline AL for teenage AL ≥ 25 mm was 0.91 (95% CI = 0.89 – 0.94). Conclusions Three-year myopia progression in childhood combined with baseline SE or AL were good predictors of teenage HM. Clinicians may use this combination of factors to guide timing of interventions, potentially reducing the risk of HM later in life.
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Affiliation(s)
| | - Li-Lian Foo
- Singapore Eye Research Institute, Singapore.,Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore.,Singapore National Eye Centre, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore.,Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore.,Singapore National Eye Centre, Singapore
| | - Chuen-Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Biten Kathrani
- Johnson & Johnson Vision, Johnson & Johnson Vision Care, Singapore
| | - Hla Myint Htoon
- Singapore Eye Research Institute, Singapore.,Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Donald Tan
- Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore.,Singapore National Eye Centre, Singapore
| | - Quan V Hoang
- Singapore Eye Research Institute, Singapore.,Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore.,Singapore National Eye Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Noel Brennan
- Johnson & Johnson Vision, Johnson & Johnson Vision Care, Jacksonville, FL, United States
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore.,Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore.,Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
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50
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Williams CK, Lashgari A, Devi N, Ang M, Chaturvedi A, Dhungana P, Jiang JJ. Hydrodechlorination of Dichloromethane by a Metal-Free Triazole-Porphyrin Electrocatalyst: Demonstration of Main-Group Element Electrocatalysis*. Chemistry 2021; 27:6240-6246. [PMID: 33476410 DOI: 10.1002/chem.202005012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Indexed: 01/17/2023]
Abstract
In this work, the electrocatalytic reduction of dichloromethane (CH2 Cl2 ) into hydrocarbons involving a main group element-based molecular triazole-porphyrin electrocatalyst H2PorT8 is reported. This catalyst converted CH2 Cl2 in acetonitrile to various hydrocarbons (methane, ethane, and ethylene) with a Faradaic efficiency of 70 % and current density of -13 mA cm-2 at a potential of -2.2 V vs. Fc/Fc+ using water as a proton source. The findings of this study and its mechanistic interpretations demonstrated that H2PorT8 was an efficient and stable catalyst for the hydrodechlorination of CH2 Cl2 and that main group catalysts could be potentially used for exploring new catalytic reaction mechanisms.
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Affiliation(s)
- Caroline K Williams
- Department of Chemistry, University of Cincinnati, P.O. Box 210172, Cincinnati, Ohio, 45221-0172, United States
| | - Amir Lashgari
- Department of Chemistry, University of Cincinnati, P.O. Box 210172, Cincinnati, Ohio, 45221-0172, United States
| | - Nilakshi Devi
- Department of Chemistry, University of Cincinnati, P.O. Box 210172, Cincinnati, Ohio, 45221-0172, United States
| | - Marcus Ang
- Department of Chemistry, University of Cincinnati, P.O. Box 210172, Cincinnati, Ohio, 45221-0172, United States
| | - Ashwin Chaturvedi
- Department of Chemistry, University of Cincinnati, P.O. Box 210172, Cincinnati, Ohio, 45221-0172, United States
| | - Pranita Dhungana
- Department of Chemistry, University of Cincinnati, P.O. Box 210172, Cincinnati, Ohio, 45221-0172, United States
| | - Jianbing Jimmy Jiang
- Department of Chemistry, University of Cincinnati, P.O. Box 210172, Cincinnati, Ohio, 45221-0172, United States
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