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Eye (London, England) Dec 2023Pathologic myopia (PM) is a major cause of severe visual impairment and blindness, and current applications of artificial intelligence (AI) have covered the diagnosis... (Meta-Analysis)
Meta-Analysis
BACKGROUND/OBJECTIVE
Pathologic myopia (PM) is a major cause of severe visual impairment and blindness, and current applications of artificial intelligence (AI) have covered the diagnosis and classification of PM. This meta-analysis and systematic review aimed to evaluate the overall performance of AI-based models in detecting PM and related complications.
METHODS
We searched PubMed, Scopus, Embase, Web of Science and IEEE Xplore for eligible studies before Dec 20, 2022. The methodological quality of included studies was evaluated using the Quality Assessment for Diagnostic Accuracy Studies (QUADAS-2). We calculated the pooled sensitivity (SEN), specificity (SPE) and the summary area under the curve (AUC) using a random effects model, to evaluate the performance of AI in the detection of PM based on fundus or optical coherence tomography (OCT) images.
RESULTS
22 studies were included in the systematic review, and 14 of them were included in the quantitative analysis. Of all included studies, SEN and SPE ranged from 80.0% to 98.7% and from 79.5% to 100.0% for PM detection, respectively. For the detection of PM, the summary AUC was 0.99 (95% confidence interval (CI) 0.97 to 0.99), and the pooled SEN and SPE were 0.95 (95% CI 0.92 to 0.96) and 0.97 (95% CI: 0.94 to 0.98), respectively. For the detection of PM-related choroid neovascularization (CNV), the summary AUC was 0.99 (95% CI: 0.97 to 0.99).
CONCLUSION
Our review demonstrated the excellent performance of current AI algorithms in detecting PM and related complications based on fundus and OCT images.
Topics: Humans; Artificial Intelligence; Sensitivity and Specificity; Choroidal Neovascularization; Blindness; Myopia
PubMed: 37117783
DOI: 10.1038/s41433-023-02551-7 -
Journal of Clinical Medicine Aug 2023Although topical medical therapy and selective-laser-trabeculoplasty represent the treatments of choice to reduce intraocular pressure, many patients do not achieve... (Review)
Review
Although topical medical therapy and selective-laser-trabeculoplasty represent the treatments of choice to reduce intraocular pressure, many patients do not achieve adequate glaucoma control; therefore, they require further options and eventually surgery. Trabeculectomy is still considered the gold standard, but the surgical management of glaucoma has undergone continuous advances in recent years, XEN-gel-stent has been introduced as a safer and less traumatic means of lowering intraocular pressure (IOP) in patients with open-angle glaucoma (OAG). This study aimed to review the effectiveness and safety of clinical data on XEN-stent in OAG patients with a Synthesis-Without-Meta-analysis (SWiM) methodology. A total of 339 studies were identified following a literature search adhering to PRISMA guidelines and, after evaluation, 96 studies are discussed. XEN63 and XEN45 device data were collected both short and long term. In addition, this document has evaluated different aspects related to the XEN implant, including: its role compared to trabeculectomy; the impact of mitomycin-C dose on clinical outcomes; postoperative management of the device; and the identification of potential factors that might predict its clinical outcomes. Finally, current challenges and future perspectives of XEN stent, such as its use in fragile or high myopia patients, were discussed.
PubMed: 37629380
DOI: 10.3390/jcm12165339 -
Scientific Reports Jan 2024Outdoor exposure is considered the primary modifiable risk factor in preventing the development of myopia. This effect is thought to be attributed to the light-induced... (Meta-Analysis)
Meta-Analysis
Outdoor exposure is considered the primary modifiable risk factor in preventing the development of myopia. This effect is thought to be attributed to the light-induced synthesis and release of dopamine in the retina. However, until recent years, there was no objective quantifiable method available to measure the association between time spent outdoors and myopia. It is only recently that the conjunctival ultraviolet autofluorescence (CUVAF) area, serving as a biomarker for sun exposure, has begun to be utilized in numerous studies. To provide a comprehensive summary of the relevant evidence pertaining to the association between the CUVAF area and myopia across different geographic regions and age groups, a systematic review and meta-analysis were conducted. The search encompassed multiple databases, including MEDLINE, SCIENCE DIRECT, GOOGLE SCHOLAR, WEB OF SCIENCE, and SCOPUS, and utilized specific search terms such as "conjunctival ultraviolet autofluorescence", "CUVAF", "UVAF", "objective marker of ocular sun exposure", "myopia", "degenerative myopia", and "high myopia". The bibliographic research included papers published between the years 2006 and 2022. A total of 4051 records were initially identified, and after duplicates were removed, 49 articles underwent full-text review. Nine articles were included in the systematic review. These studies covered myopia and outdoor exposure across different regions (Australia, Europe and India) with a total population of 3615 individuals. They found that myopes generally had smaller CUVAF areas compared to non-myopes. The meta-analysis confirmed this, revealing statistically smaller CUVAF areas in myopic patients, with a mean difference of - 3.30 mm (95% CI - 5.53; - 1.06). Additionally, some studies showed a positive correlation between more outdoor exposure and larger CUVAF areas. In terms of outdoor exposure time, myopic patients reported less time outdoors than non-myopic individuals, with a mean difference of - 3.38 h/week (95% CI - 4.66; - 2.09). Overall, these findings highlight the connection between outdoor exposure, CUVAF area and myopia, with regional variations playing a significant role. The results of this meta-analysis validate CUVAF as a quantitative method to objectively measure outdoor exposure in relation with myopia development.
Topics: Humans; Ultraviolet Rays; Sunlight; Environmental Exposure; Cross-Sectional Studies; Conjunctiva; Myopia; Biomarkers
PubMed: 38212604
DOI: 10.1038/s41598-024-51417-9 -
BMC Public Health Jun 2024This study aimed to systematically review epidemiological evidence on associations between screen time exposure and myopia in children and adolescents, and to... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This study aimed to systematically review epidemiological evidence on associations between screen time exposure and myopia in children and adolescents, and to quantitatively evaluate summary effect estimates from existing literature.
METHOD
There were three online databases including PubMed, Embase, and Web of Science, for epidemiological studies on screen time exposure and myopia published before June 1, 2023. The risk of bias was assessed by the Newcastle Ottawa Scale (NOS) checklist. Summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to evaluate the correlation between screen time exposure and myopia using random or fixed-effect models by exposure type (categorical/continuous). We also performed subgroup analysis by screen device type, study quality, geographic region, and research period.
RESULTS
We searched 7,571 records from three databases and identified 19 eligible studies, including 14 high-quality studies and 5 moderate-quality studies. Meta-analyses suggested that there was a statistically significant correlation between screen time (high vs. low) and myopia. The pooled ORs with 95%CIs were respectively 2.24 (1.47-3.42) for cross-sectional studies, and 2.39 (2.07-2.76) for cohort studies. We also found a significant association between continuous exposure to screen time (per 1 h/d increase) and myopia in cohort studies. The pooled ORs with 95%CIs were 1.07 (1.01-1.13). In subgroup analysis stratified by screen device type in cross-sectional studies, screen time exposures from computers (categorical: OR = 8.19, 95%CI: 4.78-14.04; continuous: OR = 1.22, 95%CI: 1.10-1.35) and televisions (categorical: OR = 1.46, 95%CI: 1.02-2.10) were associated with myopia, while smartphones were not. Although publication bias was detected, the pooled results did not show significant changes after adjustment using the trim and fill method.
CONCLUSION
Our findings support that screen time exposure was significantly associated with myopia in children and adolescents. Notably, screen time exposure from computers may have the most significant impact on myopia.
Topics: Humans; Screen Time; Myopia; Child; Adolescent
PubMed: 38890613
DOI: 10.1186/s12889-024-19113-5 -
Frontiers in Public Health 2024Twenty-four-hour movement behaviors have significant implications for physical and mental health throughout one's lifespan. Consistent with movement behaviors, several... (Meta-Analysis)
Meta-Analysis
UNLABELLED
Twenty-four-hour movement behaviors have significant implications for physical and mental health throughout one's lifespan. Consistent with movement behaviors, several countries have formulated and published 24-h movement guidelines. This review summarized the studies related to 24-h movement guidelines among children and adolescents from six databases (MEDLINE, EMBASE, PubMed, Web of Science, CINAHL, and SPORTDiscus). In a total of 61 studies that discussed compliance with 24-h movement guidelines, the overall adherence rate was very low (7.1%), with boys exceeding girls, children surpassing adolescents, and regional differences. A total of 39 studies examined the associations between 24-h movement guidelines and health indicators. Findings indicated that meeting all three guidelines was favorably associated with adiposity, cardiometabolic health, mental and social health, physical fitness, health-related quality of life, academic achievement, cognitive development, perceived health, dietary patterns, and myopia. Future research should utilize longitudinal and experimental designs to enhance our understanding of the associations between 24-h movement guidelines and health indicators, thereby aiding the formulation and refinement of such guidelines.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, CRD42023481230.
Topics: Humans; Adolescent; Child; Exercise; Child, Preschool; Female; Male; Quality of Life
PubMed: 38774055
DOI: 10.3389/fpubh.2024.1351972 -
BMC Ophthalmology Feb 2024Myopia is the most prevalent form of refractive error that has a major negative impact on visual function and causes blurring of vision. We aimed to determine if... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Myopia is the most prevalent form of refractive error that has a major negative impact on visual function and causes blurring of vision. We aimed to determine if Repeated Low-Level Red Light (RLRL) treatment is beneficial in treating childhood myopia in terms of axial length (AL), spherical equivalent refraction (SER), and sub foveal choroidal thickness (SFCT).
METHODS
This systematic review was performed on RLRL for treatment of myopia in children compared to single vision spectacles (SVS). We employed the search strategy with key terms myopia and low-level light therapy then we searched PubMed, Scopus, Cochrane, and Web of Science databases. The mean differences (MD) were used to evaluate the treatment effects. Heterogeneity was quantified using I statistics and explored by sensitivity analysis.
RESULTS
Five randomized controlled trials (RCTs) were included in our meta-analysis with a total of 833 patients, 407 in treatment group and 426 in control group. At a 3 month follow up period, pooled studies show a statistical difference in AL between RLRL and SVS group (MD = -0.16; 95% CI [-0.19, -0.12], SER (MD = 0.33; 95% CI [0.27, 0.38]), and SFCT (MD = 43.65; 95% CI [23.72, 45.58]). At a 6 month follow up period, pooled studies show a statistical difference in AL between RLRL and SVS group (MD = -0.21; 95% CI [-0.28, -0.15]), SER (MD = 0.46; 95% CI [0.26, 0.65]), and SFCT (MD = 25.07; 95% CI [18.18, 31.95]). At a 12 month follow up period, pooled studies show a statistical difference in AL between RLRL and SVS group (MD = -0.31; 95% CI [-0.42, -0.19]) and SER (MD = 0.63; 95% CI [0.52, 0.73]).
CONCLUSION
This is the first systematic review and meta-analysis investigating only RCTs evidence supporting the efficacy of 650 nm RLRL for myopia control in the short term of 3, 6, and 12 months follow up. The present review revealed the clinical significance of RLRL as a new alternative treatment for myopia control with good user acceptability and no documented functional or structural damage. However, the effect of long-term RLRL treatment and the rebound effect after cessation require further investigations.
Topics: Child; Humans; Red Light; Myopia; Refractive Errors; Refraction, Ocular
PubMed: 38378527
DOI: 10.1186/s12886-024-03337-5 -
Clinics (Sao Paulo, Brazil) 2024Low-Level Red-Light (LLRL) Therapy is a safe and natural way to promote healing and reduce inflammation in the body. When it comes to treating myopia in children, LLRL... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Low-Level Red-Light (LLRL) Therapy is a safe and natural way to promote healing and reduce inflammation in the body. When it comes to treating myopia in children, LLRL therapy is recent, and its efficacy and safety still are not clear.
METHODS
A systematic review and meta-analysis of the literature for LLRL was conducted in accordance with the PRISMA guidelines on November 5, 2022. Databases, including PUBMED, Cochrane Library, Web of Science, and Embase were queried. A meta-analysis of random effects was conducted. Inclusion criteria included Randomized Controlled Trials (RCTs) or observational studies where LLRL therapy was used in children (3‒15 years old) with myopia. Exclusion criteria were studies with other ocular abnormalities. Efficacy was evaluated through the mean change in Axial Length (AL) and cycloplegic Spherical Equivalent Error (SER), while safety was evaluated by monitoring adverse effects.
RESULTS
A total of 5 final studies were included (4 RCTs, and 1 observational), in which 685 total patients were analyzed. The mean age was 9.7 ± 0.66 years, with 48,2% female patients. The number of eyes in the LRLL arm is 714 and, in the control, arm is 656. LLRL showed better results in SER and AL mean change (OR = 0.58; 95% CI 0.33 to 0.83; p < 0.00001, and MD -0.33; 95% CI -0.52 to -0.13; p = 0.001, respectively), in comparison to the control group. There was no significant difference in adverse effects between groups (MD = 5.76; 95% CI 0.66 to 50.14; p = 0.11).
CONCLUSION
LLRL therapy is a non-invasive, effective, and safe short-term treatment option; however, long-term evaluation, particularly in comparison to other therapies, requires additional investigation.
Topics: Humans; Child; Myopia; Low-Level Light Therapy; Randomized Controlled Trials as Topic; Treatment Outcome; Female; Adolescent; Male; Child, Preschool
PubMed: 38723579
DOI: 10.1016/j.clinsp.2024.100375 -
Journal of Optometry 2024Myopia is a global public health concern that has a significant socioeconomic and psychological impact on schoolchildren. If Myopic patients are not detected early, they... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Myopia is a global public health concern that has a significant socioeconomic and psychological impact on schoolchildren. If Myopic patients are not detected early, they are exposed to retinal detachment, cataracts, and glaucoma. There have been previous studies conducted in Ethiopia, but there is significant inconsistency among studies. Hence, the aim of this study was to provide a single figure as well as associated factors for Myopia among Ethiopian schoolchildren.
METHOD
The national and international databases and gray literature were searched for important research articles. This review included school-based cross-sectional studies that were reported in English. The data were extracted using Microsoft word and exported to Stata™ Version 17.0 statistical software for further management and analysis .The presence of heterogeneity was checked using Cochrane Q test via fixed effects model and presented by forest plots with 95% CI. Due to the presence of substantial heterogeneity, I test using random effects model was computed to estimate the effect size. The existing heterogeneity among studies was explained by regional difference. To identify factors associated with myopia, meta regression was computed and significant factors was reported using OR with 95% CI.
RESULTS
In this systematic review and meta-analysis, 12 studies with a total of 9688 schoolchildren were included. The national estimate of myopia among schoolchildren in Ethiopia was 6.49% (95%CI: 4.86, 8.12). Having family history of myopia (OR: 9.18, 95%CI: 3.5,24.02) and being female (OR: 0.94, 95% CI: 0.50, 0.98) were the identified factors associated with myopia.
CONCLUSION
Myopia is one of the most prevalent childhood health condition in Ethiopia, which affects about one in every fourteen schoolchildren. Schoolchildren who had family history of myopia and being female were the identified risk factors of myopia among schoolchildren. Clinical and public engagement activities are needed to address the burden of myopia.
Topics: Humans; Female; Child; Male; Ethiopia; Cross-Sectional Studies; Risk Factors; Myopia; Prevalence
PubMed: 37976882
DOI: 10.1016/j.optom.2023.100480 -
Frontiers in Public Health 2023To systematically compare and rank the accuracy of AI-based intraocular lens (IOL) power calculation formulas and traditional IOL formulas in highly myopic eyes. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To systematically compare and rank the accuracy of AI-based intraocular lens (IOL) power calculation formulas and traditional IOL formulas in highly myopic eyes.
METHODS
We screened PubMed, Web of Science, Embase, and Cochrane Library databases for studies published from inception to April 2023. The following outcome data were collected: mean absolute error (MAE), percentage of eyes with a refractive prediction error (PE) within ±0.25, ±0.50, and ±1.00 diopters (D), and median absolute error (MedAE). The network meta-analysis was conducted by R 4.3.0 and STATA 17.0.
RESULTS
Twelve studies involving 2,430 adult myopic eyes (with axial lengths >26.0 mm) that underwent uncomplicated cataract surgery with mono-focal IOL implantation were included. The network meta-analysis of 21 formulas showed that the top three AI-based formulas, as per the surface under the cumulative ranking curve (SUCRA) values, were XGBoost, Hill-RBF, and Kane. The three formulas had the lowest MedAE and were more accurate than traditional vergence formulas, such as SRK/T, Holladay 1, Holladay 2, Haigis, and Hoffer Q regarding MAE, percentage of eyes with PE within ±0.25, ±0.50, and ±1.00 D.
CONCLUSIONS
The top AI-based formulas for calculating IOL power in highly myopic eyes were XGBoost, Hill-RBF, and Kane. They were significantly more accurate than traditional vergence formulas and ranked better than formulas with Wang-Koch AL modifications or newer generations of formulas such as Barrett and Olsen.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022335969.
Topics: Adult; Humans; Refraction, Ocular; Lenses, Intraocular; Artificial Intelligence; Network Meta-Analysis; Retrospective Studies; Myopia; Refractive Errors
PubMed: 38026369
DOI: 10.3389/fpubh.2023.1279718 -
Cureus Apr 2024A significant contributor to blindness and visual impairment globally is uncorrected refractive error. To plan effective interventions, eye care professionals must... (Review)
Review
A significant contributor to blindness and visual impairment globally is uncorrected refractive error. To plan effective interventions, eye care professionals must promptly identify people at a high risk of acquiring myopia, and monitor disease progress. Artificial intelligence (AI) and machine learning (ML) have enormous potential to improve diagnosis and treatment. This systematic review explores the current state of ML and AI applications in the diagnoses and treatment of refractory errors in optometry. A systematic review and meta-analysis of studies evaluating the diagnostic performance of AI-based tools in PubMed was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. To find relevant studies on the use of ML or AI in the diagnosis or treatment of refractive errors in optometry, a thorough search was conducted in various electronic databases such as PubMed, Google Scholar, and Web of Science. The search was limited to studies published between January 2015 and December 2022. The search terms used were "refractive errors," "myopia," "optometry," "machine learning," "ophthalmology," and "artificial intelligence." A total of nine studies met the inclusion criteria and were included in the final analysis. ML is increasingly being utilized for automating clinical data processing as AI technology progresses, making the formerly labor-intensive work possible. AI models that primarily use a neural network demonstrated exceptional efficiency and performance in the analysis of vast medical data, rivaling board-certified, healthcare professionals. Several studies showed that ML models could support diagnosis and clinical decision-making. Moreover, an ML algorithm predicted future refraction values in patients with myopia. AI and ML models have great potential to improve the diagnosis and treatment of refractive errors in optometry.
PubMed: 38711688
DOI: 10.7759/cureus.57706