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The New England Journal of Medicine Apr 2020Nonophthalmologist physicians do not confidently perform direct ophthalmoscopy. The use of artificial intelligence to detect papilledema and other optic-disk...
BACKGROUND
Nonophthalmologist physicians do not confidently perform direct ophthalmoscopy. The use of artificial intelligence to detect papilledema and other optic-disk abnormalities from fundus photographs has not been well studied.
METHODS
We trained, validated, and externally tested a deep-learning system to classify optic disks as being normal or having papilledema or other abnormalities from 15,846 retrospectively collected ocular fundus photographs that had been obtained with pharmacologic pupillary dilation and various digital cameras in persons from multiple ethnic populations. Of these photographs, 14,341 from 19 sites in 11 countries were used for training and validation, and 1505 photographs from 5 other sites were used for external testing. Performance at classifying the optic-disk appearance was evaluated by calculating the area under the receiver-operating-characteristic curve (AUC), sensitivity, and specificity, as compared with a reference standard of clinical diagnoses by neuro-ophthalmologists.
RESULTS
The training and validation data sets from 6779 patients included 14,341 photographs: 9156 of normal disks, 2148 of disks with papilledema, and 3037 of disks with other abnormalities. The percentage classified as being normal ranged across sites from 9.8 to 100%; the percentage classified as having papilledema ranged across sites from zero to 59.5%. In the validation set, the system discriminated disks with papilledema from normal disks and disks with nonpapilledema abnormalities with an AUC of 0.99 (95% confidence interval [CI], 0.98 to 0.99) and normal from abnormal disks with an AUC of 0.99 (95% CI, 0.99 to 0.99). In the external-testing data set of 1505 photographs, the system had an AUC for the detection of papilledema of 0.96 (95% CI, 0.95 to 0.97), a sensitivity of 96.4% (95% CI, 93.9 to 98.3), and a specificity of 84.7% (95% CI, 82.3 to 87.1).
CONCLUSIONS
A deep-learning system using fundus photographs with pharmacologically dilated pupils differentiated among optic disks with papilledema, normal disks, and disks with nonpapilledema abnormalities. (Funded by the Singapore National Medical Research Council and the SingHealth Duke-NUS Ophthalmology and Visual Sciences Academic Clinical Program.).
Topics: Algorithms; Area Under Curve; Datasets as Topic; Deep Learning; Diagnosis, Differential; Fundus Oculi; Humans; Neural Networks, Computer; Ophthalmoscopy; Papilledema; Photography; Predictive Value of Tests; ROC Curve; Retina; Retrospective Studies; Sensitivity and Specificity
PubMed: 32286748
DOI: 10.1056/NEJMoa1917130 -
PloS One 2021This study aimed to describe and determine the prevalence of ocular abnormalities in Polish Hunting Dogs. The study was conducted with 193 Polish Hunting Dogs: 101...
This study aimed to describe and determine the prevalence of ocular abnormalities in Polish Hunting Dogs. The study was conducted with 193 Polish Hunting Dogs: 101 female and 92 male animals, aged between 3 months and 12 years. Ophthalmic examinations were performed using slit lamp biomicroscopy, ophthalmoscopy, and tonometry based on the ophthalmological protocol for the examination of hereditary eye diseases. Spectral-domain optical coherence tomography (SD-OCT) was performed for dogs with sudden acquired retinal degeneration syndrome (SARDS) and progressive retinal atrophy (PRA), while electroretinography was also performed in dogs with SARDS. Five dogs (2.6%) were diagnosed with cataract, iris coloboma in 3 dogs (1.6%), ocular dermoid in 1 dog (0.5%), and retinal dysplasia, distichiasis and entropion in 1 dog (1%). Three dogs (1.6%) were diagnosed with PRA and SARDS occurred in 1 dog. Retinal lesions was observed in 16 dogs (8.3%). The clinical signs of retinopathy observed in Polish Hunting Dogs included discoloration of the tapetal fundus, patchy increased reflectivity in the region of discoloration, focus of hyperpigmentation and an area of tapetal hyper-reflectivity with a pigmented center. SD-OCT performed in the 3 dogs with PRA revealed alteration in the retinal layers, which was most advanced in the non-tapetal fundus. Although SD-OCT revealed retinal layers with normal architecture only in some parts of the dorsal, nasal and temporal regions in dogs with SARDS, areas of disorganized external limiting membrane, myeloid zone, ellipsoid zone, outer photoreceptor segment and interdigitation zone were also observed. Polish Hunting Dogs should undergo periodic ophthalmological examination for the evaluation of other hereditary eye diseases. The prevalence of retinal lesions in Polish Hunting Dogs requires further research.
Topics: Animals; Dogs; Electroretinography; Female; Fundus Oculi; Male; Ophthalmoscopy; Pedigree; Prevalence; Retina; Retinal Degeneration; Syndrome; Tomography, Optical Coherence
PubMed: 34739488
DOI: 10.1371/journal.pone.0258636 -
Journal of Binocular Vision and Ocular... Jul 2023The year 2020 has been greatly anticipated by the entire ophthalmic community. This year's Scobee lecture will be a photographic look at our past with the orthoptists...
The year 2020 has been greatly anticipated by the entire ophthalmic community. This year's Scobee lecture will be a photographic look at our past with the orthoptists and pediatric ophthalmologists we have learned from, taught, and worked with. A sobering snapshot of our present will reveal a world with extreme medical access inequality. This creates a need for an inexpensive screening device for amblyogenic anisometropia. A technique for such a fast and inexpensive screening device will be shown using first retinoscopy; and then compare the effectiveness of the direct Heine streak ophthalmoscope, a common ophthalmic instrument, will be shown to be effective in screening for ≥1 diopter of spherical anisometropia. The challenges of the present hint at an optimistic future for orthoptists, expanding their role as physician extenders to help ease the medical access inequalities in the world. Finally, I introduce the patron saint of the blind and those with vision impairment.
Topics: Child; Humans; Anisometropia; Orthoptics; Retinoscopy
PubMed: 37057981
DOI: No ID Found -
Survey of Ophthalmology 2023Retromode scanning laser ophthalmoscopy imaging captures a pseudo-3-dimensional image of the ocular fundus. Retromode scanning laser ophthalmoscopy imaging was... (Review)
Review
Retromode scanning laser ophthalmoscopy imaging captures a pseudo-3-dimensional image of the ocular fundus. Retromode scanning laser ophthalmoscopy imaging was introduced first in 2008 using the Nidek F-10 scanning laser ophthalmoscope (F-10; Nidek Co., Gamagori, Japan). At that time, no major role was described for this imaging modality. The interest in retromode scanning laser ophthalmoscopy imaging is reemerging with the recent advent of the Mirante that combines scanning laser ophthalmoscopy and optical coherence tomography (Nidek Co., Gamagori, Japan) that can capture retromode images of the fundus. We summarize the findings and clinical implications of retromode imaging using the Nidek F-10 and the Mirante in retinal diseases with the aim of helping researchers direct their future studies.
Topics: Humans; Retinal Diseases; Ophthalmoscopy; Fundus Oculi; Tomography, Optical Coherence
PubMed: 37481077
DOI: 10.1016/j.survophthal.2023.07.004 -
Vestnik Oftalmologii 2022The article presents five cases of various forms of hemangiomas of the optic nerve head (ONH) and juxtapapillary retina that were monitored and analyzed using ocular...
The article presents five cases of various forms of hemangiomas of the optic nerve head (ONH) and juxtapapillary retina that were monitored and analyzed using ocular visualization methods. The obtained data allowed a conclusion that capillary hemangioma of the ONH features clearly-seen boundaries of the lesion both on ophthalmoscopy and optical coherence tomography (OCT) images; on the other hand, juxtapapillary granuloma can be characterized by blurred outlines on ophthalmoscopy and a gradual transition of the altered retina on OCT images with secondary changes seen in the macular area. When comorbid, capillary hemangioma of the ONH and retina feature a combination of these visualization signs.
Topics: Hemangioma, Capillary; Humans; Ophthalmoscopy; Optic Disk; Retina; Tomography, Optical Coherence
PubMed: 35488564
DOI: 10.17116/oftalma202213802166 -
Experimental Eye Research May 2021Noninvasive in vivo imaging of the mouse retina is essential for eye research. However, imaging the mouse fundus is challenging due to its small size and requires... (Review)
Review
Noninvasive in vivo imaging of the mouse retina is essential for eye research. However, imaging the mouse fundus is challenging due to its small size and requires specialized equipment, maintenance, and training. These issues hinder the routine evaluation of the mouse retina. In this study, we developed a noncontact imaging system consisting of a smartphone, a 90D condensing lens, a homemade light diaphragm, a tripod, and a Bluetooth remote. With minimal training, examiners were able to capture fundus images from the mouse retina. We also found that fundus images captured using our system from wild type mice, mice with laser-induced retinal injury, and a mouse model of retinitis pigmentosa showed a quality similar to those captured using a commercial fundus camera. These images enabled us to identify normal structures and pathological changes in the mouse retina. Additionally, fluorescein angiography was possible with the smartphone system. We believe that the smartphone imaging system is low cost, simple, accessible, easy to operate, and suitable for the routine screening and examination of the mouse eye.
Topics: Animals; Fluorescein Angiography; Fundus Oculi; Mice; Ophthalmoscopy; Retina; Retinal Diseases; Smartphone
PubMed: 33675778
DOI: 10.1016/j.exer.2021.108530 -
Eye (London, England) Jan 2021Fluorescence lifetime imaging ophthalmoscopy, FLIO, has gained large interest in the scientific community in the recent years. It is a noninvasive imaging modality that... (Review)
Review
Fluorescence lifetime imaging ophthalmoscopy, FLIO, has gained large interest in the scientific community in the recent years. It is a noninvasive imaging modality that has been shown to provide additional information to conventional imaging modalities. The FLIO device is based on a Heidelberg Engineering Spectralis system. Autofluorescence lifetimes are excited at 473 nm and recorded in two spectral wavelength channels, a short spectral channel (SSC, 498-560 nm) and a long spectral channel (LSC, 560-720 nm). Typically, mean autofluorescence lifetimes in a 30° retinal field are investigated. FLIO shows a clear benefit for imaging different retinal diseases. For example, in age-related macular degeneration (AMD), ring patterns of prolonged FLIO lifetimes 1.5-3.0 mm from the fovea can be appreciated. Macular telangiectasia type 2 (MacTel) shows a different pattern, with prolonged FLIO lifetimes within the typical MacTel zone. In Stargardt disease, retinal flecks can be appreciated even before they are visible with other imaging modalities. Early hydroxychloroquine toxicity appears to be detectable with FLIO. This technique has more potential that has yet to be discovered. This review article focuses on current knowledge as well as pitfalls of this technology. It highlights clinical benefits of FLIO imaging in different ophthalmic and systemic diseases, and provides an outlook with perspectives from the authors.
Topics: Fluorescein Angiography; Humans; Ophthalmoscopy; Optical Imaging; Retina; Retinal Telangiectasis; Tomography, Optical Coherence
PubMed: 33268846
DOI: 10.1038/s41433-020-01287-y -
Indian Journal of Ophthalmology Apr 2021
Topics: Diagnostic Imaging; Humans; Ophthalmoscopy; Retina
PubMed: 33727434
DOI: 10.4103/ijo.IJO_2726_20 -
Strabismus Mar 2023Accommodation anomalies are frequently caused or exacerbated by psychological problems such as anxiety. Patients share many features with those with other anxiety based...
INTRODUCTION
Accommodation anomalies are frequently caused or exacerbated by psychological problems such as anxiety. Patients share many features with those with other anxiety based somatic symptoms such as stomach-ache, palpitations and headaches. They can be difficult to treat, and the ophthalmic literature rarely goes beyond diagnosis and ocular treatment. This study reports characteristics and outcomes of a short case series of patients with accommodation spasms and weaknesses assessed objectively, and outlines a psychological approach to treatment.
METHODS
23 patients (13 severe accommodative weakness or "paralysis," 10 accommodative spasm) aged between 8-30 years, were referred to our laboratory after diagnosis by their referring clinician and exclusion of pathology or drug-related causes. Their accommodation and convergence were assessed objectively with a laboratory photorefractive method, as well as by conventional orthoptic testing and dynamic retinoscopy. All interactions with the patients used an evidence-based psychological approach, to give them insight into how stress and anxiety can cause or exacerbate eye symptoms and help them to break a vicious cycle of anxiety and risk of deterioration.
RESULTS
83% were female and 57% had previously diagnosed anxiety or dyslexia (with many more acknowledging being "worriers"). Inconsistency of responses was the rule and all showed normal responses at some time during their visit. Responses were poorly related to the visual stimuli presented and objective responses often differed from subjective. Dissociation between convergence and accommodation was more common, compared to our large, previously reported, control groups. No participant had true paralysis of accommodation. Responses often improved dramatically within one session after discussion and explanation of the strong relationship between anxiety and accommodative anomalies. None have returned for further advice or treatment.
CONCLUSIONS
Our approach explicitly addresses psychological factors in causing, or worsening, accommodation (and co-existing convergence) anomalies. Many of these patients do not realize that a certain amount of blur is normal in everyday life. Ocular symptoms are often a sign of anxiety, not the primary problem. By recognizing this, patients can be helped to address the triggering issues and symptoms often subside or resolve spontaneously. Well-meaning professionals, offering only ocular treatments, can deflect attention away from the real cause and can unwittingly be making things worse.
Topics: Humans; Female; Child; Adolescent; Young Adult; Adult; Male; Accommodation, Ocular; Retinoscopy; Orthoptics; Convergence, Ocular
PubMed: 36710250
DOI: 10.1080/09273972.2023.2171070 -
Current Opinion in Neurology Feb 2020The aim of this review is to highlight novel artificial intelligence-based methods for the detection of optic disc abnormalities, with particular focus on neurology and... (Review)
Review
PURPOSE OF REVIEW
The aim of this review is to highlight novel artificial intelligence-based methods for the detection of optic disc abnormalities, with particular focus on neurology and neuro-ophthalmology.
RECENT FINDINGS
Methods for detection of optic disc abnormalities on retinal fundus images have evolved considerably over the last few years, from classical ophthalmoscopy to artificial intelligence-based identification methods being applied to retinal imaging with the aim of predicting sight and life-threatening complications of underlying brain or optic nerve conditions.
SUMMARY
Artificial intelligence and in particular newly developed deep-learning systems are playing an increasingly important role for the detection and classification of acquired neuro-ophthalmic optic disc abnormalities on ocular fundus images. The implementation of automatic deep-learning methods for detection of abnormal optic discs, coupled with innovative hardware solutions for fundus imaging, could revolutionize the practice of neurologists and other non-ophthalmic healthcare providers.
Topics: Artificial Intelligence; Fundus Oculi; Humans; Ophthalmoscopy; Optic Disk; Optic Nerve; Optic Nerve Diseases
PubMed: 31789676
DOI: 10.1097/WCO.0000000000000773