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Ophthalmology Jun 2024To evaluate whether providing clinicians with an artificial intelligence-based vascular severity score (AI-VSS) improves consistency in diagnosis of plus disease in...
OBJECTIVE
To evaluate whether providing clinicians with an artificial intelligence-based vascular severity score (AI-VSS) improves consistency in diagnosis of plus disease in retinopathy of prematurity (ROP).
DESIGN
This is a multi-reader diagnostic accuracy imaging study.
PARTICIPANTS
Eleven ROP experts (4 pediatric ophthalmologists, 7 retina specialists), 9 of which had been in practice for 10 or more years.
METHODS
Retcam (Natus Medical Incorporated) fundus images were obtained from premature infants during routine ROP screening as part of the Imaging and Informatics in ROP study between January 2012 and July 2020. From all available exams, a subset of 150 eye exams from 110 infants were selected for grading. An AI-VSS was assigned to each set of images using the i-ROP DL system. The clinicians were asked to diagnose plus disease for each exam and assign an estimated VSS (range 1-9) at baseline, and then again one month later with AI-VSS assistance. A reference standard diagnosis (RSD) was assigned to each eye exam from the i-ROP study based on 3 masked expert labels and the ophthalmoscopic diagnosis.
MAIN OUTCOME MEASURE
Mean linearly weighted kappa for plus disease diagnosis compared to the RSD. Area under the receiver operating characteristic and precision-recall curves (AUROC, AUPR) for 1-9 labels compared to RSD for plus disease.
RESULTS
Expert agreement improved significantly from substantial (κ: 0.69 [0.59, 0.75]) to near perfect (κ: 0.81 [0.71, 0.86]) when AI-VSS was integrated. Additionally, there was a significant improvement in plus disease discrimination as measured by mean [95% confidence interval] AUROC (0.94 [0.92, 0.96] to 0.98 [0.96, 0.99], difference: 0.04 [0.01, 0.06]) and AUPR (0.86 [0.81, 0.90] to 0.95 [0.91, 0.97], difference: 0.09 [0.03, 0.14]).
CONCLUSIONS
Providing ROP clinicians with an AI-based measurement of vascular severity in ROP was associated with both improved plus disease diagnosis and improved continuous severity labeling, as compared to a reference standard diagnosis for plus disease. If implemented in practice, AI-VSS could reduce inter-observer variability and standardize treatment for infants with ROP.
PubMed: 38866367
DOI: 10.1016/j.ophtha.2024.06.006 -
Computer Methods and Programs in... May 2024Optical coherence tomography (OCT) has ushered in a transformative era in the domain of ophthalmology, offering non-invasive imaging with high resolution for ocular... (Review)
Review
BACKGROUND AND OBJECTIVES
Optical coherence tomography (OCT) has ushered in a transformative era in the domain of ophthalmology, offering non-invasive imaging with high resolution for ocular disease detection. OCT, which is frequently used in diagnosing fundamental ocular pathologies, such as glaucoma and age-related macular degeneration (AMD), plays an important role in the widespread adoption of this technology. Apart from glaucoma and AMD, we will also investigate pertinent pathologies, such as epiretinal membrane (ERM), macular hole (MH), macular dystrophy (MD), vitreomacular traction (VMT), diabetic maculopathy (DMP), cystoid macular edema (CME), central serous chorioretinopathy (CSC), diabetic macular edema (DME), diabetic retinopathy (DR), drusen, glaucomatous optic neuropathy (GON), neovascular AMD (nAMD), myopia macular degeneration (MMD) and choroidal neovascularization (CNV) diseases. This comprehensive review examines the role that OCT-derived images play in detecting, characterizing, and monitoring eye diseases.
METHOD
The 2020 PRISMA guideline was used to structure a systematic review of research on various eye conditions using machine learning (ML) or deep learning (DL) techniques. A thorough search across IEEE, PubMed, Web of Science, and Scopus databases yielded 1787 publications, of which 1136 remained after removing duplicates. Subsequent exclusion of conference papers, review papers, and non-open-access articles reduced the selection to 511 articles. Further scrutiny led to the exclusion of 435 more articles due to lower-quality indexing or irrelevance, resulting in 76 journal articles for the review.
RESULTS
During our investigation, we found that a major challenge for ML-based decision support is the abundance of features and the determination of their significance. In contrast, DL-based decision support is characterized by a plug-and-play nature rather than relying on a trial-and-error approach. Furthermore, we observed that pre-trained networks are practical and especially useful when working on complex images such as OCT. Consequently, pre-trained deep networks were frequently utilized for classification tasks. Currently, medical decision support aims to reduce the workload of ophthalmologists and retina specialists during routine tasks. In the future, it might be possible to create continuous learning systems that can predict ocular pathologies by identifying subtle changes in OCT images.
PubMed: 38861878
DOI: 10.1016/j.cmpb.2024.108253 -
Orbit (Amsterdam, Netherlands) Jun 2024Periocular lesions in pediatric patients usually require general anesthesia for surgical intervention. The US Food and Drug Administration (FDA) warns against multiple...
PURPOSE
Periocular lesions in pediatric patients usually require general anesthesia for surgical intervention. The US Food and Drug Administration (FDA) warns against multiple exposures to anesthesia in children younger than 3 years due to the increased risk of learning disabilities in this population. This study aimed to evaluate risk factors associated with chalazion recurrence after surgery.
METHODS
A retrospective chart review over a five-year period identified 649 patients at our institution undergoing surgical intervention for chalazion. The primary outcomes examined were as follows: (1) return to the operating room for additional surgical intervention and (2) recurrence of chalazion during convalescence from surgery and follow-up.
RESULTS
Fewer than one-third of patients suffered a recurrence after surgery. Multivariate logistic regression found younger age ( = 0.01), female sex ( = 0.01), and a greater number of chalazia drained ( < 0.001) were significantly correlated with recurrence of chalazia after surgery.
CONCLUSIONS
Patients presenting at a younger age and with a greater number of chalazion were statistically more likely to have a recurrence of chalazion after surgery. Given recurrence is more likely in younger children, reconciling this with the risk-benefit ratio with regard to FDA guidelines on anesthesia in children under three years is a critical consideration for ophthalmologists.
PubMed: 38861504
DOI: 10.1080/01676830.2024.2363973 -
Clinical Ophthalmology (Auckland, N.Z.) 2024Anti-vascular endothelial growth factor (anti-VEGF) agents are widely prescribed for the treatment of neovascular age-related macular degeneration (nAMD). Although...
BACKGROUND
Anti-vascular endothelial growth factor (anti-VEGF) agents are widely prescribed for the treatment of neovascular age-related macular degeneration (nAMD). Although studies have investigated patient choice of anti-VEGF agent, little is known regarding factors that influence physician preference of anti-VEGF agent for their patients.
OBJECTIVE
To describe physician rationale and challenges in prescribing anti-VEGF treatments for patients with nAMD.
METHODS
Data were drawn from the Adelphi Real World nAMD Disease Specific Programme™, a cross-sectional survey with retrospective data capture of physicians and their patients with nAMD in the United States between October 2021 and May 2022. Physicians (n = 56) reported data for up to 13 consecutively consulting patients (n = 451), including current anti-VEGF treatments used, factors affecting physicians' choice of anti-VEGF agent and treatment strategy, and restrictions on specific agents.
RESULTS
Most physicians prefer employing a "treat-and-extend" treatment strategy, over "fixed interval" or "pro re nata" strategies. However, in routine clinical practice, "treat-and-extend" was reported for less than half of nAMD-diagnosed eyes. Top factors influencing physician choice of anti-VEGF agent and treatment strategy included maximizing clinical benefit (eg visual acuity gains and fluid control), patient convenience, and reducing out-of-pocket costs. However, physicians also reported facing substantial roadblocks in prescribing their choice of anti-VEGF agent, including restrictions on approved agents and gaps in insurance coverage. Persistent fluid was the most common physician-selected reason for switching a patient away from an anti-VEGF agent.
CONCLUSION
Physicians face barriers to prescribing their preferred anti-VEGF agents in real-world healthcare settings. Overcoming these challenges may improve treatment outcomes for patients with nAMD.
PubMed: 38860119
DOI: 10.2147/OPTH.S461846 -
Cureus May 2024Purpose Community screening programs have been in effect since they were utilized in the 19th century at county fairs. A free pediatric health screening program was...
Purpose Community screening programs have been in effect since they were utilized in the 19th century at county fairs. A free pediatric health screening program was created by an osteopathic medical school in South Carolina in collaboration with a pediatric dental outreach organization to engage the local underserved community and train community-minded medical professionals. This study sought to demonstrate the efficacy and need for a student-run monthly pediatric health screening program in an underserved pediatric demographic. Methods A retrospective study of preexisting de-identified data obtained from a student-run health screening program was analyzed to determine the efficacy of the screening program in detecting chronic health risk factors in children in an underserved population. Patients were recruited through a partnership with a free dental clinic for underserved and uninsured children. Patients who attended the clinic were offered the opportunity to have a free, comprehensive health assessment following their dental visit. The function of this program was unique in that uninsured, underserved patients were provided free dental care and a free health assessment. Pediatric patients were screened for basic health information such as weight, height, BMI, vision, cardiovascular health, hypertension, asthma (reported via questionnaire by either the parent or child when applicable), nutrition, and lead poisoning (via questionnaire). The program also offered families additional support by connecting them to local resources and answering any questions they had about their children's health. Data from 14 health screening events was collected for quality improvement and efficacy monitoring. Descriptive analyses were performed. Results and analysis The health screening program assessed 124 children between October 2021 and March 2023 over 14 health screening events. The patients ranged from one year old to 26 years old, with a mean age of 9.65 years. Patients were predominantly Hispanic (79.67%). About one-third (27.64%) of children who were screened had positive findings associated with increased risk for chronic disease. Nearly half (43.90%) of families that were screened requested further information on ways to obtain health insurance and regular primary care services (utilized Access Health). Of the one-third of children with positive risk factors, 12.20% reported positive findings associated with asthma. Of the patients with positive risk factors, 8.94% had vision abnormalities, most of whom had not been seen by an ophthalmologist. This preliminary analysis will be followed by a secondary analysis that further investigates patient demographics (primarily Hispanic) as well as age distribution across various risk factors. Conclusion This pediatric health screening program has demonstrated a basic level of efficacy by successfully identifying increased risk for chronic disease in the underserved pediatric population. The need for these screening events was highlighted by the identification of untreated positive findings.
PubMed: 38860058
DOI: 10.7759/cureus.60085 -
Cureus Jun 2024Introduction Glaucoma is the major cause of irreversible blindness worldwide. Glaucoma affects the optic nerve head in the posterior segment of the eye and the defects...
Introduction Glaucoma is the major cause of irreversible blindness worldwide. Glaucoma affects the optic nerve head in the posterior segment of the eye and the defects lead to permanent blindness if left untreated. Poor knowledge about this disease is strongly correlated with delayed diagnosis. This study aimed to evaluate doctors' knowledge and self-care practices about glaucoma at a tertiary care hospital in Chennai, presuming that healthcare professionals constitute an effective conduit between the population at risk and ophthalmologists. Methods We carried out this cross-sectional survey among 252 doctors practicing allopathic medicine in a tertiary care hospital in Chennai from July 2022 to December 2022. We have collected 252 samples by simple random sampling method. We have excluded doctors who have a degree in ophthalmology or practicing it. The data collection was interview-based using a pre-designed, structured questionnaire that contained questions on sociodemographic characteristics age, gender, and specialty in medicine. It also included questions assessing knowledge and self-care practices about glaucoma among doctors of various specialties other than ophthalmology. We entered the collected data into Microsoft Excel (Microsoft Corporation, Redmond, WA), cleaned it, and analyzed it using SPSS version 16. Results The mean age of the doctors was 33.24 ± 10.90 years in this study. About 132 (52.4%) of the study participants were females. Only 91 (36.1%) of respondents knew that glaucoma may permanently impair vision, but nearly 240 (95.2%) believed that it could be treated. Two hundred seventeen (86.1%) participants were aware that glaucoma runs in families. About 218(86.5%) doctors were aware that glaucoma destroys the optic nerve in the eye, and 171 (67.9%) knew that peripheral vision loss happens before central vision loss. Only 146 (57.9%) of physicians had their eye pressure examined. About 232(92.1%) doctors had their eyes checked routinely. Only 42 (16.7%) of physicians took part in glaucoma awareness campaigns. Nearly 199 (79%) of those surveyed thought it was required to check a patient's family members for glaucoma. We note that among doctors, the knowledge and practice score of correct replies was strongly connected with work experience (P value = 0.035). Conclusion The need for extensive eye health education and information distribution for healthcare workers should be stressed. Teaching the hospital staff about the symptoms and prognosis of this "silent thief of sight" might be a crucial first step in providing preventive ophthalmic treatment.
PubMed: 38859946
DOI: 10.7759/cureus.62043 -
Plastic and Reconstructive Surgery May 2024We examined ophthalmologic outcomes and periorbital management in patients with Treacher Collins syndrome (TCS).
BACKGROUND
We examined ophthalmologic outcomes and periorbital management in patients with Treacher Collins syndrome (TCS).
METHODS
A retrospective cohort study was performed of children with TCS treated from 2009 to 2023 at our center. Demographics and medical history were collected. Primary outcomes were periorbital findings, surgical burden, and visual acuity. Patients were stratified by risk of vision loss based on ophthalmologic findings.
RESULTS
Among 50 subjects, mean follow-up was 10.5±5.9 years. Periorbital findings included downslanting palpebral fissures (100%), eyelash deficiency (70%), eyelid coloboma (54%), and significant refractive error (50%). Twenty (40%) individuals underwent 86 periorbital procedures, including lateral canthopexy (n=23 operations) and malar/zygomatic reconstruction/augmentation (n=20). Lateral canthopexies accompanied by malar fat grafting were less likely to require reoperation (0% versus 72%, p=0.004). Subjects with eyelid coloboma were more likely to have exposure keratopathy (30% versus 4%, p=0.020). Grouped by risk of vision loss, 58% were "High" risk, 18% were "Moderate", and 24% were "Low". Among 78 eyes of 39 subjects, vision was "Good" in 90%, "Fair" in 5%, and "Poor" in 6%. Vision risk grading was associated with visual acuity outcomes (n=29) (p=0.050).
CONCLUSIONS
In assessing long-term ophthalmological outcomes, we noted good vision despite significant periorbital anomalies. Though most eyelid colobomas can be managed with lubrication, those threatening corneal integrity should be repaired in infancy. As timely intervention may prevent visual impairment, we recommend perinatal ophthalmologist evaluation for all children with TCS. Our proposed vision risk scale may serve as a helpful paradigm by which to contemplate vision-related issues.
PubMed: 38857421
DOI: 10.1097/PRS.0000000000011563 -
Beyoglu Eye Journal 2024The focus of this study was to assess and compare the h-indexes of editorial board members from eight ophthalmology journals in Türkiye and explore the potential...
OBJECTIVES
The focus of this study was to assess and compare the h-indexes of editorial board members from eight ophthalmology journals in Türkiye and explore the potential correlations between these indexes and the sub-specialties of board members.
METHODS
Conducted in December 2023, this cross-sectional study utilized publicly available data from Google Scholar (GS), Web of Science, and Scopus. The h-index and number of publications by editorial board members from eight Turkish ophthalmology journals were analyzed. Statistical analysis for this study involved the use of SPSS, employing descriptive statistics, one-way analysis of variance, and tests for group comparisons.
RESULTS
Of the 415 editorial board members, 26 were not ophthalmologists and 12 worked abroad; the credentials of 10 could not be verified. A total of 367 authors were evaluated, revealing significant differences in publication numbers and h-indices among the different subspecialties. Notably, the retinal specialists demonstrated higher productivity. Variability in citation counts was observed across databases, with GS having the widest range. Differences were also noted in the publication and h-index among the editorial boards of different journals.
CONCLUSION
The h-index and number of publications effectively reflected the active status of ophthalmology authors. This study contributes valuable information regarding Turkish ophthalmology journals and their editorial boards, serving as an inspiration for young ophthalmologists. These findings underscore the diverse successes of ophthalmologists across subspecialties, encouraging the exploration of less-explored areas in academic pursuits.
PubMed: 38855950
DOI: 10.14744/bej.2024.03030 -
Missouri Medicine 2024
Topics: Humans; Exercise; COVID-19
PubMed: 38854612
DOI: No ID Found -
Cureus May 2024Dry eye disease is a common clinical problem encountered by ophthalmologists worldwide. Interest in this entity has increased in recent years due to the consequences it... (Review)
Review
Dry eye disease is a common clinical problem encountered by ophthalmologists worldwide. Interest in this entity has increased in recent years due to the consequences it has on the ocular surface after any surface procedure. With changing times, several new factors have come to light that can influence this disease. The effect of the COVID-19 pandemic has also been greatly felt, with a range of causes, starting from increased screen work to inflammatory processes, exacerbating the condition in many. With changes in the concepts of the etiopathogenesis of the disease, a paradigm shift has taken place in the approaches to treatment. More researchers are in favor of a new tear film-oriented approach that tries to localize the disease to a single component in the tear film. Innovation of newer techniques for the treatment of meibomian gland disease has also made its foray into clinical ophthalmology. Newer drug formulations and molecules are underway to better treat the inflammatory component of the disease. Many other receptors and targets for the treatment of dry eyes are being researched. This review hopes to provide a succinct, narrative summary of the relevant research on dry eye disease to date to increase awareness about the nature and future course of this disease and its management.
PubMed: 38854318
DOI: 10.7759/cureus.59985