Diabetic retinopathy (DR) is a major microvascular complication of diabetes, affecting a substantial portion of diabetic patients worldwide. Timely intervention is pivotal in mitigating the risk of ...blindness associated with DR, yet early detection remains a challenge due to the absence of early symptoms. Screening programs have emerged as a strategy to address this burden, and this paper delves into the role of artificial intelligence (AI) in advancing DR screening in Japan. There are two pathways for DR screening in Japan: a health screening pathway and a clinical referral path from physicians to ophthalmologists. AI technologies that realize automated image classification by applying deep learning are emerging. These technologies have exhibited substantial promise, achieving sensitivity and specificity levels exceeding 90% in prospective studies. Moreover, we introduce the potential of Generative AI and large language models (LLMs) to transform healthcare delivery, particularly in patient engagement, medical records, and decision support. Considering the use of AI in DR screening in Japan, we propose to follow a seven-step framework for systematic screening and emphasize the importance of integrating AI into a well-designed screening program. Automated scoring systems with AI enhance screening quality, but their effectiveness depends on their integration into the broader screening ecosystem. LLMs emerge as an important tool to fill gaps in the screening process, from personalized invitations to reporting results, facilitating a seamless and efficient system. However, it is essential to address concerns surrounding technical accuracy and governance before full-scale integration into the healthcare system. In conclusion, this review highlights the challenges in the current screening pathway and the potential for AI, particularly LLM, to revolutionize DR screening in Japan. The future direction will depend on leadership from ophthalmologists and stakeholders to address long-standing challenges in DR screening so that all people have access to accessible and effective screening.
Retinal vessel segmentation is of great interest for diagnosis of retinal vascular diseases. To further improve the performance of vessel segmentation, we propose IterNet, a new model based on UNet ...1, with the ability to find obscured details of the vessel from the segmented vessel image itself, rather than the raw input image. IterNet consists of multiple iterations of a mini-UNet, which can be 4× deeper than the common UNet. IterNet also adopts the weight-sharing and skip-connection features to facilitate training; therefore, even with such a large architecture, IterNet can still learn from merely 10~20 labeled images, without pre-training or any prior knowledge. IterNet achieves AUCs of 0.9816, 0.9851, and 0.9881 on three mainstream datasets, namely DRIVE, CHASE-DB1, and STARE, respectively, which currently are the best scores in the literature. The source code is available 1 .
Purpose
To conduct a systematic review of clinical research on the use of regenerative medicine for the cornea in human patients.
Methods
A systematic literature search of MEDLINE and the Cochrane ...Library was performed in May 2020.
Results
Forty-two articles were identified. Thirty-eight of those articles focused on the treatment for limbal stem cell deficiency (LSCD), of which 17 articles involved autologous cultured limbal epithelial cell sheet transplantation (CLET), 13 involved allogeneic CLET, and 14 involved autologous cultured oral mucosal epithelial cell sheet transplantation (COMET). For autologous CLET, the median ocular surface reconstruction rate, visual recovery rate, incidence of immunologic rejection, infectious keratitis, and ocular hypertension/glaucoma were 74.1%, 54.5%, 0%, 4.6%, and 6.3%, respectively. For allogeneic CLET, they were 71.4%, 71.4%, 7.1%, 12.0%, and 7.1%, respectively. For autologous COMET, they were 66.7%, 66.7%, 0%, 5.3%, and 8.1%, respectively. Systemic immunosuppressants and steroid medications were predominantly used following allogeneic CLET, whereas they were not routinely used after autologous CLET. Three studies focused on the treatment of keratoconus using autologous adipose-derived adult stem cells and reported no marked adverse events. One study reported on the treatment of bullous keratopathy using allogeneic cultured corneal endothelial cells. All patients achieved an endothelial cell density of >500 cells, and the corrected distance visual acuity improved in 82% of the treated eyes.
Conclusions
The results show that regenerative medicine for the cornea demonstrated a satisfactory efficacy and safety. Through translational research, we are expecting to establish a new treatment for waiting patients.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Purpose
To investigate the subfoveal choroidal thickness in eyes with typical age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV), using enhanced depth imaging optical ...coherence tomography.
Methods
Retrospective observational case series of 44 eyes of 44 patients (12 females and 32 males) with typical AMD or PCV located in the subfoveal region. Cross-sectional images of the choroid of each of the involved eyes were obtained by a spectral-domain OCT. The choroidal thickness under the fovea was retrospectively studied.
Results
Of the 44 eyes involved in this study, 21 eyes were diagnosed as typical AMD and the other 23 eyes were diagnosed as PCV. The difference in subfoveal choroidal thickness between the eyes with typical AMD (245 μm) and those with PCV (293 μm) was statistically significant, even after adjusting for age, spherical equivalent, and gender distribution (
P
= 0.045). When compared to eyes with subfoveal choroidal thickness less than 300 μm, those with subfoveal choroidal thickness of 300 μm or more were 5.6 times more likely to have PCV (adjusted odds ratio 5.60, 95% confidence interval 1.30–24.0,
P
= 0.021).
Conclusions
The choroid under the fovea was thicker in eyes with PCV than those with typical AMD. This result suggests that the choroidal vascular lesion seen in PCV may not be just the choroidal neovascularization accompanied by saccular capillary dilations at the border, but may have a significant structural difference in the choroid compared to typical AMD.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
We show that the core of a generalized assignment problem satisfies two types of stability properties. First, the core is the unique stable set defined using the weak domination relation when ...outcomes are restricted to individually rational and pairwise feasible ones. Second, the core is the unique stable set with respect to a sequential domination relation that is defined by a sequence of weak domination relations that satisfy outsider independence. An equivalent way of stating this result is that the core satisfies the property commonly stated as the existence of a path to stability. These results add to the importance of the core in an assignment problem where agents' preferences may not be quasilinear.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Purpose
To determine the prognostic factors for success 3 years after Baerveldt glaucoma implant (BGI) surgery.
Study design
Single-center retrospective clinical study.
Methods
We analyzed 27 eyes ...(24 patients) treated with BGI surgery between 2012 and 2016 at Osaka University Hospital. Patients were followed for a minimum of 3 years postoperatively. We analyzed the success rates and risk factors. Failure was defined as the need for additional surgery for IOP reduction, loss of light perception, and intraocular pressure (IOP) ≧22 mmHg (definition 1) or ≧17 mmHg (definition 2) at two consecutive follow-up visits.
Results
The mean number of previous eye surgeries was 4.1 ± 3.3. The success rates were 81.5% and 77.8%, respectively, 1 year and 3 years after surgery based on definition 1 and 51.9% and 48.2%, respectively, based on definition 2. The early and late surgical complication rates, respectively, were 29.6% and 22.2%. An IOP 2 months after BGI surgery of ≧17 mmHg and the number of previous eye surgeries were significant risk factors for failure based on definition 2.
Conclusion
The long-term results and complication rates after BGI surgery for refractory glaucoma in our hospital were similar to previous reports, and the IOP 2 months after BGI surgery and the number of previous eye surgeries were associated with the prognosis.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Copper hexadecafluorophthalocyanine (CuFPc) has excellent environmental and thermal stability and stable n-type semiconducting properties under ambient conditions. We investigated the exciton ...diffusion dynamics in individual CuFPc single-crystalline nanorods having the width of 20–40 nm and the length of 100–1000 nm by femtosecond pump and probe single-nanoparticle spectroscopy. The excitation intensity dependence of the excited-state decay profiles was examined for 38 single nanorods. The exciton diffusion coefficient in a one-dimensional (1D) stack of CuFPc molecules in a single nanorod was estimated from the rate constant of exciton–exciton bimolecular annihilation. It was found that the values of the exciton diffusion coefficient were scattered in the range of 0.001–0.08 cm2 s–1 and showed a correlation with the resonance peak wavelengths and widths of the exciton transition of the nanorods. These results indicated that the exciton diffusion coefficient was dependent on the length of the nanorod and became large in shorter-length nanorods.
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IJS, KILJ, NUK, PNG, UL, UM
Purpose To develop a classification and grading system for myopic maculopathy. Design Development and evaluation of a classification system for myopic maculopathy based on observational case series. ...Methods A comprehensive set of myopic macular lesions was defined via literature review and through consensus meetings among retinal specialists and clinician scientists. A classification of myopic maculopathy was formulated based on fundus photographs and a modified Delphi process and consensus. Inter- and intraobserver reproducibility, assessed as agreement (%) and weighted kappa values, were evaluated. One hundred retinal photographs with myopia and myopic macular lesions were selected from case series at the High Myopia Clinic of the Tokyo Medical and Dental University, Tokyo, Japan. Results We defined 5 categories of myopic maculopathy including “no myopic retinal degenerative lesion” (Category 0), “tessellated fundus” (Category 1), “diffuse chorioretinal atrophy” (Category 2), “patchy chorioretinal atrophy” (Category 3), and “macular atrophy” (Category 4). Three additional features to supplement these categories were defined as “plus” lesions, namely, lacquer cracks, myopic choroidal neovascularization, and Fuchs spot. Posterior staphyloma was considered as a further, important sign of myopic retinopathy. The intraobserver agreement was ≥85% and the corresponding weighted kappa statistic was ≥0.6 between observations. After a brief training session, interobserver kappa statistics reached the predefined satisfactory level (≥0.4), considered as above moderate agreement. Conclusions We propose a classification system for myopic maculopathy that was found to be reproducible. Applying a uniform classification in different studies will facilitate communication and comparison of findings from clinical trials and epidemiologic studies.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
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