PurposeMany efforts have been made to explore the potential of deep learning and artificial intelligence (AI) in disciplines such as medicine, including ophthalmology. This systematic review aims to ...evaluate the reporting quality of randomised controlled trials (RCTs) that evaluate AI technologies applied to ophthalmology.MethodsA comprehensive search of three relevant databases (EMBASE, Medline, Cochrane) from 1 January 2010 to 5 February 2022 was conducted. The reporting quality of these papers was scored using the Consolidated Standards of Reporting Trials-Artificial Intelligence (CONSORT-AI) checklist and further risk of bias was assessed using the RoB-2 tool.ResultsThe initial search yielded 2973 citations from which 5 articles satisfied the inclusion/exclusion criteria. These articles featured AI technologies applied to diabetic retinopathy screening, ophthalmologic education, fungal keratitis detection and paediatric cataract diagnosis. None of the articles reported all items in the CONSORT-AI checklist. The overall mean CONSORT-AI score of the included RCTs was 53% (range 37%–78%). The individual scores of the articles were 37% (19/51), 39% (20), 49% (25), 61% (31) and 78% (40). All articles were scored as being moderate risk, or ‘some concerns present’, regarding potential risk of bias according to the RoB-2 tool.ConclusionA small number of RCTs have been published to date on the applications of AI in ophthalmology and vision science. Adherence to the 2020 CONSORT-AI reporting guidelines is suboptimal with notable reporting items often missed. Greater adherence will help facilitate reproducibility of AI research which can be a stimulus for more AI-based RCTs and clinical applications in ophthalmology.
This article presents high-resolution swept source optical coherence tomography (SS-OCT) imaging data used to describe the physiology of retinal reattachment in humans. SS-OCT imaging was performed ...at baseline and every 2 h for the first 6 h and at frequent intervals thereafter up to 6 weeks following the injection of intravitreal gas in eyes undergoing pneumatic retinopexy for rhegmatogenous retinal detachment. Imaging data presented in this article is related to the research paper titled “Real-Time in Vivo Assessment of Retinal Reattachment in Humans using Swept-Source Optical Coherence Tomography” (Bansal et al., 2021). SS-OCT images were assessed longitudinally and used to devise a novel staging system that describes the physiology of retinal reattachment. Multiple examples of each stage and the transition from one stage to the next are provided. SS-OCT images were also assessed to determine the timing associated with each stage, and the anatomic abnormalities, such as outer retinal folds and subretinal fluid blebs that occured as a result of delayed progression through certain stages.
Abstract
Background
With the rise of artificial intelligence (AI) in ophthalmology, the need to define its diagnostic accuracy is increasingly important. The review aims to elucidate the diagnostic ...accuracy of AI algorithms in screening for all ophthalmic conditions in patient care settings that involve digital imaging modalities, using the reference standard of human graders.
Methods
This is a systematic review and meta-analysis. A literature search will be conducted on Ovid MEDLINE, Ovid EMBASE, and Wiley Cochrane CENTRAL from January 1, 2000, to December 20, 2021. Studies will be selected via screening the titles and abstracts, followed by full-text screening. Articles that compare the results of AI-graded ophthalmic images with results from human graders as a reference standard will be included; articles that do not will be excluded. The systematic review software DistillerSR will be used to automate part of the screening process as an adjunct to human reviewers. After the full-text screening, data will be extracted from each study via the categories of study characteristics, patient information, AI methods, intervention, and outcomes. Risk of bias will be scored using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) by two trained independent reviewers. Disagreements at any step will be addressed by a third adjudicator. The study results will include summary receiver operating characteristic (sROC) curve plots as well as pooled sensitivity and specificity of artificial intelligence for detection of any ophthalmic conditions based on imaging modalities compared to the reference standard. Statistics will be calculated in the R statistical software.
Discussion
This study will provide novel insights into the diagnostic accuracy of AI in new domains of ophthalmology that have not been previously studied. The protocol also outlines the use of an AI-based software to assist in article screening, which may serve as a reference for improving the efficiency and accuracy of future large systematic reviews.
Trial registration
PROSPERO,
CRD42021274441
PurposeThe quality of biological fluid samples is vital for optimal preanalytical procedures and a requirement for effective translational biomarker research. This study aims to determine the effects ...of storage duration and freeze-thawing on the levels of various cytokines in the human aqueous humour and vitreous samples.Methods and analysisHuman ocular aqueous humour and vitreous samples were obtained from 25 eyes and stored at −80°C for analysis. All samples were assayed for 27 cytokine biomarker concentrations (pg/mL) using a multiplex assay. Four sample storage durations following sample collection were evaluated (1 week, 3 months, 9 months and 15 months). Additionally, samples underwent up to three freeze-thaw cycles within the study period.ResultsAmong the 27 cytokine biomarkers, concentrations of four cytokines (Interleukin (IL)−2, IL-10, IL-12 and platelet-derived growth factor-BB) were significantly decreased by storage duration at all time points, as early as 3 months following sample collection (range of 9%–37% decline between 1 week and 15 months, p<0.001). Freeze-thawing of up to three cycles did not significantly impact the cytokine biomarker concentrations in aqueous humour or vitreous. Separability of patient-specific cytokine biomarker profiles in the principal component analysis remained relatively the same over the 15 months of storage duration.ConclusionThe findings from this study suggest that several intraocular cytokine biomarkers in human aqueous humour and vitreous samples may be susceptible to degradation with long-term storage, as early as 3 months after collection. The overall patient-specific cytokine biomarker profiles are more stable than concentrations of individual cytokines. Future studies should focus on developing guidelines for optimal and standardised sample handling methods to ensure correct research findings about intraocular biomarkers are translated into clinical practice.
Correspondence to Dr Tina Felfeli; tina.felfeli@mail.utoronto.ca Introduction The global demand for eye health services is growing with increasing life expectancy and the ageing population.1 The ...estimated prevalence and relative contribution of avoidable causes of blindness and vision impairment globally is 9600 cases per 100 000 people, with cataract and glaucoma as the leading global causes of blindness in those aged 50 years and older.1 Cataract surgery and other vision saving surgeries are among the most cost-effective healthcare interventions currently available.2 However, increasing case volume and backlogs in ophthalmic surgery will place unprecedented pressures on healthcare systems, particularly those with a limited ability to increase throughput.3 Data regarding demand and supply of surgery is required to inform surgical policies for optimal outcomes and equitable care.3 In many jurisdictions including the USA, there is a lack of population-based ophthalmic surgical data, and therefore, the unmet demand is unknown. The WTIS captures wait time data in near real time4 on wait list queues for non-emergency ophthalmic surgical procedures (subspecialty surgeries including vitreoretinal, glaucoma, cornea, cataract, oculoplastics and adult strabismus surgery),5 the number of new cases added to the wait list, the number of completed surgeries performed, as well as patient demographics (age and sex). ...the wait time for patients on the wait list increased from 59 (SD 58) days to 91 (SD 95) days over the study period (table 1). With the increasing volume of completed surgery in 2018 and onwards, the wait list queue was noted to stabilise in more recent years.Table 1 Summary of average monthly ophthalmology surgical (all specialties combined) waitlist data over the study period Year Cases added* Cases cancelled* Volume of completed surgery* Wait list queue*† Wait time, days—mean (SD)* 2010 13 843 (1528) 892 (107) 12 633 (1535) 33 715 (1232) 59 (58) 2011 13 951 (1544) 888 (155) 12 947 (1568) 34 999 (1048) 58 (63) 2012 13 988 (1632) 855 (148) 12 791 (1737) 37 671 (1041) 60 (62) 2013 13 476 (1558) 960 (170) 12 462 (1736) 41 380 (822) 67 (67) 2014 13 609 (1330) 863 (153) 12 283 (1601) 42 471 (2144) 69 (70) 2015 13 643 (1288) 830 (115) 12 170 (1491) 49 821 (2535) 77 (73) 2016 13 906 (1428) 922 (152) 12 746 (1580) 54 792 (765) 84 (83) 2017 13 987 (1458) 914 (174) 12 952 (1544) 57 985 (1307) 91 (94) 2018 14 427 (1303) 822 (195) 13 289 (1441) 59 075 (1269) 90 (94) 2019 14 411 (1488) 936 (274) 13 509 (1431) 58 708 (1073) 89 (96) 2020 14 108 (1392)‡ 742 (80)‡ 13 998 (893)‡ 58 628 (225)‡ 91 (95) *Monthly average between January and December. †As of first day of Month. ‡Up to but not including March 2020.
ObjectiveTo evaluate the diagnostic accuracy of teleretinal screening compared with face-to-face examination for detection of diabetic retinopathy (DR) and age-related macular degeneration ...(AMD).Methods and analysisThis study adhered to the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA). A comprehensive search of OVID MEDLINE, EMBASE and Cochrane CENTRAL was performed from January 2010 to July 2021. QUADAS-2 tool was used to assess methodological quality and applicability of the studies. A bivariate random effects model was used to perform the meta-analysis. Referrable DR was defined as any disease severity equal to or worse than moderate non-proliferative DR or diabetic macular oedema (DMO).Results28 articles were included. Teleretinal screening achieved a sensitivity of 0.91 (95% CI: 0.82 to 0.96) and specificity of 0.88 (0.74 to 0.95) for any DR (13 studies, n=7207, Grading of Recommendations, Assessment, Development and Evaluation (GRADE) low). Accuracy for referrable DR (10 studies, n=6373, GRADE moderate) was lower with a sensitivity of 0.88 (0.81 to 0.93) and specificity of 0.86 (0.79 to 0.90). After exclusion of ungradable images, the specificity for referrable DR increased to 0.95 (0.90 to 0.98), while the sensitivity remained nearly unchanged at 0.85 (0.76 to 0.91). Teleretinal screening achieved a sensitivity of 0.71 (0.49 to 0.86) and specificity of 0.88 (0.85 to 0.90) for detection of AMD (three studies, n=697, GRADE low).ConclusionTeleretinal screening is highly accurate for detecting any DR and DR warranting referral. Data for AMD screening is promising but warrants further investigation.PROSPERO registration numberCRD42020191994.
Felfeli and Mireskandari provide details on a 14-year-old boy with autism spectrum disorder who was referred to a pediatric eye clinic for a "blue haze" in both eyes. He had a history of self-injury, ...which included hitting his head and vigorous eye rubbing that had led to bilateral lichenification of the eyelids. On examination, the patient had cataracts bilaterally, with a retinal tear and a chronic retinal detachment in the right eye and an acute shallow retinal detachment in the left eye. In an effort to preserve vision, an urgent surgical repair of the retinal detachment and cataract extraction with intraocular lens implantation for the left eye were performed, which healed successfully with the aid of a safety helmet incorporating eye protection postoperatively.
In the current study, we evaluated the virucidal efficacy and contact times for commonly used ophthalmic concentrations of PVI and CHX against SARS-CoV-2 using Vero E6 cells as indicator cell lines ...for residual viable virus based on previously established methodologies (online supplemental appendix).4–6 PVI (5% weight per volume, w/v) and CHX (0.05% and 0.1% w/v) were tested at full strength. Viable residual SARS-CoV-2 was quantified by the Reed-Muench median tissue culture infectious dose (TCID50) procedure in Vero E6 cells.7 Additional efficacy testing using 1:4 and 1:16 dilutions in phosphate buffered saline were performed in order to mimic clinical settings where dilution of the formulations occurs as a result of mixing with patients’ ocular secretions. First manuscript draft: TF.
To present a new technique, macular hole hydrodissection, that increases the likelihood of closure for challenging macular holes (MHs) with multiple risk factors.
A retrospective review of all ...consecutive eyes with idiopathic Stage 3 and 4 MHs that were either persistent (failed previous vitrectomy surgery), chronic (symptoms of central vision loss of ≥2 years or a clinical diagnosis for ≥1 year), and/or large (aperture diameter of ≥400 μm), having undergone the macular hole hydrodissection surgical technique between January 1, 2014, and May 1, 2017, from an institutional practice setting was conducted. This technique lyses retina-retinal pigment epithelium adhesions by injecting fluid into the MH and allows for successful closure as the mobile edges are then brought closer together.
Thirty-nine eyes of 39 patients with mean MH aperture and base diameters of 549.1 ± 159.47 μm and 941.97 ± 344.14 were included. Complete anatomical closure was achieved in 87.2% (34/39) of MHs. Vision improvement was observed in 94.9% (37/39) and gain of ≥2 lines was achieved in 79.5% (31/39). Of the MHs that achieved anatomical success, 100% (34/34) had a Type 1 closure. The mean postoperative follow-up was 320.33 ± 269.04 days.
The macular hole hydrodissection surgical technique improves anatomical and functional outcomes of persistent, chronic, and/or large MHs.
PDF
