•The healthcare workers and non-healthcare workers exhibited perceptional differences regarding safety, validity, trust, and expectations of the implementation of medical AI, in addition to ...differences in demands about desired improvements to AI.•The current achievements of medical AI have catered to the public and won their approval, which is noteworthy given the high level of receptivity and demands expressed by the public.•There is a very large gap between public demands and current achievements.
The general public’s attitudes, demands, and expectations regarding medical AI could provide guidance for the future development of medical AI to satisfy the increasing needs of doctors and patients. The objective of this study is to investigate public perceptions, receptivity, and demands regarding the implementation of medical AI. An online questionnaire was designed to investigate the perceptions, receptivity, and demands of general public regarding medical AI between October 13 and October 30, 2018. The distributions of the current achievements, public perceptions, receptivity, and demands among individuals in different lines of work (i.e., healthcare vs non-healthcare) and different age groups were assessed by performing descriptive statistics. The factors associated with public receptivity of medical AI were assessed using a linear regression model. In total, 2,780 participants from 22 provinces were enrolled. Healthcare workers accounted for 54.3 % of all participants. There was no significant difference between the healthcare workers and non-healthcare workers in the high proportion (99 %) of participants expressing acceptance of AI (p = 0.8568), but remarkable distributional differences were observed in demands (p < 0.001 for both demands for AI assistance and the desire for AI improvements) and perceptions (p < 0.001 for safety, validity, trust, and expectations). High levels of receptivity (approximately 100 %), demands (approximately 80 %), and expectations (100 %) were expressed among different age groups. The receptivity of medical AI among the non-healthcare workers was associated with gender, educational qualifications, and demands and perceptions of AI. There was a very large gap between current availability of and public demands for intelligence services (p < 0.001). More than 90 % of healthcare workers expressed a willingness to devote time to learning about AI and participating in AI research. The public exhibits a high level of receptivity regarding the implementation of medical AI. To date, the achievements have been rewarding, and further advancements are required to satisfy public demands. There is a strong demand for intelligent assistance in many medical areas, including imaging and pathology departments, outpatient services, and surgery. More contributions are imperative to facilitate integrated and advantageous implementation in medical AI.
Abstract
Age is closely related to human health and disease risks. However, chronologically defined age often disagrees with biological age, primarily due to genetic and environmental variables. ...Identifying effective indicators for biological age in clinical practice and self-monitoring is important but currently lacking. The human lens accumulates age-related changes that are amenable to rapid and objective assessment. Here, using lens photographs from 20 to 96-year-olds, we develop LensAge to reflect lens aging via deep learning. LensAge is closely correlated with chronological age of relatively healthy individuals (R
2
> 0.80, mean absolute errors of 4.25 to 4.82 years). Among the general population, we calculate the LensAge index by contrasting LensAge and chronological age to reflect the aging rate relative to peers. The LensAge index effectively reveals the risks of age-related eye and systemic disease occurrence, as well as all-cause mortality. It outperforms chronological age in reflecting age-related disease risks (
p
< 0.001). More importantly, our models can conveniently work based on smartphone photographs, suggesting suitability for routine self-examination of aging status. Overall, our study demonstrates that the LensAge index may serve as an ideal quantitative indicator for clinically assessing and self-monitoring biological age in humans.
We compared the anterior segment characteristics of congenital cataract (CC) patients with lens opacities in different locations and proposed a modified, simple CC category system.
Cataractous eyes ...of CC patients were classified into four groups based on the locations of lens opacities shown in slit-lamp examinations and by a 3-dimensional anterior segment imaging system as follows: total, anterior, interior, and posterior cataracts. The mean keratometry value, corneal astigmatism (CA), central corneal thickness (CCT), and anterior chamber depth (ACD) of eyes in different groups were compared.
We included a total of 428 CC patients. Half of the patients with an anterior cataract had the complication of a pupillary residual membrane. Among the patients with posterior lentiglobus cataracts, 90.38% had unilateral involvement. Patients with total, anterior, or interior cataracts had larger keratometry values than those with either posterior cataracts or clear lens. Congenital cataract patients had greater CA and CCT values than those with a clear lens. The largest CA was presented in patients with anterior cataracts, and the value decreased gradually with more posterior locations of lens opacities. Eyes with total and anterior cataracts had smaller ACDs, and eyes with interior and posterior cataracts had greater ACDs than eyes with a clear lens.
Cataractous eyes in CC patients with lens opacities in different locations presented distinct anterior segment characteristics. The modified CC category system, based on the relationships among the locations of lens opacities and anterior segment characteristics, may be beneficial for CC diagnosis and treatment.
Tacrolimus has been widely applied to prevent organ rejection after transplantation. However, the conventional pharmaceutical formulation of tacrolimus limits its applications in ocular therapy due ...to its hydrophobicity and low corneal penetrability. We optimized tacrolimus-loaded methoxy poly (ethylene glycol-block-poly (d, l)-lactic-co-glycolic acid) nanoparticles (TAC-NPs) by simple and effective nanotechnology as a drug delivery system for corneal graft rejection to overcome these drawbacks. The prepared TAC-NPs were 82.9 ± 1.3 nm in size, and the drug loading and encapsulation efficiency were 8.01 ± 0.23% and 80.10 ± 2.33%. Furthermore, New Zealand rabbits were used to analyze the single-dose pharmacokinetics of the TAC-NPs using high-performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS). In rats with allogenic penetrating keratoplasty, the administration of TAC-NPs dispersion drops improved the TAC concentrations in the aqueous humor and cornea, consistent with a significantly higher effective inhibition of IL-2, IL-17, and VEGF expression compared with conventional 0.1% tacrolimus drops. Meanwhile, we also compared two different topical administration methods (including eye drop and subconjunctival injection) of TAC-NPs to maximize the sustained release characteristic of NPs. In summary, the small-sized TAC-NPs enhanced transcorneal permeation and absorption of TAC and more effectively inhibited corneal allograft rejection, which indicated that biodegradable polymeric nanomaterials-based drug delivery system had great potential for improving the clinical therapy efficacy of hydrophobic drugs.
Abstract
Artificial intelligence (AI) based on deep learning has shown excellent diagnostic performance in detecting various diseases with good-quality clinical images. Recently, AI diagnostic ...systems developed from ultra-widefield fundus (UWF) images have become popular standard-of-care tools in screening for ocular fundus diseases. However, in real-world settings, these systems must base their diagnoses on images with uncontrolled quality (“passive feeding”), leading to uncertainty about their performance. Here, using 40,562 UWF images, we develop a deep learning–based image filtering system (DLIFS) for detecting and filtering out poor-quality images in an automated fashion such that only good-quality images are transferred to the subsequent AI diagnostic system (“selective eating”). In three independent datasets from different clinical institutions, the DLIFS performed well with sensitivities of 96.9%, 95.6% and 96.6%, and specificities of 96.6%, 97.9% and 98.8%, respectively. Furthermore, we show that the application of our DLIFS significantly improves the performance of established AI diagnostic systems in real-world settings. Our work demonstrates that “selective eating” of real-world data is necessary and needs to be considered in the development of image-based AI systems.
Visual neuroadaptation is believed to play an important role in determining the final visual outcomes following intraocular lens (IOL) implantation. To investigate visual neuroadaptation in patients ...with age-related cataracts (ARCs) after phacoemulsification with multifocal and monofocal IOL implantation, we conducted a prospective, controlled clinical trial in Zhongshan Ophthalmology Center. This study included 22 patients with bilateral ARCs: 11 patients underwent phacoemulsification and multifocal IOL (Mu-IOL) implantation, and 11 patients underwent phacoemulsification and monofocal IOL (Mo-IOL) implantation. Visual disturbances (glare and halos), visual function (including visual acuity, retinal straylight, contrast sensitivity, and visual evoked potentials) and visual cortical function (fractional amplitude of low-frequency fluctuations, fALFF) in Bowman’s areas 17–19 as the region of interest were assessed before and after surgeries. The results showed that the fALFF values of the visual cortex in the Mu-IOL group decreased at 1 week postoperatively and recovered to baseline at 3 months and then improved at 6 months, compared with preoperative levels (at a whole-brain threshold of
P
< 0.05, AlphaSim-corrected, voxels > 228, repeated measures analysis of variance). Significantly increased fALFF values in the visual cortex were detected 1 week after surgery in the Mo-IOL group and decreased to baseline at 3 and 6 months. The fALFF of the lingual gyrus was negatively correlated with visual disturbances (
P
< 0.05). To conclude, early postoperative visual neuroadaptation was detected in the Mu-IOL group by resting-state fMRI analysis. The different changing trends of postoperative fALFF values in the two groups indicated distinct neuroadaptations patterns after Mu-IOL and Mo-IOL implantation.
Deep learning (DL) is the new high-profile technology in medical artificial intelligence (AI) for building screening and diagnosing algorithms for various diseases. The eye provides a window for ...observing neurovascular pathophysiological changes. Previous studies have proposed that ocular manifestations indicate systemic conditions, revealing a new route in disease screening and management. There have been multiple DL models developed for identifying systemic diseases based on ocular data. However, the methods and results varied immensely across studies. This systematic review aims to summarize the existing studies and provide an overview of the present and future aspects of DL-based algorithms for screening systemic diseases based on ophthalmic examinations. We performed a thorough search in PubMed
, Embase, and Web of Science for English-language articles published until August 2022. Among the 2873 articles collected, 62 were included for analysis and quality assessment. The selected studies mainly utilized eye appearance, retinal data, and eye movements as model input and covered a wide range of systemic diseases such as cardiovascular diseases, neurodegenerative diseases, and systemic health features. Despite the decent performance reported, most models lack disease specificity and public generalizability for real-world application. This review concludes the pros and cons and discusses the prospect of implementing AI based on ocular data in real-world clinical scenarios.
A review of 6 years of hospitalization charts from Zhongshan Ophthalmic Center (ZOC) revealed that congenital cataracts (CC) accounted for 2.39% of all cataract in-patient cases and that the age at ...surgery was decreasing before the establishment of the Childhood Cataract Program of the Chinese Ministry of Health (CCPMOH) in December 2010. We aimed to investigate data from the 4 years (January 2011 to December 2014) following the establishment of the CCPMOH, compared, and combined with data from the previous study period (January 2005 to December 2010) to generate a 10-year overview of the hospital-based prevalence and treatment of CC. In the 4-year period after CCPMOH establishment, the prevalence of CC was 2.01% in all hospitalizations, and was 2.78% in all cataract in-patients. Most of the eligible CC in-patients (71%) lived in south China. The ratio of boys to girls was 1.42:1. Nearly 2/3 of the patients underwent cataract extraction with primary intraocular lens (IOL) implantation at a mean age of 78.40±51.45 months, and cataract extraction surgeries without IOL implantation were performed in the remaining 1/3 of patients at a mean age of 10.03±15.92 months. After CCPMOH establishment, an increased incidence of CC was revealed, and the CC in-patients were younger than the patients in the previous period. The 10-year overview (2421 CC in-patients from 206630 hospitalizations) revealed upward trends in both the number and the prevalence of CC and a further reduction in age at surgery. In conclusion, the data from 4-year period after CCPMOH establishment and the 10-year overview showed upward trends in the hospital-based prevalence of CC cases and a further reduction in age at surgery, likely reflecting the effects of the CCPMOH establishment and providing useful information for further CC studies and a valuable foundation for the prevention and treatment of this cause of childhood blindness.
Cerebrovascular disease (CeVD) is one of the leading global causes of death and severe disability. To date, retinal microangiopathy has become a reflection of cerebral microangiopathy, mirroring the ...vascular pathological modifications
. To evaluate the retinal structure and microvasculature in patients with CeVD, we conducted a cross-sectional study in Zhongshan Ophthalmic Center and Department of Neurology of Third Affiliated Hospital, Sun Yat-sen University using optical coherence tomography angiography (OCTA). CeVD patients (
= 121; 238 eyes) and healthy controls (
= 44; 57 eyes) were included in the analysis. The CeVD group showed significant thinning of the peripapillary retinal nerve fiber layer (pRNFL) thickness in the temporal and nasal quadrants, and thinning of the macular ganglion cell-inner plexiform layer (GC-IPL) in the inferior quadrant, while macular microvasculature reduction was prominent in all nine quadrants. There were significant correlations between OCTA parameters, visual acuity, and transcranial doppler parameters in the CeVD group. The specific structural parameters combining microvasculature indices showed the best diagnostic accuracies (AUC = 0.918) to discriminate CeVD group from healthy controls. To conclude, we proved that OCTA reveals specific patterns of retinal structural changes and extensive macular microvascular changes in CeVD. Additionally, these retinal abnormalities could prove useful disease biomarkers in the management of individuals at high risk of debilitating complications from a cerebrovascular event.
Visual function and brain function decline concurrently with aging. Notably, cataract patients often present with accelerated age-related decreases in brain function, but the underlying mechanisms ...are still unclear. Optical structures of the anterior segment of the eyes, such as the lens and cornea, can be readily reconstructed to improve refraction and vision quality. However, the effects of visual restoration on human brain function and structure remain largely unexplored.
A prospective, controlled clinical trial was conducted. Twenty-six patients with bilateral age-related cataracts (ARCs) who underwent phacoemulsification and intraocular lens implantation and 26 healthy controls without ARC, matched for age, sex, and education, were recruited. Visual functions (including visual acuity, visual evoke potential, and contrast sensitivity), the Mini-Mental State Examination and functional magnetic resonance imaging (including the fractional amplitude of low-frequency fluctuations and grey matter volume variation) were assessed for all the participants and reexamined for ARC patients after cataract surgery. This trial was registered with ClinicalTrials.gov (NCT02644720).
Compared with the healthy controls, the ARC patients presented decreased brain functionality as well as structural alterations in visual and cognitive-related brain areas preoperatively. Three months postoperatively, significant functional improvements were observed in the visual and cognitive-related brain areas of the patients. Six months postoperatively, the patients' grey matter volumes in these areas were significantly increased. Notably, both the function and structure in the visual and cognitive-related brain areas of the patients improved significantly and became comparable to those of the healthy controls 6months postoperatively.
We demonstrated that ocular reconstruction can functionally and structurally reverse cataract-induced brain changes. The integrity of the eye is essential for maintaining the structure and function of the brain within and beyond the primary visual pathway.
•Cataract patients with reduced visual function presented a simultaneous decrease in brain function and grey matter volume.•Cataract surgery can reverse cerebral changes in both visual and cognitive-related regions associated with visual decline.•The integrity of the eye is essential for maintaining the structure and function of the brain.
The eyes and brain are anatomically and functionally connected. Age related cataract (ARC) is associated with structural and functional impairments of the brain. However, whether these changes are reversible after cataract surgery is largely unknown. We assessed the patients based on subjective cognitive evaluations and objective functional magnetic resonance imaging before and after surgery. Significant improvements in brain function and increases in the grey matter volumes of the visual, cognitive-related, and somatosensory brain areas were observed, demonstrating that the impaired brain function and structure of ARC patients can be reversed after restoration of visual acuity.
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