Pub Date : 2024-10-31DOI: 10.1016/j.survophthal.2024.10.005
Maram EA Abdalla Elsayed , Beatrice Lander , Sirisha Senthil , Deepak P. Edward , Rizwan Malik
The secondary childhood glaucomas are a heterogenous group, often associated with other ocular or systemic abnormalities. These childhood glaucomas are distinct from primary childhood glaucomas, both in terms of their clinical features and their response to conventional treatment. Surgical management can be challenging in children with secondary glaucoma. On average, this group undergo more surgical procedures and revisions than those with primary congenital glaucoma. We provide a synopsis of secondary childhood glaucomas in terms of classification, clinical features, and management strategies, with emphasis on recent developments.
{"title":"The secondary childhood glaucomas","authors":"Maram EA Abdalla Elsayed , Beatrice Lander , Sirisha Senthil , Deepak P. Edward , Rizwan Malik","doi":"10.1016/j.survophthal.2024.10.005","DOIUrl":"10.1016/j.survophthal.2024.10.005","url":null,"abstract":"<div><div>The secondary childhood glaucomas are a heterogenous group, often associated with other ocular or systemic abnormalities. These childhood glaucomas are distinct from primary childhood glaucomas, both in terms of their clinical features and their response to conventional treatment. Surgical management can be challenging in children with secondary glaucoma. On average, this group undergo more surgical procedures and revisions than those with primary congenital glaucoma. We provide a synopsis of secondary childhood glaucomas in terms of classification, clinical features, and management strategies, with emphasis on recent developments.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"70 3","pages":"Pages 544-562"},"PeriodicalIF":5.1,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-18DOI: 10.1016/j.survophthal.2024.10.004
Elham Sadeghi MD , Nicola Valsecchi MD , Elham Rahmanipour MD , Mahsa Ejlalidiz MD , Nasiq Hasan MD , Kiran Kumar Vupparaboina PhD , Mohammed Nasar Ibrahim PhD , Mohammed Abdul Rasheed , Jiwon Baek , Danilo Iannetta MD , Jay Chhablani MD
Age-related macular degeneration (AMD) is the leading cause of central visual impairment in the elderly. The exact pathophysiological mechanisms for AMD remain uncertain. Several studies suggest that choroidal abnormalities and alterations are critical in AMD progression. The transition from manual to automated segmentation and binarization techniques has resulted in accurate and precise measurements of different choroidal parameters. These qualitative and quantitative parameters, known as choroidal imaging biomarkers, have advanced from basic vertical subfoveal choroidal thickness to more intricate 3-dimensional choroidal reconstruction methods in the last decade. Therefore, a comprehensive evaluation of choroidal metrics may investigate valuable insights into AMD, potentially guiding the future development of customized therapeutic strategies and personalized patient care in AMD management. We describe the role of different choroidal biomarkers in evaluating patients with AMD and their contribution to management.
{"title":"Choroidal biomarkers in age-related macular degeneration","authors":"Elham Sadeghi MD , Nicola Valsecchi MD , Elham Rahmanipour MD , Mahsa Ejlalidiz MD , Nasiq Hasan MD , Kiran Kumar Vupparaboina PhD , Mohammed Nasar Ibrahim PhD , Mohammed Abdul Rasheed , Jiwon Baek , Danilo Iannetta MD , Jay Chhablani MD","doi":"10.1016/j.survophthal.2024.10.004","DOIUrl":"10.1016/j.survophthal.2024.10.004","url":null,"abstract":"<div><div>Age-related macular degeneration (AMD) is the leading cause of central visual impairment in the elderly. The exact pathophysiological mechanisms for AMD remain uncertain. Several studies suggest that choroidal abnormalities and alterations are critical in AMD progression. The transition from manual to automated segmentation and binarization techniques has resulted in accurate and precise measurements of different choroidal parameters. These qualitative and quantitative parameters, known as choroidal imaging biomarkers, have advanced from basic vertical subfoveal choroidal thickness to more intricate 3-dimensional choroidal reconstruction methods in the last decade. Therefore, a comprehensive evaluation of choroidal metrics may investigate valuable insights into AMD, potentially guiding the future development of customized therapeutic strategies and personalized patient care in AMD management. We describe the role of different choroidal biomarkers in evaluating patients with AMD and their contribution to management.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"70 2","pages":"Pages 167-183"},"PeriodicalIF":5.1,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1016/j.survophthal.2024.10.001
Michael Albrecht, Gerd U. Auffarth, Maximilian Friedrich, Lucy J. Kessler, Ramin Khoramnia
Vitreous floaters are visual phenomena resulting from floating opacities inside the eye that disturb vision. The opacities consist of microscopic collagen fibers that aggregate in myopia and during aging. These collagen fibers are then seen as irregular, sometimes worm-like shadows or structures of a translucent to black color. Because of the floating aspect, they tend to follow the movements of the eye, causing distress and having a negative impact on a patient’s quality of life due to degradation in contrast sensitivity function. This is referred to as vision degrading myodesopsia (VDM). The overall importance of floaters and their effect on quality of life gained attention in recent years. While the existence of floaters alone is labeled as harmless, there is an increasing group of young people suffering from VDM. This coincides with the growing prevalence of myopia. Indeed, myopia and myopic vitreopathy are the major causes of VDM in the young. This aspect of myopia, however, is often overlooked. We review the current research status in floater formation, quality of life impact, symptom assessment, localization and therapeutic options for vitreous floaters from the perspective of a myopic, potentially younger patient group.
{"title":"Vision degrading myodesopsia from vitreous floaters in the young: An important aspect of myopia","authors":"Michael Albrecht, Gerd U. Auffarth, Maximilian Friedrich, Lucy J. Kessler, Ramin Khoramnia","doi":"10.1016/j.survophthal.2024.10.001","DOIUrl":"10.1016/j.survophthal.2024.10.001","url":null,"abstract":"<div><div>Vitreous floaters are visual phenomena resulting from floating opacities inside the eye that disturb vision. The opacities consist of microscopic collagen fibers that aggregate in myopia and during aging. These collagen fibers are then seen as irregular, sometimes worm-like shadows or structures of a translucent to black color. Because of the floating aspect, they tend to follow the movements of the eye, causing distress and having a negative impact on a patient’s quality of life due to degradation in contrast sensitivity function. This is referred to as vision degrading myodesopsia (VDM). The overall importance of floaters and their effect on quality of life gained attention in recent years. While the existence of floaters alone is labeled as harmless, there is an increasing group of young people suffering from VDM. This coincides with the growing prevalence of myopia. Indeed, myopia and myopic vitreopathy are the major causes of VDM in the young. This aspect of myopia, however, is often overlooked. We review the current research status in floater formation, quality of life impact, symptom assessment, localization and therapeutic options for vitreous floaters from the perspective of a myopic, potentially younger patient group.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"70 2","pages":"Pages 265-282"},"PeriodicalIF":5.1,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Our aim was to assess the visual outcomes of patients with Leber hereditary optic neuropathy (LHON) harboring the m.11778G>A MT-ND4 mutation who had no treatment (natural history) or received idebenone or lenadogene nolparvovec. Efficacy outcomes included clinically relevant recovery (CRR) from nadir and final best-corrected visual acuity (BCVA). For the natural history and idebenone groups, we performed a systematic review of the literature and available clinical/regulatory reports. For the lenadogene nolparvovec group, all data from phase 3 studies were included. The overall effect and its 95 % confidence interval (CI) were estimated using a random effects model. For each meta-analysis, patients had a mean age of approximately 30 years at vision loss and were mostly (≥78 %) men. The CRR from nadir [95 % CI] at eye level was 17 % [7 %; 30 %] (n=316 eyes), 31 % [24 %; 40 %] (n=313) and 59 % [54 %; 64 %] (n=348) in untreated, idebenone-treated and lenadogene nolparvovec-treated patients, respectively. This gradient of efficacy was also observed with CRR at the patient level and final BCVA. There was a gradient of efficacy in all assessed visual outcomes, more marked for CRR than for final BCVA, with lenadogene nolparvovec gene therapy superior to idebenone treatment, and both superior to the natural history of the disease.
{"title":"Meta-analysis of treatment outcomes for patients with m.11778G>A MT-ND4 Leber hereditary optic neuropathy","authors":"Nancy J. Newman MD , Valérie Biousse MD , Patrick Yu-Wai-Man MD, PhD , Valerio Carelli MD, PhD , Catherine Vignal-Clermont MD , François Montestruc MSc , Magali Taiel MD , José-Alain Sahel MD, PhD","doi":"10.1016/j.survophthal.2024.10.002","DOIUrl":"10.1016/j.survophthal.2024.10.002","url":null,"abstract":"<div><div>Our aim was to assess the visual outcomes of patients with Leber hereditary optic neuropathy (LHON) harboring the m.11778G>A <em>MT-ND4</em> mutation who had no treatment (natural history) or received idebenone or lenadogene nolparvovec. Efficacy outcomes included clinically relevant recovery (CRR) from nadir and final best-corrected visual acuity (BCVA). For the natural history and idebenone groups, we performed a systematic review of the literature and available clinical/regulatory reports. For the lenadogene nolparvovec group, all data from phase 3 studies were included. The overall effect and its 95 % confidence interval (CI) were estimated using a random effects model. For each meta-analysis, patients had a mean age of approximately 30 years at vision loss and were mostly (≥78 %) men. The CRR from nadir [95 % CI] at eye level was 17 % [7 %; 30 %] (n=316 eyes), 31 % [24 %; 40 %] (n=313) and 59 % [54 %; 64 %] (n=348) in untreated, idebenone-treated and lenadogene nolparvovec-treated patients, respectively. This gradient of efficacy was also observed with CRR at the patient level and final BCVA. There was a gradient of efficacy in all assessed visual outcomes, more marked for CRR than for final BCVA, with lenadogene nolparvovec gene therapy superior to idebenone treatment, and both superior to the natural history of the disease.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"70 2","pages":"Pages 283-295"},"PeriodicalIF":5.1,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Keratoconus is a common pediatric corneal disease, leading to vision impairment and amblyopia. Compared to its adult counterpart, pediatric keratoconus has an advanced presentation, rapid progression, higher incidence of complications such as corneal hydrops, and greater potential impact on the quality of life. It typically manifests during puberty and can evolve rapidly to more severe stages if left untreated. This rapid progression underscores the importance of early diagnosis through regular screening in pediatric populations and vigilant monitoring of pediatric keratoconus suspects. Concomitant ocular allergies, ocular anomalies, systemic diseases (e.g. syndromes), and poor compliance with contact lenses might impede prompt intervention and frequently postpone rehabilitation. Corneal collagen crosslinking is a crucial intervention in the management of pediatric keratoconus because it strengthens the corneal microstructure and halts the disease progression. When conservative measures fail, keratoplasty remains a viable option with generally favorable outcomes, though with unique challenges in post-operative care, including concerns related to sutures, long-term graft survival and need for repeated examinations under anesthesia. A multidisciplinary approach involving ophthalmologists, optometrists, pediatricians, and other healthcare professionals, focusing on early diagnosis and timely intervention, is essential for the comprehensive management of pediatric keratoconus and to mitigate its impact on children's lives.
{"title":"Pediatric keratoconus","authors":"Yogita Gupta , Chandradevi Shanmugam , Priyadarshini K , Sohini Mandal , Radhika Tandon , Namrata Sharma","doi":"10.1016/j.survophthal.2024.10.003","DOIUrl":"10.1016/j.survophthal.2024.10.003","url":null,"abstract":"<div><div>Keratoconus is a common pediatric corneal disease, leading to vision impairment and amblyopia. Compared to its adult counterpart, pediatric keratoconus has an advanced presentation, rapid progression, higher incidence of complications such as corneal hydrops, and greater potential impact on the quality of life. It typically manifests during puberty and can evolve rapidly to more severe stages if left untreated. This rapid progression underscores the importance of early diagnosis through regular screening in pediatric populations and vigilant monitoring of pediatric keratoconus suspects. Concomitant ocular allergies, ocular anomalies, systemic diseases (e.g. syndromes), and poor compliance with contact lenses might impede prompt intervention and frequently postpone rehabilitation. Corneal collagen crosslinking is a crucial intervention in the management of pediatric keratoconus because it strengthens the corneal microstructure and halts the disease progression. When conservative measures fail, keratoplasty remains a viable option with generally favorable outcomes, though with unique challenges in post-operative care, including concerns related to sutures, long-term graft survival and need for repeated examinations under anesthesia. A multidisciplinary approach involving ophthalmologists, optometrists, pediatricians, and other healthcare professionals, focusing on early diagnosis and timely intervention, is essential for the comprehensive management of pediatric keratoconus and to mitigate its impact on children's lives.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"70 2","pages":"Pages 296-330"},"PeriodicalIF":5.1,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-05DOI: 10.1016/j.survophthal.2024.09.011
Erlend Hoven MD , John-Thomas Michelet MD , Mario V. Vettore PhD , Neil Lagali PhD
Age-related macular degeneration (AMD) is one of the leading causes of blindness in the world and anti-vascular endothelial growth factor (VEGF) injections have been the standard of care for the wet/neovascular variant since 2004. Currently, there are conflicting reports regarding its effect on the choroid, which supplies outer retina with oxygen and other nutrients. We synthesize available information of anti-VEGF on choroidal thickness (CT) in treatment-naïve typical neovascular AMD patients during the initial 12-week loading phase. We found 43 studies involving 1901 eyes from 1878 patients were included. Meta-analysis of 35 studies reporting CT at baseline and after 12 weeks suggested a significant decrease in CT with anti-VEGF treatment. A greater mean change with aflibercept compared to ranibizumab was found in subgroup analyses of sub-foveal CT in types 1 and 2 macular neovascularization. The long-term consequences of reduced CT in neovascular AMD remain unclear and require further targeted studies.
{"title":"Choroidal thickness after anti-vascular endothelial growth factor in typical neovascular age-related macular degeneration – A systematic review and meta-analysis","authors":"Erlend Hoven MD , John-Thomas Michelet MD , Mario V. Vettore PhD , Neil Lagali PhD","doi":"10.1016/j.survophthal.2024.09.011","DOIUrl":"10.1016/j.survophthal.2024.09.011","url":null,"abstract":"<div><div>Age-related macular degeneration (AMD) is one of the leading causes of blindness in the world and anti-vascular endothelial growth factor (VEGF) injections have been the standard of care for the wet/neovascular variant since 2004. Currently, there are conflicting reports regarding its effect on the choroid, which supplies outer retina with oxygen and other nutrients. We synthesize available information of anti-VEGF on choroidal thickness (CT) in treatment-naïve typical neovascular AMD patients during the initial 12-week loading phase. We found 43 studies involving 1901 eyes from 1878 patients were included. Meta-analysis of 35 studies reporting CT at baseline and after 12 weeks suggested a significant decrease in CT with anti-VEGF treatment. A greater mean change with aflibercept compared to ranibizumab was found in subgroup analyses of sub-foveal CT in types 1 and 2 macular neovascularization. The long-term consequences of reduced CT in neovascular AMD remain unclear and require further targeted studies.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"70 1","pages":"Pages 86-95"},"PeriodicalIF":5.1,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-03DOI: 10.1016/j.survophthal.2024.09.009
Tianyu Liu , Ayman G. Elnahry , Zujaja Tauqeer , Yinxi Yu , Gui-shuang Ying , Benjamin J. Kim
Suprachoroidal hemorrhage (SCH) is a potentially visually devastating complication of intraocular surgery, but estimates of perioperative SCH incidence vary. We performed a systematic review and meta-analysis of perioperative SCH incidence among population-based studies published between 1990 and 2023. Thirty-five studies collectively reported 1657 cases of perioperative SCH from a population of 3,028,911 surgeries. The estimated incidence of SCH was 0.12 % (95 % CI, 0.10–0.14 %), or about 1 in every 800 surgeries. The estimated incidence of perioperative massive SCH was 0.06 % (95 % CI, 0.04–0.08 %). In multivariable meta-regression, greater SCH incidence was significantly associated with smaller study population size, comparative study design, multicenter study setting, and intraoperative or delayed SCH timing (vs intraoperative alone), while lower SCH incidence was significantly associated with vitreoretinal or mixed surgery type (vs. cataract) (all P < 0.05). Study year was not a significant predictor of SCH incidence, suggesting that the incidence of SCH has not decreased over the past 3 decades despite improvements in surgical technologies and techniques. Given the rarity of SCH, and the strong effect of study population size on reported SCH incidence rates, future studies of SCH incidence should include a minimum population size of at least 1000 surgeries to obtain an accurate estimate of SCH incidence.
{"title":"Incidence and risk factors of perioperative suprachoroidal hemorrhage: A systematic review and meta-analysis","authors":"Tianyu Liu , Ayman G. Elnahry , Zujaja Tauqeer , Yinxi Yu , Gui-shuang Ying , Benjamin J. Kim","doi":"10.1016/j.survophthal.2024.09.009","DOIUrl":"10.1016/j.survophthal.2024.09.009","url":null,"abstract":"<div><div>Suprachoroidal hemorrhage (SCH) is a potentially visually devastating complication of intraocular surgery, but estimates of perioperative SCH incidence vary. We performed a systematic review and meta-analysis of perioperative SCH incidence among population-based studies published between 1990 and 2023. Thirty-five studies collectively reported 1657 cases of perioperative SCH from a population of 3,028,911 surgeries. The estimated incidence of SCH was 0.12 % (95 % CI, 0.10–0.14 %), or about 1 in every 800 surgeries. The estimated incidence of perioperative massive SCH was 0.06 % (95 % CI, 0.04–0.08 %). In multivariable meta-regression, greater SCH incidence was significantly associated with smaller study population size, comparative study design, multicenter study setting, and intraoperative or delayed SCH timing (vs intraoperative alone), while lower SCH incidence was significantly associated with vitreoretinal or mixed surgery type (vs. cataract) (all P < 0.05). Study year was not a significant predictor of SCH incidence, suggesting that the incidence of SCH has not decreased over the past 3 decades despite improvements in surgical technologies and techniques. Given the rarity of SCH, and the strong effect of study population size on reported SCH incidence rates, future studies of SCH incidence should include a minimum population size of at least 1000 surgeries to obtain an accurate estimate of SCH incidence.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"70 1","pages":"Pages 54-62"},"PeriodicalIF":5.1,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-30DOI: 10.1016/j.survophthal.2024.09.012
Gabriele Berman MD , Andrew M. Pendley MD , David W. Wright MD , Rachel Silverman BA , Chris Kelley BA , Mariana Rodriguez Duran BSA , Mariam Torres Soto BA, MA , Nithya Shanmugam BA , Matthew Keadey MD , Nancy J. Newman MD , Valérie Biousse MD
Despite evidence that non-mydriatic fundus cameras are beneficial in non-ophthalmic settings, they are only available in a minority of hospitals in the US. The lag from research-based evidence to change in clinical practice highlights the complexities of implementation of new technology and practice. We describe the steps used to implement successfully a non-mydriatic ocular fundus camera combined with optical coherence tomography (OCT) in a general emergency department (ED) using Kotter’s 8-Step Change Model. We prospectively collected the number of trained personnel in the ED, the number of imaging studies obtained each week during the first year following implementation, and we documented major achievements each month, as well as outcome measures, barriers to implementation and possible solutions. Between 12 and 42 patients were imaged per week, resulting in a total of 1274 patients imaged demonstrating sustained usage of non-mydriatic fundus camera/OCT in the ED one year after implementation. The implementation process was contingent upon multidisciplinary collaboration, extensive communication, coordinated training of staff, and continuous motivation. The future will likely include the use of artificial intelligence deep learning systems for automated interpretation of ocular imaging as an immediate diagnostic aid for ED or other non-eye care providers.
{"title":"Breaking the barriers: Methodology of implementation of a non-mydriatic ocular fundus camera in an emergency department","authors":"Gabriele Berman MD , Andrew M. Pendley MD , David W. Wright MD , Rachel Silverman BA , Chris Kelley BA , Mariana Rodriguez Duran BSA , Mariam Torres Soto BA, MA , Nithya Shanmugam BA , Matthew Keadey MD , Nancy J. Newman MD , Valérie Biousse MD","doi":"10.1016/j.survophthal.2024.09.012","DOIUrl":"10.1016/j.survophthal.2024.09.012","url":null,"abstract":"<div><div>Despite evidence that non-mydriatic fundus cameras are beneficial in non-ophthalmic settings, they are only available in a minority of hospitals in the US. The lag from research-based evidence to change in clinical practice highlights the complexities of implementation of new technology and practice. We describe the steps used to implement successfully a non-mydriatic ocular fundus camera combined with optical coherence tomography (OCT) in a general emergency department (ED) using Kotter’s 8-Step Change Model. We prospectively collected the number of trained personnel in the ED, the number of imaging studies obtained each week during the first year following implementation, and we documented major achievements each month, as well as outcome measures, barriers to implementation and possible solutions. Between 12 and 42 patients were imaged per week, resulting in a total of 1274 patients imaged demonstrating sustained usage of non-mydriatic fundus camera/OCT in the ED one year after implementation. The implementation process was contingent upon multidisciplinary collaboration, extensive communication, coordinated training of staff, and continuous motivation. The future will likely include the use of artificial intelligence deep learning systems for automated interpretation of ocular imaging as an immediate diagnostic aid for ED or other non-eye care providers.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"70 1","pages":"Pages 153-161"},"PeriodicalIF":5.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We focus on the utility of artificial intelligence (AI) in the management of macular hole (MH). We synthesize 25 studies, comprehensively reporting on each AI model’s development strategy, validation, tasks, performance, strengths, and limitations. All models analyzed ophthalmic images, and 5 (20 %) also analyzed clinical features. Study objectives were categorized based on 3 stages of MH care: diagnosis, identification of MH characteristics, and postoperative predictions of hole closure and vision recovery. Twenty-two (88 %) AI models underwent supervised learning, and the models were most often deployed to determine a MH diagnosis. None of the articles applied AI to guiding treatment plans. AI model performance was compared to other algorithms and to human graders. Of the 10 studies comparing AI to human graders (i.e., retinal specialists, general ophthalmologists, and ophthalmology trainees), 5 (50 %) reported equivalent or higher performance. Overall, AI analysis of images and clinical characteristics in MH demonstrated high diagnostic and predictive accuracy. Convolutional neural networks comprised the majority of included AI models, including those which were high performing. Future research may consider validating algorithms to propose personalized treatment plans and explore clinical use of the aforementioned algorithms.
{"title":"The role of artificial intelligence in macular hole management: A scoping review","authors":"David Mikhail MD (C) MSc (C) , Daniel Milad MD , Fares Antaki MD FRCSC , Karim Hammamji MD FRCSC , Cynthia X. Qian MD FRCSC , Flavio A. Rezende MD, PhD FRCSC , Renaud Duval MD FRCSC","doi":"10.1016/j.survophthal.2024.09.003","DOIUrl":"10.1016/j.survophthal.2024.09.003","url":null,"abstract":"<div><div>We focus on the utility of artificial intelligence (AI) in the management of macular hole (MH). We synthesize 25 studies, comprehensively reporting on each AI model’s development strategy, validation, tasks, performance, strengths, and limitations. All models analyzed ophthalmic images, and 5 (20 %) also analyzed clinical features. Study objectives were categorized based on 3 stages of MH care: diagnosis, identification of MH characteristics, and postoperative predictions of hole closure and vision recovery. Twenty-two (88 %) AI models underwent supervised learning, and the models were most often deployed to determine a MH diagnosis. None of the articles applied AI to guiding treatment plans. AI model performance was compared to other algorithms and to human graders. Of the 10 studies comparing AI to human graders (i.e., retinal specialists, general ophthalmologists, and ophthalmology trainees), 5 (50 %) reported equivalent or higher performance. Overall, AI analysis of images and clinical characteristics in MH demonstrated high diagnostic and predictive accuracy. Convolutional neural networks comprised the majority of included AI models, including those which were high performing. Future research may consider validating algorithms to propose personalized treatment plans and explore clinical use of the aforementioned algorithms.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"70 1","pages":"Pages 12-27"},"PeriodicalIF":5.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-29DOI: 10.1016/j.survophthal.2024.09.005
Jeremy C.K. Tan , Jithin Yohannan , Pradeep Y. Ramulu , Michael Kalloniatis , David P. Crabb , Jonathan Crowston , Jack Phu
The Swedish Interactive Thresholding Algorithm (SITA) is the main measurement acquisition algorithm used on the Humphrey Field Analyser, the most commonly used instrument for visual field (VF) assessment worldwide. We compare the sensitivity outputs and reliability parameters of the three currently available SITA algorithms—SITA Standard (SS), Fast (SF), and Faster (SFR), with a focus on the newly released SFR and the 24–2C test grid. SFR displays similar sensitivity outputs to SS and SF, but may not be interchangeable with SS in eyes with more severe VF loss. The reliability metric with the greatest impact on VF reliability is the level of false positives, although the recommended 15 % false positive cut off may be inappropriate as a threshold for judging whether a test is reliable and should be included for use in SFR. Finally, the 24–2C grid may be useful in flagging the presence of a clustered central VF defect, while the 10–2 grid can be used to more comprehensively characterize central field defects. We also discuss strategies to improve testing frequency in clinical practice.
瑞典交互式阈值算法（SITA）是汉弗莱视野分析仪（Humphrey Field Analyser）上使用的主要测量采集算法，汉弗莱视野分析仪是全球最常用的视野（VF）评估仪器。我们比较了目前可用的三种 SITA 算法--SITA 标准（SS）、快速（SF）和更快（SFR）的灵敏度输出和可靠性参数，重点是新发布的 SFR 和 24-2C 测试网格。SFR 显示出与 SS 和 SF 相似的灵敏度输出，但在视力损失更严重的眼睛中可能无法与 SS 互换。对 VF 可靠性影响最大的可靠性指标是假阳性水平，尽管推荐的 15%假阳性临界值可能不适合作为判断测试是否可靠的阈值，而应纳入 SFR 中使用。最后，24-2C 网格可用于标记中心 VF 缺陷集群的存在，而 10-2 网格可用于更全面地描述中心场缺陷的特征。我们还讨论了在临床实践中提高检测频率的策略。
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