Pub Date : 2022-12-20DOI: 10.1080/17469899.2022.2160321
C. McMonnies
ABSTRACT Introduction Notwithstanding continuing improvements in contact lens technology and increasing use of daily disposables, discontinuations from soft contact lens wear remain a significant problem with ‘drop-out’ too often occurring after patients have initially achieved successful routine use. Areas covered This review examines the possibility that the signs and symptoms of discontinuations might, for example be associated with corneal and/or lid wiper neuropathy and/or aqueous, mucin and lipid deficiencies and/or mental health disorders. In addition, this review examines how soft contact lens wear places high demands on tear functions. Expert opinion Limitations in clinically detecting evidence of some adverse responses to soft contact lens wear may explain how discontinuations can sometimes be described as unexplained. Similarly, limitations in clinically determining the significance of different forms of tear dysfunction and their exacerbation by soft contact lens wear may be a barrier to explaining why symptoms of dryness are most commonly associated with discontinuations. The wider experience obtained with cosmetic contact lens fittings that is discussed in this review may be relevant to problems encountered in therapeutic contact lens applications.
{"title":"Why are soft contact lens wear discontinuation rates still too high?","authors":"C. McMonnies","doi":"10.1080/17469899.2022.2160321","DOIUrl":"https://doi.org/10.1080/17469899.2022.2160321","url":null,"abstract":"ABSTRACT Introduction Notwithstanding continuing improvements in contact lens technology and increasing use of daily disposables, discontinuations from soft contact lens wear remain a significant problem with ‘drop-out’ too often occurring after patients have initially achieved successful routine use. Areas covered This review examines the possibility that the signs and symptoms of discontinuations might, for example be associated with corneal and/or lid wiper neuropathy and/or aqueous, mucin and lipid deficiencies and/or mental health disorders. In addition, this review examines how soft contact lens wear places high demands on tear functions. Expert opinion Limitations in clinically detecting evidence of some adverse responses to soft contact lens wear may explain how discontinuations can sometimes be described as unexplained. Similarly, limitations in clinically determining the significance of different forms of tear dysfunction and their exacerbation by soft contact lens wear may be a barrier to explaining why symptoms of dryness are most commonly associated with discontinuations. The wider experience obtained with cosmetic contact lens fittings that is discussed in this review may be relevant to problems encountered in therapeutic contact lens applications.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45263974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-02DOI: 10.1080/17469899.2022.2152005
Ashish Sharma, N. Parachuri, Nilesh Kumar, F. Bandello, B. Kuppermann
ABSTRACT Introduction Biosimilars for retinal diseases have been a topic of discussion recently due to the approval of two biosimilar ranibizumab by the US FDA and EMA. It is important to understand this emerging field in retina with many other biosimilar anti-VEGF molecules in the final stage of their trials. Hopefully, they will be available for clinical use very soon. Areas covered Articles update about the approved biosimilar ranibizumab for retinal diseases and list out ranibizumab and aflibercept biosimilars in the pipeline. Expert opinion Approval of biosimilar anti-VEGFs might be able to drive a geographically variable change in the usage of retinal pharmacotherapy based on the local policies of the health system.
{"title":"Emerging biosimilars for retinal diseases","authors":"Ashish Sharma, N. Parachuri, Nilesh Kumar, F. Bandello, B. Kuppermann","doi":"10.1080/17469899.2022.2152005","DOIUrl":"https://doi.org/10.1080/17469899.2022.2152005","url":null,"abstract":"ABSTRACT Introduction Biosimilars for retinal diseases have been a topic of discussion recently due to the approval of two biosimilar ranibizumab by the US FDA and EMA. It is important to understand this emerging field in retina with many other biosimilar anti-VEGF molecules in the final stage of their trials. Hopefully, they will be available for clinical use very soon. Areas covered Articles update about the approved biosimilar ranibizumab for retinal diseases and list out ranibizumab and aflibercept biosimilars in the pipeline. Expert opinion Approval of biosimilar anti-VEGFs might be able to drive a geographically variable change in the usage of retinal pharmacotherapy based on the local policies of the health system.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48018442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-02DOI: 10.1080/17469899.2022.2145945
S. Askari, F. Azizi, Pegah Javadpour, N. Karimi, Rasoul Ghasemi
ABSTRACT Introduction Mounting evidence has emerged showing that endoplasmic reticulum (ER) stress participates in triggering cell injuries in ocular tissues, manifested as disorders such as cataracts, age-related macular degeneration, glaucoma, and diabetic retinopathy. Areas covered ER stress is a condition in which the ER is perturbed by the accumulation of unfolded and misfolded proteins. In a dynamic signaling cascade, the unfolded protein response (UPR) is triggered by three ER-transmembrane stress sensors to restore homeostasis and cell survival, however, if it fails, the cell will undergo a sustained ER stress condition which deteriorates cell function and promote cell death. Sustained ER stress is shown to contribute in a wide range of diseases including ophthalmologic disorders. Targeting ER stress by inhibitor agents might have promising therapeutic implications in treating eye disorders. The current review summarizes the results of the latest studies in support of the potential therapeutic utility of 4-phenylbutyric acid (4-PBA), an FDA approved ER stress inhibitor, in disorders leading to permanent vision loss. Expert opinion The therapeutic potential of 4-PBA in ophthalmic diseases is strongly supported by many experimental studies. Safety and efficacy studies of intravitreal injection of 4-PBA and other ER stress by inhibitors, are lacking.
{"title":"Endoplasmic reticulum stress as an underlying factor in leading causes of blindness and potential therapeutic effects of 4-phenylbutyric acid: from bench to bedside","authors":"S. Askari, F. Azizi, Pegah Javadpour, N. Karimi, Rasoul Ghasemi","doi":"10.1080/17469899.2022.2145945","DOIUrl":"https://doi.org/10.1080/17469899.2022.2145945","url":null,"abstract":"ABSTRACT Introduction Mounting evidence has emerged showing that endoplasmic reticulum (ER) stress participates in triggering cell injuries in ocular tissues, manifested as disorders such as cataracts, age-related macular degeneration, glaucoma, and diabetic retinopathy. Areas covered ER stress is a condition in which the ER is perturbed by the accumulation of unfolded and misfolded proteins. In a dynamic signaling cascade, the unfolded protein response (UPR) is triggered by three ER-transmembrane stress sensors to restore homeostasis and cell survival, however, if it fails, the cell will undergo a sustained ER stress condition which deteriorates cell function and promote cell death. Sustained ER stress is shown to contribute in a wide range of diseases including ophthalmologic disorders. Targeting ER stress by inhibitor agents might have promising therapeutic implications in treating eye disorders. The current review summarizes the results of the latest studies in support of the potential therapeutic utility of 4-phenylbutyric acid (4-PBA), an FDA approved ER stress inhibitor, in disorders leading to permanent vision loss. Expert opinion The therapeutic potential of 4-PBA in ophthalmic diseases is strongly supported by many experimental studies. Safety and efficacy studies of intravitreal injection of 4-PBA and other ER stress by inhibitors, are lacking.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42753128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-02DOI: 10.1080/17469899.2022.2152004
Lucy V. Cobbs, Taku Wakabayashi, Y. Yonekawa
ABSTRACT Introduction Primary rhegmatogenous retinal detachment (RRD) repair with modern surgical techniques provides high rates of anatomic success; however, anatomic failure may still occur with any primary surgery, including after pneumatic retinopexy (PR), scleral buckle (SB), and pars plana vitrectomy (PPV), resulting in recurrent RRD. Areas covered This review includes a summary of surgical options and management strategies for eyes with primary failure of PR, SB, and PPV. Expert opinion No standardized protocol is available for determining the optimal secondary surgical options to treat recurrent RRD. However, understanding of the causes and characteristics of the re-detachment, expected anatomic success rates with each surgical option, and potential complications, may improve the outcomes after re-operations. Causes of primary failure include formation of new breaks, re-opening of the original breaks, missed breaks, and most commonly, proliferative vitreoretinopathy (PVR). Rescue PR, revision of SB, and reoperation with PPV with membrane peeling, relaxing retinectomy, and/or long-acting tamponade combined with or without encircling SB, are effective options depending on the cause of primary failure and characteristics and severity of the re-detachment. Further advances in the management of PVR, which is a major cause of primary failure, will help improve treatment outcomes for eyes with complicated recurrent detachments.
{"title":"Surgical management of recurrent rhegmatogenous retinal detachment","authors":"Lucy V. Cobbs, Taku Wakabayashi, Y. Yonekawa","doi":"10.1080/17469899.2022.2152004","DOIUrl":"https://doi.org/10.1080/17469899.2022.2152004","url":null,"abstract":"ABSTRACT Introduction Primary rhegmatogenous retinal detachment (RRD) repair with modern surgical techniques provides high rates of anatomic success; however, anatomic failure may still occur with any primary surgery, including after pneumatic retinopexy (PR), scleral buckle (SB), and pars plana vitrectomy (PPV), resulting in recurrent RRD. Areas covered This review includes a summary of surgical options and management strategies for eyes with primary failure of PR, SB, and PPV. Expert opinion No standardized protocol is available for determining the optimal secondary surgical options to treat recurrent RRD. However, understanding of the causes and characteristics of the re-detachment, expected anatomic success rates with each surgical option, and potential complications, may improve the outcomes after re-operations. Causes of primary failure include formation of new breaks, re-opening of the original breaks, missed breaks, and most commonly, proliferative vitreoretinopathy (PVR). Rescue PR, revision of SB, and reoperation with PPV with membrane peeling, relaxing retinectomy, and/or long-acting tamponade combined with or without encircling SB, are effective options depending on the cause of primary failure and characteristics and severity of the re-detachment. Further advances in the management of PVR, which is a major cause of primary failure, will help improve treatment outcomes for eyes with complicated recurrent detachments.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47006396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-02DOI: 10.1080/17469899.2022.2148656
Jacob G. Light, H. Anderson, Sunir J. Garg
ABSTRACT Introduction Pars plana vitrectomy is the basis of modern retina surgery, and for the last 40 years, has been achieved using the pneumatic guillotine cutter. Recently, a new vitrectomy design has been developed: the hypersonic vitrector. This technology utilizes ultrasound energy to liquefy vitreous in contrast to the mechanical segmentation of vitreous strands that characterizes pneumatic cutters. Areas covered This review provides a history of the development of vitrectomy and summarizes the critical elements of effective and safe vitrectomy systems. The article will describe the novel hypersonic vitrectomy design, discuss what the initial pre-clinical and in-human studies tell us about its performance compared to standard pneumatic cutters, and considers its role in the future of retina surgery. Expert opinion Hypersonic vitrectomy is the first novel way to segment vitreous since the development of pneumatic guillotine cutters. It has the potential to make vitrectomy more efficient both by reducing operating times as well as enabling surgeons to remove silicone oil and retained lens material all with one instrument. With concurrent advancements in guillotine cutters, hypersonic vitrectomy has a high bar to clear to demonstrate advantages that would result in widespread adoption.
{"title":"Hypersonic vitrectomy: a novel approach to vitreous removal","authors":"Jacob G. Light, H. Anderson, Sunir J. Garg","doi":"10.1080/17469899.2022.2148656","DOIUrl":"https://doi.org/10.1080/17469899.2022.2148656","url":null,"abstract":"ABSTRACT Introduction Pars plana vitrectomy is the basis of modern retina surgery, and for the last 40 years, has been achieved using the pneumatic guillotine cutter. Recently, a new vitrectomy design has been developed: the hypersonic vitrector. This technology utilizes ultrasound energy to liquefy vitreous in contrast to the mechanical segmentation of vitreous strands that characterizes pneumatic cutters. Areas covered This review provides a history of the development of vitrectomy and summarizes the critical elements of effective and safe vitrectomy systems. The article will describe the novel hypersonic vitrectomy design, discuss what the initial pre-clinical and in-human studies tell us about its performance compared to standard pneumatic cutters, and considers its role in the future of retina surgery. Expert opinion Hypersonic vitrectomy is the first novel way to segment vitreous since the development of pneumatic guillotine cutters. It has the potential to make vitrectomy more efficient both by reducing operating times as well as enabling surgeons to remove silicone oil and retained lens material all with one instrument. With concurrent advancements in guillotine cutters, hypersonic vitrectomy has a high bar to clear to demonstrate advantages that would result in widespread adoption.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45798882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-02DOI: 10.1080/17469899.2022.2147928
A. Borgia, R. Raimondi, G. Fossati, Francesco Paolo De Rosa, V. Romano, D. Borroni, L. Vigo, V. Scorcia, G. Giannaccare
ABSTRACT Introduction Dry eye disease (DED) is a multifactorial chronic condition with a broad spectrum of symptoms that can affect daily activities and quality of life. Areas covered New treatment approaches that target more systematically distinct parts of the pathophysiology would present new potential to effectively regulate signs and symptoms of DED. In this review, a comprehensive list of device-based treatments has been provided, according to their mechanism of action. Expert opinion Given the variability and complexity of DED, adjuvant treatments should be considered as a boost for patients who do not respond to first-line therapy. Most of those devices primarily target meibomian glands, using heat or mechanical energy to restore normal meibum flow. Although several treatments have been discussed in this review, further studies are needed to identify new options, evaluate current therapies in randomized clinical trials more extensively, and identify which subtypes of DED could benefit from any given therapy.
{"title":"Device-based therapies as a boost of conventional treatment in dry eye disease","authors":"A. Borgia, R. Raimondi, G. Fossati, Francesco Paolo De Rosa, V. Romano, D. Borroni, L. Vigo, V. Scorcia, G. Giannaccare","doi":"10.1080/17469899.2022.2147928","DOIUrl":"https://doi.org/10.1080/17469899.2022.2147928","url":null,"abstract":"ABSTRACT Introduction Dry eye disease (DED) is a multifactorial chronic condition with a broad spectrum of symptoms that can affect daily activities and quality of life. Areas covered New treatment approaches that target more systematically distinct parts of the pathophysiology would present new potential to effectively regulate signs and symptoms of DED. In this review, a comprehensive list of device-based treatments has been provided, according to their mechanism of action. Expert opinion Given the variability and complexity of DED, adjuvant treatments should be considered as a boost for patients who do not respond to first-line therapy. Most of those devices primarily target meibomian glands, using heat or mechanical energy to restore normal meibum flow. Although several treatments have been discussed in this review, further studies are needed to identify new options, evaluate current therapies in randomized clinical trials more extensively, and identify which subtypes of DED could benefit from any given therapy.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43846676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-02DOI: 10.1080/17469899.2022.2147927
Huma Khan, Hannah Khan, A. Aziz, Tyler M Ewing, A. Khanani
Age-related macular degeneration (AMD) is the leading cause of permanent vision loss in individuals over 50 years of age [1]. Advanced AMD can anatomically present as either neovascular (nAMD) or atrophic AMD. nAMD displays characteristic growth of abnormal vasculature that originates from the choroid or retina, resulting in macular neovascularization (MNV). MNV progression can lead to degeneration of photoreceptors, macular damage, and retinal pigment epithelium disruption [1]. If left untreated, MNV in nAMD can lead to leakage of fluid, lipid, and blood into the outer retina, resulting in irreversible vision loss [1]. Atrophic AMD can progress to geographic atrophy (GA), characterized by atrophy of choriocapillaris, retinal pigment epithelial cells, and macular photoreceptors [1].
{"title":"How could gene therapy change the way we treat age-related macular degeneration?","authors":"Huma Khan, Hannah Khan, A. Aziz, Tyler M Ewing, A. Khanani","doi":"10.1080/17469899.2022.2147927","DOIUrl":"https://doi.org/10.1080/17469899.2022.2147927","url":null,"abstract":"Age-related macular degeneration (AMD) is the leading cause of permanent vision loss in individuals over 50 years of age [1]. Advanced AMD can anatomically present as either neovascular (nAMD) or atrophic AMD. nAMD displays characteristic growth of abnormal vasculature that originates from the choroid or retina, resulting in macular neovascularization (MNV). MNV progression can lead to degeneration of photoreceptors, macular damage, and retinal pigment epithelium disruption [1]. If left untreated, MNV in nAMD can lead to leakage of fluid, lipid, and blood into the outer retina, resulting in irreversible vision loss [1]. Atrophic AMD can progress to geographic atrophy (GA), characterized by atrophy of choriocapillaris, retinal pigment epithelial cells, and macular photoreceptors [1].","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46340868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-02DOI: 10.1080/17469899.2022.2153119
C. McMonnies
ABSTRACT Introduction The potential for eye rubbing to contribute to keratoconus development and progression is well established, but the mechanisms of that association have not been fully elucidated. Areas covered This review examines mechanisms for rubbing-related corneal trauma from both anterior and posterior surface responses to elevated intraocular pressure. Apart from rubbing-related intraocular pressure elevation, consideration is given to other sources of elevation which may contribute to corneal bulging and cone formation. Mechanisms whereby intraocular pressure-related increased posterior corneal surface distending stress and stromal hydrostatic pressure may alter keratocyte functions and increase susceptibility to such stress are examined. Expert opinion Elevated intraocular pressure (IOP) that is associated with a chronic habit of abnormal rubbing (CHAR) can be a major contributor of keratoconus (KC) development and progression. Anterior corneal surface protection during rubbing due to Bell’s reflex in most patients, at least for the central and para-central cornea, increases the likelihood that IOP distending stress can be an important source of KC pathogenesis, perhaps even in patients who do not have abnormal rubbing habits. That the earliest pathological changes in KC occur at the posterior corneal surface is consistent with the significance of an IOP-related distending force mechanism for KC pathogenesis.
{"title":"Mechanisms of corneal trauma in response to rubbing and other intraocular pressure elevating activities in keratoconus","authors":"C. McMonnies","doi":"10.1080/17469899.2022.2153119","DOIUrl":"https://doi.org/10.1080/17469899.2022.2153119","url":null,"abstract":"ABSTRACT Introduction The potential for eye rubbing to contribute to keratoconus development and progression is well established, but the mechanisms of that association have not been fully elucidated. Areas covered This review examines mechanisms for rubbing-related corneal trauma from both anterior and posterior surface responses to elevated intraocular pressure. Apart from rubbing-related intraocular pressure elevation, consideration is given to other sources of elevation which may contribute to corneal bulging and cone formation. Mechanisms whereby intraocular pressure-related increased posterior corneal surface distending stress and stromal hydrostatic pressure may alter keratocyte functions and increase susceptibility to such stress are examined. Expert opinion Elevated intraocular pressure (IOP) that is associated with a chronic habit of abnormal rubbing (CHAR) can be a major contributor of keratoconus (KC) development and progression. Anterior corneal surface protection during rubbing due to Bell’s reflex in most patients, at least for the central and para-central cornea, increases the likelihood that IOP distending stress can be an important source of KC pathogenesis, perhaps even in patients who do not have abnormal rubbing habits. That the earliest pathological changes in KC occur at the posterior corneal surface is consistent with the significance of an IOP-related distending force mechanism for KC pathogenesis.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45516388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-28DOI: 10.1080/17469899.2022.2142120
Ronald Cheung, Samantha So, Monali S. Malvankar-Mehta
ABSTRACT Objective The objective of this study was to systematically review and meta-analyze the diagnostic accuracy of current machine learning classifiers for pediatric and adult cataracts. Methods MEDLINE, EMBASE, CINAHL, and ProQuest Dissertations and Theses were searched systematically and thoroughly. Conferences held through Association for Research in Vision and Ophthalmology, American Academy of Ophthalmology, and Canadian Society of Ophthalmology were searched. Studies were screened using Covidence software and data on sensitivity, specificity and area under curve were extracted from the included studies. STATA 15.0 was used to conduct the meta-analysis. Results Our search strategy identified 150 records from databases and 35 records from gray literature. Total of 21 records were used for the qualitative analysis and 11 records (100 134 images) were used for the quantitative analysis. In adult patients with cataracts, the pooled estimate for sensitivity was 0.948 [95% CI: 0.815–0.987] and specificity was 0.960 [95% CI: 0.924–0.980] for cataract screening using machine learning classifiers. For pediatric cataracts, the pooled estimate for sensitivity was 0.882 [95% CI: 0.696–0.960] and specificity was 0.891 [95% CI: 0.807–0.942]. Conclusion The included studies show promising results for the diagnostic accuracy of the machine learning classifiers for cataracts and its potential implementation in clinical settings. Prospero registration CRD42020219316
{"title":"Diagnostic accuracy of machine learning classifiers for cataracts: a systematic review and meta-analysis","authors":"Ronald Cheung, Samantha So, Monali S. Malvankar-Mehta","doi":"10.1080/17469899.2022.2142120","DOIUrl":"https://doi.org/10.1080/17469899.2022.2142120","url":null,"abstract":"ABSTRACT Objective The objective of this study was to systematically review and meta-analyze the diagnostic accuracy of current machine learning classifiers for pediatric and adult cataracts. Methods MEDLINE, EMBASE, CINAHL, and ProQuest Dissertations and Theses were searched systematically and thoroughly. Conferences held through Association for Research in Vision and Ophthalmology, American Academy of Ophthalmology, and Canadian Society of Ophthalmology were searched. Studies were screened using Covidence software and data on sensitivity, specificity and area under curve were extracted from the included studies. STATA 15.0 was used to conduct the meta-analysis. Results Our search strategy identified 150 records from databases and 35 records from gray literature. Total of 21 records were used for the qualitative analysis and 11 records (100 134 images) were used for the quantitative analysis. In adult patients with cataracts, the pooled estimate for sensitivity was 0.948 [95% CI: 0.815–0.987] and specificity was 0.960 [95% CI: 0.924–0.980] for cataract screening using machine learning classifiers. For pediatric cataracts, the pooled estimate for sensitivity was 0.882 [95% CI: 0.696–0.960] and specificity was 0.891 [95% CI: 0.807–0.942]. Conclusion The included studies show promising results for the diagnostic accuracy of the machine learning classifiers for cataracts and its potential implementation in clinical settings. Prospero registration CRD42020219316","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47318696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-03DOI: 10.1080/17469899.2022.2139677
Daniel Egger, Reinhard Angermann, S. Waldstein
The introduction of intravitreal injections of anti-vascular endothelial growth factor (VEGF) has led to a new standard of care regarding the treatment of neovascular age-related macular degeneration (nAMD). Although VEGF inhibitors caused a paradigm shift in the management of these patients, the burden of frequent follow-up and direct as well as indirect costs of treatment remain a challenge for patients, healthcare systems, and societies. Initial treatment and particularly retreatment decisions still rest upon optical coherence tomography (OCT)-based biomarkers, especially the presence of subretinal fluid (SRF) and intraretinal fluid (IRF). A complete resolution of fluid is often considered a therapeutic target. However, in order to further reduce disease burden and adapt treatment frequency to the individual disease activity, this paradigm needs to be reconsidered.
{"title":"The future of biomarkers in neovascular age-related macular degeneration: active disease or degenerative process?","authors":"Daniel Egger, Reinhard Angermann, S. Waldstein","doi":"10.1080/17469899.2022.2139677","DOIUrl":"https://doi.org/10.1080/17469899.2022.2139677","url":null,"abstract":"The introduction of intravitreal injections of anti-vascular endothelial growth factor (VEGF) has led to a new standard of care regarding the treatment of neovascular age-related macular degeneration (nAMD). Although VEGF inhibitors caused a paradigm shift in the management of these patients, the burden of frequent follow-up and direct as well as indirect costs of treatment remain a challenge for patients, healthcare systems, and societies. Initial treatment and particularly retreatment decisions still rest upon optical coherence tomography (OCT)-based biomarkers, especially the presence of subretinal fluid (SRF) and intraretinal fluid (IRF). A complete resolution of fluid is often considered a therapeutic target. However, in order to further reduce disease burden and adapt treatment frequency to the individual disease activity, this paradigm needs to be reconsidered.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2022-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41365542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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