American Journal of Ophthalmology最新文献

{"title":"Erratum to \"Visual Function Benefit After Treatment With Pegcetacoplan: Microperimetry Analysis From the Phase 3 OAKS Trial,\" [Am J Ophthalmol 2025; 273:119-129].","authors":"Usha Chakravarthy, Roy Schwartz, Robyn H Guymer, Frank G Holz, Aleksandra V Rachitskaya, Stela Vujosevic, Philip Lewis, Hanne Vorwerk, A Yasin Alibhai, Eric M Moult, Marco U Morales, Caleb Bliss, Caroline R Baumall, Nadia K Waheed","doi":"10.1016/j.ajo.2025.05.012","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.05.012","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visual Acuity and Quality of Life Outcomes With Pegcetacoplan Treatment: A Post Hoc Analysis From the OAKS and DERBY Trials","authors":"Allen Chiang ,&nbsp;Matthew Davis ,&nbsp;Warren Stevens ,&nbsp;Sunir Garg ,&nbsp;Tom Sheidow ,&nbsp;Daniel L. Jones ,&nbsp;Michele Intorcia ,&nbsp;Alex McKeown ,&nbsp;Ursula M. Schmidt-Erfurth ,&nbsp;Sujata P. Sarda ,&nbsp;Caroline R. Baumal","doi":"10.1016/j.ajo.2025.05.023","DOIUrl":"10.1016/j.ajo.2025.05.023","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>To evaluate the effect of pegcetacoplan on visual function and patient quality of life (QoL) measures based on distance of geographic atrophy (GA) lesions from the center of the fovea.</div></div><div><h3>DESIGN</h3><div>Post hoc analysis from OAKS and DERBY, two global, 24-month, multicenter, randomized, double-masked, sham-controlled phase 3 studies evaluating pegcetacoplan treatment for GA in age-related macular degeneration (AMD).</div></div><div><h3>PARTICIPANTS</h3><div>888 study patients with GA for whom all data necessary for the post hoc analysis to be performed had been collected were included.</div></div><div><h3>METHODS</h3><div>Best-corrected visual acuity (BCVA) and 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) were assessed at baseline and every 4 and 6 months, respectively, to completion at month 24 in both pegcetacoplan-treated eyes and sham (observed) eyes. Eyes were stratified based on optical coherence tomography‒derived GA lesion location ≥250 µm (<em>n</em> = 192) or &lt;250 µm (<em>n</em> = 696) from the foveal center.</div></div><div><h3>MAIN OUTCOME MEASURES</h3><div>Change from baseline in BCVA and NEI VFQ-25 was evaluated over 24 months in GA lesions based on distance (≥250 or &lt;250 µm) from the foveal center. Adjustment was conducted via propensity score weighting, where model specification and baseline covariate selection were done a priori based on clinical rationale.</div></div><div><h3>RESULTS</h3><div>Pegcetacoplan-treated eyes with GA lesion margins ≥250 µm from the foveal center demonstrated directionally slower decline in visual acuity (mean +5.6 [SE 3.2] [<em>P</em> = .0785]) and QoL (mean +4.0 [SE 2.4] [<em>P</em> = .0905]) from baseline at 24 months compared with sham. The change in visual acuity (BCVA, mean −1.6 [SE 1.1] [<em>P</em> = .1522]) and QoL (NEI VFQ-25, −2.3 [1.1] [<em>P</em> = .0284]) in pegcetacoplan-treated eyes with GA lesion margins &lt;250 µm from the foveal center were within the limits of variability compared with sham.</div></div><div><h3>CONCLUSIONS</h3><div>Pegcetacoplan treatment demonstrated a potentially meaningful slower decline in visual acuity and QoL for patients with GA lesions ≥250 µm from the foveal center. The change in visual acuity and QoL seen with pegcetacoplan treatment for patients with GA lesions &lt;250 µm from the foveal center were within the limits of variability.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 471-481"},"PeriodicalIF":4.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technique: Implantable 6-0 Polypropylene Capsular Hook Combined With Flanged Fixation to Stabilize the Multifocal Intraocular Lens.","authors":"Rui Feng, Ruijue Peng, Chao Qu","doi":"10.1016/j.ajo.2025.05.020","DOIUrl":"10.1016/j.ajo.2025.05.020","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Learning Differentiates Papilledema, NAION, and Healthy Eyes With Unsegmented 3D OCT Volumes","authors":"David Szanto ,&nbsp;Jui-Kai Wang ,&nbsp;Brian Woods ,&nbsp;Mona K. Garvin ,&nbsp;Brett A. Johnson ,&nbsp;Randy H. Kardon ,&nbsp;Edward F. Linton ,&nbsp;Mark J. Kupersmith","doi":"10.1016/j.ajo.2025.05.036","DOIUrl":"10.1016/j.ajo.2025.05.036","url":null,"abstract":"<div><h3>Objective</h3><div>Deep learning (DL) has been used to differentiate papilledema from healthy eyes and optic disc elevation on fundus photos. As we described optic nerve head (ONH) and peripapillary retina (PPR) optical coherence tomography (OCT) features that distinguish non-arteritic anterior ischemic optic neuropathy (NAION) from papilledema, we hypothesized that a DL approach using the full 3D OCT volume could reliably differentiate NAION, papilledema and healthy eyes.</div></div><div><h3>Design</h3><div>This retrospective review analyzed OCT scans from eyes with acute NAION, papilledema, and healthy eyes from randomized and nonrandomized clinical trials.</div></div><div><h3>Participants</h3><div>We investigated a total of 4619 raw spectral domain ONH volume scans from 1539 eyes, including 1138 from eyes with idiopathic intracranial hypertension (IIH, Frisén grade ≥ 1), 648 from eyes with acute NAION, and 2833 scans from healthy eyes. We performed external validation on an additional 1663 scans from 742 eyes across these groups.</div></div><div><h3>Methods</h3><div>We fine-tuned 3 ResNet 3D-18 models: one with the entire OCT volume, one with the PPR, and one with the optic nerve head excluding the PPR. We then evaluated the models on an external validation set.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome measures were accuracy, area under the Receiver Operating Characteristic curve (AUC-ROC), and weighted precision, recall, and F1 scores.</div></div><div><h3>Results</h3><div>Our model classified the 3 conditions using the entire scan with an internal validation accuracy of 94.9%, macro-average AUC-ROC of 0.986 with weighted F1 scores ranging from 0.93 to 0.95. In external validation, the entire scan model had an accuracy of 90.1% with a macro-average AUC-ROC of 0.977 and weighted F1-score range of 0.89 to 0.94. The PPR alone model attained an accuracy of 94.2%, with a macro-average AUC-ROC of 0.966 and weighted F1-score range of 0.81 to 0.88. The ONH alone model reached an accuracy of 85.0% with an AUC-ROC of 0.965 and weighted F1-score range of 0.84 to 0.89.</div></div><div><h3>Conclusion</h3><div>Our findings demonstrate that the model using the whole ONH OCT scan is a robust diagnostic tool for differentiating causes of swollen ONH. Changes in the PPR due to ONH swelling as well as ONH alone can also differentiate the disorders. The results reinforce the potential of automated approaches in assisting in the diagnosis of acquired optic disc swelling.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 249-259"},"PeriodicalIF":4.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Changes in Optoretinography Provide an Early and Sensitive Biomarker of Outer Retinal Disease","authors":"Teng Liu ,&nbsp;Benjamin J. Wendel ,&nbsp;Jennifer Huey ,&nbsp;Vimal Prabhu Pandiyan ,&nbsp;Debarshi Mustafi ,&nbsp;Jennifer R. Chao ,&nbsp;Ramkumar Sabesan","doi":"10.1016/j.ajo.2025.05.032","DOIUrl":"10.1016/j.ajo.2025.05.032","url":null,"abstract":"<div><h3>Objective</h3><div>To examine whether optoretinography (ORG) can provide greater sensitivity for assessing the time-course of disease progression in Retinitis Pigmentosa (RP) compared to standard clinical imaging in a longitudinal study.</div></div><div><h3>Design</h3><div>Cohort study.</div></div><div><h3>Participants</h3><div>Five non-syndromic RP patients and 8 control subjects participated in the study.</div></div><div><h3>Methods</h3><div>Clinical examination, imaging sessions and data analysis were all conducted at the University of Washington. Five eyes of 5 patients diagnosed with RP, comparing standard clinical imaging to ORG, were collected over a 21-month span between August 2022 and May 2024.</div></div><div><h3>Main outcome and measures</h3><div>ORG response to visual stimuli, ellipsoid zone (EZ) width and outer segment length (OS length) were evaluated for longitudinal changes as markers of disease progression.</div></div><div><h3>Results</h3><div>The reduction in cone function with ORG over time exceeds that observed in standard clinical markers of photoreceptor structure - EZ width and OS length. EZ width and OSL decreased by 4.5% ± 5.9% and 6.5% ± 1.4%, respectively, approximately 9.9 and 6.9 times less than the reduction noted in ORG, respectively. The most notable degradation was noted at the borders of the transition zone, where ORG showed progressive and sub-clinical losses in photoreceptor function whereas standard OCT showed currently intact outer retinal structure.</div></div><div><h3>Conclusions</h3><div>Optoretinography detects sub-clinical disease and reliably identifies longitudinal markers of progression with greater sensitivity compared to standard clinical imaging. The ability to detect functional changes in the outer retina prior to standard clinical measures underscores its potential as a sensitive, accelerated and clinically-relevant outcome measure to guide patient selection and their therapeutic response in future clinical trials.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 375-386"},"PeriodicalIF":4.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TFOS DEWS III Editorial.","authors":"","doi":"10.1016/j.ajo.2025.05.038","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.05.038","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Prevalence of Scleritis Subtypes and Associated Ocular Complications in the TriNetX Database","authors":"Matthew D. Spangler ,&nbsp;Rayna F. Marshall ,&nbsp;Nila Kirupaharan ,&nbsp;Karen R. Armbrust ,&nbsp;Meghan K. Berkenstock","doi":"10.1016/j.ajo.2025.05.028","DOIUrl":"10.1016/j.ajo.2025.05.028","url":null,"abstract":"<div><div>Objective: To analyze the demographics, systemic and ocular comorbidities, and the yearly and cumulative incidence and prevalence of scleritis in the TriNetX United States Collaborative Network database from 2014 to 2023.</div><div>Design: Retrospective cohort study.</div><div>Participants: Out of 109,154,791 patients in TriNetX, 41,435 were diagnosed with scleritis.</div><div>Methods: Data were collected and analyzed by scleritis subtype: anterior, posterior, scleritis with corneal involvement, and scleromalacia perforans. Data collected included demographics, concurrent use of immunosuppressants, presence of an associated systemic disease, and ocular complications.</div><div>Main Outcome Measures: Incidence and prevalence (yearly and cumulative) of scleritis and its subtypes. Incidence of scleritis stratified by age and low vision and blindness in the scleritis cohort were analyzed from 2014 to 2023.</div><div>Results: Of the 41,435 scleritis patients, the majority were Caucasian (56.6%) and female (62.5%) with a mean ± standard deviation age of 58 ± 18 years. The most commonly prescribed immunosuppressants were prednisone, methylprednisolone, and methotrexate (34.1%, 22.4%, and 8.7%). The most commonly associated systemic disease was rheumatoid arthritis (9.9%), and the most prevalent ocular complication was glaucoma (9.9%). The 10-year cumulative incidence and 10-year prevalence rates of scleritis were 6.8 cases per 100,000 person-years and 35.4 cases per 100,000 persons, respectively. The 10-year cumulative incidence of low vision and blindness in the cohort of scleritis was 1263.6 cases per 100,000 person-years.</div><div>Conclusions: Demographics and comorbidities of the TriNetX scleritis cohort were similar to scleritis cohorts in previous studies. However, the overall scleritis incidence rate was higher when compared to the previous literature, with varying yearly incidence and prevalence scleritis subtype rates. Further research is needed to assess for the increasing incidence of low vision over time.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 365-374"},"PeriodicalIF":4.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Refractive Changes After Pediatric Cataract Surgery: An Average Follow-up of 15 Years","authors":"Tetsuro Oshika ,&nbsp;Sachiko Nishina ,&nbsp;Sawako Ura ,&nbsp;Mai Miyagi ,&nbsp;Koji Nomura ,&nbsp;Takafumi Mori ,&nbsp;Naoko Matsuki ,&nbsp;Takao Endo ,&nbsp;Daijiro Kurosaka ,&nbsp;Kazuno Negishi ,&nbsp;Shigeo Yoshida ,&nbsp;Toshiyuki Nagamoto","doi":"10.1016/j.ajo.2025.05.035","DOIUrl":"10.1016/j.ajo.2025.05.035","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate long-term refractive changes following pediatric cataract surgery.</div></div><div><h3>Design</h3><div>Retrospective case series.</div></div><div><h3>Methods</h3><div>A total of 451 eyes from 273 patients who had undergone cataract surgery at age 6 years or younger (mean 1.8 ± 1.8 years) were analyzed, with a mean follow-up of 15.0 ± 2.5 years (range: 12-18 years). The cohort included 120 cases with bilateral aphakia, 58 cases with bilateral pseudophakia, 40 cases with unilateral aphakia, and 55 cases with unilateral pseudophakia.</div></div><div><h3>Results</h3><div>In eyes that underwent surgery at or before age 2, the median myopic shift was –8.2 D (interquartile range: –11.0 to –5.0 D) in the bilateral aphakia group and –11.2 D (–16.4 to –6.6 D) in the bilateral pseudophakia group, while the median changes in anisometropia (refractive difference between the operated and healthy contralateral eyes) were –8.0 D (–15.3 to –1.2 D) in the unilateral aphakia group and –10.6 D (–14.8 to –4.4 D) in the unilateral pseudophakia group. In eyes that were operated on after age 2, the median myopic shift was –3.7 D (–6.7 to –0.0 D) in the bilateral aphakia group and –5.7 D (–8.6 to –2.8 D) in the bilateral pseudophakia group, while the median changes in anisometropia were –5.1 D (–8.3 to –2.4 D) in the unilateral aphakia group and –6.5 D (–8.8 to –4.1 D) in the unilateral pseudophakia group.</div></div><div><h3>Conclusions</h3><div>Refractive changes following pediatric cataract surgery were greater in eyes that underwent surgery at a younger age. In cases operated on at or before 2 years of age, median myopic shifts (in bilateral cases) or anisometropic changes (in unilateral cases) ranged from –8 to –11 D in both aphakic and pseudophakic groups over an average follow-up period of 15 years.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 305-312"},"PeriodicalIF":4.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Relationship of Hydroxychloroquine Retinopathy Progression to Stage at Cessation of Therapy","authors":"David J. Browning ,&nbsp;Donnie R. Koonce ,&nbsp;Akshay Mentreddy ,&nbsp;Omar Punjabi","doi":"10.1016/j.ajo.2025.05.030","DOIUrl":"10.1016/j.ajo.2025.05.030","url":null,"abstract":"<div><h3>Purpose</h3><div>To examine the progression of hydroxychloroquine retinopathy (HCR) from the time of drug cessation to the last follow-up.</div></div><div><h3>Design</h3><div>Retrospective, consecutive case series</div></div><div><h3>Subjects</h3><div>17 patients with HCR in whom drug was stopped and follow-up maintained.</div></div><div><h3>Methods</h3><div>Charts, visual fields, and retinal images were reviewed. Four ancillary studies were investigated: 10-2 visual fields (10-2 VF), multifocal electroretinography (mfERG), spectral domain optical coherence tomography (SD-OCT), and fundus autofluorescence (FAF) imaging. Retinopathy was graded as none, early, and advanced.</div></div><div><h3>Main Outcome Measures</h3><div>Progression of retinopathy by the four test methods.</div></div><div><h3>Results</h3><div>Of the 17 patients, the numbers with at least two follow-up studies to allow comparison for progression were 17, 8, 16, and 9 for 10-2 VF, mfERG, SD-OCT, and FAF, respectively. Median follow-ups were 25, 22, 41, and 37 months for 10-2 VF, mfERG, SD-OCT, and FAF, respectively. The proportions of eyes with no retinopathy at drug cessation that progressed were 0/0, 3/5, 0/0, and 2/6 for 10-2 VF, mfERG, SD-OCT, and FAF, respectively. The proportions of eyes with early retinopathy that progressed were 4/6, 0/6, 2/15, and 3/7 for 10-2 VF, mfERG, SD-OCT, and FAF, respectively. The proportions of eyes with advanced retinopathy that progressed were 16/20, 0/5, 10/17, and 5/5 for 10-2 VF, mfERG, SD-OCT, and FAF, respectively. Progression of retinopathy was seen in cases without retinal pigment epithelium loss at the time of drug cessation. Not all ancillary studies show retinopathy at the time of diagnosis of HCR. Multifocal ERG shows a floor effect. Once response densities are low, detecting further progression of toxicity by this modality is not possible. A greater breadth of retinopathy progression is possible with 10-2 VF, SD-OCT, and FAF.</div></div><div><h3>Conclusions</h3><div>If HC is stopped when decreased reflectivity of the parafoveal ellipsoid zone is detected by SD-OCT, the probability of retinopathy progression is low. The cut point at which progression of retinopathy is acknowledged to be likely despite drug cessation needs to be moved earlier to discontinuity of the ellipsoid zone.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 335-348"},"PeriodicalIF":4.1,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Explainable Deep Learning System for Automatic Detection of Thyroid Eye Disease Using Facial Images","authors":"Xiaodan Sui ,&nbsp;Kenneth Ka Hei Lai ,&nbsp;Richard Wai Chak Choy ,&nbsp;Han Wang ,&nbsp;Karen Kar Wun Chan ,&nbsp;Fatema Mohamed Ali Abdulla Aljufairi ,&nbsp;Yuanjie Zheng ,&nbsp;Wilson Wai Kuen Yip ,&nbsp;Alvin Lerrmann Young ,&nbsp;Clement Chee Yung Tham ,&nbsp;Chi Pui Pang ,&nbsp;Hongsheng Li ,&nbsp;Kelvin Kam Lung Chong","doi":"10.1016/j.ajo.2025.05.022","DOIUrl":"10.1016/j.ajo.2025.05.022","url":null,"abstract":"<div><h3>Purpose</h3><div>To report an explainable deep learning (XDL) system to automatically detect thyroid eye disease (TED) using facial images.</div></div><div><h3>Design</h3><div>Prospective study to develop and evaluate a deep-learning diagnostic algorithm.</div></div><div><h3>Methods</h3><div>A dataset consisting of 302 and 289 facial images of newly diagnosed, treatment-naïve, TED patients and healthy subjects were compiled, annotated, and applied to train the XDL model. It consisted of a periocular landmarks localization network that identified the periocular landmarks on facial images, and the TED detection network (TDN) that uses a binary classification to detect TED using facial images. The generalizability of the XDL system was evaluated using a threefold cross-validation strategy and further validated using 100 facial images of TED patients from an independent thyroid eye clinic.</div></div><div><h3>Results</h3><div>The area under the receiver operating characteristic curve was 99.7%, sensitivity 99.7%, and specificity 94.5% (95% confidence interval: 99.6%-99.9%). Heatmaps demonstrated upper and lower eyelids as key regions of interest. The validation cohort achieved area under the receiver operating characteristic curve of 98.9%, sensitivity 92%, and specificity 93%.</div></div><div><h3>Conclusions</h3><div>This XDL system detected TED using facial images with excellent accuracy and explainability. It should be further evaluated in prospective Graves’ disease cohorts at nonspecialist setting for early detection and referral of progressive TED.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 323-334"},"PeriodicalIF":4.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}