Asia-Pacific Journal of Ophthalmology最新文献

{"title":"Advances in understanding and management of IgG4-related ophthalmic disease","authors":"Kenneth Ka Hei Lai ,&nbsp;Terence Wee Xiang Ang ,&nbsp;Wah Cheuk ,&nbsp;Angie Kwok ,&nbsp;Ming Lin ,&nbsp;Yael Lustig ,&nbsp;Dinesh Selva ,&nbsp;Guy Ben Simon ,&nbsp;Yue Xing ,&nbsp;Zhi Hui Xu ,&nbsp;Hua Sheng Yang ,&nbsp;Kelvin Kam Lung Chong ,&nbsp;Hunter Kwok Lai Yuen","doi":"10.1016/j.apjo.2024.100101","DOIUrl":"10.1016/j.apjo.2024.100101","url":null,"abstract":"<div><div>Immunoglobulin G4-related ophthalmic disease (IgG4-ROD) is an emerging, immune-mediated fibroinflammatory orbital disease, characterized by tumefactive lesions with noticeable IgG4+ plasma cell infiltration and distinctive pathohistological features. This disease is often associated with elevated serum IgG4 concentrations. IgG4-ROD may affect any ophthalmic tissues, particularly the lacrimal gland, extraocular muscles, and trigeminal nerves. Although the exact pathogenic role of IgG4 antibodies remains unclear, B-cell depleting agents have been reported to be an effective treatment. The diverse clinical manifestations of IgG4-ROD complicate diagnosis, and without prompt treatment, visual-threatening complications such as optic neuropathy may arise. Recent advances in understanding and managing IgG4-ROD have revolutionized the diagnosis and treatment of this emerging disease. This review article aims to provide a comprehensive overview of the latest advancements in the field of IgG4-ROD.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"13 5","pages":"Article 100101"},"PeriodicalIF":3.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142340185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Macular Neuroretinopathy Associated with COVID-19 Pandemic: A Real-world Observation Study","authors":"Xiaojia Song ,&nbsp;Yajie Yu ,&nbsp;Haiying Zhou ,&nbsp;Yongpeng Zhang ,&nbsp;Yu Mao ,&nbsp;Hong Wang ,&nbsp;Xusheng Cao ,&nbsp;Xiaoqing Zhu ,&nbsp;Zhihua Li ,&nbsp;Lin Li ,&nbsp;Jinghua Liu ,&nbsp;Xiaoyan Peng ,&nbsp;Qian Li","doi":"10.1016/j.apjo.2024.100103","DOIUrl":"10.1016/j.apjo.2024.100103","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the clinical and retinal imaging features of Chinese patients with acute macular neuroretinopathy (AMN) associated with COVID-19.</div></div><div><h3>Design</h3><div>A prospective observational study.</div></div><div><h3>Methods</h3><div>Retinal imaging, including color fundus photography, near-infrared imaging (NIR), swept-source optical coherence tomography (SS-OCT), optical coherence tomography angiography (OCTA), and Humphrey perimetry, were conducted for each case.</div></div><div><h3>Results</h3><div>All cases were included within the first three months following the pandemic outbreak. A total of 12 male patients (36.36 %) and 21 female patients (63.64 %) were prospectively recruited, and 29 cases (87.88 %) were bilaterally affected. The median interval between the onset of fever and the appearance of ocular symptoms was two days (range, 0.5–5.0 days). Apart from the outer retinal changes typical of AMN, changes in the inner retinal layers were observed, including intraretinal hemorrhage (8.06 %), cotton wool spots (9.68 %), and paracentral acute middle maculopathy (PAMM) (8.06 %). Smaller retinal inner nuclear layer hyperreflective speckles (RIHS) (41.94 %) were identified as a distinguishing feature from typical PAMM. Voids of vessel signals were found in the superficial (11.54 %), intermediate (82.69 %), and deep capillary plexus (98.08 %), and in the choriocapillaris (19.23 %) on OCTA. Humphrey perimetry illustrated central, paracentral, and peripheral scotomas. The occult lesions associated with AMN, PAMM, and some of the RIHS illustrated by OCT were visualized topographically and further confirmed by OCTA as perfusion defects.</div></div><div><h3>Conclusion</h3><div>An increase in AMN cases correlated with the SARS-CoV-2 outbreak. Additional features, including widespread inner retinal perfusion deficits, were observed and may serve as potential biomarkers for systemic microcirculation dysregulation in COVID-19.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"13 5","pages":"Article 100103"},"PeriodicalIF":3.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142340184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Perceptions Regarding the Use of Eyeglasses Among Ophthalmologists","authors":"Andrew Oh,&nbsp;Brian Chou","doi":"10.1016/j.apjo.2024.100099","DOIUrl":"10.1016/j.apjo.2024.100099","url":null,"abstract":"","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"13 5","pages":"Article 100099"},"PeriodicalIF":3.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Large Sample Assessment of Drug-related Dry Eye Risk: Based on the FDA Adverse Event Reporting System Database","authors":"Shi-Nan Wu ,&nbsp;Caihong Huang ,&nbsp;Yu-Qian Wang ,&nbsp;Xiao-Dong Chen ,&nbsp;Xiang Li ,&nbsp;Si-Qi Zhang ,&nbsp;Dan-Yi Qin ,&nbsp;Linfangzi Zhu ,&nbsp;Chang-Sheng Xu ,&nbsp;Qing-He Zhang ,&nbsp;Jiaoyue Hu ,&nbsp;Zuguo Liu","doi":"10.1016/j.apjo.2024.100104","DOIUrl":"10.1016/j.apjo.2024.100104","url":null,"abstract":"<div><h3>Purpose and design</h3><div>This study aimed to evaluate the risk of drug-related dry eye using real-world data, underscoring the significance of tracing pharmacological etiology for distinct clinical types of dry eye.</div></div><div><h3>Methods</h3><div>Analyzing adverse event reports in the Food and Drug Administration Adverse Event Reporting System (FAERS) from January 2004 to September 2023, we employed disproportionality analysis and the Bayesian confidence propagation neural network algorithm. The analysis involved categorizing drugs causing dry eye, assessing risk levels, and conducting segmental assessments based on the time of onset of drug-related dry eye adverse reactions.</div></div><div><h3>Results</h3><div>In the FAERS database, adverse reactions related to dry eye were linked to 1160 drugs. Disproportionality analysis identified 33 drugs with significant risk, notably in ophthalmic (brimonidine, bimatoprost), oncology (tisotumab vedotin, erdafitinib), and other medications (isotretinoin, oxymetazoline). The top three drugs with the highest risk of drug-related dry eye are isotretinoin (Bayesian confidence propagation neural network (BCPNN) = 6.88), tisotumab vedotin (BCPNN = 6.88), and brimonidine (BCPNN = 6.77). Among different categories of drugs, respiratory medications have the shortest mean onset time for drug-related dry eye, averaging 50.99 days. The prevalence skewed towards females (69.9 %), particularly in menopausal and elderly individuals (45–70 years old, mean age 54.7 ± 18.2). Reports of drug-related dry eye adverse reactions showed an annual increase.</div></div><div><h3>Conclusion</h3><div>Informed clinical decision-making is crucial for preventing drug-related dry eye. Assessing the risk of dry eyes associated with both local and systemic medications helps optimize treatment and provide necessary cautionary information.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"13 5","pages":"Article 100104"},"PeriodicalIF":3.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142340187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of large language models in answering ophthalmology board-style questions: A meta-analysis","authors":"Jo-Hsuan Wu ,&nbsp;Takashi Nishida ,&nbsp;T. Y. Alvin Liu","doi":"10.1016/j.apjo.2024.100106","DOIUrl":"10.1016/j.apjo.2024.100106","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the accuracy of large language models (LLMs) in answering ophthalmology board-style questions.</div></div><div><h3>Design</h3><div>Meta-analysis.</div></div><div><h3>Methods</h3><div>Literature search was conducted using PubMed and Embase in March 2024. We included full-length articles and research letters published in English that reported the accuracy of LLMs in answering ophthalmology board-style questions. Data on LLM performance, including the number of questions submitted and correct responses generated, were extracted for each question set from individual studies. Pooled accuracy was calculated using a random-effects model. Subgroup analyses were performed based on the LLMs used and specific ophthalmology topics assessed.</div></div><div><h3>Results</h3><div>Among the 14 studies retrieved, 13 (93 %) tested LLMs on multiple ophthalmology topics. ChatGPT-3.5, ChatGPT-4, Bard, and Bing Chat were assessed in 12 (86 %), 11 (79 %), 4 (29 %), and 4 (29 %) studies, respectively. The overall pooled accuracy of LLMs was 0.65 (95 % CI: 0.61–0.69). Among the different LLMs, ChatGPT-4 achieved the highest pooled accuracy at 0.74 (95 % CI: 0.73–0.79), while ChatGPT-3.5 recorded the lowest at 0.52 (95 % CI: 0.51–0.54). LLMs performed best in “pathology” (0.78 [95 % CI: 0.70–0.86]) and worst in “fundamentals and principles of ophthalmology” (0.52 [95 % CI: 0.48–0.56]).</div></div><div><h3>Conclusions</h3><div>The overall accuracy of LLMs in answering ophthalmology board-style questions was acceptable but not exceptional, with ChatGPT-4 and Bing Chat being top-performing models. Performance varied significantly based on specific ophthalmology topics tested. Inconsistent performances are of concern, highlighting the need for future studies to include ophthalmology board-style questions with images to more comprehensively examine the competency of LLMs.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"13 5","pages":"Article 100106"},"PeriodicalIF":3.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current research and future strategies for the management of vision-threatening diabetic retinopathy","authors":"Huating Li ,&nbsp;Weiping Jia ,&nbsp;Stela Vujosevic ,&nbsp;Charumathi Sabanayagam ,&nbsp;Jakob Grauslund ,&nbsp;Sobha Sivaprasad ,&nbsp;Tien Yin Wong","doi":"10.1016/j.apjo.2024.100109","DOIUrl":"10.1016/j.apjo.2024.100109","url":null,"abstract":"<div><div>Diabetic retinopathy (DR) is a major ocular complication of diabetes and the leading cause of blindness and visual impairment, particularly among adults of working-age adults. Although the medical and economic burden of DR is significant and its global prevalence is expected to increase, particularly in low- and middle-income countries, a large portion of vision loss caused by DR remains preventable through early detection and timely intervention. This perspective reviewed the latest developments in research and innovation in three areas, first novel biomarkers (including advanced imaging modalities, serum biomarkers, and artificial intelligence technology) to predict the incidence and progression of DR, second, screening and early detection of referable DR and vision-threatening DR (VTDR), and finally, novel therapeutic strategies for VTDR, including diabetic macular oedema (DME), with the goal of reducing diabetic blindness.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"13 5","pages":"Article 100109"},"PeriodicalIF":3.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practice Patterns and Challenges in Managing Inherited Retinal Diseases Across Asia-Pacific: A Survey from the APIED Network","authors":"Wendy M. Wong ,&nbsp;Yih Chung Tham ,&nbsp;Lauren N. Ayton ,&nbsp;Alexis Ceecee Britten-Jones ,&nbsp;Thomas L. Edwards ,&nbsp;John Grigg ,&nbsp;Matthew P. Simunovic ,&nbsp;Fred K. Chen ,&nbsp;Zi-Bing Jin ,&nbsp;Ren-Juan Shen ,&nbsp;Ruifang Sui ,&nbsp;Liping Yang ,&nbsp;Chen Zhao ,&nbsp;Haoyu Chen ,&nbsp;Shiying Li ,&nbsp;Xiaoyan Ding ,&nbsp;Muna Bhende ,&nbsp;Rajiv Raman ,&nbsp;Parveen Sen ,&nbsp;B. Poornachandra ,&nbsp;Hwei Wuen Chan","doi":"10.1016/j.apjo.2024.100098","DOIUrl":"10.1016/j.apjo.2024.100098","url":null,"abstract":"<div><h3>Purpose</h3><div>The objective of this paper is to shed light on the current landscape of genotyping practices, phenotyping practices and availability of essential vision rehabilitation management for inherited retinal diseases (IRD) in the Asia-Pacific (APAC) Region.</div></div><div><h3>Methods</h3><div>The 62-item questionnaire was distributed electronically via email. The questions covered five domains: (1) structure of the IRD service and registry/database; (2) genotyping practices; (3) genetic counselling; (4) deep phenotyping practices; (5) low-vision rehabilitation services.</div></div><div><h3>Results</h3><div>The survey was completed by 36 of 45 centres in twelve countries and regions in APAC. Among these centres, 42 % reported managing more than 1000 patients. Notably, 39 % of centres lack an IRD database or registry, and 44 % of centres have tested less than one-quarter of their IRD patients. The majority of centres (67 %) do not have genetic counsellors. While there was consistency in the imaging-based investigations, there was marked heterogeneity for functional testing using electrophysiology and formal perimetry. Only 34 % of centres confirmed the availability of access to low-vision assistive devices.</div></div><div><h3>Conclusions</h3><div>This study reveals several critical gaps in managing IRDs in the APAC region. These include the lack of IRD database/registry in one-third of centres, a substantial proportion of patients remaining genetically undiagnosed, and limited availability of genetic counsellors. The findings also underscore a need to harmonise investigations for evaluating retinal function and identify areas for improvement in the provision of low-vision rehabilitation services.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"13 5","pages":"Article 100098"},"PeriodicalIF":3.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of childhood atropine treatment on adult choroidal thickness using sequential deep learning-enabled segmentation","authors":"Yong Li ,&nbsp;Damon Wong ,&nbsp;Syna Sreng ,&nbsp;Joey Chung ,&nbsp;Angeline Toh ,&nbsp;Han Yuan ,&nbsp;Leila Sara Eppenberger ,&nbsp;Cheryl Leow ,&nbsp;Daniel Ting ,&nbsp;Nan Liu ,&nbsp;Leopold Schmetterer ,&nbsp;Seang-Mei Saw ,&nbsp;Jost B. Jonas ,&nbsp;Audrey Chia ,&nbsp;Marcus Ang","doi":"10.1016/j.apjo.2024.100107","DOIUrl":"10.1016/j.apjo.2024.100107","url":null,"abstract":"<div><h3>Purpose</h3><div>To describe choroidal thickness measurements using a sequential deep learning segmentation in adults who received childhood atropine treatment for myopia control.</div></div><div><h3>Design</h3><div>Prospective, observational study.</div></div><div><h3>Methods</h3><div>Choroidal thickness was measured by swept-source optical coherence tomography in adults who received childhood atropine, segmented using a sequential deep learning approach.</div></div><div><h3>Results</h3><div>Of 422 eyes, 94 (22.3 %) had no previous exposure to atropine treatment, while 328 (77.7 %) had received topical atropine during childhood. After adjusting for age, sex, and axial length, childhood atropine exposure was associated with a thicker choroid by 32.1 μm (95 % CI, 9.2–55.0; <em>P</em> = 0.006) in the inner inferior, 23.5 μm (95 % CI, 1.9–45.1; <em>P</em> = 0.03) in the outer inferior, 21.8 μm (95 % CI, 0.76–42.9; <em>P</em> = 0.04) in the inner nasal, and 21.8 μm (95 % CI, 2.6–41.0; <em>P</em> = 0.03) in the outer nasal. Multivariable analysis, adjusted for age, sex, atropine use, and axial length, showed an independent association between central subfield choroidal thickness and the incidence of tessellated fundus (<em>P</em> &lt; 0.001; OR, 0.97; 95 % CI, 0.96–0.98).</div></div><div><h3>Conclusions</h3><div>This study demonstrated that short-term (2–4 years) atropine treatment during childhood was associated with an increase in choroidal thickness of 20–40 μm in adulthood (10–20 years later), after adjusting for age, sex, and axial length. We also observed an independent association between eyes with thicker central choroidal measurements and reduced incidence of tessellated fundus. Our study suggests that childhood exposure to atropine treatment may affect choroidal thickness in adulthood.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"13 5","pages":"Article 100107"},"PeriodicalIF":3.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gain of chromosome 8q and high expression of EZH2 may predict poor prognosis in Chinese patients with uveal melanoma","authors":"Lingyu Zhang ,&nbsp;Hui Pan ,&nbsp;Yiran Yao ,&nbsp;Xiang Gu ,&nbsp;Tongxin Ge ,&nbsp;Junqi Cui ,&nbsp;Peiwei Chai ,&nbsp;Xiaofang Xu ,&nbsp;Renbing Jia ,&nbsp;Ai Zhuang ,&nbsp;Xianqun Fan","doi":"10.1016/j.apjo.2024.100108","DOIUrl":"10.1016/j.apjo.2024.100108","url":null,"abstract":"<div><h3>Purpose</h3><div>To explore risk factors predicting poor prognosis of uveal melanoma in a Chinese population, with specific emphasis on monosomy 3, 8q gain, and EZH2 staining.</div></div><div><h3>Methods</h3><div>Eighty-nine patients with uveal melanoma from 2012 to 2021 were reviewed. Clinical and pathological records were collected and analyzed. Immunohistochemical staining of EZH2, monosomy 3 and 8q gain were respectively conducted in 45, 54, and 57 cases. Survival was evaluated by Kaplan–Meier analysis and log-rank test. Cox proportional hazard regressions were employed to predict risk factors of distant metastasis.</div></div><div><h3>Results</h3><div>The median follow-up was 44 months. Altogether, 16 % of patients developed distant metastases and died from disease-related causes. Disease-specific survival at one and three years was 96.6 % and 88.4 % while distant metastasis rates were 7.9 % and 12 %. Univariate Cox regression analysis revealed that age (HR: 1.04), tumor largest basal diameter (HR: 1.21), tumor thickness (HR: 1.21), ciliary body involvement (HR: 3.50), AJCC stage (HR: 5.68), epithelioid cell type (HR: 7.71), 8q gain (HR: 7.48), and high expression of EZH2 (HR: 6.09) were associated with distant metastasis. 8q gain was associated with epithelioid cell type and thicker tumor while EZH2 was correlated with epithelioid cell type. Monosomy 3 lacked a significant correlation with other factors.</div></div><div><h3>Conclusion</h3><div>EZH2 and 8q gain could be taken into consideration when calculating poor prognosis in Chinese patients with uveal melanoma. Monosomy 3 showed no significance in distant metastasis, but this may be due to a small sample size.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"13 5","pages":"Article 100108"},"PeriodicalIF":3.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Testing of Artificial Intelligence-Based Mobile Application to Achieve Cataract Backlog-Free Status in Uttar Pradesh, India","authors":"Madhavi Devaraj ,&nbsp;Vasanthakumar Namasivayam ,&nbsp;Satya Swarup Srichandan ,&nbsp;Eshan Sharma ,&nbsp;Apjit Kaur ,&nbsp;Nibha Mishra ,&nbsp;Dev Vimal Seth ,&nbsp;Akanksha Singh ,&nbsp;Pankaj Saxena ,&nbsp;Eshaan Vasanthakumar ,&nbsp;James Blanchard ,&nbsp;Ravi Prakash","doi":"10.1016/j.apjo.2024.100094","DOIUrl":"10.1016/j.apjo.2024.100094","url":null,"abstract":"<div><h3>Background</h3><div>Uttar Pradesh (UP), the most populous state in India, has about 36 million people aged 50 years or older, spread across more than 100,000 villages. Among them, an estimated 3.5 million suffer from visual impairments, including blindness due to untreated cataracts. To achieve cataract backlog-free status, UP is required to screen this population at the community level and provide treatment to those suffering from cataracts. We envisioned an AI-powered primary screening app utilizing eye images, deployable to frontline health workers for community-level screening. This paper outlines insights gained from developing the AI mobile app “Roshni” for cataract screening.</div></div><div><h3>Method</h3><div>The AI-based cataract classification model was developed using 13,633 eye images and finalized after three stages of experiments, detecting cataracts in images focused on the eye, iris, and pupil. Overall, 155 experiments were conducted using multiple deep learning algorithms, including ResNet50, ResNet101, YOLOv5, EfficientNetV2, and InceptionV3. We established a minimum threshold of 90 % specificity and sensitivity to ensure the algorithm’s suitability for field use.</div></div><div><h3>Results</h3><div>The cataract detection model for eye-focused images achieved 51.9 % sensitivity and 87.6 % specificity, while the model for iris-focused images, using a good/bad iris filter, achieved 52.4 % sensitivity and 93.3 % specificity. The classification model for segmented-pupil images, employing a good/bad pupil filter with UNet-based semantic segmentation model and EfficientNetV2, yielded 96 % sensitivity and 97 % specificity. Field testing with 302 beneficiaries (604 images) showed an overall sensitivity of 86.6 %, specificity of 93.3 %, positive predictive value of 58.4 %, and negative predictive value of 98.5 %.</div></div><div><h3>Conclusion</h3><div>This paper details the development of an AI mobile app designed to facilitate community screening for cataracts by frontline health workers.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"13 5","pages":"Article 100094"},"PeriodicalIF":3.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142071889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}