BMJ Open Ophthalmology最新文献

{"title":"Effect of the gut microbiome in glaucoma risk from the causal perspective.","authors":"Yaxuan Wu, Ronghua Shi, He Chen, Zicheng Zhang, Siqi Bao, Jia Qu, Meng Zhou","doi":"10.1136/bmjophth-2023-001547","DOIUrl":"10.1136/bmjophth-2023-001547","url":null,"abstract":"<p><strong>Objective: </strong>Evidence from observational studies has reported possible associations between the gut microbiome (GM) and glaucoma. However, the causal effect of GM on glaucoma risk remains to be determined.</p><p><strong>Methods and analysis: </strong>We conducted two-sample bidirectional Mendelian randomisation (MR) analyses to explore the causal association between GM and glaucoma. Genome-wide association study summary statistics of 196 GM taxa (n=18 340) and glaucoma (18 902 cases and 358 375 controls) were obtained from MiBioGen and FinnGen Consortium. Inverse variance weighted, MR-Egger, weighted median, weighted mode, Mendelian Randomisation Pleiotropy Residual Sum and Outlier, MR-Egger intercept and Cochran's Q statistical analyses were used to supplement MR results and sensitivity analysis. An independent cohort from the Medical Research Council (MRC) Integrative Epidemiology Unit at the University of Bristol (MRC-IEU) Consortium (1715 cases and 359 479 controls) was used to validate causal effects.</p><p><strong>Results: </strong>Results of the MR analysis suggested that the family <i>Oxalobacteraceae</i> (OR 0.900, 95% CI 0.843 to 0.961, p=0.002) and the genus <i>Eggerthella</i> (OR 0.881, 95% CI 0.811 to 0.957, p=0.003) had a negative effect on glaucoma, whereas the genus <i>Bilophila</i> (OR 1.202, 95% CI 1.074 to 1.346, p=0.001), <i>LachnospiraceaeUCG010</i> (OR 1.256, 95% CI 1.109 to 1.423, p=0.0003) and <i>Ruminiclostridium 9</i> (OR 1.258, 95% CI 1.083 to 1.461, p=0.003) had a positive effect on glaucoma. Among these, the positive causal effect of <i>LachnospiraceaeUCG010</i> (OR 1.002, 95% CI 1.000 to 1.004, p=0.033) on glaucoma was replicated in an independent cohort.</p><p><strong>Conclusion: </strong>This MR analysis from large population studies demonstrated the causal effect of GM on glaucoma risk and supported the role of GM in influencing glaucoma susceptibility.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10826588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139575167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selective retina therapy with real-time feedback-controlled technology in central serous chorioretinopathy: a 24-month follow-up real-world prospective study.","authors":"Chang Ki Yoon, Hyeong Gon Yu","doi":"10.1136/bmjophth-2023-001517","DOIUrl":"10.1136/bmjophth-2023-001517","url":null,"abstract":"<p><strong>Objective: </strong>Although central serous chorioretinopathy (CSC) treatment using selective retinal therapy (SRT) has presented favourable outcomes, no long-term studies with a real-world clinical practice regimen have been conducted.</p><p><strong>Methods and analysis: </strong>We performed a long-term assessment of CSC treatment using SRT with real-time feedback (RTF) technology. 50 patients (53 eyes) with CSC and more than a 1-month symptom duration were recruited and treated with SRT using a 1.7 µs pulse width, 527 nm neodymium-doped yttrium lithium fluoride (Nd:YLF) laser equipped with an RTF system.</p><p><strong>Results: </strong>After 6 months of treatment, complete subretinal fluid resolution was achieved in 62% of the eyes. The mean best-corrected visual acuity (BCVA; logarithm of the minimum angle of resolution, mean±SD) improved slightly from 0.15±0.18 at baseline to 0.12±0.21 at 6 months (p=0.062). The central retinal thickness (CRT; mean±SD) was reduced significantly from 350.6±100.1 µm at baseline to 268.2±70.6 µm at 6 months (p<0.001). Long-term follow-up revealed significant improvements in BCVA, from 9 months until 24 months, and in CRT, from 1 month until 24 months. No treatment-related adverse events were observed during the 24-month follow-up period.</p><p><strong>Conclusion: </strong>Our results suggest that SRT with RTF technology is a long-term safe treatment with anatomical improvement for patients with CSC.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10806644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139520197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early impairment of magnocellular visual pathways mediated by isolated-check visual evoked potentials in primary open-angle glaucoma: a cross-sectional study.","authors":"Qiaona Ye, Kezheng Xu, Zidong Chen, Zitian Liu, Yanmei Fan, Pingping Liu, Minbin Yu, Yangfan Yang","doi":"10.1136/bmjophth-2023-001463","DOIUrl":"10.1136/bmjophth-2023-001463","url":null,"abstract":"<p><strong>Objective: </strong>To explore different performances in the magnocellular (MC) and parvocellular (PC) visual pathways in patients with primary open-angle glaucoma (POAG) and to objectively assess impairment in early stage of POAG.</p><p><strong>Methods and analysis: </strong>This is a cross-sectional study. MC and PC visual pathways were assessed using isolated-check visual evoked potential (ic-VEP). Visual acuity, intraocular pressure, fundus examination, optical coherence tomography and visual field were measured. Signal-to-noise ratios (SNRs), mediated by ic-VEP were recorded. The Spearman's correlation analysis was used to estimate the relationships between visual functions and structures. Receiver-operating-characteristic (ROC) curves were used to estimate the accuracy in detection of early POAG.</p><p><strong>Results: </strong>60 participants (30 early POAG eyes and 30 age-matched control subjects) were recruited. MC visual pathway showed a non-linear response function, while PC visual pathway was a linear response function as contrast increased. Early POAG eyes exhibited significantly weaker initial contrast gains and lower maximum responses in the MC visual pathway (p=0.001, p=0.004, respectively). The SNRs at 8% and 32% depths of modulation (DOM) were significantly correlated with temporal-side retinal nerve fibre layer (RNFL) thickness in early POAG in MC-biased stimulation (p=0.017, p=0.020, respectively). The areas under ROC of 16% DOM were 0.780 (sensitivity 80.0%, specificity 63.3%) with the cut-off SNR of 2.07.</p><p><strong>Conclusions: </strong>The MC visual pathway was damaged in the early stage of POAG. The SNRs at 8% and 32% DOM of MC-biased stimulation were significantly correlated with temporal-side RNFL thickness in early POAG, which helped in understanding the mechanisms of visual impairment in the early stage of POAG.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10806665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139490709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eyecare practitioner perspectives and attitudes towards myopia and myopia management in the UK.","authors":"Sophie Coverdale, Lindsay Rountree, Kathryn Webber, Matthew Cufflin, Edward Mallen, Alison Alderson, Neema Ghorbani-Mojarrad","doi":"10.1136/bmjophth-2023-001527","DOIUrl":"10.1136/bmjophth-2023-001527","url":null,"abstract":"<p><strong>Objective: </strong>Many children with progressive myopia are still prescribed single-vision correction. An investigation into UK eyecare practitioners' (ECPs) perceptions of myopia management was carried out to ascertain factors which may be limiting its implementation and uptake within clinical practice.</p><p><strong>Methods and analysis: </strong>Online focus groups were held with UK ECPs. Participants were encouraged to discuss their knowledge of the available myopia management options, their perception of how myopia management is being delivered in the UK and any barriers limiting ECPs' prescribing of these management options in practice. The discussions were transcribed and analysed thematically.</p><p><strong>Results: </strong>Focus groups were held with 41 ECPs from primary and secondary eyecare. ECPs felt that provision of myopia management in the UK is variable. Most ECPs believe they have sufficient knowledge, but felt a lack of confidence in decision-making and practical experience. Less experienced ECPs sought more definitive guidance to support their decision-making. ECPs desired clarity on their duty of care obligations and were concerned over possible future litigation if they had not offered, or referred for, myopia management when indicated. The greatest barrier appears to be financial-treatment is expensive and ECPs are uncomfortable communicating this to parents. Many barriers were indicative of systemic problems within UK eyecare, such as commercial pressures, inadequate National Health Service funding and poor public awareness of paediatric eyecare.</p><p><strong>Conclusion: </strong>Myopia management is not implemented consistently across the UK. To improve accessibility, changes are required at multiple levels, from individual ECPs through to wider stakeholders in UK eyecare provision.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10806590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139432073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of an artificial intelligence phone call for postoperative care following cataract surgery in a diverse population: two phase prospective study protocol.","authors":"Amin Hatamnejad, Aisling Higham, Sohel Somani, Eric S Tam, Ernest Lim, Sarah Khavandi, Nick de Pennington, Hannah H Chiu","doi":"10.1136/bmjophth-2023-001475","DOIUrl":"10.1136/bmjophth-2023-001475","url":null,"abstract":"<p><strong>Introduction: </strong>Artificial intelligence (AI) development has led to improvements in many areas of medicine. Canada has workforce pressures in delivering cataract care. A potential solution is using AI technology that can automate care delivery, increase effectiveness and decrease burdens placed on patients and the healthcare system. This study assesses the use of 'Dora', an example of an AI assistant that is able to deliver a regulated autonomous, voice-based, natural-language consultation with patients over the telephone. Dora is used in routine practice in the UK, but this study seeks to assess the safety, usability, acceptability and cost-effectiveness of using the technology in Canada.</p><p><strong>Methods and analysis: </strong>This is a two-phase prospective single-centred trial. An expected 250 patients will be recruited for each phase of the study. For Phase I of the study, Dora will phone patients at postoperative week 1 and for Phase II of the study, Dora will phone patients within 24hours of their cataract surgery and again at postoperative week 1. We will evaluate the agreement between Dora and a supervising clinician regarding the need for further review based on the patients' symptoms. A random sample of patients will undergo the System Usability Scale followed by an extended semi-structured interview. The primary outcome of agreement between Dora and the supervisor will be assessed using the kappa statistic. Qualitative data from the interviews will further gauge patient opinions about Dora's usability, appropriateness and level of satisfaction.</p><p><strong>Ethics and dissemination: </strong>Research Ethics Board William Osler Health System (ID: 22-0044) has approved this study and will be conducted by guidelines of Declaration of Helsinki. Master-linking sheet will contain the patient chart identification (ID), full name, date of birth and study ID. Results will be shared through peer-reviewed journals and presentations at conferences.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10806655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139416412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between dry eye disease and sleep quality: a cross-sectional analysis.","authors":"Mohammad Ayoubi, Kimberly Cabrera, Simran Mangwani, Elyana Vittoria Tessa Locatelli, Anat Galor","doi":"10.1136/bmjophth-2023-001584","DOIUrl":"10.1136/bmjophth-2023-001584","url":null,"abstract":"<p><strong>Background/aims: </strong>To investigate relationships between dry eye (DE) disease and sleep quality, with a focus on which aspects of sleep most closely relate to DE.</p><p><strong>Methods: </strong>141 veterans (mean age: 56±5) seen at the Miami Veterans Affairs eye clinic filled out questionnaires to quantify the severity of DE symptoms (5-Item Dry Eye Questionnaire (DEQ-5) and Ocular Surface Disease Index (OSDI)) and ocular pain (Numerical Rating Scale (NRS) and Neuropathic Pain Symptom Inventory modified for the Eye (NPSI-E)). All individuals also underwent an ocular surface examination. Aspects of sleep quality were assessed using the Pittsburgh Sleep Quality Index (PSQI). DE metrics were examined by PSQI scores and subscores.</p><p><strong>Results: </strong>Most participants (76%) reported mild or greater DE symptoms (DEQ-5 ≥6). Overall, ocular symptoms were more related to sleep metrics than signs. The strongest DE symptom association was between the OSDI and sleep disturbances (PSQI subscore 5, r=0.49, p<0.0005). For DE signs, ocular surface inflammation and meibum quality were related to subjective sleep quality (PSQI subscore 1, r=0.29, p=0.03, for both). On linear regression analyses, most ocular symptom questionnaires remained associated with sleep disturbances (PSQI subscore 5: NRS (r=0.52, p<0.0005), DEQ-5 (r=0.36, p<0.0005), and OSDI (r=0.31, p<0.0005)). For DE signs, ocular surface inflammation and meibum quality remained associated with subjective sleep quality (r=0.26, p=0.01; r=0.46, p<0.0005, respectively).</p><p><strong>Conclusion: </strong>DE symptom and ocular pain intensity were closely related to sleep metrics, most strongly to sleep disturbances. Relationships were weaker for DE signs, with subjective sleep quality relating to inflammation and meibum quality.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139097345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance outcomes from a DMEK peeling and preparation wet lab","authors":"Mohit Parekh, Alexander George Wallace, Matteo Airaldi, Alessandro Ruzza, Stefano Ferrari, Vito Romano, Sajjad Ahmad","doi":"10.1136/bmjophth-2023-001540","DOIUrl":"https://doi.org/10.1136/bmjophth-2023-001540","url":null,"abstract":"Objective To evaluate the Descemet membrane endothelial keratoplasty (DMEK) preparation performance of trainee surgeons in an ex vivo human donor cornea DMEK wet lab simulation setting. Methods Human donor corneoscleral rims unsuitable for transplantation were obtained from Moorfields Lions Eye Bank. At the wet lab, graft stripping was performed by scoring the peripheral endothelium. The trypan blue positive cells (TBPC) and cell density (cells/mm2—reticule count) were counted manually before and after stripping. The procedural time, peripheral and central tears and complete peel-off were also recorded and analysed. Results Eight trainee surgeons attended the wet lab each attempting three DMEKs. Between the first and last attempts a significant decrease was seen in the procedural time (17.6 min vs 10.6 min (p<0.05)) and the TBPC % (12.9% vs 3.8% (p<0.05)). The percentage of tears peripherally and centrally also reduced between the first and the last trials (50% vs 13% (p=0.2226) and 38% vs 0% (p=0.1327)). A significant correlation was found between longer peeling times and higher TBPC % (p<0.001) with a 0.7% endothelial mortality increase for each additional minute required to complete the peel. Conclusions DMEK wet labs provide a controlled risk-free learning opportunity for trainee surgeons to improve confidence and competence. Wet labs improve the success rate of DMEK graft preparation as well as flatten the learning curve. This emphasises the importance of continued support for the expansion of this valuable learning resource, promoting wider uptake of DMEK surgery. No data are available.","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139557225","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}

{"title":"Incident glaucoma and ocular hypertension after periocular and intravitreal steroid injections: a claims-based analysis.","authors":"Ashley Polski, Katy C Liu, Divakar Gupta, Dilraj S Grewal, Joshua Horns, Barbara M Wirostko, Brian C Stagg","doi":"10.1136/bmjophth-2023-001508","DOIUrl":"10.1136/bmjophth-2023-001508","url":null,"abstract":"<p><strong>Background/aims: </strong>This study aims to determine the incidence and risk of open-angle glaucoma or ocular hypertension (OHT) following ocular steroid injections using healthcare claims data.</p><p><strong>Methods: </strong>We retrospectively reviewed deidentified insurance claims data from the IBM MarketScan Database to identify 19 156 adult patients with no prior history of glaucoma who received ocular steroid injections between 2011 and 2020. Patient demographics and steroid treatment characteristics were collected. Postinjection glaucoma/OHT development was defined as a new diagnosis of glaucoma/OHT, initiation of glaucoma drops, and/or surgical or laser glaucoma treatment. Cox proportional hazards models were used to determine the risk of glaucoma/OHT development within 5 years after first steroid injection.</p><p><strong>Results: </strong>Overall, 3932 (20.5%) patients were diagnosed with new glaucoma/OHT, 3345 (17.5%) started glaucoma drops and 435 (2.27%) required a laser or surgical glaucoma procedure within 5 years of first steroid injection. Triamcinolone subconjunctival injections were associated with a lower risk of glaucoma/OHT development than retrobulbar or intravitreal steroid injections (p<0.001, HR 0.68, 95% CI 0.59 to 0.79), whereas the 0.59 mg fluocinolone acetonide intravitreal implant had the highest risk of glaucoma/OHT development (p=0.001, HR 2.01, 95% CI 1.34 to 3.02). The risk of glaucoma/OHT development was also higher for patients receiving multiple steroid injections (p<0.001), with the largest increase in risk occurring after three total steroid injections.</p><p><strong>Conclusion: </strong>Patients receiving ocular steroid injections are at risk of developing glaucoma/OHT, even with no prior glaucoma/OHT diagnosis or treatment. Patients should be closely monitored for the development of glaucoma following ocular steroid injections, particularly in the setting of intravitreal and/or repeated steroid administration.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138884481","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}

{"title":"Real-world evaluation of smartphone-based artificial intelligence to screen for diabetic retinopathy in Dominica: a clinical validation study.","authors":"Oliver Kemp, Covadonga Bascaran, Edyta Cartwright, Lauren McQuillan, Nanda Matthew, Hazel Shillingford-Ricketts, Marcia Zondervan, Allen Foster, Matthew Burton","doi":"10.1136/bmjophth-2023-001491","DOIUrl":"10.1136/bmjophth-2023-001491","url":null,"abstract":"<p><strong>Objective: </strong>Several artificial intelligence (AI) systems for diabetic retinopathy screening have been validated but there is limited evidence on their performance in real-world settings. This study aimed to assess the performance of an AI software deployed within the diabetic retinopathy screening programme in Dominica.</p><p><strong>Methods and analysis: </strong>We conducted a prospective, cross-sectional clinical validation study. Patients with diabetes aged 18 years and above attending the diabetic retinopathy screening in primary care facilities in Dominica from 5 June to 3 July 2021 were enrolled.Grading was done at the point of care by the field grader, followed by counselling and referral to the eye clinic. Images were then graded by an AI system. Sensitivity, specificity with 95% CIs and area under the curve (AUC) were calculated for comparing the AI to field grader as gold standard.</p><p><strong>Results: </strong>A total of 587 participants were screened. The AI had a sensitivity and specificity for detecting referable diabetic retinopathy of 77.5% and 91.5% compared with the grader, for all participants, including ungradable images. The AUC was 0.8455. Excluding 52 participants deemed ungradable by the grader, the AI had a sensitivity and specificity of 81.4% and 91.5%, with an AUC of 0.9648.</p><p><strong>Conclusion: </strong>This study provides evidence that AI has the potential to be deployed to assist a diabetic screening programme in a middle-income real-world setting and perform with reasonable accuracy compared with a specialist grader.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138884482","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}

{"title":"Classification of diabetic maculopathy based on optical coherence tomography images using a Vision Transformer model.","authors":"Liwei Cai, Chi Wen, Jingwen Jiang, Congbi Liang, Hongmei Zheng, Yu Su, Changzheng Chen","doi":"10.1136/bmjophth-2023-001423","DOIUrl":"10.1136/bmjophth-2023-001423","url":null,"abstract":"<p><strong>Purpose: </strong>To develop a Vision Transformer model to detect different stages of diabetic maculopathy (DM) based on optical coherence tomography (OCT) images.</p><p><strong>Methods: </strong>After removing images with poor quality, a total of 3319 OCT images were extracted from the Eye Center of the Renmin Hospital of Wuhan University and randomly split the images into training and validation sets in a 7:3 ratio. All macular cross-sectional scan OCT images were collected retrospectively from the eyes of DM patients from 2016 to 2022. One of the OCT stages of DM, including early diabetic macular oedema (DME), advanced DME, severe DME and atrophic maculopathy, was labelled on the collected images, respectively. A deep learning (DL) model based on Vision Transformer was trained to detect four OCT grading of DM.</p><p><strong>Results: </strong>The model proposed in our paper can provide an impressive detection performance. We achieved an accuracy of 82.00%, an F1 score of 83.11%, an area under the receiver operating characteristic curve (AUC) of 0.96. The AUC for the detection of four OCT grading (ie, early DME, advanced DME, severe DME and atrophic maculopathy) was 0.96, 0.95, 0.87 and 0.98, respectively, with an accuracy of 90.87%, 89.96%, 94.42% and 95.13%, respectively, a precision of 88.46%, 80.31%, 89.42% and 87.74%, respectively, a sensitivity of 87.03%, 88.18%, 63.39% and 89.42%, respectively, a specificity of 93.02%, 90.72%, 98.40% and 96.66%, respectively and an F1 score of 87.74%, 84.06%, 88.18% and 88.57%, respectively.</p><p><strong>Conclusion: </strong>Our DL model based on Vision Transformer demonstrated a relatively high accuracy in the detection of OCT grading of DM, which can help with patients in a preliminary screening to identify groups with serious conditions. These patients need a further test for an accurate diagnosis, and a timely treatment to obtain a good visual prognosis. These results emphasised the potential of artificial intelligence in assisting clinicians in developing therapeutic strategies with DM in the future.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138884480","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}