1
|
Zhang J, Lin S, Cheng T, Xu Y, Lu L, He J, Yu T, Peng Y, Zhang Y, Zou H, Ma Y. RETFound-enhanced community-based fundus disease screening: real-world evidence and decision curve analysis. NPJ Digit Med 2024; 7:108. [PMID: 38693205 PMCID: PMC11063045 DOI: 10.1038/s41746-024-01109-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 04/12/2024] [Indexed: 05/03/2024] Open
Abstract
Visual impairments and blindness are major public health concerns globally. Effective eye disease screening aided by artificial intelligence (AI) is a promising countermeasure, although it is challenged by practical constraints such as poor image quality in community screening. The recently developed ophthalmic foundation model RETFound has shown higher accuracy in retinal image recognition tasks. This study developed an RETFound-enhanced deep learning (DL) model for multiple-eye disease screening using real-world images from community screenings. Our results revealed that our DL model improved the sensitivity and specificity by over 15% compared with commercial models. Our model also shows better generalisation ability than AI models developed using traditional processes. Additionally, decision curve analysis underscores the higher net benefit of employing our model in both urban and rural settings in China. These findings indicate that the RETFound-enhanced DL model can achieve a higher net benefit in community-based screening, advocating its adoption in low- and middle-income countries to address global eye health challenges.
Collapse
Affiliation(s)
- Juzhao Zhang
- Shanghai Eye Disease Prevention & Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China
- National Clinical Research Center for Eye Disease, Shanghai, China
- Shanghai Engineering Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Senlin Lin
- Shanghai Eye Disease Prevention & Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China
- National Clinical Research Center for Eye Disease, Shanghai, China
- Shanghai Engineering Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Tianhao Cheng
- School of Computer Science, Shanghai Key Laboratory of Intelligent Information Processing, Fudan University, Shanghai, China
| | - Yi Xu
- Shanghai Eye Disease Prevention & Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China
- National Clinical Research Center for Eye Disease, Shanghai, China
- Shanghai Engineering Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Lina Lu
- Shanghai Eye Disease Prevention & Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China
- National Clinical Research Center for Eye Disease, Shanghai, China
- Shanghai Engineering Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
| | - Jiangnan He
- Shanghai Eye Disease Prevention & Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Tao Yu
- Shanghai Eye Disease Prevention & Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yajun Peng
- Shanghai Eye Disease Prevention & Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yuejie Zhang
- School of Computer Science, Shanghai Key Laboratory of Intelligent Information Processing, Fudan University, Shanghai, China.
| | - Haidong Zou
- Shanghai Eye Disease Prevention & Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China.
- National Clinical Research Center for Eye Disease, Shanghai, China.
- Shanghai Engineering Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China.
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yingyan Ma
- Shanghai Eye Disease Prevention & Treatment Center/ Shanghai Eye Hospital, School of Medicine, Tongji University, Shanghai, China.
- National Clinical Research Center for Eye Disease, Shanghai, China.
- Shanghai Engineering Center of Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China.
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
2
|
Gour N, Tanveer M, Khanna P. Challenges for ocular disease identification in the era of artificial intelligence. Neural Comput Appl 2022. [DOI: 10.1007/s00521-021-06770-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
3
|
Tauscher RG, Simon SS, Volpe NJ. Retinal disease in the neurology clinic. Curr Opin Neurol 2021; 34:122-132. [PMID: 33278143 DOI: 10.1097/wco.0000000000000883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Retinal disease can manifest with visual symptoms similar to those which result from central nervous system disorders. We provide a framework for considering retinal causes of common visual complaints presenting to a neurology clinic. RECENT FINDINGS Technological advances have afforded quicker detection and a more thorough understanding of these retinal entities and are crucial to consider when evaluating visual complaints in the neurology clinic. SUMMARY It is essential to maintain a working knowledge of common retinal conditions that symptomatically overlap with common neurologic conditions. Furthermore, the ophthalmoscopic exam and retinal imaging modalities can both aid in the diagnosis and workup of visual complaints and neurologic disease.
Collapse
Affiliation(s)
| | - Shira S Simon
- Department of Ophthalmology
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | |
Collapse
|
4
|
Lin TC, Chiang YH, Hsu CL, Liao LS, Chen YY, Chen SJ. Image quality and diagnostic accuracy of a handheld nonmydriatic fundus camera: Feasibility of a telemedical approach in screening retinal diseases. J Chin Med Assoc 2020; 83:962-966. [PMID: 32649414 PMCID: PMC7526587 DOI: 10.1097/jcma.0000000000000382] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND A suitable fundus camera for telemedicine screening can expand the scale of eye care service. The purpose of this study was to compare a handheld nonmydriatic digital fundus camera and a conventional mydriatic fundus camera according to the image quality of their photographs and usability of those photographs to accurately diagnose various retinal diseases. METHODS A handheld nonmydriatic fundus camera and conventional fundus camera were used to take fundus photographs of outpatients at an ophthalmic clinic before and after pupillary dilation. Image quality and diagnostic agreement of the photos were graded by two masked and experienced retinal specialists. RESULTS A total of 867 photographs of 393 eyes of 200 patients were collected. Approximately 80% of photos taken under nonmydriasis status using the handheld nonmydriatic fundus camera had good (55.7%) or excellent (22.7%) image quality. The overall agreement of diagnoses between the doctors was more than 90%. When the handheld nonmydriatic fundus camera was used after mydriasis, the proportion of images with good (45%) or excellent (49.7%) quality reached 94.7% and diagnostic agreement was 93.4%. Lens opacity was associated with the quality of images obtained using the handheld camera (p = 0.041), and diagnosis disagreement for handheld camera images was associated with preexisting diabetes diagnosis (p = 0.009). Approximately 40% of patients expressed preference for use of the handheld nonmydriatic camera. CONCLUSION This study demonstrated the effectiveness of the handheld nonmydriatic fundus camera in clinical practice and its feasibility for telemedicine screening of retinal diseases.
Collapse
Affiliation(s)
- Tai-Chi Lin
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yueh-Hua Chiang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chih-Lu Hsu
- Medimaging Integrated Solution Inc., Hsinchu, Taiwan, ROC
| | | | - Yi-Ying Chen
- Medimaging Integrated Solution Inc., Hsinchu, Taiwan, ROC
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang-Ming University Taipei, Taiwan, ROC
- Address correspondence. Dr. Shih-Jen Chen, Department of Ophthalmology, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail address: (S.-J. Chen)
| |
Collapse
|
5
|
Alm M, Hautala N, Bloigu R, Huhtakangas J. Comparison of optic disc evaluation methods in neurology emergency patients. Acta Neurol Scand 2019; 140:449-451. [PMID: 31518442 DOI: 10.1111/ane.13167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The optic disc examination is critical for the diagnostics of several acute neurological disorders. However, dilation of the pupil is not recommended for neurological patients, which complicates ophthalmoscopy. AIMS OF THE STUDY Present pilot study compared a portable fundus camera to an ophthalmoscope in fundus examinations of neurological emergency patients. To our knowledge, this is the first comparative study of the subject. The fundus photographs were later reviewed with an ophthalmologist. METHODS The study included 60 adults, volunteer neurological emergency patients with either headache, cerebrovascular disorder, or acute confusional state (delirium). Patients' non-mydriatic fundus examination was conducted with an ophthalmoscope and a Smartscope Pro fundus camera. RESULTS Fundus photography succeeded in 56 (93%), partially succeeded in 2 (3%), and failed in 2 (3%) cases compared with ophthalmoscopy that succeeded in 35 (58%), partially succeeded in 14 (23%), and failed in 11 (18%) cases (P < .0005). The researcher and the ophthalmologist agreed in the findings in 54 out of 58 cases (93%). In six cases (7%), the researcher had failed to detect a non-critical ophthalmic finding. CONCLUSIONS The neurological fundus examination by fundus camera seems to be superior to regular ophthalmoscopy in defining the critical optic disc findings in emergency patients.
Collapse
Affiliation(s)
| | - Nina Hautala
- Department of Ophthalmology PEDEGO Research Unit and Medical Research Centre University of Oulu and Oulu University Hospital Oulu Finland
| | - Risto Bloigu
- Medical Informatics Group University of Oulu Oulu Finland
| | | |
Collapse
|
6
|
Affiliation(s)
- Susan P Mollan
- Birmingham Neuro-Ophthalmology Unit, University Hospitals Birmingham NHS Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
- Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Institute of Translational Medicine, Birmingham Health Partners, University of Birmingham, UK
| | - David Spitzer
- PHGH Doctors, Temple Fortune Medical Centre, London, UK
| | - David J Nicholl
- Department of Neurology, City Hospital, Birmingham, UK
- Department of Neurology, University Hospitals Birmingham NHS Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| |
Collapse
|
7
|
Gosheva M, Klameth C, Norrenberg L, Clin L, Dietter J, Haq W, Ivanov IV, Ziemssen F, Leitritz MA. Quality and learning curve of handheld versus stand-alone non-mydriatic cameras. Clin Ophthalmol 2017; 11:1601-1606. [PMID: 28919703 PMCID: PMC5587188 DOI: 10.2147/opth.s140064] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Nowadays, complex digital imaging systems allow detailed retinal imaging without dilating patients’ pupils. These so-called non-mydriatic cameras have advantages in common circumstances (eg, for screening or emergency purposes) but present limitations in terms of image quality and field of view. We compare the usefulness of two non-mydriatic camera systems (ie, a handheld versus a stand-alone device) for fundus imaging. The primary outcome was image quality. The secondary outcomes were learning effects and quality grade-influencing factors. Methods The imaging procedures followed standard protocol and were all performed by the same investigator. Camera 1 (DRS®) was a stand-alone system, while Camera 2 (Smartscope® PRO) was a mobile system. In order to evaluate possible learning effects, we selected an examiner with no prior training in the use of these systems. The images were graded separately by two experienced and “blinded” ophthalmologists following a defined protocol. Results In total, 211 people were enrolled. Quality grade comparisons showed significantly better grades for Camera 1. Both systems achieved better quality grades for macular images than for disc-centered images. No remarkable learning effects could be demonstrated. Conclusions Both camera systems are useful for fundus imaging. The greater mobility of Camera 2 was associated with lower image quality. For screening scenarios or telemedicine, it must be determined whether image quality or mobility is more important.
Collapse
Affiliation(s)
- Mariya Gosheva
- University Eye Hospital, Centre for Ophthalmology, Tuebingen
| | | | - Lars Norrenberg
- Department of Obstetrics and Gynecology, Klinikum am Steinenberg, District Hospital Reutlingen, Reutlingen
| | - Lucien Clin
- School of Informatics, Reutlingen University
| | - Johannes Dietter
- Division of Experimental Ophthalmology, Centre for Ophthalmology, Institute for Ophthalmic Research
| | - Wadood Haq
- Division of Experimental Ophthalmology, Centre for Ophthalmology, Institute for Ophthalmic Research
| | - Iliya V Ivanov
- Division of Experimental Ophthalmology, Centre for Ophthalmology, Institute for Ophthalmic Research.,Vision Rehabilitation Research Unit, Centre for Ophthalmology, University Eye Hospital, Eberhard Karls.,ZEISS Vision Science Lab, Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tuebingen
| | - Focke Ziemssen
- University Eye Hospital, Centre for Ophthalmology, Tuebingen
| | - Martin A Leitritz
- Section for Experimental Ophthalmic Surgery and Refractive Surgery, University Eye Hospital, Centre for Ophthalmology, Tuebingen, Germany
| |
Collapse
|