Smart Eye Camera: A Validation Study for Evaluating the Tear Film Breakup Time in Human Subjects

Reliability and Accuracy of Smart Eye Camera in Determining Grading of Nuclear Cataract

PURPOSE

Cataracts are the cause of more than 50% of blindness in the world. Cataract is diagnosed using a slit lamp to evaluate the opacity of the lens. Slit lamps as the primary tools cataract are not available in primary care units. Smart Eye Camera (SEC) is a medical device placed on smartphone, capable of creating slit beam similar to conventional slit lamp. Previous studies have been conducted in Japan. We wanted to further compare ocular examination between SEC and conventional slit lamp with samples taken from UPTD Eye Clinic Ambon Vlissingen in Indonesia.

METHODS

Observational analytical study with a cross-sectional study design. The research sample consisted of 67 people selected by consecutive sampling. All samples were examined for cataracts using a conventional slit lamp and SEC. To evaluate the accuracy of SEC, diagnosis of cataract was carried out by one observer based on slit-lamp images. The results of examinations were then compared with the examinations by two observers based on the SEC video, where the videos were read two times in a span of 1 week.

RESULTS

Sixty-seven eye samples were taken with average age of 61.76 ± 5.83 years, visual acuity was 0.07 ± 0.12, intraocular pressure was 14.12 ± 2.06 mmHg, and SEC video duration was 4.15 ± 1.09 seconds. SEC intraobserver reliability has a κ of 0.795/0.818, SEC interobserver reliability has a κ of 0.795/0.817. SEC assessment accuracy for observer 1 has a κ of 0.606/0.681 and for observer 2 has a κ of 0.629/0.717, with the highest accuracy for cataract grade 3 (86.67% and 91.18%, respectively).

CONCLUSIONS

This study shows SEC has good consistency and reliability in assessing the degree of nuclear cataract compared to conventional slit lamp. This tool could be used for cataract screening in remote areas.

Validation and optimization of smart eye camera as teleophthalmology device for the reduction of preventable and treatable blindness in Nigeria

BACKGROUND/OBJECTIVES

Limited resources and staffing hinders efforts to reduce preventable blindness, especially in low- to middle-income countries. The slit-lamp examination (SLE), which is essential for ophthalmology practices, is often unavailable in primary and secondary eye care facilities due to the high costs and lengthy training required for operation. We conducted a cross-sectional, multicentre study exploring the potential for a smart eye camera (SEC; a tele-ophthalmology handheld device developed by OUI Inc., Japan) to address the limitations of the SLE.

SUBJECT/METHODS

Ocular diagnoses, visual acuity assessments and examinations of the eyes were performed independently using both a conventional SLE and a SEC. Four independent assessors (blind to the study) reviewed the images captured by the SEC and the SLE as administered by separate investigators. All analyses were performed using R version 4.2.2 for macOS at a 5% level of statistical significance.

RESULTS

The results of the image quality analysis demonstrated that the number of higher-quality images was significantly higher (p < 0.05) for the images captured using the SEC device compared to the SLE machine. Remarkably, up to 96% accuracy of diagnosis was recorded with SEC. Evaluation of diagnostic accuracy rates derived from images obtained from both machines revealed a degree of divergence in assessments among evaluators, yielding a Fleiss's Kappa value of 0.092. The sensitivity analysis for the SEC device revealed a reasonably strong capacity to correctly identify true positive cases, with an average sensitivity score of 90%.

CONCLUSION

The results of this study indicate that SEC can effectively evaluate anterior segment lesions in ophthalmology.

Successful Transition From Topical Ophthalmic Drops to Cream Formulation in the Management of Mild Allergic Conjunctivitis: A Case Report

This case report highlights the successful transition from epinastine eye drops to a novel epinastine eyelid cream in managing mild allergic conjunctivitis. A 33-year-old Japanese female with mild allergic conjunctivitis, previously managed with 0.1% epinastine hydrochloride eye drops, requested an alternative formulation due to daily contact lens wear. Treatment was changed to a once-daily application of 0.5% epinastine hydrochloride eyelid cream. Clinical assessment and symptom evaluation were performed at baseline and after 28 days using slit-lamp examination and the Japanese Allergic Conjunctival Disease Quality of Life Questionnaire. Following the transition, the patient's clinical signs (mild conjunctival hyperemia and moderate papillae) and subjective symptoms (itching and mild discomfort) remained stable. Slit-lamp examination showed no corneal or limbal pathology, and tear fluid immunoglobulin E (IgE) testing remained positive, consistent with mild allergic conjunctivitis. No adverse effects or cutaneous reactions were observed. This case suggests that epinastine eyelid cream may serve as an effective once-daily alternative to conventional eye drops in mild allergic conjunctivitis. While this represents the first documented successful transition between delivery methods, larger clinical trials are warranted to confirm these findings and explore applications across various presentations and severities of allergic ocular disease.

Clinical evaluation of corneal ulcer with a portable and smartphone-attachable slit lamp device: Smart Eye Camera

Corneal ulcer is one of the most important ophthalmic emergencies. A portable, recordable, and smartphone-attachable slit-lamp device called the "Smart Eye Camera" (SEC) is introduced to compare evaluating corneal ulcers between the SEC and the conventional slit-lamp. A total of 110 participants were included in the study, consisting of 55 patients with corneal ulcers and 55 age- and gender-matched healthy volunteers as controls. The participants were first subjected to examination by a conventional slit lamp. The video recording with SEC and imaging with a slit lamp were done by a non-medical person. Both SEC videos and slit-lamp photos were reported by two independent ophthalmologists and compared with a slit-lamp examination as a gold standard. The average age of the study participants was 48.85 ± 20.45 years and 68 participants (61.8%) were male. All corneal ulcers were detected by two ophthalmologists using SEC. Ulcer size evaluated in slit lamp and SEC horizontally (Intraclass Correlation Coefficient (ICC); 0.90, 95% CI; 0.84-0.94) and vertically (ICC; 0.90, 95% CI; 0.84-0.94) is correlated about 90%. Hypopyon size (ICC; 0.95, 95% CI; 0.92-0.97), and corneal epithelial defect (CED) size horizontally (ICC; 0.94, 95% CI; 0.91-0.96) and vertically (ICC; 0.94, 95% CI; 0.91-0.96) also correlated about 94%. The infiltration pattern evaluated by SEC was consistent with the pattern evaluated in slit lamps in more than 80% of patients. The SEC is so accurate in diagnosing corneal ulcers and its reliability makes it a valuable telemedicine device.

Epidemiological survey of anterior segment diseases in Japanese isolated island using a portable slit-lamp device in home-based cases in Miyako Island

The ophthalmic diseases often affect the elderly and require proper diagnosis, treatments, and follow ups. However, many cases lack adequate eye care due to limited resources and decreased daily living activities among individuals. Despite the importance of ophthalmic home care, epidemiological research in this area has been lacking. This study utilized portable ophthalmological equipment to conduct an epidemiological research of anterior segment diseases in patients receiving home-based medical care in Japanese isolated island "Miyako island". A retrospective examination was conducted on home visit cases from a single facility in Miyako island (Dr. Gon Clinic). Data from 147 cases were collected and analyzed which the data are all recorded by the home care doctors and send the data to the cloud in order to make a diagnosis by the ophthalmologists. Findings included various anterior segment eye diseases such as Ptosis, meibomian gland dysfunction, conjunctival chalasis, corneal opacity, conjunctival hyperemia, pterygium, and cataract. Notably, over half of the cases (51.67%) had not undergone cataract surgery although the average age are notably high (85.69 ± 12.11 age of years). Among those without surgery, all showed signs of moderate to severe cataracts, with severity increasing with age. Additionally, a shallow anterior chamber depth was observed in one-third of these cases (33.63%) which considerable to receive a surgery to prevent the acute glaucoma attack. From our study, to ensure that patients in remote islands as Miyako island do not miss opportunities for eye care, there is an urgent need for the establishment of a supportive medical system.

Evaluating the Effect of Image Enhancement on Diagnostic Reliability in Dry Eye Disease Using a Portable Imaging Device

BACKGROUND

This study aimed to evaluate the impact of image enhancement techniques on the interobserver reliability of tear break-up time (TBUT), tear meniscus height (TMH), corneal fluorescein staining (CFS) scoring, and conjunctivochalasis detection using the Smart Eye Camera (SEC), a portable device for anterior segment examination.

METHODS

A retrospective analysis was conducted on video recordings captured by the SEC from 46 patients with dry eye disease (DED). Separate sets of images were created for each level of enhancement: unenhanced (G0), mildly enhanced (G3), and strongly enhanced (G7). These sets were not intermixed, ensuring that each enhancement level was assessed independently. Three observers-two DED specialists and one general ophthalmologist-assessed TBUT, TMH, CFS scores, and conjunctivochalasis. Interobserver reliability was evaluated using intraclass correlation coefficients (ICCs) for each image set.

RESULTS

Interobserver reliability for CFS scores significantly improved with G3, yielding an ICC of 0.8413. In contrast, G7 improved reliability for TBUT measurements (ICC = 0.7381), but led to a notable decrease in reliability for both CFS scoring (ICC = 0.2259) and conjunctivochalasis detection (ICC = 0.0786). Furthermore, the assessment of TMH demonstrated a progressive decline in accuracy with increasing levels of image enhancement.

CONCLUSIONS

Image enhancement using the SEC improved the diagnostic consistency of dry eye specialists and general ophthalmologists, especially for TBUT and CFS assessments. However, excessive enhancement may obscure key diagnostic features, indicating the need for careful optimization of image processing techniques depending on the diagnostic focus.

Primary Angle Closure Observed During a House Visit: A Case Treated With Laser Iridotomy

Laser iridotomy (LI) is an effective treatment for patients with pupillary block mechanisms. Here, we report a case of LI performed on a patient with primary angle closure (PAC) and elevated intraocular pressure (IOP), who was unsuitable for other treatments due to specific social circumstances. The patient, a 97-year-old female residing in a private nursing home, had a medical history notable only for mild dementia and was wheelchair-bound. She had not undergone ophthalmologic evaluation for over 50 years. The patient presented with intermittent tenderness and redness in the left eye. Therefore, an ophthalmologist visited the nursing home. Examination revealed visual acuity of 20/200 in the right eye and 20/100 in the left eye, IOP of 24 mmHg in the right eye and 26 mmHg in the left eye, no conjunctival hyperemia, shallow anterior chambers, and nuclear sclerosis grade 4 cataracts in both eyes. Fundus examination was challenging due to lens opacity, and both optic nerve papillae appeared pale. Given her history of episodic eye pain and hyperemia, PAC was diagnosed. Treatment options, including eye drops and cataract surgery, were discussed. However, the patient opted for LI due to her advanced age and inability to attend frequent follow-up visits. LI was successfully performed on both eyes during her visit to the clinic. One week post-procedure, IOP decreased to 12 mmHg bilaterally, with no complications. This case demonstrates that LI can be a viable option for managing PAC and high IOP in patients who are not candidates for surgery or eye drops due to social constraints.

A Case of Traumatic Hyphema Diagnoses by Telemedicine Between a Remote Island and the Mainland of Tokyo

Chichijima Island, part of the Ogasawara Islands in Tokyo, is a remote island with a population of approximately 2,000, served by a few resident general practitioners (GPs). This case report discusses the application of teleophthalmology in managing pediatric ocular trauma on this remote island. A pediatric patient sustained an ocular injury from a badminton shuttlecock and was initially examined by a resident GP using a recordable slit-lamp microscope. The ocular images were transmitted to a mainland ophthalmologist through a telemedicine system. The specialist provided remote consultation and recommended further examination and treatment, leading to the patient's transfer to the mainland. The successful management of this case underscores the critical role of telemedicine in enhancing healthcare delivery in isolated regions. With advancements in medical technology, teleophthalmology is expected to become increasingly vital in providing specialized care in remote and underserved areas. The case highlights the importance of telemedicine in improving access to specialized medical expertise, ensuring timely and effective patient care, and potentially reducing the need for patient transfers to more equipped healthcare facilities.

Development of the AI Pipeline for Corneal Opacity Detection

Ophthalmological services face global inadequacies, especially in low- and middle-income countries, which are marked by a shortage of practitioners and equipment. This study employed a portable slit lamp microscope with video capabilities and cloud storage for more equitable global diagnostic resource distribution. To enhance accessibility and quality of care, this study targets corneal opacity, which is a global cause of blindness. This study has two purposes. The first is to detect corneal opacity from videos in which the anterior segment of the eye is captured. The other is to develop an AI pipeline to detect corneal opacities. First, we extracted image frames from videos and processed them using a convolutional neural network (CNN) model. Second, we manually annotated the images to extract only the corneal margins, adjusted the contrast with CLAHE, and processed them using the CNN model. Finally, we performed semantic segmentation of the cornea using annotated data. The results showed an accuracy of 0.8 for image frames and 0.96 for corneal margins. Dice and IoU achieved a score of 0.94 for semantic segmentation of the corneal margins. Although corneal opacity detection from video frames seemed challenging in the early stages of this study, manual annotation, corneal extraction, and CLAHE contrast adjustment significantly improved accuracy. The incorporation of manual annotation into the AI pipeline, through semantic segmentation, facilitated high accuracy in detecting corneal opacity.

Smartphone Eye Examination: Artificial Intelligence and Telemedicine

Background: The current medical scenario is closely linked to recent progress in telecommunications, photodocumentation, and artificial intelligence (AI). Smartphone eye examination may represent a promising tool in the technological spectrum, with special interest for primary health care services. Obtaining fundus imaging with this technique has improved and democratized the teaching of fundoscopy, but in particular, it contributes greatly to screening diseases with high rates of blindness. Eye examination using smartphones essentially represents a cheap and safe method, thus contributing to public policies on population screening. This review aims to provide an update on the use of this resource and its future prospects, especially as a screening and ophthalmic diagnostic tool. Methods: In this review, we surveyed major published advances in retinal and anterior segment analysis using AI. We performed an electronic search on the Medical Literature Analysis and Retrieval System Online (MEDLINE), EMBASE, and Cochrane Library for published literature without a deadline. We included studies that compared the diagnostic accuracy of smartphone ophthalmoscopy for detecting prevalent diseases with an accurate or commonly employed reference standard. Results: There are few databases with complete metadata, providing demographic data, and few databases with sufficient images involving current or new therapies. It should be taken into consideration that these are databases containing images captured using different systems and formats, with information often being excluded without essential detailing of the reasons for exclusion, which further distances them from real-life conditions. The safety, portability, low cost, and reproducibility of smartphone eye images are discussed in several studies, with encouraging results. Conclusions: The high level of agreement between conventional and a smartphone method shows a powerful arsenal for screening and early diagnosis of the main causes of blindness, such as cataract, glaucoma, diabetic retinopathy, and age-related macular degeneration. In addition to streamlining the medical workflow and bringing benefits for public health policies, smartphone eye examination can make safe and quality assessment available to the population.

Feasibility of Tear Meniscus Height Measurements Obtained with a Smartphone-Attachable Portable Device and Agreement of the Results with Standard Slit Lamp Examination

PURPOSE

We aimed to evaluate the feasibility of using a novel device, the Smart Eye Camera (SEC), for assessing tear meniscus height (TMH) after fluorescein staining and the agreement of the results with measurements obtained using standard slit lamp examination.

METHODS

TMH was assessed using both SEC and conventional slit lamp examination. The images were analyzed using the software ImageJ 1.53t (National Institutes of Health, Bethesda, MD, USA). A common measurement unit scale was established based on a paper strip, which was used as a calibration marker to convert pixels into metric scale. A color threshold was applied using uniform parameters for brightness, saturation, and hue. The images were then binarized to black and white to enhance the representation of the tear menisci. A 2 mm area around the upper and lower meniscus in the central eye lid zone was selected and magnified 3200 times to facilitate manual measurement. The values obtained using SEC were compared with those obtained with a slit lamp.

RESULTS

The upper and lower TMH values measured using the SEC were not statistically different from those obtained with a slit lamp (0.209 ± 0.073 mm vs. 0.235 ± 0.085, p = 0.073, and 0.297 ± 0.168 vs. 0.260 ± 0.173, p = 0.275, respectively). The results of Bland-Altman analysis demonstrated strong agreement between the two instruments, with a mean bias of -0.016 mm (agreement limits: -0.117 to 0.145 mm) for upper TMH and 0.031 mm (agreement limits: -0.306 to 0.368 mm) for lower TMH.

CONCLUSIONS

The SEC demonstrated sufficient validity and reliability for assessing TMH in healthy eyes in a clinical setting, demonstrating concordance with the conventional slit lamp examination.

Clinical Features of Sjögren Syndrome-Related Dry Eye Disease in Anterior Segment Photographs

PURPOSE

Dry eye disease (DED) is a major complication of autoimmune disorders, including Sjögren syndrome (SS), ocular graft-versus-host disease, and other rheumatic diseases. DED often affects patients' quality of life, necessitating early detection and treatment. However, no simple screening method for DED has yet been established in ophthalmologic practice. This retrospective study aimed to identify the characteristic features of SS-related DED from anterior segment images.

METHODS

Five hundred two cases (SS, 68 cases; ocular graft-versus-host disease, 50 cases; other conditions, 27 cases; simple DED, 72 cases; and no DED, 97 cases) were enrolled.

RESULTS

The inferior corneal fluorescein staining score (CFS_I) was significantly higher in the SS group ( P < 0.001). Moreover, the nasal lissamine green staining score (LG_N) was high in the SS group ( P < 0.001). The sensitivity, specificity, and area under the curve of the receiver operating characteristic curve were calculated for the CFS_I plus LG_N in relation to the SS-positive and SS-negative statuses; the sensitivity and specificity were 80.6% and 91.1%, respectively, with an area under the curve of 0.926.

CONCLUSIONS

A positive CFS_I combined with a positive LG_N correlates with a high risk for SS. A positive CFS_I and a positive LG_N are important signs for an immune-related DED, especially SS, and may be useful in the early detection of SS-related DED.

AI-based diagnosis of nuclear cataract from slit-lamp videos

In ophthalmology, the availability of many fundus photographs and optical coherence tomography images has spurred consideration of using artificial intelligence (AI) for diagnosing retinal and optic nerve disorders. However, AI application for diagnosing anterior segment eye conditions remains unfeasible due to limited standardized images and analysis models. We addressed this limitation by augmenting the quantity of standardized optical images using a video-recordable slit-lamp device. We then investigated whether our proposed machine learning (ML) AI algorithm could accurately diagnose cataracts from videos recorded with this device. We collected 206,574 cataract frames from 1812 cataract eye videos. Ophthalmologists graded the nuclear cataracts (NUCs) using the cataract grading scale of the World Health Organization. These gradings were used to train and validate an ML algorithm. A validation dataset was used to compare the NUC diagnosis and grading of AI and ophthalmologists. The results of individual cataract gradings were: NUC 0: area under the curve (AUC) = 0.967; NUC 1: AUC = 0.928; NUC 2: AUC = 0.923; and NUC 3: AUC = 0.949. Our ML-based cataract diagnostic model achieved performance comparable to a conventional device, presenting a promising and accurate auto diagnostic AI tool.

Telemedicine for Cornea and External Disease: A Scoping Review of Imaging Devices

OBJECTIVE

The objective of this scoping review is to understand the extent and type of evidence in relation to telemedicine imaging devices for cornea and external segment conditions.

INTRODUCTION

The coronavirus pandemic has emphasized the benefits of telemedicine in diagnosing and managing ocular diseases. With the rapid advancement of technology in slit lamp biomicroscopes, smartphones and other ocular surface imaging modalities, telemedicine applications for cornea and external diseases have become an active area of research.

INCLUSION CRITERIA

For studies to be included, they had to discuss the concept of imaging devices for cornea and external diseases in the context of telemedicine. There was no restriction on the studied population or participants.

METHODS

A scoping review was conducted according to an a priori protocol. Documents written in English were identified from the PubMed and Embase databases and searches. Anterior segment imaging devices were then classified into different categories.

RESULTS

Anterior segment imaging devices identified in this review included 19 slit lamp-based devices, 17 smartphone-based devices and 15 other devices. These tools can detect a wide variety of cornea and external diseases (e.g., pterygium, conjunctivitis, corneal opacity, corneal ulcer, and blepharitis). Fewer than half of the devices (24/51) were assessed for diagnostic performance. Their diagnostic accuracy varied greatly from condition to condition and from device to device. The inter-rater reliability of different photo-graders assessing images was assessed in only a few studies.

CONCLUSIONS

Anterior segment imaging devices are promising tools for remote diagnosis and management of patients with cornea and external disease. However, there are significant gaps in the literature regarding the diagnostic accuracy and inter-rater reliability of several devices. Future research with rigorous methods is required to validate the use of these devices in telemedicine settings.

Interobserver Reliability of Tear Break-Up Time Examination Using "Smart Eye Camera" in Indonesian Remote Area

Introduction

Dry eye disease (DED) is a multifactorial disease of tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability leading to decrease of vision, productivity and quality of life, and blindness. DED diagnosis remains difficult and underdiagnosed regarding inconsistency between subjective symptoms and clinical findings. Tear break-up time (TBUT) is an objective indicator of tear film stability in diagnostic DED. A novel smartphone attachment, namely SEC (smart eye camera), could mimic conventional slit lamp to assess TBUT and beneficial in facilitating DED diagnosis. Reliability between a non and an ophthalmologist in TBUT assessment and DED diagnosis is observed in this study.

Purpose

To determine interobserver reliability of TBUT measurement for diagnosing DED using SEC.

Design

This a cross-sectional analytic study involving 99 participants (198 eyes) aged 40 years who visited Pratama Gema Santi Hospital, Nusa Penida, from September 2nd to 4th, 2022, with consecutive sampling technique.

Methods

Fluoresceined eyes were filmed using the SEC device and apps, continued by masked ophthalmologist and resident assessing TBUT based on the video. The primary outcome is interobserver reliability for TBUT measurement and DED diagnosis.

Results

The mean age of participants was 55.22±9.78 years, 48.5% male and 51.5% female. The reliability of interobserver in assessing DED based on TBUT test is 0.78 (95% CI=0.31-1.26, P-value=0.001), and interobserver reliability in diagnosing DED based on OSDI and TBUT showed good agreement (weighted kappa=0.71). Good interobserver reliability underscores that non-ophthalmologists can diagnose DED based on TBUT video using SEC.

Conclusion

SEC video has good interobserver reliability to assess TBUT for DED diagnosis. SEC can be used as one of the methods in assessing DED in limited health care facilities. The high reliability of interobserver assessment indicates that DED diagnosis using video taken with SEC may be useful for telemedicine evaluation in remote areas.

Clinical observation of tear film breakup time with a novel smartphone-attachable technology

PURPOSE

To demonstrate the practicability of a portable instrument in assessing tear film breakup time (TFBUT): a lens attachment for smartphones (LAS).

METHODS

By applying LAS in combination with the iPhone 12 pro, and a recordable slit-lamp microscope, we obtained TFBUT videos from 58 volunteers. The comparison between the conventional slit-lamp microscope and LAS by an experienced ophthalmologist. Moreover, we also invited an ophthalmic postgraduate student and an undergraduate student with no clinical experience to assess TFBUT in those videos. The inter-observer reliability was assessed using intraclass correlation coefficients (ICC).

RESULTS

The TFBUT of 116 eyes in total was recorded. Reliability indexes were adequate. The Spearman's correlation analysis and the intraclass correlation coefficient suggested a strong correlation between the 2 modalities (Right eye: Spearman's r = 0.929, 95% confidence interval (CI) = 0.847-0.963, ICC = 0.978, p < 0.001; Left eye: Spearman's r = 0.931, 95% CI = 0.866-0.964, ICC = 0.985, p < 0.001;). Between instruments, the majority of TFBUT measurements showed good agreement on Bland Altman plot. A high concordance was observed in TFBUT, when assessed by an ophthalmologist and an ophthalmic postgraduate student (Left eye: LAS ICC = 0.951, p < 0.001; Left eye: slit-lamp microscope ICC = 0.944, p < 0.001).

CONCLUSIONS

Compared with the conventional slit-lamp microscope, the LAS has sufficient validity for evaluating TFBUT in clinics or at home.

Artificial intelligence to estimate the tear film breakup time and diagnose dry eye disease

The use of artificial intelligence (AI) in the diagnosis of dry eye disease (DED) remains limited due to the lack of standardized image formats and analysis models. To overcome these issues, we used the Smart Eye Camera (SEC), a video-recordable slit-lamp device, and collected videos of the anterior segment of the eye. This study aimed to evaluate the accuracy of the AI algorithm in estimating the tear film breakup time and apply this model for the diagnosis of DED according to the Asia Dry Eye Society (ADES) DED diagnostic criteria. Using the retrospectively corrected DED videos of 158 eyes from 79 patients, 22,172 frames were annotated by the DED specialist to label whether or not the frame had breakup. The AI algorithm was developed using the training dataset and machine learning. The DED criteria of the ADES was used to determine the diagnostic performance. The accuracy of tear film breakup time estimation was 0.789 (95% confidence interval (CI) 0.769-0.809), and the area under the receiver operating characteristic curve of this AI model was 0.877 (95% CI 0.861-0.893). The sensitivity and specificity of this AI model for the diagnosis of DED was 0.778 (95% CI 0.572-0.912) and 0.857 (95% CI 0.564-0.866), respectively. We successfully developed a novel AI-based diagnostic model for DED. Our diagnostic model has the potential to enable ophthalmology examination outside hospitals and clinics.

TFOS Lifestyle: Impact of the digital environment on the ocular surface

Eye strain when performing tasks reliant on a digital environment can cause discomfort, affecting productivity and quality of life. Digital eye strain (the preferred terminology) was defined as "the development or exacerbation of recurrent ocular symptoms and/or signs related specifically to digital device screen viewing". Digital eye strain prevalence of up to 97% has been reported, due to no previously agreed definition/diagnostic criteria and limitations of current questionnaires which fail to differentiate such symptoms from those arising from non-digital tasks. Objective signs such as blink rate or critical flicker frequency changes are not 'diagnostic' of digital eye strain nor validated as sensitive. The mechanisms attributed to ocular surface disease exacerbation are mainly reduced blink rate and completeness, partial/uncorrected refractive error and/or underlying binocular vision anomalies, together with the cognitive demand of the task and differences in position, size, brightness and glare compared to an equivalent non-digital task. In general, interventions are not well established; patients experiencing digital eye strain should be provided with a full refractive correction for the appropriate working distances. Improving blinking, optimizing the work environment and encouraging regular breaks may help. Based on current, best evidence, blue-light blocking interventions do not appear to be an effective management strategy. More and larger clinical trials are needed to assess artificial tear effectiveness for relieving digital eye strain, particularly comparing different constituents; a systematic review within the report identified use of secretagogues and warm compress/humidity goggles/ambient humidifiers as promising strategies, along with nutritional supplementation (such as omega-3 fatty acid supplementation and berry extracts).

Clinical Observation of Allergic Conjunctival Diseases with Portable and Recordable Slit-Lamp Device

BACKGROUND

The incidence of allergic conjunctival diseases (ACDs) is gradually increasing worldwide. Both ophthalmologists and non-ophthalmologists prescribe eye drops to treat ACDs; however, there are many cases which are treated without sufficient examination and diagnosis of the eyes. We have invented a portable, recordable, and smartphone-attachable slit-lamp device-Smart Eye Camera (SEC). The purpose of this study was to compare the diagnostic abilities of ACDs between the SEC and the conventional, non-portable slit-lamp microscope.

METHODS

This prospective observational study included 32 eyes of 17 Japanese patients (mean age: 21.5 ± 14.8 years; range: 11-51 years; female: 5). The severity of 10 objective signs in the palpebral conjunctiva, bulbar conjunctiva, limbus, and cornea were scored on a grading scale of 0 to 4 (0 = normal; 1+ = mild; 2+ = moderate; 3+ = severe), respectively. First, the conventional slit-lamp microscope was used to examine the grade of the ACDs. Second, another ophthalmologist filmed the eyes using the SEC and two other ophthalmologists evaluated the grades on another day. The correlation and inter-rater reproducibility in total scores among the two devices were determined.

RESULTS

Total scores of clinical signs, evaluated by the two approaches, correlated significantly (both eyes: r = 0.918 (95% CI: 0.839 to 0.959; p < 0.001)), with substantial inter-rater agreement (weighted κ value = 0.631 (95% CI: 0.601 to 0.661; p < 0.001)).

CONCLUSIONS

The SEC is as reliable as the conventional non-portable slit-lamp microscope for assessing ACDs.