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Yu S, Yan C, Qin G, Pazo EE, He X, Qi P, Li M, Han D, He W, He X. Assessing the Impact of AI-Assisted Portable Slit Lamps on Rural Primary Ophthalmic Medical Service. Curr Eye Res 2025; 50:551-558. [PMID: 39910748 DOI: 10.1080/02713683.2025.2458131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 12/13/2024] [Accepted: 01/19/2025] [Indexed: 02/07/2025]
Abstract
PURPOSE To investigate the effect of an AI-assisted portable slit lamp (iSpector) and basic ophthalmology training on cataract detection, referral, and surgery rate in rural areas. METHODS This randomized control trial randomly assigned 63 village doctors to either the AI-assisted group (providing iSpector and training) or the control group (providing training). Doctors were followed for 1 year before intervention as a baseline and 1 year after to make the comparison. Multivariable Poisson regression was applied to compare the difference in cataract detection, referral, and surgery rate between the two groups, adjusted for primary doctors' baseline characteristics. We further conducted subgroup analysis to estimate the change after the intervention. RESULTS Compared to the control group, the detection, referral, and surgery rate of cataracts among the AI-assisted group was comparable, 1.7 times higher, and 4.9 times higher, respectively. Providing iSpector and training increased the detection, referral, and surgery rate of cataracts. However, only based on training to elevate the detection rate of cataracts did not change the referral and surgery rate. CONCLUSIONS iSpector helps village doctors detect and refer cataract patients appropriately, thus increasing the probability that patients receive cataract surgery.
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Affiliation(s)
- Sile Yu
- He University, Shenyang, China
| | | | | | | | | | - Peng Qi
- He Eye Specialist Hospital, Shenyang, China
| | - Mingze Li
- He Eye Specialist Hospital, Shenyang, China
| | | | - Wei He
- He Eye Specialist Hospital, Shenyang, China
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Triningrat AAMP, Doniho A, Jayanegara WG, Widiana IGR, Wigono S, Utari NML, Shimizu E, Nakayama S, Foraldy T. Reliability and Accuracy of Smart Eye Camera in Determining Grading of Nuclear Cataract. KOREAN JOURNAL OF OPHTHALMOLOGY 2025; 39:114-124. [PMID: 40007094 PMCID: PMC12010183 DOI: 10.3341/kjo.2023.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 05/08/2024] [Accepted: 01/20/2025] [Indexed: 02/27/2025] Open
Abstract
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.
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Affiliation(s)
| | - Angelo Doniho
- Department of Ophthalmology, Faculty of Medicine, Udayana University, Bali,
Indonesia
| | - Wayan Gede Jayanegara
- Department of Ophthalmology, Faculty of Medicine, Udayana University, Bali,
Indonesia
| | - I Gde Raka Widiana
- Department of Ophthalmology, Faculty of Medicine, Udayana University, Bali,
Indonesia
| | - Siska Wigono
- Department of Ophthalmology, Faculty of Medicine, Udayana University, Bali,
Indonesia
| | - Ni Made Laksmi Utari
- Department of Ophthalmology, Faculty of Medicine, Udayana University, Bali,
Indonesia
| | - Eisuke Shimizu
- Department of Ophthalmology, Keio University School of Medicine, Tokyo,
Japan
- OUI Inc, Tokyo,
Japan
| | - Shintaro Nakayama
- Department of Ophthalmology, Keio University School of Medicine, Tokyo,
Japan
- OUI Inc, Tokyo,
Japan
| | - Thendy Foraldy
- Department of Ophthalmology, Faculty of Medicine and Health Science, Atma Jaya University, Jakarta,
Indonesia
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Orugun AJ, Atima MO, Idakwo U, Komolafe O, Oladigbolu KK, Peter E, Abdulsalam HO, Atima-Ayeni E, Dingwoke EJ, Khemlani R, Nakayama S, Shimizu E, Balogun EO. Validation and optimization of smart eye camera as teleophthalmology device for the reduction of preventable and treatable blindness in Nigeria. Eye (Lond) 2025; 39:925-930. [PMID: 39623111 PMCID: PMC11933363 DOI: 10.1038/s41433-024-03489-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 11/06/2024] [Accepted: 11/12/2024] [Indexed: 03/05/2025] Open
Abstract
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.
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Affiliation(s)
| | | | | | | | - Kehinde Kabir Oladigbolu
- Department of Ophthalmology, Faculty of Clinical Sciences, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Elijah Peter
- Department of Ophthalmology, Faculty of Clinical Sciences, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Halima Olufunmilola Abdulsalam
- Department of Ophthalmology, Faculty of Clinical Sciences, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | | | - Emeka John Dingwoke
- UNESCO-International Center for Biotechnology, Nsukka, 410001, Enugu State, Nigeria
| | - Rohan Khemlani
- OUI Inc., Tokyo, Japan
- Yokohama Keiai Eye Clinic, Yokohama, Japan
| | - Shintaro Nakayama
- OUI Inc., Tokyo, Japan
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Eisuke Shimizu
- OUI Inc., Tokyo, Japan
- Yokohama Keiai Eye Clinic, Yokohama, Japan
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Emmanuel Oluwadare Balogun
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Zaria, Kaduna State, Nigeria.
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Maehara H, Ueno Y, Yamaguchi T, Kitaguchi Y, Miyazaki D, Nejima R, Inomata T, Kato N, Chikama TI, Ominato J, Yunoki T, Tsubota K, Oda M, Suzutani M, Sekiryu T, Oshika T. Artificial intelligence support improves diagnosis accuracy in anterior segment eye diseases. Sci Rep 2025; 15:5117. [PMID: 39934383 PMCID: PMC11814138 DOI: 10.1038/s41598-025-89768-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Accepted: 02/07/2025] [Indexed: 02/13/2025] Open
Abstract
CorneAI, a deep learning model designed for diagnosing cataracts and corneal diseases, was assessed for its impact on ophthalmologists' diagnostic accuracy. In the study, 40 ophthalmologists (20 specialists and 20 residents) classified 100 images, including iPhone 13 Pro photos (50 images) and diffuser slit-lamp photos (50 images), into nine categories (normal condition, infectious keratitis, immunological keratitis, corneal scar, corneal deposit, bullous keratopathy, ocular surface tumor, cataract/intraocular lens opacity, and primary angle-closure glaucoma). The iPhone and slit-lamp images represented the same cases. After initially answering without CorneAI, the same ophthalmologists responded to the same cases with CorneAI 2-4 weeks later. With CorneAI's support, the overall accuracy of ophthalmologists increased significantly from 79.2 to 88.8% (P < 0.001). Specialists' accuracy rose from 82.8 to 90.0%, and residents' from 75.6 to 86.2% (P < 0.001). Smartphone image accuracy improved from 78.7 to 85.5% and slit-lamp image accuracy from 81.2 to 90.6% (both, P < 0.001). In this study, CorneAI's own accuracy was 86%, but its support enhanced ophthalmologists' accuracy beyond the CorneAI's baseline. This study demonstrated that CorneAI, despite being trained on diffuser slit-lamp images, effectively improved diagnostic accuracy, even with smartphone images.
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Affiliation(s)
- Hiroki Maehara
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Fukushima, Japan
- Japan Anterior Segment Artificial Intelligence Research Group, Tsukuba, Japan
| | - Yuta Ueno
- Departement of Ophthalmology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8576, Japan.
- Japan Anterior Segment Artificial Intelligence Research Group, Tsukuba, Japan.
| | - Takefumi Yamaguchi
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
- Japan Anterior Segment Artificial Intelligence Research Group, Tsukuba, Japan
| | - Yoshiyuki Kitaguchi
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
- Japan Anterior Segment Artificial Intelligence Research Group, Tsukuba, Japan
| | - Dai Miyazaki
- Division of Ophthalmology and Visual Science, Faculty of Medicine, Tottori University, Tottori, Japan
- Japan Anterior Segment Artificial Intelligence Research Group, Tsukuba, Japan
| | - Ryohei Nejima
- Department of Ophthalmology, Miyata Eye Hospital, Miyazaki, Japan
- Japan Anterior Segment Artificial Intelligence Research Group, Tsukuba, Japan
| | - Takenori Inomata
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Japan Anterior Segment Artificial Intelligence Research Group, Tsukuba, Japan
| | - Naoko Kato
- Department of Ophthalmology, Tsukazaki Hospital, Hyogo, Japan
- Japan Anterior Segment Artificial Intelligence Research Group, Tsukuba, Japan
| | - Tai-Ichiro Chikama
- Division of Ophthalmology and Visual Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Japan Anterior Segment Artificial Intelligence Research Group, Tsukuba, Japan
| | - Jun Ominato
- Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
- Japan Anterior Segment Artificial Intelligence Research Group, Tsukuba, Japan
| | - Tatsuya Yunoki
- Department of Ophthalmology, University of Toyama, Toyama, Japan
- Japan Anterior Segment Artificial Intelligence Research Group, Tsukuba, Japan
| | - Kinya Tsubota
- Department of Ophthalmology, Tokyo Medical University, Tokyo, Japan
- Japan Anterior Segment Artificial Intelligence Research Group, Tsukuba, Japan
| | - Masahiro Oda
- Graduate School of Informatics, Nagoya University, Nagoya, Japan
- Japan Anterior Segment Artificial Intelligence Research Group, Tsukuba, Japan
| | - Manabu Suzutani
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tetsuju Sekiryu
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tetsuro Oshika
- Departement of Ophthalmology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8576, Japan
- Japan Anterior Segment Artificial Intelligence Research Group, Tsukuba, Japan
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Ghafarian S, Masoumi A, Tabatabaei SA, Yaseri M, Shimizu E, Nakayama S, Jeetendra Khemlani R, Nishimura H, Asadigandomani H. Clinical evaluation of corneal ulcer with a portable and smartphone-attachable slit lamp device: Smart Eye Camera. Sci Rep 2025; 15:3099. [PMID: 39856154 PMCID: PMC11759699 DOI: 10.1038/s41598-025-87820-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Accepted: 01/22/2025] [Indexed: 01/27/2025] Open
Abstract
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.
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Affiliation(s)
- Sadegh Ghafarian
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Masoumi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Tabatabaei
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Eisuke Shimizu
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- OUI Inc., Minato-ku, Minami-Aoyama, 2-2-8, DF Building 510, Tokyo, 107-0062, Japan
- Keiai Yokohama Eye Clinic, Hodogaya Ward, Wada, 1-11-17, 2F, Yokohama, Kanagawa, 240-0065, Japan
| | - Shintaro Nakayama
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- OUI Inc., Minato-ku, Minami-Aoyama, 2-2-8, DF Building 510, Tokyo, 107-0062, Japan
| | - Rohan Jeetendra Khemlani
- OUI Inc., Minato-ku, Minami-Aoyama, 2-2-8, DF Building 510, Tokyo, 107-0062, Japan
- Keiai Yokohama Eye Clinic, Hodogaya Ward, Wada, 1-11-17, 2F, Yokohama, Kanagawa, 240-0065, Japan
| | - Hiroki Nishimura
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- OUI Inc., Minato-ku, Minami-Aoyama, 2-2-8, DF Building 510, Tokyo, 107-0062, Japan
- Keiai Yokohama Eye Clinic, Hodogaya Ward, Wada, 1-11-17, 2F, Yokohama, Kanagawa, 240-0065, Japan
| | - Hassan Asadigandomani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Duong NM, Nguyen Vu NQ, Le HT. Diagnostic Assessment of Nuclear Cataracts Using a Smartphone-Attachable Slit-Lamp Device: A Cross-Sectional Study in Vietnam. Cureus 2024; 16:e73783. [PMID: 39691138 PMCID: PMC11650093 DOI: 10.7759/cureus.73783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2024] [Indexed: 12/19/2024] Open
Abstract
Purpose The purpose of this study was to compare the accuracy and agreement in nuclear cataract opacity classification between the Smart Eye Camera (SEC) device, and the slit-lamp. Methods A cross-sectional study was conducted with a convenient sampling of 221 eyes from 139 patients with phakic eyes, visiting IVISION Eye Center, Ho Chi Minh City, Vietnam, from November 1, 2023, to April 30, 2024. Two grading systems, Lucio-Buratto (Buratto) and World Health Organization (WHO), were used to compare the effectiveness of the two devices, with statistical analysis using Spearman's correlation coefficient and Cohen's kappa to evaluate the agreement level. Results Results showed no significant difference in Buratto and WHO grading between the two devices (p > 0.05), indicating consistency between the two measurement methods. Spearman's correlation coefficient demonstrated a strong correlation between the results from both devices, with r = 0.797 for Buratto and r = 0.579 for WHO (p < 0.001). The reliability was confirmed by high weighted-kappa values (k = 0.774 for Buratto and k = 0.539 for WHO). Conclusion The SEC's comparable effectiveness to the slit-lamp supports its potential utility in blindness-prevention screening efforts.
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Affiliation(s)
- Nguyet M Duong
- Pediatrics Department, Ho Chi Minh City Eye Hospital, Ho Chi Minh City, VNM
- Ophthalmology Department, IVISION Eye Center, Ho Chi Minh City, VNM
| | - Nhu Q Nguyen Vu
- Optometry Department, IVISION Eye Center, Ho Chi Minh City, VNM
| | - Hai T Le
- Optometry Department, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, VNM
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Nishimura H, Khemukani RJ, Yokoiwa R, Nakayama S, Shimizu E. Primary Angle Closure Observed During a House Visit: A Case Treated With Laser Iridotomy. Cureus 2024; 16:e66321. [PMID: 39246965 PMCID: PMC11377127 DOI: 10.7759/cureus.66321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2024] [Indexed: 09/10/2024] Open
Abstract
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.
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Affiliation(s)
- Hiroki Nishimura
- Department of Research, OUI Inc., Tokyo, JPN
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, JPN
- Department of Research, Yokohama Keiai Eye Clinic, Kanagawa, JPN
| | - Rohan J Khemukani
- Department of Research, OUI Inc., Tokyo, JPN
- Department of Research, Yokohama Keiai Eye Clinic, Kanagawa, JPN
| | | | - Shintaro Nakayama
- Department of Research, OUI Inc., Tokyo, JPN
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, JPN
- Department of Research, Yokohama Keiai Eye Clinic, Kanagawa, JPN
| | - Eisuke Shimizu
- Department of Research, OUI Inc., Tokyo, JPN
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, JPN
- Department of Research, Yokohama Keiai Eye Clinic, Kanagawa, JPN
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Shimizu E, Kamezaki M, Nishimura H, Nakayama S, Toda I. A Case of Traumatic Hyphema Diagnoses by Telemedicine Between a Remote Island and the Mainland of Tokyo. Cureus 2024; 16:e65153. [PMID: 39176324 PMCID: PMC11339394 DOI: 10.7759/cureus.65153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2024] [Indexed: 08/24/2024] Open
Abstract
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.
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Affiliation(s)
- Eisuke Shimizu
- Ophthalmology, Yokohama Keiai Eye Clinic, Yokohama, JPN
- Ophthalmology, Keio University School of Medicine, Tokyo, JPN
- Optometry, OUI Inc., Tokyo, JPN
- Ophthalmology, Minamiaoyama Eye Clinic, Tokyo, JPN
| | | | - Hiroki Nishimura
- Optometry, OUI Inc., Tokyo, JPN
- Ophthalmology, Keio University School of Medicine, Tokyo, JPN
- Ophthalmology, Yokohama Keiai Eye Clinic, Yokohama, JPN
| | - Shintaro Nakayama
- Optometry, OUI Inc., Tokyo, JPN
- Ophthalmology, Keio University School of Medicine, Tokyo, JPN
| | - Ikuko Toda
- Ophthalmology, Minamiaoyama Eye Clinic, Tokyo, JPN
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Kobashi H, Tsubota K, Aoki S, Kobayashi M, Sumali B, Mitsukura Y. Evaluation of a new portable corneal topography system for self-measurement using smartphones: a pilot study. Graefes Arch Clin Exp Ophthalmol 2024; 262:2199-2207. [PMID: 38407590 DOI: 10.1007/s00417-024-06426-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/08/2024] [Accepted: 02/19/2024] [Indexed: 02/27/2024] Open
Abstract
PURPOSE Herein, we propose the use of the "KeraVio Ring", which is a portable, selfie-based, smartphone-attached corneal topography system that is based on the Placido ring videokeratoscope. The goal of this study was to evaluate and compare corneal parameters between KeraVio Ring and conventional corneal tomography images. METHODS We designed the KeraVio Ring as a device comprising 3D-printed LED rings for generating Placido rings that can be attached to a smartphone. Two LED rings are attached to a cone-shaped device, and both corneas are illuminated. Selfies were taken using the KeraVio Ring attached to the smartphone without assistance from any of the examiners. Captured Placido rings on the cornea were analysed by intelligent software to calculate corneal parameters. Patients with normal, keratoconus, or LASIK-treated eyes were included. Anterior segment optical coherence tomography (AS-OCT) was also performed for each subject. RESULTS We found highly significant correlations between the steepest and flattest keratometry, corneal astigmatism, and vector components obtained with the KeraVio Ring and AS-OCT. In subjects with normal, keratoconus, and LASIK-treated eyes, the mean difference in corneal astigmatism between the two devices was -0.8 ± 1.4 diopters (D) (95% limits of agreement (LoA), -3.6 to 2.0), -1.8 ± 3.7 D (95% LoA, -9.1 to 5.5), and -1.5 ± 1.3 D (95% LoA, -4.0 to 1.1), respectively. CONCLUSIONS The experimental results showed that the corneal parameters obtained by the KeraVio Ring were correlated with those obtained with AS-OCT. The KeraVio Ring has the potential to address an unmet need by providing a tool for portable selfie-based corneal topography.
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Affiliation(s)
- Hidenaga Kobashi
- Tsubota Laboratory, Inc., Tokyo, Japan.
- Department of Ophthalmology, Keio University, School of Medicine, Tokyo, Japan.
- Ebina-Ekimae Eye Clinic, Kanagawa, Japan.
| | - Kazuo Tsubota
- Tsubota Laboratory, Inc., Tokyo, Japan
- Department of Ophthalmology, Keio University, School of Medicine, Tokyo, Japan
| | | | | | - Brian Sumali
- Department of System Design Engineering, Faculty of Science and Technology, Keio University, Kanagawa, Tokyo, Japan
| | - Yasue Mitsukura
- Department of System Design Engineering, Faculty of Science and Technology, Keio University, Kanagawa, Tokyo, Japan
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Chandrakanth P, Akkara JD, Joshi SM, Gosalia H, Chandrakanth KS, Narendran V. The Slitscope. Indian J Ophthalmol 2024; 72:741-744. [PMID: 38189430 PMCID: PMC11168557 DOI: 10.4103/ijo.ijo_1589_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 10/12/2023] [Accepted: 10/25/2023] [Indexed: 01/09/2024] Open
Abstract
Slit lamp biomicroscope is the right hand of an Ophthalmologist. Even though precise, its bulky design and complex working process are limiting constraints, making it difficult for screening at outreach camps, which are an integral part of this field for the purpose of eliminating needless blindness. The torchlight is the main tool used for screening. Recently, the integration of smartphones with instruments and the digitization of slit lamp has been explored, to provide simple and easy hacks. By bringing the slit of the slit lamp to traditional torchlight, we have created "The Slitscope". It combines the best of both worlds as a simple innovative do-it-yourself novel technique for precise cataract screening. It is especially useful in peripheral centers, vision centers, and outreach camps. We present two prototypes which can also be 3D printed.
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Affiliation(s)
- Prithvi Chandrakanth
- Department of Vitreoretinal Services, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - John Davis Akkara
- Department of Glaucoma Services, Chaitanya Eye Hospital and Westend Eye Hospital, Kochi, Kerala, India
| | - Saloni M Joshi
- Department of General Ophthalmology, Aravind Eye Hospital, Pondicherry, India
| | - Hirika Gosalia
- Department of General Ophthalmology, Aravind Eye Hospital, Pondicherry, India
| | - K S Chandrakanth
- Chief Medical Officer, General Ophthalmology, Dr. Chandrakanth Nethralaya, Kozhikode, Kerala, India
| | - V Narendran
- Department of Vitreoretinal Services, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
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11
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Emam MM, Alharbi MA, Alammar A, Aldekhail MI, Alammar A, Solyman O, Alaraj AM. Medical Students' Perspectives Regarding the Use of a Slit-Lamp Smartphone Adapter for Clinical Slit-Lamp Photography. Cureus 2024; 16:e57986. [PMID: 38606028 PMCID: PMC11008057 DOI: 10.7759/cureus.57986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 04/13/2024] Open
Abstract
Background This study aimed to investigate medical students' perspectives regarding the ease and utility of smartphone slit-lamp photography. Methodology In this prospective experimental study, fourth and fifth-year medical students who were in or had finished ophthalmology rotation were included to attempt slit-lamp smartphone anterior segment photography on adult patients after a brief hands-on instruction course. Each medical student attempted to record five supervised slit-lamp videos of the anterior segment of five patients using the described adapter and their own smartphone. The time taken until photography was calculated for each attempt. After the fifth attempt, each medical student rated the ease of the use of this method of slit-lamp photography as well as their perspective regarding its utility as a potential means of medical education and telemedical consultations on a five-point Likert scale. Results A total of 33 medical students participated, with each successfully recording five slit-lamp examinations using their smartphones. The time used for the application of the adapter until the image capture ranged from 6 to 278 seconds (average = 39.51 ± 34.7 seconds) and markedly improved by the fifth attempt (30.5 ± 25.7 seconds) compared to the first attempt (67.3 ± 49.3 seconds). Learning this skill was perceived to be relatively easy (2.2 ± 1), with high potential in clinical education (4.6 ± 0.75) and teleconsultations (4.7 ± 0.65). Conclusions Smartphone slit-lamp photography is a relatively easy process. It can be quickly acquired by medical students and has the potential to enhance their medical education and telemedical consultation capabilities.
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Affiliation(s)
- Mohammed M Emam
- Department of Radiologic Technology, College of Applied Medical Sciences, Qassim University, Al-Qassim, SAU
| | | | | | | | | | - Omar Solyman
- Department of Ophthalmology, Qassim University Medical City, Al-Qassim, SAU
| | - Ahmed M Alaraj
- Department of Ophthalmology, College of Medicine, Qassim University, Al-Qassim, SAU
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12
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Yoshitsugu K, Shimizu E, Nishimura H, Khemlani R, Nakayama S, Takemura T. Development of the AI Pipeline for Corneal Opacity Detection. Bioengineering (Basel) 2024; 11:273. [PMID: 38534547 DOI: 10.3390/bioengineering11030273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/03/2024] [Accepted: 03/07/2024] [Indexed: 03/28/2024] Open
Abstract
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.
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Affiliation(s)
- Kenji Yoshitsugu
- Graduate School of Information Science, University of Hyogo, Kobe Information Science Campus, Kobe 6500047, Japan
- OUI Inc., Tokyo 1070062, Japan
| | - Eisuke Shimizu
- OUI Inc., Tokyo 1070062, Japan
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 1608582, Japan
| | - Hiroki Nishimura
- OUI Inc., Tokyo 1070062, Japan
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 1608582, Japan
- Yokohama Keiai Eye Clinic, Kanagawa 2400065, Japan
| | - Rohan Khemlani
- OUI Inc., Tokyo 1070062, Japan
- Yokohama Keiai Eye Clinic, Kanagawa 2400065, Japan
| | - Shintaro Nakayama
- OUI Inc., Tokyo 1070062, Japan
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 1608582, Japan
| | - Tadamasa Takemura
- Graduate School of Information Science, University of Hyogo, Kobe Information Science Campus, Kobe 6500047, Japan
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13
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Kaushik N, Sharma P, Himori N, Matsumoto T, Miya T, Nakazawa T. Mobile infrared slit-light scanner for rapid eye disease screening. J Med Imaging (Bellingham) 2024; 11:026003. [PMID: 38606184 PMCID: PMC11003872 DOI: 10.1117/1.jmi.11.2.026003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 03/14/2024] [Accepted: 03/28/2024] [Indexed: 04/13/2024] Open
Abstract
Purpose Timely detection and treatment of visual impairments and age-related eye diseases are essential for maintaining a longer, healthier life. However, the shortage of appropriate medical equipment often impedes early detection. We have developed a portable self-imaging slit-light device utilizing NIR light and a scanning mirror. The objective of our study is to assess the accuracy and compare the performance of our device with conventional nonportable slit-lamp microscopes and anterior segment optical coherence tomography (AS-OCT) for screening and remotely diagnosing eye diseases, such as cataracts and glaucoma, outside of an eye clinic. Approach The NIR light provides an advantage as measurements are nonmydriatic and less traumatic for patients. A cross-sectional study involving Japanese adults was conducted. Cataract evaluation was performed using photographs captured by the device. Van-Herick grading was assessed by the ratio of peripheral anterior chamber depth to peripheral corneal thickness, in addition to the iridocorneal angle using Image J software. Results The correlation coefficient between values obtained by AS-OCT, and our fabricated portable scanning slit-light device was notably high. The results indicate that our portable device is equally reliable as the conventional nonportable slit-lamp microscope and AS-OCT for screening and evaluating eye diseases. Conclusions Our fabricated device matches the functionality of the traditional slit lamp, offering a cost-effective and portable solution. Ideal for remote locations, healthcare facilities, or areas affected by disasters, our scanning slit-light device can provide easy access to initial eye examinations and supports digital eye healthcare initiatives.
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Affiliation(s)
- Neelam Kaushik
- Tohoku University Graduate School of Medicine, Department of Ophthalmology, Sendai, Japan
| | - Parmanand Sharma
- Tohoku University Graduate School of Medicine, Department of Ophthalmology, Sendai, Japan
- Tohoku University Graduate School of Medicine, Advanced Research Center for Innovations in Next-Generation Medicine, Sendai, Japan
| | - Noriko Himori
- Tohoku University Graduate School of Medicine, Department of Ophthalmology, Sendai, Japan
- Tohoku University Graduate School of Biomedical Engineering, Department of Aging Vision Healthcare, Sendai, Japan
| | - Takuro Matsumoto
- Tohoku University Graduate School of Medicine, Department of Ophthalmology, Sendai, Japan
| | - Takehiro Miya
- Tohoku University Graduate School of Medicine, Department of Ophthalmology, Sendai, Japan
| | - Toru Nakazawa
- Tohoku University Graduate School of Medicine, Department of Ophthalmology, Sendai, Japan
- Tohoku University Graduate School of Medicine, Advanced Research Center for Innovations in Next-Generation Medicine, Sendai, Japan
- Tohoku University Graduate School of Medicine, Department of Retinal Disease Control, Sendai, Japan
- Tohoku University Graduate School of Medicine, Department of Ophthalmic Imaging and Information Analytics, Sendai, Japan
- Tohoku University Graduate School of Medicine, Department of Advanced Ophthalmic Medicine, Sendai, Japan
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14
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Borselli M, Toro MD, Rossi C, Taloni A, Khemlani R, Nakayama S, Nishimura H, Shimizu E, Scorcia V, Giannaccare G. Feasibility of Tear Meniscus Height Measurements Obtained with a Smartphone-Attachable Portable Device and Agreement of the Results with Standard Slit Lamp Examination. Diagnostics (Basel) 2024; 14:316. [PMID: 38337832 PMCID: PMC10855891 DOI: 10.3390/diagnostics14030316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
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.
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Affiliation(s)
- Massimiliano Borselli
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (M.B.); (C.R.); (A.T.); (V.S.)
| | - Mario Damiano Toro
- Department of Ophthalmology, Federico II University Hospital, 80131 Naples, Italy;
- Department of Ophthalmology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Costanza Rossi
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (M.B.); (C.R.); (A.T.); (V.S.)
| | - Andrea Taloni
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (M.B.); (C.R.); (A.T.); (V.S.)
| | - Rohan Khemlani
- OUI Inc., Tokyo 160-0022, Japan; (R.K.); (S.N.); (H.N.); (E.S.)
- Yokohama Keiai Eye Clinic, Yokohama 240-0065, Japan
| | - Shintato Nakayama
- OUI Inc., Tokyo 160-0022, Japan; (R.K.); (S.N.); (H.N.); (E.S.)
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-0016, Japan
| | - Hiroki Nishimura
- OUI Inc., Tokyo 160-0022, Japan; (R.K.); (S.N.); (H.N.); (E.S.)
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-0016, Japan
| | - Eisuke Shimizu
- OUI Inc., Tokyo 160-0022, Japan; (R.K.); (S.N.); (H.N.); (E.S.)
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-0016, Japan
| | - Vincenzo Scorcia
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (M.B.); (C.R.); (A.T.); (V.S.)
| | - Giuseppe Giannaccare
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
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15
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Shimizu E, Sato S, Asai K, Ogawa Y, Shimmura S, Negishi K. Clinical Features of Sjögren Syndrome-Related Dry Eye Disease in Anterior Segment Photographs. Cornea 2024; 43:18-25. [PMID: 37487173 DOI: 10.1097/ico.0000000000003342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 05/26/2023] [Indexed: 07/26/2023]
Abstract
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.
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Affiliation(s)
- Eisuke Shimizu
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; and
- Yokohama Keiai Eye Clinic, Kanagawa, Japan
| | - Shinri Sato
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; and
- Yokohama Keiai Eye Clinic, Kanagawa, Japan
| | - Kazuki Asai
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; and
| | - Yoko Ogawa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; and
| | - Shigeto Shimmura
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; and
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; and
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16
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Shimizu E, Tanji M, Nakayama S, Ishikawa T, Agata N, Yokoiwa R, Nishimura H, Khemlani RJ, Sato S, Hanyuda A, Sato Y. AI-based diagnosis of nuclear cataract from slit-lamp videos. Sci Rep 2023; 13:22046. [PMID: 38086904 PMCID: PMC10716159 DOI: 10.1038/s41598-023-49563-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 12/09/2023] [Indexed: 12/18/2023] Open
Abstract
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.
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Affiliation(s)
- Eisuke Shimizu
- OUI Inc., Tokyo, Japan.
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
- Yokohama Keiai Eye Clinic, Yokohama, Japan.
| | - Makoto Tanji
- OUI Inc., Tokyo, Japan
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Shintato Nakayama
- OUI Inc., Tokyo, Japan
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Toshiki Ishikawa
- OUI Inc., Tokyo, Japan
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | | | | | - Hiroki Nishimura
- OUI Inc., Tokyo, Japan
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- Yokohama Keiai Eye Clinic, Yokohama, Japan
| | | | - Shinri Sato
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- Yokohama Keiai Eye Clinic, Yokohama, Japan
| | - Akiko Hanyuda
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
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17
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Li R, Chen W, Li M, Wang R, Zhao L, Lin Y, Chen X, Shang Y, Tu X, Lin D, Wu X, Lin Z, Xu A, Wang X, Wang D, Zhang X, Dongye M, Huang Y, Chen C, Zhu Y, Liu C, Hu Y, Zhao L, Ouyang H, Li M, Li X, Lin H. LensAge index as a deep learning-based biological age for self-monitoring the risks of age-related diseases and mortality. Nat Commun 2023; 14:7126. [PMID: 37932255 PMCID: PMC10628111 DOI: 10.1038/s41467-023-42934-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 10/25/2023] [Indexed: 11/08/2023] Open
Abstract
Age is closely related to human health and disease risks. However, chronologically defined age often disagrees with biological age, primarily due to genetic and environmental variables. Identifying effective indicators for biological age in clinical practice and self-monitoring is important but currently lacking. The human lens accumulates age-related changes that are amenable to rapid and objective assessment. Here, using lens photographs from 20 to 96-year-olds, we develop LensAge to reflect lens aging via deep learning. LensAge is closely correlated with chronological age of relatively healthy individuals (R2 > 0.80, mean absolute errors of 4.25 to 4.82 years). Among the general population, we calculate the LensAge index by contrasting LensAge and chronological age to reflect the aging rate relative to peers. The LensAge index effectively reveals the risks of age-related eye and systemic disease occurrence, as well as all-cause mortality. It outperforms chronological age in reflecting age-related disease risks (p < 0.001). More importantly, our models can conveniently work based on smartphone photographs, suggesting suitability for routine self-examination of aging status. Overall, our study demonstrates that the LensAge index may serve as an ideal quantitative indicator for clinically assessing and self-monitoring biological age in humans.
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Affiliation(s)
- Ruiyang Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wenben Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Mingyuan Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Ruixin Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Lanqin Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yuanfan Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xinwei Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yuanjun Shang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xueer Tu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Duoru Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xiaohang Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Zhenzhe Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Andi Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xun Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Dongni Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xulin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Meimei Dongye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yunjian Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Chuan Chen
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Yi Zhu
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chunqiao Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Youjin Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Ling Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Hong Ouyang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Miaoxin Li
- Center for Precision Medicine and Department of Genetics and Biomedical Informatics, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Tropical Disease Control (Sun Yat-sen University), Ministry of Education, Sun Yat-sen University, Guangzhou, China
| | - Xuri Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Vision Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China.
- Center for Precision Medicine and Department of Genetics and Biomedical Informatics, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Haikou, China.
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Baker A, Morgan W. A Review of Smartphone Adapters Capable of Imaging the Anterior Segment in Ophthalmology. Semin Ophthalmol 2023; 38:713-721. [PMID: 37171162 DOI: 10.1080/08820538.2023.2211160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/08/2023] [Accepted: 03/13/2023] [Indexed: 05/13/2023]
Abstract
Teleophthalmology is a widely recognised way to provide health care to patients living in rural and remote regions by leveraging limited clinician availability and resources. This is most important in low socioeconomic areas, where the disparity between prevalence of preventable blindness and practicing ophthalmologists is greatest. The ubiquity and accessibility of smartphones allow them to be utilised in a clinical setting and facilitate teleophthalmology. While the current market of smartphone adapters capable of imaging ocular pathology is expanding, few focus on the anterior segment and operate independently of the slit-lamp microscope. This article reviews the available smartphone adapters capable of imaging anterior segment pathology.
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Affiliation(s)
- Annabelle Baker
- Lions Eye Institute, The University of Western Australia, Perth, Australia
| | - William Morgan
- Lions Eye Institute, The University of Western Australia, Perth, Australia
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Andhare P, Ramasamy K, Ramesh R, Shimizu E, Nakayama S, Gandhi P. A study establishing sensitivity and accuracy of smartphone photography in ophthalmologic community outreach programs: Review of a smart eye camera. Indian J Ophthalmol 2023; 71:2416-2420. [PMID: 37322651 PMCID: PMC10418033 DOI: 10.4103/ijo.ijo_292_23] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/28/2023] [Accepted: 03/23/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose Diseases affecting the cornea are a major cause of corneal blindness globally. The pressing issue we are facing today is the lack of diagnostic devices in rural areas to diagnose these conditions. The aim of the study is to establish sensitivity and accuracy of smartphone photography using a smart eye camera (SEC) in ophthalmologic community outreach programs. Methods In this pilot study, a prospective non-randomized comparative analysis of inter-observer variability of anterior segment imaging recorded using an SEC was performed. Consecutive 100 patients with corneal pathologies, who visited the cornea specialty outpatient clinic, were enrolled. They were examined with a conventional non-portable slit lamp by a cornea consultant, and the diagnoses were recorded. This was compared with the diagnoses made by two other consultants based on SEC videos of the anterior segment of the same 100 patients. The accuracy of SEC was accessed using sensitivity, specificity, PPV, and NPV. Kappa statistics was used to find the agreement between two consultants by using STATA 17.0 (Texas, USA). Results There was agreement between the two consultants to diagnosing by using SEC. Above 90% agreements were found in all the diagnoses, which were statistically significant (P-value < 0.001). More than 90% sensitivity and a negative predictive value were found. Conclusion SEC can be used successfully in the community outreach programs like field visits, eye camps, teleophthalmology, and community centers, where either a clinical setup is lacking or ophthalmologists are not available.
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Affiliation(s)
- Pooja Andhare
- Department of Cornea, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Kim Ramasamy
- Department of Retina, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Rahul Ramesh
- Department of Cornea, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | - Eisuke Shimizu
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- OUI Inc., Tokyo, Japan
| | - Shintaro Nakayama
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- OUI Inc., Tokyo, Japan
| | - Preethika Gandhi
- Department of Cornea, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
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20
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Meer E, Grob S, Antonsen EL, Sawyer A. Ocular conditions and injuries, detection and management in spaceflight. NPJ Microgravity 2023; 9:37. [PMID: 37193709 DOI: 10.1038/s41526-023-00279-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 04/12/2023] [Indexed: 05/18/2023] Open
Abstract
Ocular trauma or other ocular conditions can be significantly debilitating in space. A literature review of over 100 articles and NASA evidence books, queried for eye related trauma, conditions, and exposures was conducted. Ocular trauma and conditions during NASA space missions during the Space Shuttle Program and ISS through Expedition 13 in 2006 were reviewed. There were 70 corneal abrasions, 4 dry eyes, 4 eye debris, 5 complaints of ocular irritation, 6 chemical burns, and 5 ocular infections noted. Unique exposures on spaceflight, such as foreign bodies, including celestial dust, which may infiltrate the habitat and contact the ocular surface, as well as chemical and thermal injuries due to prolonged CO2 and heat exposure were reported. Diagnostic modalities used to evaluate the above conditions in space flight include vision questionnaires, visual acuity and Amsler grid testing, fundoscopy, orbital ultrasound, and ocular coherence tomography. Several types of ocular injuries and conditions, mostly affecting the anterior segment, are reported. Further research is necessary to understand the greatest ocular risks that astronauts face and how better we can prevent, but also diagnose and treat these conditions in space.
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Affiliation(s)
- Elana Meer
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
- University of California Space Health Program, San Francisco, CA, USA
| | - Seanna Grob
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Erik L Antonsen
- Department of Emergency Medicine and Center for Space Medicine, Baylor College of Medicine, Houstan, Texas, USA
| | - Aenor Sawyer
- University of California Space Health Program, San Francisco, CA, USA.
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA.
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21
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Zhang X, Shen J, Kang Z, Chen A, Cao Q, Xue C. Clinical observation of tear film breakup time with a novel smartphone-attachable technology. BMC Ophthalmol 2023; 23:204. [PMID: 37165312 PMCID: PMC10170453 DOI: 10.1186/s12886-023-02932-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/21/2023] [Indexed: 05/12/2023] Open
Abstract
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.
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Affiliation(s)
- Xiaoran Zhang
- Department of Ophthalmology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Jiawei Shen
- Department of Ophthalmology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Zhen Kang
- Department of Ophthalmology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Andrew Chen
- Department of Biology, Stony Brook University, New York, USA
| | - Qian Cao
- Department of Ophthalmology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, 210002, China.
| | - Chunyan Xue
- Department of Ophthalmology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, 210002, China.
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22
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Shimizu E, Ishikawa T, Tanji M, Agata N, Nakayama S, Nakahara Y, Yokoiwa R, Sato S, Hanyuda A, Ogawa Y, Hirayama M, Tsubota K, Sato Y, Shimazaki J, Negishi K. Artificial intelligence to estimate the tear film breakup time and diagnose dry eye disease. Sci Rep 2023; 13:5822. [PMID: 37037877 PMCID: PMC10085985 DOI: 10.1038/s41598-023-33021-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/06/2023] [Indexed: 04/12/2023] Open
Abstract
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.
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Affiliation(s)
- Eisuke Shimizu
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
- OUI Inc., DF Building 510, 2-2-8 Minami-Aoyama, Minato-ku, Tokyo, 107-0062, Japan.
- Yokohama Keiai Eye Clinic, Courtley House 2F, 1-11-17 Wada, Hodogaya-ku, Kanagawa, 240-0065, Japan.
| | - Toshiki Ishikawa
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- OUI Inc., DF Building 510, 2-2-8 Minami-Aoyama, Minato-ku, Tokyo, 107-0062, Japan
| | - Makoto Tanji
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- OUI Inc., DF Building 510, 2-2-8 Minami-Aoyama, Minato-ku, Tokyo, 107-0062, Japan
| | - Naomichi Agata
- OUI Inc., DF Building 510, 2-2-8 Minami-Aoyama, Minato-ku, Tokyo, 107-0062, Japan
| | - Shintaro Nakayama
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- OUI Inc., DF Building 510, 2-2-8 Minami-Aoyama, Minato-ku, Tokyo, 107-0062, Japan
| | - Yo Nakahara
- OUI Inc., DF Building 510, 2-2-8 Minami-Aoyama, Minato-ku, Tokyo, 107-0062, Japan
| | - Ryota Yokoiwa
- OUI Inc., DF Building 510, 2-2-8 Minami-Aoyama, Minato-ku, Tokyo, 107-0062, Japan
| | - Shinri Sato
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Yokohama Keiai Eye Clinic, Courtley House 2F, 1-11-17 Wada, Hodogaya-ku, Kanagawa, 240-0065, Japan
| | - Akiko Hanyuda
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yoko Ogawa
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masatoshi Hirayama
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Jun Shimazaki
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Wiedenmann CJ, Böhringer D, Reinhard T, Wacker K. [Corneal endothelial cell photography: comparison of smartphones]. DIE OPHTHALMOLOGIE 2023; 120:382-389. [PMID: 36301370 DOI: 10.1007/s00347-022-01742-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/15/2022] [Accepted: 09/21/2022] [Indexed: 04/29/2023]
Abstract
BACKGROUND The documentation of ophthalmologic findings using smartphone photography can confirm diagnoses and enable follow-up assessments in outpatient care. Photographing corneal endothelial cells using a smartphone on a slit lamp is complex for both smartphone and examiner. Smartphone models differ in their ability to quickly and safely take images of the corneal endothelium. AIM OF THIS WORK In this paper different smartphone models are presented with respect to their applicability for corneal endothelial cell photography and success factors for good smartphone imaging are described. MATERIAL AND METHODS In a cross-sectional study, a selection of 16 different smartphone models were compared with respect to their use in corneal endothelial cell photography. The smartphones were attached to the slit lamp eyepiece using an adjustable adapter. It was tested whether high-quality endothelial cell images of healthy subjects could be obtained within 3 min using the standard photo app of the respective smartphone. In addition, the subjective difficulty of creating the image was recorded. Factors contributing to successful imaging of corneal endothelial cells were summarized in a figure. RESULTS AND DISCUSSION Distinct differences regarding feasibility and quality of endothelial cell photography were detected between the different smartphones. Not every smartphone is suitable for endothelial cell photography.
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Affiliation(s)
| | - Daniel Böhringer
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - Thomas Reinhard
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - Katrin Wacker
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
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24
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Computational intelligence in eye disease diagnosis: a comparative study. Med Biol Eng Comput 2023; 61:593-615. [PMID: 36595155 DOI: 10.1007/s11517-022-02737-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 12/09/2022] [Indexed: 01/04/2023]
Abstract
In recent years, eye disorders are an important health issue among older people. Generally, individuals with eye diseases are unaware of the gradual growth of symptoms. Therefore, routine eye examinations are required for early diagnosis. Usually, eye disorders are identified by an ophthalmologist via a slit-lamp investigation. Slit-lamp interpretations are inadequate due to the differences in the analytical skills of the ophthalmologist, inconsistency in eye disorder analysis, and record maintenance issues. Therefore, digital images of an eye and computational intelligence (CI)-based approaches are preferred as assistive methods for eye disease diagnosis. A comparative study of CI-based decision support models for eye disorder diagnosis is presented in this paper. The CI-based decision support systems used for eye abnormalities diagnosis were grouped as anterior and retinal eye abnormalities diagnostic systems, and numerous algorithms used for diagnosing the eye abnormalities were also briefed. Various eye imaging modalities, pre-processing methods such as reflection removal, contrast enhancement, region of interest segmentation methods, and public eye image databases used for CI-based eye disease diagnosis system development were also discussed in this paper. In this comparative study, the reliability of various CI-based systems used for anterior eye and retinal disorder diagnosis was compared based on the precision, sensitivity, and specificity in eye disease diagnosis. The outcomes of the comparative analysis indicate that the CI-based anterior and retinal disease diagnosis systems attained significant prediction accuracy. Hence, these CI-based diagnosis systems can be used in clinics to reduce the burden on physicians, minimize fatigue-related misdetection, and take precise clinical decisions.
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25
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INOMATA TAKENORI, SUNG JAEMYOUNG, YEE ALAN, MURAKAMI AKIRA, OKUMURA YUICHI, NAGINO KEN, FUJIO KENTA, AKASAKI YASUTSUGU, MIDORIKAWA-INOMATA AKIE, EGUCHI ATSUKO, FUJIMOTO KEIICHI, HUANG TIANXIANG, MOROOKA YUKI, MIURA MARIA, SHOKIROVA HURRAMHON, HIROSAWA KUNIHIKO, OHNO MIZU, KOBAYASHI HIROYUKI. P4 Medicine for Heterogeneity of Dry Eye: A Mobile Health-based Digital Cohort Study. JUNTENDO IJI ZASSHI = JUNTENDO MEDICAL JOURNAL 2023; 69:2-13. [PMID: 38854846 PMCID: PMC11153075 DOI: 10.14789/jmj.jmj22-0032-r] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/11/2022] [Indexed: 06/11/2024]
Abstract
During the 5th Science, Technology, and Innovation Basic Plan, the Japanese government proposed a novel societal concept -Society 5.0- that promoted a healthcare system characterized by its capability to provide unintrusive, predictive, longitudinal care through the integration of cyber and physical space. The role of Society 5.0 in managing our quality of vision will become more important in the modern digitalized and aging society, both of which are known risk factors for developing dry eye. Dry eye is the most common ocular surface disease encountered in Japan with symptoms including increased dryness, eye discomfort, and decreased visual acuity. Owing to its complexity, implementation of P4 (predictive, preventive, personalized, participatory) medicine in managing dry eye requires a comprehensive understanding of its pathology, as well as a strategy to visualize and stratify its risk factors. Using DryEyeRhythm®, a mobile health (mHealth) smartphone software (app), we established a route to collect holistic medical big data on dry eye, such as the subjective symptoms and lifestyle data for each individual. The studies to date aided in determining the risk factors for severe dry eye, the association between major depressive disorder and dry eye exacerbation, eye drop treatment adherence, app-based stratification algorithms based on symptomology, blink detection biosensoring as a dry eye-related digital phenotype, and effectiveness of app-based dry eye diagnosis support compared to traditional methods. These results contribute to elucidating disease pathophysiology and promoting preventive and effective measures to counteract dry eye through mHealth.
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Affiliation(s)
- TAKENORI INOMATA
- Corresponding author: Takenori Inomata, Juntendo University Graduate School of Medicine, Department of Ophthalmology, 2-1-1 Hongo, Bunkyo-ku, Tokyo. 113-8431, Japan, TEL: +81-3-5802-1228 FAX: +81-3-5689-0394 E-mail:
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26
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Wan Zaki WMD, Abdul Mutalib H, Ramlan LA, Hussain A, Mustapha A. Towards a Connected Mobile Cataract Screening System: A Future Approach. J Imaging 2022; 8:jimaging8020041. [PMID: 35200743 PMCID: PMC8879609 DOI: 10.3390/jimaging8020041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 11/26/2022] Open
Abstract
Advances in computing and AI technology have promoted the development of connected health systems, indirectly influencing approaches to cataract treatment. In addition, thanks to the development of methods for cataract detection and grading using different imaging modalities, ophthalmologists can make diagnoses with significant objectivity. This paper aims to review the development and limitations of published methods for cataract detection and grading using different imaging modalities. Over the years, the proposed methods have shown significant improvement and reasonable effort towards automated cataract detection and grading systems that utilise various imaging modalities, such as optical coherence tomography (OCT), fundus, and slit-lamp images. However, more robust and fully automated cataract detection and grading systems are still needed. In addition, imaging modalities such as fundus, slit-lamps, and OCT images require medical equipment that is expensive and not portable. Therefore, the use of digital images from a smartphone as the future of cataract screening tools could be a practical and helpful solution for ophthalmologists, especially in rural areas with limited healthcare facilities.
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Affiliation(s)
- Wan Mimi Diyana Wan Zaki
- Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia; (W.M.D.W.Z.); (L.A.R.); (A.H.)
| | - Haliza Abdul Mutalib
- Optometry and Vision Science Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
- Correspondence:
| | - Laily Azyan Ramlan
- Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia; (W.M.D.W.Z.); (L.A.R.); (A.H.)
| | - Aini Hussain
- Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering and Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia; (W.M.D.W.Z.); (L.A.R.); (A.H.)
| | - Aouache Mustapha
- Division Telecom, Center for Development of Advanced Technologies (CDTA), Baba Hassen, Algiers 16081, Algeria;
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27
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Keenan TDL, Chen Q, Agrón E, Tham YC, Lin Goh JH, Lei X, Ng YP, Liu Y, Xu X, Cheng CY, Bikbov MM, Jonas JB, Bhandari S, Broadhead GK, Colyer MH, Corsini J, Cousineau-Krieger C, Gensheimer W, Grasic D, Lamba T, Magone MT, Maiberger M, Oshinsky A, Purt B, Shin SY, Thavikulwat AT, Lu Z, Chew EY. Deep Learning Automated Diagnosis and Quantitative Classification of Cataract Type and Severity. Ophthalmology 2022; 129:571-584. [PMID: 34990643 PMCID: PMC9038670 DOI: 10.1016/j.ophtha.2021.12.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/10/2021] [Accepted: 12/27/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To develop and evaluate deep learning models to perform automated diagnosis and quantitative classification of age-related cataract, including all three anatomical types, from anterior segment photographs. DESIGN Application of deep learning models to Age-Related Eye Disease Study (AREDS) dataset. PARTICIPANTS 18,999 photographs (6,333 triplets) from longitudinal follow-up of 1,137 eyes (576 AREDS participants). METHODS Deep learning models were trained to detect and quantify nuclear cataract (NS; scale 0.9-7.1) from 45-degree slit-lamp photographs and cortical (CLO; scale 0-100%) and posterior subcapsular (PSC; scale 0-100%) cataract from retroillumination photographs. Model performance was compared with that of 14 ophthalmologists and 24 medical students. The ground truth labels were from reading center grading. MAIN OUTCOME MEASURES Mean squared error (MSE). RESULTS On the full test set, mean MSE values for the deep learning models were: 0.23 (SD 0.01) for NS, 13.1 (SD 1.6) for CLO, and 16.6 (SD 2.4) for PSC. On a subset of the test set (substantially enriched for positive cases of CLO and PSC), for NS, mean MSE for the models was 0.23 (SD 0.02), compared to 0.98 (SD 0.23; p=0.000001) for the ophthalmologists, and 1.24 (SD 0.33; p=0.000005) for the medical students. For CLO, mean MSE values were 53.5 (SD 14.8), compared to 134.9 (SD 89.9; p=0.003) and 422.0 (SD 944.4; p=0.0007), respectively. For PSC, mean MSE values were 171.9 (SD 38.9), compared to 176.8 (SD 98.0; p=0.67) and 395.2 (SD 632.5; p=0.18), respectively. In external validation on the Singapore Malay Eye Study (sampled to reflect the distribution of cataract severity in AREDS), MSE was 1.27 for NS and 25.5 for PSC. CONCLUSIONS A deep learning framework was able to perform automated and quantitative classification of cataract severity for all three types of age-related cataract. For the two most common types (NS and CLO), the accuracy was significantly superior to that of ophthalmologists; for the least common type (PSC), the accuracy was similar. The framework may have wide potential applications in both clinical and research domains. In the future, such approaches may increase the accessibility of cataract assessment globally. The code and models are publicly available at https://XXX.
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Affiliation(s)
- Tiarnan D L Keenan
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Qingyu Chen
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD, USA.
| | - Elvira Agrón
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore
| | | | - Xiaofeng Lei
- Institute of High Performance Computing, A*STAR, Singapore
| | - Yi Pin Ng
- Institute of High Performance Computing, A*STAR, Singapore
| | - Yong Liu
- Duke-NUS Medical School, Singapore; Institute of High Performance Computing, A*STAR, Singapore
| | - Xinxing Xu
- Duke-NUS Medical School, Singapore; Institute of High Performance Computing, A*STAR, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore; Institute of High Performance Computing, A*STAR, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Institute of Molecular and Clinical Ophthalmology Basel, Switzerland; Privatpraxis Prof Jonas und Dr Panda-Jonas, Heidelberg, Germany
| | - Sanjeeb Bhandari
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Geoffrey K Broadhead
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marcus H Colyer
- Department of Ophthalmology, Madigan Army Medical Center, Tacoma, WA, USA; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jonathan Corsini
- Warfighter Eye Center, Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, MD, USA
| | - Chantal Cousineau-Krieger
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - William Gensheimer
- White River Junction Veterans Affairs Medical Center, White River Junction, VT, USA; Geisel School of Medicine, Dartmouth, NH, USA
| | - David Grasic
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tania Lamba
- Washington DC Veterans Affairs Medical Center, Washington DC, USA
| | - M Teresa Magone
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Arnold Oshinsky
- Washington DC Veterans Affairs Medical Center, Washington DC, USA
| | - Boonkit Purt
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Soo Y Shin
- Washington DC Veterans Affairs Medical Center, Washington DC, USA
| | - Alisa T Thavikulwat
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Zhiyong Lu
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD, USA.
| | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA.
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Dutt S, Nagarajan S, Vadivel SS, Baig AU, Savoy FM, Ganapathy VM, Dominic M, Sivaraman A, Rao DP. Design and Performance Characterization of a Novel, Smartphone-Based, Portable Digital Slit Lamp for Anterior Segment Screening Using Telemedicine. Transl Vis Sci Technol 2021; 10:29. [PMID: 34319384 PMCID: PMC8322723 DOI: 10.1167/tvst.10.8.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Telemedicine-enabled, portable digital slit lamps can help to decentralize screening to close-to-patient contexts. We report a novel design for a portable, digital slit lamp using a smartphone. It works on an advanced optical design and has the capability of instantaneous, objective photodocumentation to capture anterior segment images and is telemedicine-enabled. Methods The device is constructed keeping its usability and the importance of design ergonomics for nonspecialized field personnel in mind. The optical design is described, and the resolution and magnification are compared with traditional desktop-based slit lamps. A Health Insurance Portability and Accountability Act (HIPAA)–compliant, patient management software is integrated to synchronize the captured images with a secure cloud server along with a sharpness algorithm to extract the best focused frames of the cornea, iris, and lens, from videos. We demonstrate its photodocumentation ability and teleophthalmology feasibility by capturing images in a pilot study from nine subjects. Results Images were obtained in various illumination, magnification, and filter settings. Synchronous and asynchronous teleophthalmology consults were conducted. The performance of the device was shown to be limited by the smartphone sensor resolution and not the optical design, because the Air Force target resolution was found to be the same on smartphone-mounted traditional slit lamps despite a lower magnification. Conclusions The novel, portable, digital slit lamp with advanced optical design using smartphones has the ability to screen for anterior segment pathologies using telemedicine. Translational Relevance A portable, telemedicine-friendly, ergonomically designed, slit lamp used by nonspecialist personnel allows for both synchronous and asynchronous modes of consultation at remote locations, facilitating mass screening programs.
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Affiliation(s)
- Sreetama Dutt
- Research & Development, Remidio Innovative Solutions Pvt. Ltd., Bangalore, Karnataka, India
| | | | - Siva S Vadivel
- Research & Development, Remidio Innovative Solutions Pvt. Ltd., Bangalore, Karnataka, India
| | - Adeeb Ulla Baig
- Research & Development, Remidio Innovative Solutions Pvt. Ltd., Bangalore, Karnataka, India
| | | | - Vasudev M Ganapathy
- Research & Development, Remidio Innovative Solutions Pvt. Ltd., Bangalore, Karnataka, India
| | - Mathew Dominic
- Research & Development, Remidio Innovative Solutions Pvt. Ltd., Bangalore, Karnataka, India
| | - Anand Sivaraman
- Research & Development, Remidio Innovative Solutions Pvt. Ltd., Bangalore, Karnataka, India
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Shimizu E, Yazu H, Aketa N, Yokoiwa R, Sato S, Katayama T, Hanyuda A, Sato Y, Ogawa Y, Tsubota K. Smart Eye Camera: A Validation Study for Evaluating the Tear Film Breakup Time in Human Subjects. Transl Vis Sci Technol 2021; 10:28. [PMID: 34004005 PMCID: PMC8083120 DOI: 10.1167/tvst.10.4.28] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/13/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose This study aimed to demonstrate the efficacy of a "Smart Eye Camera (SEC)" in comparison with the efficacy of the conventional slit-lamp microscope by evaluating their diagnostic functionality for dry eye disease (DED) in clinical cases. Methods This retrospective study included 106 eyes from 53 adult Japanese patients who visited the Ophthalmology outpatient clinics in Keio University Hospital from June 2019 to March 2020. Tear film breakup time (TFBUT) and corneal fluorescence score (CFS) measurements for the diagnosis of DED were compared between the conventional slit-lamp microscope and SEC. Results The objective findings of DED showed that there was a strong correlation between the conventional slit-lamp microscope and SEC with respect to TFBUT and CFS results (Spearman's r = 0.887, 95% confidence interval [CI] = 0.838-0.922, and r = 0.920, 95% CI = 0.884-0.945, respectively). The interobserver reliability between the conventional slit-lamp microscope and SEC showed a moderate agreement (weighted Kappa κ = 0.527, 95% CI = 0.517-0.537 and κ = 0.550, 95% CI = 0.539-0.561 for TFBUT and CFS, respectively). The diagnostic performance of the SEC for Asia Dry Eye Society diagnostic criteria showed a sensitivity of 0.957 (95% CI = 0.841-0.992), specificity of 0.900 (95% CI = 0.811-0.927), positive predictive value of 0.880 (95% CI = 0.774-0.912), and negative predictive value of 0.964 (95% CI = 0.869-0.993). Moreover, the area under the receiver operating characteristic curve was 0.928 (95% CI = 0.849-1.000). Conclusions Compared with the conventional slit-lamp microscope, SEC has sufficient validity and reliability for diagnosing DED in the clinical setting. Translational Relevance The SEC can portably evaluate TFBUT in both basic research and clinical care.
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Affiliation(s)
- Eisuke Shimizu
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- OUI Inc., Tokyo, Japan
| | - Hiroyuki Yazu
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- OUI Inc., Tokyo, Japan
- Department of Ophthalmology, Tsurumi University School of Dental Medicine, Kanagawa, Japan
| | - Naohiko Aketa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- OUI Inc., Tokyo, Japan
| | | | - Shinri Sato
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Taiichiro Katayama
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Akiko Hanyuda
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Yoko Ogawa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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30
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Yazu H, Shimizu E, Sato S, Aketa N, Katayama T, Yokoiwa R, Sato Y, Fukagawa K, Ogawa Y, Tsubota K, Fujishima H. Clinical Observation of Allergic Conjunctival Diseases with Portable and Recordable Slit-Lamp Device. Diagnostics (Basel) 2021; 11:535. [PMID: 33802736 PMCID: PMC8002473 DOI: 10.3390/diagnostics11030535] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 01/08/2023] Open
Abstract
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.
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Affiliation(s)
- Hiroyuki Yazu
- Department of Ophthalmology, Tsurumi University School of Dental Medicine, Kanagawa 230-0063, Japan;
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-0016, Japan; (E.S.); (S.S.); (N.A.); (T.K.); (K.F.); (Y.O.); (K.T.)
- OUI Inc., Tokyo 160-0022, Japan;
| | - Eisuke Shimizu
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-0016, Japan; (E.S.); (S.S.); (N.A.); (T.K.); (K.F.); (Y.O.); (K.T.)
- OUI Inc., Tokyo 160-0022, Japan;
| | - Shinri Sato
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-0016, Japan; (E.S.); (S.S.); (N.A.); (T.K.); (K.F.); (Y.O.); (K.T.)
| | - Naohiko Aketa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-0016, Japan; (E.S.); (S.S.); (N.A.); (T.K.); (K.F.); (Y.O.); (K.T.)
| | - Taiichiro Katayama
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-0016, Japan; (E.S.); (S.S.); (N.A.); (T.K.); (K.F.); (Y.O.); (K.T.)
| | | | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Biostatistics at Clinical and Translational Research Center, Keio University School of Medicine, Tokyo 160-0016, Japan;
| | - Kazumi Fukagawa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-0016, Japan; (E.S.); (S.S.); (N.A.); (T.K.); (K.F.); (Y.O.); (K.T.)
- Ryogoku Eye Clinic, Tokyo 130-0026, Japan
| | - Yoko Ogawa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-0016, Japan; (E.S.); (S.S.); (N.A.); (T.K.); (K.F.); (Y.O.); (K.T.)
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-0016, Japan; (E.S.); (S.S.); (N.A.); (T.K.); (K.F.); (Y.O.); (K.T.)
| | - Hiroshi Fujishima
- Department of Ophthalmology, Tsurumi University School of Dental Medicine, Kanagawa 230-0063, Japan;
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-0016, Japan; (E.S.); (S.S.); (N.A.); (T.K.); (K.F.); (Y.O.); (K.T.)
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Xu QB, Hu ZY, Wu SQ. Renal cell carcinoma choroidal metastasis recorded by smartphone with interface eyepiece adapter mounted on slit lamp: A case report. Medicine (Baltimore) 2021; 100:e24910. [PMID: 33725849 PMCID: PMC7969302 DOI: 10.1097/md.0000000000024910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/04/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Ocular metastasis of renal cell carcinoma (RCC) is rare, and mainly located on the choroid. We report a choroidal metastasis from RCC, which was recorded by a smartphone with an interface eyepiece adapter mounted on a slit lamp. PATIENT CONCERNS A 45-year-old female presented with 1-month history of painless occlusion of the vision field on the left eye, who had undergone right nephrectomy for RCC 19 months ago. DIAGNOSES A smooth, hemispherical and brown protrusion was found behind the pupil nasally. An enhanced computed tomography scan of the orbit showed a slightly high-density hemispherical nodule involving the nasal portions of the left eyeball, the enhancement of the lesion was obvious and homogeneous. A metastatic choroidal space-occupying lesion from RCC was highly suspected according to the clinical and radiological findings. INTERVENTIONS The patient was advised to undergo further treatment, such as radiotherapy. OUTCOMES The images of choroid metastasis were recorded by the smartphone with the interface eyepiece adapter mounted on the slit lamp handily. CONCLUSIONS The smartphone with an interface eyepiece adapter mounted on the slit lamp can be widely used to record the precious images in the clinic in a timely manner.
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Affiliation(s)
- Qi-bin Xu
- Department of Ophthalmology, Zhejiang Medicine and Western Medicine Integrated Hospital, Hangzhou Red-Cross Hospital
| | - Zhi-yi Hu
- Department of Ophthalmology, Zhejiang Medicine and Western Medicine Integrated Hospital, Hangzhou Red-Cross Hospital
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shuang-qing Wu
- Department of Ophthalmology, Zhejiang Medicine and Western Medicine Integrated Hospital, Hangzhou Red-Cross Hospital
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Shimizu E, Yazu H, Aketa N, Yokoiwa R, Sato S, Yajima J, Katayama T, Sato R, Tanji M, Sato Y, Ogawa Y, Tsubota K. A Study Validating the Estimation of Anterior Chamber Depth and Iridocorneal Angle with Portable and Non-Portable Slit-Lamp Microscopy. SENSORS (BASEL, SWITZERLAND) 2021; 21:1436. [PMID: 33669487 PMCID: PMC7921911 DOI: 10.3390/s21041436] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/13/2021] [Accepted: 02/17/2021] [Indexed: 11/16/2022]
Abstract
This study assessed the anterior chamber depth (ACD) and iridocorneal angle using a portable smart eye camera (SEC) compared to the conventional slit-lamp microscope and anterior-segment optical coherence tomography (AS-OCT). This retrospective case-control study included 170 eyes from 85 Japanese patients. The correlation between the ACD evaluations conducted with the SEC and conventional slit-lamp was high (r = 0.814). The correlation between the Van-Herick Plus grade obtained using two devices was also high (r = 0.919). A high kappa value was observed for the Van-Herick Plus grading (Kappa = 0.757). A moderate correlation was observed between the ACD measured using AS-OCT and the slit-lamp image acquired with the conventional slit-lamp microscope and SEC (r = 0.609 and 0.641). A strong correlation was observed between the trabecular-iris angle (TIA) measured using AS-OCT and Van-Herick Plus grade obtained with the conventional slit-lamp microscope and SEC (r = 0.702 and 0.764). Strong correlations of ACD evaluation and high kappa value of the Van-Herick Plus grading indicated the adequate subjective assessment function of the SEC. Moderate correlations between the ACD objective measurement and evaluation and strong correlation between the TIA and Van-Herick Plus grade suggested the good objective assessment function of the SEC. The SEC demonstrated adequate performance for ACD evaluation and angle estimation.
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Affiliation(s)
- Eisuke Shimizu
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (H.Y.); (N.A.); (S.S.); (J.Y.); (T.K.); (R.S.); (M.T.); (Y.O.); (K.T.)
- OUI Inc., Tokyo 160-0022, Japan;
- Yokohama Keiai Eye Clinic, Kanagawa 240-0065, Japan
| | - Hiroyuki Yazu
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (H.Y.); (N.A.); (S.S.); (J.Y.); (T.K.); (R.S.); (M.T.); (Y.O.); (K.T.)
- OUI Inc., Tokyo 160-0022, Japan;
- Yokohama Keiai Eye Clinic, Kanagawa 240-0065, Japan
- Department of Ophthalmology, Tsurumi University School of Dental Medicine, Kanagawa 230-8501, Japan
| | - Naohiko Aketa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (H.Y.); (N.A.); (S.S.); (J.Y.); (T.K.); (R.S.); (M.T.); (Y.O.); (K.T.)
| | | | - Shinri Sato
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (H.Y.); (N.A.); (S.S.); (J.Y.); (T.K.); (R.S.); (M.T.); (Y.O.); (K.T.)
- Yokohama Keiai Eye Clinic, Kanagawa 240-0065, Japan
| | - Junichiro Yajima
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (H.Y.); (N.A.); (S.S.); (J.Y.); (T.K.); (R.S.); (M.T.); (Y.O.); (K.T.)
| | - Taiichiro Katayama
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (H.Y.); (N.A.); (S.S.); (J.Y.); (T.K.); (R.S.); (M.T.); (Y.O.); (K.T.)
| | - Rio Sato
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (H.Y.); (N.A.); (S.S.); (J.Y.); (T.K.); (R.S.); (M.T.); (Y.O.); (K.T.)
| | - Makoto Tanji
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (H.Y.); (N.A.); (S.S.); (J.Y.); (T.K.); (R.S.); (M.T.); (Y.O.); (K.T.)
- OUI Inc., Tokyo 160-0022, Japan;
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo 160-8582, Japan;
| | - Yoko Ogawa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (H.Y.); (N.A.); (S.S.); (J.Y.); (T.K.); (R.S.); (M.T.); (Y.O.); (K.T.)
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan; (H.Y.); (N.A.); (S.S.); (J.Y.); (T.K.); (R.S.); (M.T.); (Y.O.); (K.T.)
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