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Hung JY, Chen KW, Perera C, Chiu HK, Hsu CR, Myung D, Luo AC, Fuh CS, Liao SL, Kossler AL. An Outperforming Artificial Intelligence Model to Identify Referable Blepharoptosis for General Practitioners. J Pers Med 2022; 12:jpm12020283. [PMID: 35207771 PMCID: PMC8877622 DOI: 10.3390/jpm12020283] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/25/2022] [Accepted: 02/06/2022] [Indexed: 02/05/2023] Open
Abstract
The aim of this study is to develop an AI model that accurately identifies referable blepharoptosis automatically and to compare the AI model’s performance to a group of non-ophthalmic physicians. In total, 1000 retrospective single-eye images from tertiary oculoplastic clinics were labeled by three oculoplastic surgeons as having either ptosis, including true and pseudoptosis, or a healthy eyelid. A convolutional neural network (CNN) was trained for binary classification. The same dataset was used in testing three non-ophthalmic physicians. The CNN model achieved a sensitivity of 92% and a specificity of 88%, compared with the non-ophthalmic physician group, which achieved a mean sensitivity of 72% and a mean specificity of 82.67%. The AI model showed better performance than the non-ophthalmic physician group in identifying referable blepharoptosis, including true and pseudoptosis, correctly. Therefore, artificial intelligence-aided tools have the potential to assist in the diagnosis and referral of blepharoptosis for general practitioners.
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Affiliation(s)
- Ju-Yi Hung
- Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA 94303, USA; (J.-Y.H.); (K.-W.C.); (C.P.); (D.M.)
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei 10617, Taiwan;
| | - Ke-Wei Chen
- Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA 94303, USA; (J.-Y.H.); (K.-W.C.); (C.P.); (D.M.)
- Department of Biomedical Engineering, National Cheng Kung University, Tainan City 70101, Taiwan
| | - Chandrashan Perera
- Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA 94303, USA; (J.-Y.H.); (K.-W.C.); (C.P.); (D.M.)
| | - Hsu-Kuang Chiu
- Computer Science, Stanford University, Stanford, CA 94305, USA;
| | - Cherng-Ru Hsu
- Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan;
| | - David Myung
- Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA 94303, USA; (J.-Y.H.); (K.-W.C.); (C.P.); (D.M.)
| | - An-Chun Luo
- Department of Electronic and Optoelectronic System Research Laboratories, Industrial Technology Research Institute, Hsinchu 31040, Taiwan;
| | - Chiou-Shann Fuh
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei 10617, Taiwan;
| | - Shu-Lang Liao
- Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan
- College of Medicine, National Taiwan University, Taipei 10617, Taiwan
- Correspondence: (S.-L.L.); (A.L.K.)
| | - Andrea Lora Kossler
- Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA 94303, USA; (J.-Y.H.); (K.-W.C.); (C.P.); (D.M.)
- Correspondence: (S.-L.L.); (A.L.K.)
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Hung JY, Perera C, Chen KW, Myung D, Chiu HK, Fuh CS, Hsu CR, Liao SL, Kossler AL. A deep learning approach to identify blepharoptosis by convolutional neural networks. Int J Med Inform 2021; 148:104402. [PMID: 33609928 PMCID: PMC8191181 DOI: 10.1016/j.ijmedinf.2021.104402] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/22/2021] [Accepted: 01/24/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Blepharoptosis is a known cause of reversible vision loss. Accurate assessment can be difficult, especially amongst non-specialists. Existing automated techniques disrupt clinical workflow by requiring user input, or placement of reference markers. Neural networks are known to be effective in image classification tasks. We aim to develop an algorithm that can accurately identify blepharoptosis from a clinical photo. METHODS A total of 500 clinical photographs from patients with and without blepharoptosis were sourced from a tertiary ophthalmic center in Taiwan. Images were labeled by two oculoplastic surgeons, with an independent third oculoplastic surgeon to adjudicate disagreements. These images were used to train a series of convolutional neural networks (CNNs) to ascertain the best CNN architecture for this particular task. RESULTS Of the models that trained on the dataset, most were able to identify ptosis images with reasonable accuracy. We found the best performing model to use the DenseNet121 architecture without pre-training which achieved a sensitivity of 90.1 % with a specificity of 82.4 %, compared to the worst performing model which was used a Resnet34 architecture with pre-training, achieving a sensitivity of 74.1 %, and specificity of 63.6 %. Models with and without pre-training performed similarly (mean accuracy 82.6 % vs. 85.8 % respectively, p = 0.06), though models with pre-training took less time to train (1-minute vs. 16 min, p < 0.01). CONCLUSIONS We report the use of AI to accurately diagnose blepharoptosis from a clinical photograph with no external reference markers or user input requirement. Most current-generation CNN architectures performed reasonably on this task, with the DenseNet121, and Resnet18 architectures without pre-training performing best in our dataset.
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Affiliation(s)
- Ju-Yi Hung
- Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, United States; Ophthalmology, Taipei Medical University Hospital, Taipei, Taiwan; Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Chandrashan Perera
- Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, United States
| | - Ke-Wei Chen
- Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, United States; Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - David Myung
- Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, United States
| | - Hsu-Kuang Chiu
- Computer Science, Stanford University, Stanford, California, United States
| | - Chiou-Shann Fuh
- Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Cherng-Ru Hsu
- Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shu-Lang Liao
- Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Andrea Lora Kossler
- Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, United States.
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Hung JY, Wei YH, Huang CH, Chen LW, Fuh CS, Liao SL. Survival outcomes of eye-sparing surgery for adenoid cystic carcinoma of lacrimal gland. Jpn J Ophthalmol 2019; 63:344-351. [PMID: 31134459 DOI: 10.1007/s10384-019-00671-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 04/23/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE To survey adenoid cystic carcinoma of lacrimal glands in Asian population and investigate the predictability in prognosis following the 8th edition American Joint Committee on Cancer (AJCC) staging guideline. STUDY DESIGN Retrospective study. METHODS The clinical entities and surgical outcomes of the patients who were histologically confirmed with a diagnosis of lacrimal adenoid cystic carcinoma in National Taiwan University Hospital between January 1995 and December 2015 were retrospectively reviewed. RESULTS Enrolled were 11 patients. The median follow-up was 7.2 years. Eight patients (72.7%) were diagnosed as T1 or T2 disease, and three patients (27.3%) were diagnosed as T3 or T4 disease according to the AJCC 8th edition guideline. Eye-sparing surgery with radiotherapy was performed in nine patients. Local recurrence was noted in six patients (54.5%) with median disease-free interval of 23.5 months. Six patients (54.5%) developed distant metastases, including lung, bone, and cranial invasions. Overall survival rate during the study period was 54.6%. Five-year overall survival was 81.8% and ten-year overall survival was 68.2%. The Log-rank test for overall survival and disease-free survival between patients with less than T3 disease (p=0.001) and patients with T3 or T4 disease (p=0.006) revealed significant differences. CONCLUSION This study highlighted the aggressive nature of adenoid cystic carcinoma of lacrimal glands. Eye-sparing surgery with adjunctive radiotherapy may achieve relatively optimal disease control in diseases staged T1 or T2, but in advanced disease metastasis and mortality are usually inevitable.
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Affiliation(s)
- Ju-Yi Hung
- Department of Ophthalmology, Taipei Medical University Hospital, No. 252, Wuxing St, Xinyi District, Taipei City, Taiwan.,Department of Computer Science and Information Engineering, National Taiwan University, No. 1, Sec. 4, Roosevelt Road, Taipei City, Taiwan
| | - Yi-Hsuan Wei
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zongzheng Dist., Taipei City, Taiwan
| | - Chu-Hsuan Huang
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zongzheng Dist., Taipei City, Taiwan
| | - Lily-Wei Chen
- College of Medicine, University of Massachusetts, Boston, USA.,University of Massachusetts, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Chiou-Shann Fuh
- Department of Computer Science and Information Engineering, National Taiwan University, No. 1, Sec. 4, Roosevelt Road, Taipei City, Taiwan
| | - Shu-Lang Liao
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zongzheng Dist., Taipei City, Taiwan. .,College of Medicine, National Taiwan University, No. 1, Jen Ai Road, Section 1, Taipei City, Taiwan.
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Mead LJ, Gillespie MT, Hung JY, Rane US, Rayeroux KC, Irving LB, Campbell LJ. Frequent loss of heterozygosity in early non-small cell lung cancers at chromosome 9p21 proximal to the CDKN2a gene. Int J Cancer 1997; 71:213-7. [PMID: 9139845 DOI: 10.1002/(sici)1097-0215(19970410)71:2<213::aid-ijc15>3.0.co;2-i] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Deletions involving the chromosome 9p21 region have been reported as frequent events in non-small cell lung cancer (NSCLC). To investigate potential tumor-suppressor gene (TSG) loci within the 9p21 region, which also harbors the candidate TSG locus CDKN2a, we studied 32 cases of primary NSCLC for loss of heterozygosity (LOH). Tumor and paired normal lung cells were microdissected from lung tissue imprints and all samples screened using PCR-LOH analysis with 15 9p markers. In addition, 3 NSCLC cell lines and their matched normal lung and tumor DNA were similarly analyzed. LOH at the marker D9S259, which is proximal to the CDKN2a locus, was found most frequently (52%), while LOH at D9S942, the marker closest (5 kb) to the CDKN2a gene, was seen in only 17%. Homozygous loss of markers close to CDKN2a was, however, detected in 2 of the 3 cell lines and one accompanying tumor sample. We propose that a TSG in the region of deletion proximal to the CDKN2a gene within 9p21 may play a significant role in the pathogenesis and progression of NSCLC.
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Affiliation(s)
- L J Mead
- Victorian Cancer Cytogenetics Service, St. Vincent's Hospital, Fitzroy, Australia
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Kishimoto Y, Sugio K, Hung JY, Virmani AK, McIntire DD, Minna JD, Gazdar AF. Allele-specific loss in chromosome 9p loci in preneoplastic lesions accompanying non-small-cell lung cancers. J Natl Cancer Inst 1995; 87:1224-9. [PMID: 7563168 DOI: 10.1093/jnci/87.16.1224] [Citation(s) in RCA: 146] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Carcinogenesis is a multistep process, which may begin as a consequence of chromosomal changes. Deletions in the short arm of chromosome 9 (9p) have been observed in lung carcinomas. In addition, morphologically recognizable preneoplastic lesions, frequently multiple in number, precede onset of invasive carcinomas. PURPOSE We tested for deletions and loss of heterozygosity (LOH) at 9p loci in preneoplastic and neoplastic foci in lungs of patients with non-small-cell lung carcinomas (NSCLCs). METHODS Seven archival, paraffin-embedded, surgically resected NSCLC specimens were selected. They were predominantly from patients with adenocarcinomas and contained multiple preneoplastic lesions, including hyperplasia, metaplasia, dysplasia, and carcinoma in situ (CIS). Fifty-three histologically identified preneoplastic and malignant lesions present in bronchi, bronchioles, and alveoli were precisely microdissected from stained tissue sections with a micromanipulator. Stromal lymphocytes were used to determine constitutional heterozygosity. The specimens were analyzed for LOH using polymerase chain reaction-based assays for polymorphism in dinucleotide repeats (microsatellite markers) in interferon alfa (IFNA) and D9S171 loci on 9p. RESULTS All seven cases were constitutionally heterozygous for one or both microsatellite markers. Five of seven cases had LOH at one or both 9p loci in the invasive primary cancers (doubly informative cases). Four of these five cases also revealed LOH in preneoplastic foci. In the doubly informative cases, LOH was detected in five (38%) of 13 foci of hyperplasia, four (80%) of five foci of dysplasia, and three (100%) of three CIS lesions. LOH was detected in preneoplastic lesions from all regions of the respiratory tract, including bronchi, bronchioles, and alveoli, and involved five different cell types. The identical allele was lost from both the preneoplastic lesions and the corresponding tumors (12 of 12 lesions, 17 of 17 comparisons), a phenomenon we have referred to as "allele-specific mutation." Statistical analyses employing a cumulative binomial test demonstrated that the probabilities of such findings occurring by chance are 2.4 x 10(-4) and 7.6 x 10(-6), respectively. From comparisons with the previously published data on other chromosomal abnormalities in the same tissue specimens, it appears that LOH at 3p and 9p loci occurred early in the hyperplasia stage, but the ras gene point mutations were relatively late, at the CIS stage. CONCLUSIONS LOH at 9p loci occurs at the earliest stage in the pathogenesis of lung cancer and involves all regions of the respiratory tract. LOH in NSCLC is not random but targets a specific allele in individuals. Studying preneoplastic lesions may help identify intermediate markers for risk assessment and chemoprevention.
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Affiliation(s)
- Y Kishimoto
- Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX 75235-8593, USA
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Sugio K, Kishimoto Y, Virmani AK, Hung JY, Gazdar AF. K-ras mutations are a relatively late event in the pathogenesis of lung carcinomas. Cancer Res 1994; 54:5811-5. [PMID: 7954406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We investigated preneoplastic lesions associated with lung cancer to determine at what stage in lung carcinogenesis K-ras mutations appear. We selected six archival lung cancer resection cases that had ras mutations. We precisely microdissected 74 relevant areas from paraffin-embedded sections. K-ras mutations at codons 12, 13, and 61 were determined by the designed restriction fragment length polymorphism method using mismatched nested primers and confirmed by direct sequencing. All samples of invasive and metastatic cancers had K-ras mutations, as did four of five lesions of noninvasive cancer. Mutations were detected in only 1 of 12 dysplastic lesions and were absent from hyperplastic and normal-appearing cells. In all cases, the specific point mutations and the mutational pattern in the tumors, metastases, and the corresponding noninvasive lesions were identical. These results indicate that K-ras mutations arise relatively late in the pathogenesis of lung cancer and may be associated with the appearance of the malignant phenotype.
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Affiliation(s)
- K Sugio
- Simmons Cancer Center University of Texas Southwestern Medical Center at Dallas 75235-8593
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Lam S, Hung JY, Kennedy SM, Leriche JC, Vedal S, Nelems B, Macaulay CE, Palcic B. Detection of dysplasia and carcinoma in situ by ratio fluorometry. Am Rev Respir Dis 1992; 146:1458-61. [PMID: 1280929 DOI: 10.1164/ajrccm/146.6.1458] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Fluorescence bronchoscopy was performed in 82 volunteers recruited from occupational groups at risk of exposure to asbestos and/or diesel fumes to determine whether differences in tissue autofluorescence between normal and malignant bronchial tissues can be used to improve the sensitivity of standard fiberoptic bronchoscopy in detecting dysplasic and carcinoma in situ (CIS). This study consisted of 25 nonsmokers, 40 exsmokers, and 17 current smokers with mean ages of 52, 55, and 49 yr, respectively. Tissue autofluorescence was induced by a blue light from an He-Cd laser coupled to the illumination channel of the bronchoscope and analyzed by a ratiofluorometer. One or more sites of moderate or severe dysplasia were found in 12% of the exsmokers and current smokers but in none of the nonsmoker volunteers. CIS was found in two of the exsmokers. The sensitivity of fluorescence bronchoscopy (86%) was found to be 50% better than that of conventional white-light bronchoscopy (52%) in detecting dysplasia and CIS. Pre- and post-bronchoscopy sputum cytology failed to detect these precancerous lesions. Our results suggest that fluorescence bronchoscopy may be an important new method that can improve the ability to detect and localize precancerous and/or CIS lesions.
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Affiliation(s)
- S Lam
- Occupational and Environmental Lung Disease Research Unit, University of British Columbia, Vancouver, Canada
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Hung JY. Corneal sensation in retinal detachment surgery. Ann Ophthalmol 1987; 19:313-5, 318. [PMID: 3662317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We compared the rate of recovery of corneal sensation in two randomly selected groups of patients with rhegmatogenous retinal detachment whose eyes were otherwise healthy. One of the groups underwent removal of the epithelium and, and the other was characterized by nonremoval of the epithelium. The corneal sensations were measured serially with an esthesiometer. The return of corneal sensation occurred sooner in the nonremoval group than in the removal group in the early postoperative period, but at three months, the difference was negligible.
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Affiliation(s)
- J Y Hung
- University of California, San Francisco
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Hung JY, Hilton GF. Neovascular glaucoma in a patient with X-linked juvenile retinoschisis. Ann Ophthalmol 1980; 12:1054-5. [PMID: 6085608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
A patient with X-linked juvenile retinoschisis was followed from age 5 years. At age 15 he developed rubeosis iridis and neovascular glaucoma in one eye, resulting in no light perception. A review of the literature revealed this case to be the first reported association of X-linked juvenile retinoschisis and neovascular glaucoma.
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