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Application of artifcial intelligence in cataract management:current and future directions

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Eye and Vision 2024年第1期10卷 21-30页

作者： Laura Gutierrez Jane Sujuan Lim Li Lian Foo Wei Yan Ng Michelle Yip Gilbert Yong San Lim Melissa Hsing Yi Wong Allan Fong Mohamad Rosman jodhbir Singth mehta Haotian Lin Darren Shu Jeng Ting Daniel Shu Wei Ting Singapore Eye Research Institute SingaporeSingapore Singapore National Eye Center 11 Third Hospital AvenueSingapore 168751Singapore Academic Ophthalmology School of MedicineUniversity of NottinghamNottinghamUK Zhongshan Ophthalmic Center Sun Yet Sen UniversityGuangzhouChina

The rise of artifcial intelligence(AI)has brought breakthroughs in many areas of *** ophthalmology,AI has delivered robust results in the screening and detection of diabetic retinopathy,age-related macular degeneration,glaucoma,and retinopathy of *** management is another feld that can beneft from greater AI *** is the leading cause of reversible visual impairment with a rising global clinical *** diagnosis,monitoring,and surgical management are necessary to address this *** addition,patients in large developing countries often sufer from limited access to tertiary care,a problem further exacerbated by the ongoing COVID-19 *** on the other hand,can help transform cataract management by improving automation,efcacy and overcoming geographical ***,AI can be applied as a telediagnostic platform to screen and diagnose patients with cataract using slit-lamp and fundus *** utilizes a deep-learning,convolutional neural network(CNN)to detect and classify referable cataracts ***,some of the latest intraocular lens formulas have used AI to enhance prediction accuracy,achieving superior postoperative refractive results compared to traditional ***,AI can be used to augment cataract surgical skill training by identifying diferent phases of cataract surgery on video and to optimize operating theater workfows by accurately predicting the duration of surgical ***,some AI CNN models are able to efectively predict the progression of posterior capsule opacifcation and eventual need for YAG laser *** advances in AI could transform cataract management and enable delivery of efcient ophthalmic *** key challenges include ethical management of data,ensuring data security and privacy,demonstrating clinically acceptable performance,improving the generalizability of AI models across heterogeneous populations,and improving the trust of e

关键词： Artifcial intelligence Telemedicine Cataract Cataract screening Cataract surgery IOL calculations Biometry Machine learning

Corneal neuromediator profiles following laser refractive surgery

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Neural Regeneration Research 2021年第11期16卷 2177-2183页

作者： Lily Wei Yun Yang jodhbir S.mehta Yu-Chi Liu Yong Loo Lin School of Medicine National University of SingaporeSingapore Tissue Engineering and Cell Therapy Group Singapore Eye Research InstituteSingapore Department of Cornea and External Eye Disease Singapore National Eye CentreSingapore Ophthalmology and Visual Sciences Academic Clinical Program Duke-NUS Medical SchoolSingapore

Laser refractive surgery is one of the most commonly performed procedures *** laser refractive surgery,Femtosecond Laser in Situ Keratomileusis and Refractive Lenticule Extraction have emerged as promising alternatives to microkeratome Laser in Situ Keratomileusis and Photorefractive *** laser refractive surgery,the corneal nerves,epithelial and stromal cells release neuromediators,including neurotrophins,neuropeptides and ***,nerve growth factor,substance P,calcitonin gene-related peptide and various cytokines are important mediators of neurogenic inflammation and corneal nerve *** in neuromediator profiles and ocular surface parameters following laser refractive surgery are attributed to the surgical techniques and the severity of tissue insult *** this review,we will discuss the(1)Functions of neuromediators and their physiological and clinical significance;(2)Changes in the neuromediators following various laser refractive surgeries;(3)Correlation between neuromediators,ocular surface health and corneal nerve status;and(4)Future directions,including the use of neuromediators as potential biomarkers for ocular surface health following laser refractive surgery,and as adjuncts to aid in corneal regeneration after laser refractive surgery.

关键词： cornea corneal nerves dry eye femtosecond laser laser in situ keratomileusis neuromediator refractive surgery small incision lenticule extraction

Analysis of corneal nerve plexus in corneal confocal microscopy images

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Neural Regeneration Research 2021年第4期16卷 690-691页

作者： Yu-Chi Liu Molly Tzu-Yu Lin jodhbir S.mehta Tissue Engineering and Cell Therapy Group Singapore Eye Research InstituteSingapore Department of Cornea and External Eye Disease Singapore National Eye CentreOphthalmology and Visual Sciences Academic Clinical ProgramDuke-NUS Medical SchoolSingapore

Small Aδand C nerve fibers of the sensory and autonomic nervous systems constitute 70–90%of peripheral nerve fibers including corneal nerves(Muller et al.,2003).Corneal nerves originate from the ophthalmic branch of the trigeminal nerve and enter the cornea at the limbus radially from all directions toward the central cornea at the level of anterior and middle *** subepithelial nerve plexus lies at the interface between the Bowman layer and anterior *** then divide into smaller branches and turn 90°toward Bowman’s layer(Muller et al.,2003),travelling between Bowman’s layer and the basal epithelial layer and forming the sub-basal nerve plexus(Muller et al.,2003).

关键词： Bowman layer travelling

Cosmetic outcome of femtosecond laserassisted pterygium surgery

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Eye and Vision 2021年第1期8卷 59-66页

作者： Darren Shu Jeng Ting Yu-Chi Liu Yi Fang Lee Angel Jung Se Ji Tien-En Tan Hla M.Htoon jodhbir S.mehta Academic Ophthalmology Division of Clinical NeuroscienceSchool of MedicineUniversity of NottinghamNottinghamUK Department of Ophthalmology Queen’s Medical CentreNottinghamUK Singapore Eye Research Institute SingaporeSingapore Singapore National Eye Centre 11 Third Hospital AvenueSingapore 168751Singapore Duke-NUS Graduate Medical School SingaporeSingapore.

Background:To examine the cosmetic outcome of femtosecond laser-assisted pterygium surgery(FLAPS)with conjunctival autograft(CAG)and its potential predictive ***:This was a prospective interventional case series(NCT02866968).We included 29 patients(29 eyes)with primary pterygium who underwent *** outcome was graded by two graders(an ophthalmology resident and an experienced ophthalmologist)using Hirst classification system(1-4=excellent-poor).Weighted Cohen’s kappa analysis was performed to examine the intra-and inter-rater *** relationship between cosmetic outcome and various factors were determined by Spearman’s correlation coefficients(r).Results:The preoperative severity of pterygium(Tan grading system)was mild/atrophic(7%),moderate/intermediate(62%),and severe/fleshy(31%).An ultrathin CAG(mean thickness of 74.5±9.8μm)was fashioned *** excellent cosmetic outcome of FLAPS(median±IQR)was observed at 3 months(1.0±1.0)and remained similar at 6months(1.0±0.0)and 12months(1.0±0.0)*** final follow-up,27(93%)patients achieved good-to-excellent cosmetic outcome,with 1(3%)patient having a poor outcome due to incomplete pterygium *** kappa analysis of Hirst grading system showed excellent intra-rater(κ=0.86-0.95)and inter-rater reliability(κ=0.84-0.88).There was a weak and borderline significant correlation between good cosmetic outcome and reduced postoperative CAG thickness(r=0.38,P=0.06)but not with age,gender,preoperative pterygium severity,or intraoperative CAG ***:FLAPS can result in an excellent cosmetic outcome,which may be attributed to the beneficial effect of an ultrathin CAG.

关键词： Cosmesis Cosmetic outcome Femtosecond laser Pterygium Pterygium surgery

Diabetic corneal neuropathy as a surrogate marker for diabetic peripheral neuropathy

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Neural Regeneration Research 2022年第10期17卷 2172-2178页

作者： Wei Zheng So Natalie Shi Qi Wong Hong Chang Tan Molly Tzu Yu Lin Isabelle Xin Yu Lee jodhbir S.mehta Yu-Chi Liu Yong Loo Lin School of Medicine National University of SingaporeSingaporeSingapore Singapore Eye Research Institute SingaporeSingapore Department of Endocrinology Singapore General HospitalSingaporeSingapore Department of Cornea and External Eye Disease Singapore National Eye CentreSingaporeSingapore Ophthalmology and Visual Sciences Academic Clinical Program Duke-NUS Medical SchoolSingaporeSingapore

Diabetic neuropathy is a prevalent microvascular complication of diabetes mellitus,affecting nerves in all parts of the body including corneal nerves and peripheral nervous system,leading to diabetic corneal neuropathy and diabetic peripheral neuropathy,*** peripheral neuropathy is diagnosed in clinical practice using electrophysiological nerve conduction studies,clinical scoring,and skin ***,these diagnostic methods have limited sensitivity in detecting small-fiber disease,hence they do not accurately reflect the status of diabetic *** recently,analysis of alterations in the corneal nerves has emerged as a promising surrogate marker for diabetic peripheral *** this review,we will discuss the relationship between diabetic corneal neuropathy and diabetic peripheral neuropathy,elaborating on the foundational aspects of each:pathogenesis,clinical presentation,evaluation,and *** will further discuss the relevance of diabetic corneal neuropathy in detecting the presence of diabetic peripheral neuropathy,particularly early diabetic peripheral neuropathy;the correlation between the severity of diabetic corneal neuropathy and that of diabetic peripheral neuropathy;and the role of diabetic corneal neuropathy in the stratification of complications of diabetic peripheral neuropathy.

关键词： corneal nerve quantification corneal nerves diabetic cornea diabetic corneal neuropathy diabetic microvascular complications diabetic peripheral neuropathy in vivo confocal microscopy neurotrophic keratopathy ocular surface

Vessel density and En-face segmentation of optical coherence tomography angiography to analyse corneal vascularisation in an animal model

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Eye and Vision 2019年第1期6卷 6-16页

作者： Kavya Devarajan Wen Di Lee Hon Shing Ong Nyein C.Lwin Jacqueline Chua Leopold Schmetterer jodhbir S.mehta Marcus Ang Singapore Eye Research Institute SingaporeSingapore Singapore National Eye Center SingaporeSingapore Eye-ACP Duke-NUS Graduate Medical SchoolSingaporeSingapore Department of Clinical Pharmacology Medical University of ViennaViennaAustria Center for Medical Physics and Biomedical Engineering Medical University of ViennaViennaAustria Nanyang Technological University SingaporeSingapore

Background:Optical coherence tomography angiography(OCTA)is a novel non-invasive angiography technology that has recently been extensively studied for its utility in anterior segment *** this study,we compared a split-spectrum amplitude decorrelation angiography(SSADA)OCTA and an optical micro-angiography(OMAG SD)OCTA system to current angiographic technique,indocyanine green angiography(ICGA),to assess corneal vascularisation in an animal ***:We imaged 16 rabbits,(one eye per animal)with corneal vascularisation using SSADA OCTA(AngioVue;Optovue Inc.,USA),OMAG OCTA(Angioscan;RS-3000 Nidek ***.,Japan)and ICGA in the same region of interest of the cornea at successive *** then analysed all scanned images for vessel density measurements and used paired t-tests and Bland-Altman plots to examine for significant *** en-face segmentation images from each of the OCTA scans were also extracted and were matched at every 50μm segmentation to be compared for vessel density at the respective ***:Bland-Altman plots revealed a good agreement between all three imaging techniques(P>0.05)for all vessel density measurements computed,and the ranges of 95%limit of agreement were acceptable from a clinical *** significant difference was reported,with ICGA(μ=16.52±8.94%)being more comparable to the OMAG OCTA(μ=16.23±9.51%;p=0.50)than the SSADA OCTA(μ=17.09±7.34%;p=0.33)***,a good correlation value(r>0.9)was obtained when comparing the vessel density measurements of the en-face segmentations between the OCTA ***:Comparable vessel density quantification between the two OCTA systems,and with ICGA was *** analysis of the vasculature at different depths showed varied performance in the two OCTA systems relative to each *** implications of the study may help to aid in the development of better OCTA algorithms for the anterior segment and its use in clinical translational research.

关键词： OCTA Corneal vascularisation Optical micro angiography Split-spectrum amplitude decorrelation angiography Vessel density Anterior segment En-face OCTA

In vitro eye embryogenesis from induced pluripotent stem cells for ocular surface disease treatment

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Eye Science 2016年第4期31卷 230-233页

作者： Matthias Fuest jodhbir S.mehta Tissue Engineering and Stem Cell Group Singapore Eye Research InstituteSingapore Department of Ophthalmology RWTH Aachen UniversityAachenGermany Singapore National Eye Centre Singapore Eye-ACP Duke-NUS Graduate Medical SchoolSingapore School of Materials Science and Engineering Nanyang Technological UniversitySingapore

In their letter to Nature,Hayashi et *** a new method for the generation of ocular surface epitheliumlike cells by incubating human induced pluripotent stem cells(iPS)into four defined concentric zones mimicking the d... 详细信息

关键词：多能干细胞胚胎发生疾病治疗诱导体外表面上皮细胞 iPS

A cellular and proteomic approach to assess proteins extracted from cryopreserved human amnion in the cultivation of corneal stromal keratocytes for stromal cell therapy

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Eye and Vision 2019年第1期6卷 247-260页

作者： Beau J.Fenner Nur Zahirah B.M.Yusoff Matthias Fuest Lei Zhou Francisco Bandeira Howard ***-Uy H.K.Tan jodhbir S.mehta Gary H.F.Yam Tissue Engineering and Stem Cell Group Singapore Eye Research Institute20 College RoadThe AcademiaDiscovery Tower Level 6Singapore 169856Singapore Singapore National Eye Centre SingaporeSingapore Department of Ophthalmology RWTH Aachen UniversityAachenGermany Eye-Academic Clinical Programme Duke-NUS Graduate Medical SchoolSingaporeSingapore Proteomics Platform Singapore Eye Research InstituteSingaporeSingapore Federal University of São Paulo Sao PauloBrazil Singapore Eye Bank SingaporeSingapore Department of Obstetrics and Gynaecology Singapore General HospitalSingaporeSingapore

Background:Human corneal stromal keratocytes propagated in culture media supplemented with human amnion extract(AME)can correct early corneal haze in an animal *** application of cultivated keratocytes is limited by infectious disease screening before amnion products can be used in *** remains unclear if AME from cryopreserved versus fresh human amnion can support human keratocyte propagation,and which components of the extract promote keratocyte ***:Three placentas were collected for the preparation of fresh and cryopreserved amnion tissues followed by homogenization and protein *** protein profiles were studied using isobaric tagging for relative and absolute quantitation(iTRAQ)*** gene ontology(GO)terms and functional classes were *** human keratocytes from 4 donor corneas were cultured in media supplemented with fresh AME(F-AME)or cryopreserved AME(C-AME).Cell viability,proliferation and keratocyte marker expression were examined by confocal immunofluorescence and flow ***:AME proteomics revealed 1385 proteins with similar expression levels(between 0.5-and 2-fold)between Fand C-AME,while 286 proteins were reduced(less than 0.5-fold)in *** GO term and biological pathway analysis showed that those proteins with comparable expression between F-AME and C-AME were involved in cell metabolism,epithelial-mesenchymal transition,focal adhesion,cell-extracellular matrix interaction,cell stress regulation and complement *** corneal stromal keratocytes cultured with F-AME or C-AME showed similar morphology and viability,while cell proliferation was mildly suppressed with C-AME(P>0.05).Expression of aldehyde dehydrogenase 3A1(ALDH3A1)and CD34 was similar in both ***:AME from cryopreserved amnion had limited influence on keratocyte *** is feasible to use protein extract from cryopreserved amnion to propagate human keratocytes for potential translati

关键词： Amnion extract Proteomics Corneal stromal keratocytes Marker expression

Optical coherence tomography angiography for the anterior segment

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Eye and Vision 2019年第1期6卷 23-31页

作者： Wen Di Lee Kavya Devarajan Jacqueline Chua Leopold Schmetterer jodhbir S.mehta Marcus Ang Singapore Eye Research Institute Singapore National Eye CenterSingaporeSingapore Eye-ACP Duke-NUS Graduate Medical SchoolSingaporeSingapore Department of Clinical Pharmacology Medical University of ViennaViennaAustria Center for Medical Physics and Biomedical Engineering Medical University of ViennaViennaAustria Nanyang Technological University SingaporeSingapore

Optical coherence tomography angiography(OCTA)is a rapid and non-invasive technique for imaging vasculature in the *** OCTA can produce high-resolution cross-sectional images and allow depth-resolved analysis for accurate localization of pathology of interest,it has become a promising method for anterior segment ***,OCTA offers a more patient-friendly alternative to the conventional invasive dye-based fluorescent ***,conventional OCTA systems are typically designed and optimized for the posterior segment of the eye,and thus using OCTA for anterior segment imaging can present several difficulties and *** this review,we summarized the recent developments and clinical applications in anterior segment OCTA(AS-OCTA)imaging,such as for the cornea,iris,sclera and *** also compared commercially available OCTA systems,discussed the limitations of adapting current OCTA technology for the anterior segment imaging,and proposed possible future directions for AS-OCTA ***-OCTA provides potential for future clinical applications such as diagnosis of corneal and iris pathologies,pre-operative surgical planning,assessment of new antiangiogenic therapeutics or evaluation of limbal stem cell *** further development,OCTA for anterior segment imaging in the clinics may become common in the near future.

关键词： Optical coherence tomography angiography Vascularisation Cornea Iris Anterior segment