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Health burden associated with visual impairment in Singapore: the Singapore epidemiology of eye disease study

Wang X, Lamoureux E, Zheng Y, Ang M, Wong TY, Luo N

Ophthalmology, 2014 Sep;121(9):1837-42.
PMID: 24768238 DOI: 10.1016/j.ophtha.2014.03.017

To assess the impact of visual impairment (VI) on health-related quality of life and to compare the health burden of VI and other health conditions in Singapore.
Impact of glaucoma severity and laterality on vision-specific functioning: the Singapore Malay eye study

Chan EW, Chiang PP, Wong TY, Saw SM, Loon SC, Aung T, et al.

Invest Ophthalmol Vis Sci, 2013 Feb;54(2):1169-75.
PMID: 23341009 DOI: 10.1167/iovs.12-10258

We determined the impact of glaucoma severity and laterality on vision-specific functioning (VF) in an Asian population.
Independent impact of area-level socioeconomic measures on visual impairment

Zheng Y, Lamoureux E, Finkelstein E, Wu R, Lavanya R, Chua D, et al.

Invest Ophthalmol Vis Sci, 2011;52(12):8799-805.
PMID: 21969296 DOI: 10.1167/iovs.11-7700

It is known that a person's socioeconomic status (SES; individual-level SES) is closely correlated with his or her degree of visual impairment. Whether there is an independent relationship between area-level measures of SES (e.g., living in a lower SES environment) and visual impairment is unclear. This study describes the associations of area-level SES with visual impairment.
Fulltext Retinal vascular geometry in Asian persons with diabetes and retinopathy

Cheung CY, Lamoureux E, Ikram MK, Sasongko MB, Ding J, Zheng Y, et al.

J Diabetes Sci Technol, 2012 May 01;6(3):595-605.
PMID: 22768891 DOI: 10.1177/193229681200600315

Purpose: Our purpose was to examine the relationship of retinal vascular parameters with diabetes and retinopathy in an older Asian population.

Methods: Retinal photographs from participants of a population-based survey of Asian Malay persons aged 40-80 years were analyzed. Specific retinal vascular parameters (tortuosity, branching angle, fractal dimension, and caliber) were measured using a semiautomated computer-based program. Diabetes was defined as random plasma glucose ≥ 11.1 mmol/liter, the use of diabetes medication, or physician-diagnosed diabetes. Retinopathy signs were graded from photographs using the modified Airlie House classification system.

Results: A total of 2735 persons were included in the study. Persons with diabetes (n = 594) were more likely to have straighter (less tortuous) arterioles and wider arteriolar and venular caliber than those without diabetes (n = 2141). Among subjects with diabetes, those with retinopathy had wider venular caliber than those without retinopathy (211.3 versus 204.9 mm, p = .001). Among nondiabetic subjects, however, those with retinopathy had more tortuous venules than those without retinopathy [5.19(×10(4)) versus 4.27(×10(4)), p < .001].

Conclusions: Retinal vascular parameters varied by diabetes and retinopathy status in this older Asian cohort. Our findings suggest that subtle alterations in retinal vascular architecture are influenced by diabetes.
Fulltext Classification of SD-OCT Volumes Using Local Binary Patterns: Experimental Validation for DME Detection

Lemaître G, Rastgoo M, Massich J, Cheung CY, Wong TY, Lamoureux E, et al.

J Ophthalmol, 2016;2016:3298606.
PMID: 27555965 DOI: 10.1155/2016/3298606

This paper addresses the problem of automatic classification of Spectral Domain OCT (SD-OCT) data for automatic identification of patients with DME versus normal subjects. Optical Coherence Tomography (OCT) has been a valuable diagnostic tool for DME, which is among the most common causes of irreversible vision loss in individuals with diabetes. Here, a classification framework with five distinctive steps is proposed and we present an extensive study of each step. Our method considers combination of various preprocessing steps in conjunction with Local Binary Patterns (LBP) features and different mapping strategies. Using linear and nonlinear classifiers, we tested the developed framework on a balanced cohort of 32 patients. Experimental results show that the proposed method outperforms the previous studies by achieving a Sensitivity (SE) and a Specificity (SP) of 81.2% and 93.7%, respectively. Our study concludes that the 3D features and high-level representation of 2D features using patches achieve the best results. However, the effects of preprocessing are inconsistent with different classifiers and feature configurations.
An anomaly detection approach for the identification of DME patients using spectral domain optical coherence tomography images

Sidibé D, Sankar S, Lemaître G, Rastgoo M, Massich J, Cheung CY, et al.

Comput Methods Programs Biomed, 2017 Feb;139:109-117.
PMID: 28187882 DOI: 10.1016/j.cmpb.2016.11.001

This paper proposes a method for automatic classification of spectral domain OCT data for the identification of patients with retinal diseases such as Diabetic Macular Edema (DME). We address this issue as an anomaly detection problem and propose a method that not only allows the classification of the OCT volume, but also allows the identification of the individual diseased B-scans inside the volume. Our approach is based on modeling the appearance of normal OCT images with a Gaussian Mixture Model (GMM) and detecting abnormal OCT images as outliers. The classification of an OCT volume is based on the number of detected outliers. Experimental results with two different datasets show that the proposed method achieves a sensitivity and a specificity of 80% and 93% on the first dataset, and 100% and 80% on the second one. Moreover, the experiments show that the proposed method achieves better classification performance than other recently published works.
Fulltext Acceptance and Perception of Artificial Intelligence Usability in Eye Care (APPRAISE) for Ophthalmologists: A Multinational Perspective

Gunasekeran DV, Zheng F, Lim GYS, Chong CCY, Zhang S, Ng WY, et al.

Front Med (Lausanne), 2022;9:875242.
PMID: 36314006 DOI: 10.3389/fmed.2022.875242

BACKGROUND: Many artificial intelligence (AI) studies have focused on development of AI models, novel techniques, and reporting guidelines. However, little is understood about clinicians' perspectives of AI applications in medical fields including ophthalmology, particularly in light of recent regulatory guidelines. The aim for this study was to evaluate the perspectives of ophthalmologists regarding AI in 4 major eye conditions: diabetic retinopathy (DR), glaucoma, age-related macular degeneration (AMD) and cataract.
METHODS: This was a multi-national survey of ophthalmologists between March 1st, 2020 to February 29th, 2021 disseminated via the major global ophthalmology societies. The survey was designed based on microsystem, mesosystem and macrosystem questions, and the software as a medical device (SaMD) regulatory framework chaired by the Food and Drug Administration (FDA). Factors associated with AI adoption for ophthalmology analyzed with multivariable logistic regression random forest machine learning.
RESULTS: One thousand one hundred seventy-six ophthalmologists from 70 countries participated with a response rate ranging from 78.8 to 85.8% per question. Ophthalmologists were more willing to use AI as clinical assistive tools (88.1%, n = 890/1,010) especially those with over 20 years' experience (OR 3.70, 95% CI: 1.10-12.5, p = 0.035), as compared to clinical decision support tools (78.8%, n = 796/1,010) or diagnostic tools (64.5%, n = 651). A majority of Ophthalmologists felt that AI is most relevant to DR (78.2%), followed by glaucoma (70.7%), AMD (66.8%), and cataract (51.4%) detection. Many participants were confident their roles will not be replaced (68.2%, n = 632/927), and felt COVID-19 catalyzed willingness to adopt AI (80.9%, n = 750/927). Common barriers to implementation include medical liability from errors (72.5%, n = 672/927) whereas enablers include improving access (94.5%, n = 876/927). Machine learning modeling predicted acceptance from participant demographics with moderate to high accuracy, and area under the receiver operating curves of 0.63-0.83.
CONCLUSION: Ophthalmologists are receptive to adopting AI as assistive tools for DR, glaucoma, and AMD. Furthermore, ML is a useful method that can be applied to evaluate predictive factors on clinical qualitative questionnaires. This study outlines actionable insights for future research and facilitation interventions to drive adoption and operationalization of AI tools for Ophthalmology.