المؤلفون: Redd, Travis K, Campbell, John Peter, Brown, James M, Kim, Sang Jin, Ostmo, Susan, Chan, Robison Vernon Paul, Dy, Jennifer, Erdogmus, Deniz, Ioannidis, Stratis, Kalpathy-Cramer, Jayashree, Chiang, Michael F, for the Imaging and Informatics in Retinopathy of Prematurity (i-ROP) Research Consortium, Sonmez, Kemal, Jonas, Karyn, Horowitz, Jason, Coki, Osode, Eccles, Cheryl-Ann, Sarna, Leora, Orlin, Anton, Berrocal, Audina, Negron, Catherin, Denser, Kimberly, Cumming, Kristi, Osentoski, Tammy, Check, Tammy, Zajechowski, Mary, Lee, Thomas, Kruger, Evan, McGovern, Kathryn, Simmons, Charles, Murthy, Raghu, Galvis, Sharon, Rotter, Jerome, Chen, Ida, Li, Xiaohui, Taylor, Kent, Roll, Kaye, Martinez-Castellanos, Maria Ana, Salinas-Longoria, Samantha, Romero, Rafael, Arriola, Andrea, Olguin-Manriquez, Francisco, Meraz-Gutierrez, Miroslava, Dulanto-Reinoso, Carlos M, Montero-Mendoza, Cristina

مصطلحات موضوعية: Original articles - Clinical science

الوصف: Background Prior work has demonstrated the near-perfect accuracy of a deep learning retinal image analysis system for diagnosing plus disease in retinopathy of prematurity (ROP). Here we assess the screening potential of this scoring system by determining its ability to detect all components of ROP diagnosis. Methods Clinical examination and fundus photography were performed at seven participating centres. A deep learning system was trained to detect plus disease, generating a quantitative assessment of retinal vascular abnormality (the i-ROP plus score) on a 1–9 scale. Overall ROP disease category was established using a consensus reference standard diagnosis combining clinical and image-based diagnosis. Experts then ranked ordered a second data set of 100 posterior images according to overall ROP severity. Results 4861 examinations from 870 infants were analysed. 155 examinations (3%) had a reference standard diagnosis of type 1 ROP. The i-ROP deep learning (DL) vascular severity score had an area under the receiver operating curve of 0.960 for detecting type 1 ROP. Establishing a threshold i-ROP DL score of 3 conferred 94% sensitivity, 79% specificity, 13% positive predictive value and 99.7% negative predictive value for type 1 ROP. There was strong correlation between expert rank ordering of overall ROP severity and the i-ROP DL vascular severity score (Spearman correlation coefficient=0.93; p<0.0001). Conclusion The i-ROP DL system accurately identifies diagnostic categories and overall disease severity in an automated fashion, after being trained only on posterior pole vascular morphology. These data provide proof of concept that a deep learning screening platform could improve objectivity of ROP diagnosis and accessibility of screening.

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العلاقة: http://bjo.bmj.com/cgi/content/short/103/5/580Test; http://dx.doi.org/10.1136/bjophthalmol-2018-313156Test

الإتاحة: https://doi.org/10.1136/bjophthalmol-2018-313156Test
http://bjo.bmj.com/cgi/content/short/103/5/580Test

المؤلفون: Simó, Rafael, Hernández, Cristina, on behalf of the European Consortium for the Early Treatment of Diabetic Retinopathy (EUROCONDOR)*

مصطلحات موضوعية: Review

الوصف: Diabetic retinopathy (DR) remains the leading cause of blindness among working-age individuals in developed countries . Current treatments for DR are indicated in advanced stages of the disease and are associated with significant adverse effects. Therefore, new pharmacological treatments for the early stages of DR are needed. DR has been classically considered to be a microcirculatory disease of the retina. However, there is growing evidence to suggest that retinal neurodegeneration is an early event in the pathogenesis of DR, which participates in the microcirculatory abnormalities that occur in DR. Therefore, the study of the underlying mechanisms that lead to neurodegeneration will be essential for identifying new therapeutic targets. From the clinical point of view, the identification of those patients in whom retinal neurodegeneration appears will be crucial for implementing early treatment based on neuroprotective drugs. When the early stages of DR are the therapeutic target, it would be inconceivable to recommend an aggressive treatment such as intravitreous injections. By contrast, topical administration of neuroprotective drugs by using eye drops is a possible option. However, clinical trials to determine the safety and effectiveness of this non-invasive route, as well as a standardisation of the methods for monitoring neurodegeneration, are needed.

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العلاقة: http://bjo.bmj.com/cgi/content/short/bjophthalmol-2012-302005v1Test; http://dx.doi.org/10.1136/bjophthalmol-2012-302005Test

الإتاحة: https://doi.org/10.1136/bjophthalmol-2012-302005Test
http://bjo.bmj.com/cgi/content/short/bjophthalmol-2012-302005v1Test

المؤلفون: Simó, Rafael, Hernández, Cristina, on behalf of the European Consortium for the Early Treatment of Diabetic Retinopathy (EUROCONDOR)*

مصطلحات موضوعية: Review

الوصف: Diabetic retinopathy (DR) remains the leading cause of blindness among working-age individuals in developed countries . Current treatments for DR are indicated in advanced stages of the disease and are associated with significant adverse effects. Therefore, new pharmacological treatments for the early stages of DR are needed. DR has been classically considered to be a microcirculatory disease of the retina. However, there is growing evidence to suggest that retinal neurodegeneration is an early event in the pathogenesis of DR, which participates in the microcirculatory abnormalities that occur in DR. Therefore, the study of the underlying mechanisms that lead to neurodegeneration will be essential for identifying new therapeutic targets. From the clinical point of view, the identification of those patients in whom retinal neurodegeneration appears will be crucial for implementing early treatment based on neuroprotective drugs. When the early stages of DR are the therapeutic target, it would be inconceivable to recommend an aggressive treatment such as intravitreous injections. By contrast, topical administration of neuroprotective drugs by using eye drops is a possible option. However, clinical trials to determine the safety and effectiveness of this non-invasive route, as well as a standardisation of the methods for monitoring neurodegeneration, are needed.

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العلاقة: http://bjo.bmj.com/cgi/content/short/96/10/1285Test; http://dx.doi.org/10.1136/bjophthalmol-2012-302005Test

الإتاحة: https://doi.org/10.1136/bjophthalmol-2012-302005Test
http://bjo.bmj.com/cgi/content/short/96/10/1285Test

المؤلفون: Fleming, Alan D, Goatman, Keith A, Philip, Sam, Williams, Graeme J, Prescott, Gordon J, Scotland, Graham S, McNamee, Paul, Leese, Graham P, Wykes, William N, Sharp, Peter F, Olson, John A, on behalf of the Scottish Diabetic Retinopathy Clinical Research Network

مصطلحات موضوعية: Original articles - Clinical science

الوصف: Background/aims Automated grading has the potential to improve the efficiency of diabetic retinopathy screening services. While disease/no disease grading can be performed using only microaneurysm detection and image-quality assessment, automated recognition of other types of lesions may be advantageous. This study investigated whether inclusion of automated recognition of exudates and haemorrhages improves the detection of observable/referable diabetic retinopathy. Methods Images from 1253 patients with observable/referable retinopathy and 6333 patients with non-referable retinopathy were obtained from three grading centres. All images were reference-graded, and automated disease/no disease assessments were made based on microaneurysm detection and combined microaneurysm, exudate and haemorrhage detection. Results Introduction of algorithms for exudates and haemorrhages resulted in a statistically significant increase in the sensitivity for detection of observable/referable retinopathy from 94.9% (95% CI 93.5 to 96.0) to 96.6% (95.4 to 97.4) without affecting manual grading workload. Conclusion Automated detection of exudates and haemorrhages improved the detection of observable/referable retinopathy.

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العلاقة: http://bjo.bmj.com/cgi/content/short/bjo.2008.149807v2Test; http://dx.doi.org/10.1136/bjo.2008.149807Test

الإتاحة: https://doi.org/10.1136/bjo.2008.149807Test
http://bjo.bmj.com/cgi/content/short/bjo.2008.149807v2Test

المؤلفون: Fleming, Alan D, Goatman, Keith A, Philip, Sam, Williams, Graeme J, Prescott, Gordon J, Scotland, Graham S, McNamee, Paul, Leese, Graham P, Wykes, William N, Sharp, Peter F, Olson, John A, on behalf of the Scottish Diabetic Retinopathy Clinical Research Network

مصطلحات موضوعية: Original articles - Clinical science

الوصف: Background/aims Automated grading has the potential to improve the efficiency of diabetic retinopathy screening services. While disease/no disease grading can be performed using only microaneurysm detection and image-quality assessment, automated recognition of other types of lesions may be advantageous. This study investigated whether inclusion of automated recognition of exudates and haemorrhages improves the detection of observable/referable diabetic retinopathy. Methods Images from 1253 patients with observable/referable retinopathy and 6333 patients with non-referable retinopathy were obtained from three grading centres. All images were reference-graded, and automated disease/no disease assessments were made based on microaneurysm detection and combined microaneurysm, exudate and haemorrhage detection. Results Introduction of algorithms for exudates and haemorrhages resulted in a statistically significant increase in the sensitivity for detection of observable/referable retinopathy from 94.9% (95% CI 93.5 to 96.0) to 96.6% (95.4 to 97.4) without affecting manual grading workload. Conclusion Automated detection of exudates and haemorrhages improved the detection of observable/referable retinopathy.

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العلاقة: http://bjo.bmj.com/cgi/content/short/94/6/706Test; http://dx.doi.org/10.1136/bjo.2008.149807Test

الإتاحة: https://doi.org/10.1136/bjo.2008.149807Test
http://bjo.bmj.com/cgi/content/short/94/6/706Test

المؤلفون: Scotland, G S, McNamee, P, Fleming, A D, Goatman, K A, Philip, S, Prescott, G J, Sharp, P F, Williams, G J, Wykes, W, Leese, G P, Olson, J A, on behalf of the Scottish Diabetic Retinopathy Clinical Research Network

مصطلحات موضوعية: Original articles - Clinical science

الوصف: Aims To assess the cost-effectiveness of an improved automated grading algorithm for diabetic retinopathy against a previously described algorithm, and in comparison with manual grading. Methods Efficacy of the alternative algorithms was assessed using a reference graded set of images from three screening centres in Scotland (1253 cases with observable/referable retinopathy and 6333 individuals with mild or no retinopathy). Screening outcomes and grading and diagnosis costs were modelled for a cohort of 180 000 people, with prevalence of referable retinopathy at 4%. Algorithm (b), which combines image quality assessment with detection algorithms for microaneurysms (MA), blot haemorrhages and exudates, was compared with a simpler algorithm (a) (using image quality assessment and MA/dot haemorrhage (DH) detection), and the current practice of manual grading. Results Compared with algorithm (a), algorithm (b) would identify an additional 113 cases of referable retinopathy for an incremental cost of £68 per additional case. Compared with manual grading, automated grading would be expected to identify between 54 and 123 fewer referable cases, for a grading cost saving between £3834 and £1727 per case missed. Extrapolation modelling over a 20-year time horizon suggests manual grading would cost between £25 676 and £267 115 per additional quality adjusted life year gained. Conclusions Algorithm (b) is more cost-effective than the algorithm based on quality assessment and MA/DH detection. With respect to the value of introducing automated detection systems into screening programmes, automated grading operates within the recommended national standards in Scotland and is likely to be considered a cost-effective alternative to manual disease/no disease grading.

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العلاقة: http://bjo.bmj.com/cgi/content/short/94/6/712Test; http://dx.doi.org/10.1136/bjo.2008.151126Test

الإتاحة: https://doi.org/10.1136/bjo.2008.151126Test
http://bjo.bmj.com/cgi/content/short/94/6/712Test

المؤلفون: The Early Treatment for Retinopathy of Prematurity Cooperative Group

مصطلحات موضوعية: Clinical science - Extended reports

الوصف: Objective: To determine whether earlier treatment of high-risk, prethreshold retinopathy of prematurity (ROP) improves retinal structural outcome at 2 years of age. Methods: Infants with bilateral high-risk prethreshold ROP had one eye randomly assigned to treatment with peripheral retinal ablation. The fellow eye was managed conventionally, and either treated at threshold ROP or observed if threshold was never reached. In patients with asymmetrical disease, the high-risk, prethreshold eye was randomised to earlier treatment or to conventional management. At 2 years of age, children were examined comprehensively by certified ophthalmologists to determine structural outcomes for their eyes. For the purposes of this study, an unfavourable structural outcome was defined as (1) a posterior retinal fold involving the macula, (2) a retinal detachment involving the macula or (3) retrolental tissue or “mass” obscuring the view of the posterior pole. Results of the 2-year examination were compared with those from the 9 months examination. Results: Data were available on 339 of 374 (90.6%) surviving children. Unfavourable structural outcomes were reduced from 15.4% in conventionally managed eyes to 9.1% in earlier-treated eyes (p = 0.002) at 2 years of age. Ophthalmic side effects (excluding retinal structure) from the ROP or its treatment were similar in the earlier-treated eyes and the conventionally managed eyes. Conclusion: The benefit of earlier treatment of high-risk prethreshold ROP on retinal structure endures to 2 years of age, and is not counterbalanced by any known side effect caused by earlier intervention. Earlier treatment improves the chance for long-term favourable retinal structural outcome in eyes with high-risk prethreshold ROP. Long-term follow-up is planned to determine structural and functional outcomes at 6 years of age.

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العلاقة: http://bjo.bmj.com/cgi/content/short/90/11/1378Test; http://dx.doi.org/10.1136/bjo.2006.098582Test

الإتاحة: https://doi.org/10.1136/bjo.2006.098582Test
http://bjo.bmj.com/cgi/content/short/90/11/1378Test

المؤلفون: Christen, William G., Manson, JoAnn E., Bubes, Vadim, Glynnf, Robert J., or the Sorbinil Retinopathy Trial Research Group

مصطلحات موضوعية: ORIGINAL CONTRIBUTIONS

الوصف: In a prospective cohort study, the authors examined risk factors for progression of distal symmetric polyneuropathy (DSP) in type 1 (insulin-dependent) diabetes mellitus. The study population consisted of participants in the Sorbinil Retinopathy Trial, a randomized trial of aldose reductase inhibition among patients aged 18-56 years with type 1 diabetes mellitus of 1-15 years' duration. Diagnosis of DSP was based on standardized clinical neurologic evaluation. A total of 407 participants who did not have definite DSP at randomization and had at least one follow-up visit were included in the analysis. Stepwise Cox proportional hazards models were used to examine the independent contribution of baseline variables to progression of DSP. During follow-up (median, 40 months), 68 participants (17%) showed progression to definite DSP. After adjustment for age and treatment assignment, independent predictors of progression to definite DSP were total glycosylated hemoglobin (relative risk (RR) for increase of one percentage point= 1.25; 95% confidence interval (Cl) 1.12,1.39), height (RR associated with being one inch (2.54 cm) taller= 1.15; 95% Cl 1.05,1.26), cigarette smoking (ever vs. never) (RR= 1.87; 95% Cl 1.09, 3.21), and female gender (RR= 2.26; 95% Cl 1.09, 4.67). These data indicate that, in addition to the previously established role for total glycosylated hemoglobin, other factors including height, cigarette smoking, and female gender may also be independent risk factors for progression of DSP in type 1 diabetes mellitus. Am JEp/ctem/o/1999;150:1142-51.

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العلاقة: http://aje.oxfordjournals.org/cgi/content/short/150/11/1142Test

الإتاحة: http://aje.oxfordjournals.org/cgi/content/short/150/11/1142Test