1. Articles from pearse a. keane

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    1. Deep learning to detect optical coherence tomography-derived diabetic macular edema from retinal photographs: a multicenter validation study

      Deep learning to detect optical coherence tomography-derived diabetic macular edema from retinal photographs: a multicenter validation study

      Purpose: To validate the generalizability of a deep learning system (DLS) that detects diabetic macular edema (DME) from two-dimensional color fundus photography (CFP), where the reference standard for retinal thickness and fluid presence is derived from three-dimensional optical coherence tomography (OCT). Design: Retrospective validation of a DLS across international datasets. Participants: Paired CFP and OCT of patients from diabetic retinopathy (DR) screening programs or retina clinics. The DLS was developed using datasets from Thailand, the United Kingdom (UK) and the United States and validated using 3,060 unique eyes from 1,582 patients across screening populations in Australia, India and ...

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    2. OCT Assisted Quantification of Vitreous Inflammation in Uveitis

      OCT Assisted Quantification of Vitreous Inflammation in Uveitis

      Purpose: Vitreous haze (VH) is a key marker of inflammation in uveitis but limited by its subjectivity. Optical coherence tomography (OCT) has potential as an objective, noninvasive method for quantifying VH. We test the hypotheses that OCT can reliably quantify VH and the measurement is associated with slit-lamp based grading of VH. Methods: In this prospective study, participants underwent three repeated OCT macular scans to evaluate the within-eye reliability of the OCT vitreous intensity (VI). Association between OCT VI and clinical findings (including VH grade, phakic status, visual acuity [VA], anterior chamber cells, and macular thickness) were assessed. Results: One ...

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    3. ADVANCED OCT ANALYSIS OF BIOPSY PROVEN VITREORETINAL LYMPHOMA: OCT findings in vitreo-retinal lymphoma

      ADVANCED OCT ANALYSIS OF BIOPSY PROVEN VITREORETINAL LYMPHOMA: OCT findings in vitreo-retinal lymphoma

      Importance: Although the diagnosis of vitreoretinal lymphoma (VRL) can be challenging, early detection is critical for visual prognosis. Objective: To analyze the spectrum of optical coherence tomography (OCT) findings in patients with biopsy-proven VRL and correlate these features with clinical parameters. Design: Retrospective cross-sectional study SETTING: Multicenter chart review from 13 retina, uveitis and ocular oncology clinics worldwide over an 11-year period (2008-2019). Participants: Patients with a diagnosis of biopsy-proven VRL imaged with OCT at presentation EXPOSURE: The ocular information, systemic information and multimodal retinal imaging findings were collected and studied. Main outcome measure: Characteristics of VRL on OCT RESULTS ...

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    4. Clinically relevant deep learning for detection and quantification of geographic atrophy from optical coherence tomography: a model development and external validation study

      Clinically relevant deep learning for detection and quantification of geographic atrophy from optical coherence tomography: a model development and external validation study

      Background: Geographic atrophy is a major vision-threatening manifestation of age-related macular degeneration, one of the leading causes of blindness globally. Geographic atrophy has no proven treatment or method for easy detection. Rapid, reliable, and objective detection and quantification of geographic atrophy from optical coherence tomography (OCT) retinal scans is necessary for disease monitoring, prognostic research, and to serve as clinical endpoints for therapy development. To this end, we aimed to develop and validate a fully automated method to detect and quantify geographic atrophy from OCT. Methods: We did a deep-learning model development and external validation study on OCT retinal scans ...

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    5. Validation and Clinical Applicability of Whole-Volume Automated Segmentation of Optical Coherence Tomography in Retinal Disease Using Deep Learning

      Validation and Clinical Applicability of Whole-Volume Automated Segmentation of Optical Coherence Tomography in Retinal Disease Using Deep Learning

      Importance: Quantitative volumetric measures of retinal disease in optical coherence tomography (OCT) scans are infeasible to perform owing to the time required for manual grading. Expert-level deep learning systems for automatic OCT segmentation have recently been developed. However, the potential clinical applicability of these systems is largely unknown. Objective: To evaluate a deep learning model for whole-volume segmentation of 4 clinically important pathological features and assess clinical applicability. Design, setting, participants: This diagnostic study used OCT data from 173 patients with a total of 15 558 B-scans, treated at Moorfields Eye Hospital. The data set included 2 common OCT devices ...

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    6. Re-evaluating diabetic papillopathy using optical coherence tomography and inner retinal sublayer analysis

      Re-evaluating diabetic papillopathy using optical coherence tomography and inner retinal sublayer analysis

      Background/Objectives To re-evaluate diabetic papillopathy using optical coherence tomography (OCT) for quantitative analysis of the peripapillary retinal nerve fibre layer (pRNFL), macular ganglion cell layer (mGCL) and inner nuclear layer (mINL) thickness. Subjects/Methods In this retrospective observational case series between June 2008 and July 2019 at Moorfields Eye hospital, 24 eyes of 22 patients with diabetes and optic disc swelling with confirmed diagnosis of NAION or diabetic papillopathy by neuro-ophthalmological assessment were included for evaluation of the pRNFL, mGCL and mINL thicknesses after resolution of optic disc swelling. Results The mean age of included patients was 56.5 ...

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    7. Automated quantification of posterior vitreous inflammation: optical coherence tomography scan number requirements

      Automated quantification of posterior vitreous inflammation: optical coherence tomography scan number requirements

      Quantifying intraocular inflammation is crucial in managing uveitis patients. We assessed the minimum B-scan density for reliable automated vitreous intensity (VI) assessment, using a novel approach based on optical coherence tomography (OCT). OCT volume scans centered on the macula were retrospectively collected in patients with uveitis. Nine B-scans per volume scan at fixed locations were automatically analyzed. The following B-scan selections were compared against the average score of 9 B-scans per volume scan as a reference standard: 1/3/5/7 central scans (1c/3c/5c/7c), 3 widely distributed scans (3w). Image data of 49 patients (31 females) were ...

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    8. Phenotyping of retinal neovascularization in ischemic retinal vein occlusion using wide field OCT angiography

      Phenotyping of retinal neovascularization in ischemic retinal vein occlusion using wide field OCT angiography

      Background/objectives Abnormal retinal neovascularization caused by ischemic retinal vein occlusion (RVO) is a frequent cause of visually significant vitreous hemorrhage. The early detection of new vessels may be challenging and often requires the use of invasive tests such as fundus fluorescein angiography (FA). We demonstrate the use of wide-field optical coherence tomography angiography (WF-OCTA) in the detection and characterization of neovascularization secondary to ischemic RVO. Subjects/methods We conducted a retrospective observational case series of patients diagnosed with ischemic RVO between August 2018 and March 2019, who underwent WF-SS-OCTA imaging (PLEX Elite 9000, Carl Zeiss Meditec). We performed real-life ...

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    9. Optical coherence tomography in the 2020s—outside the eye clinic

      Optical coherence tomography in the 2020s—outside the eye clinic

      Optical coherence tomography (OCT) is a paragon of success in the translation of biophotonics science to clinical practice. OCT systems have become ubiquitous in eye clinics but access beyond this is limited by their cost, size and the skill required to operate the devices. Remarkable progress has been made in the development of OCT technology to improve the speed of acquisition, the quality of images and into functional extensions of OCT such as OCT angiography. However, more needs to be done to radically improve the access to OCT by addressing its limitations and enable penetration outside of typical clinical settings ...

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    10. Artificial Intelligence Algorithms to Diagnose Glaucoma and Detect Glaucoma Progression: Translation to Clinical Practice

      Artificial Intelligence Algorithms to Diagnose Glaucoma and Detect Glaucoma Progression: Translation to Clinical Practice

      Purpose : This concise review aims to explore the potential for the clinical implementation of artificial intelligence (AI) strategies for detecting glaucoma and monitoring glaucoma progression. Methods : Nonsystematic literature review using the search combinations “Artificial Intelligence,” “Deep Learning,” “Machine Learning,” “Neural Networks,” “Bayesian Networks,” “Glaucoma Diagnosis,” and “Glaucoma Progression.” Information on sensitivity and specificity regarding glaucoma diagnosis and progression analysis as well as methodological details were extracted. Results : Numerous AI strategies provide promising levels of specificity and sensitivity for structural (e.g. optical coherence tomography [OCT] imaging, fundus photography) and functional (visual field [VF] testing) test modalities used for the detection ...

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    11. The eye, the kidney, and cardiovascular disease: old concepts, better tools, and new horizons

      The eye, the kidney, and cardiovascular disease: old concepts, better tools, and new horizons

      Chronic kidney disease (CKD) is common, with hypertension and diabetes mellitus acting as major risk factors for its development. Cardiovascular disease is the leading cause of death worldwide and the most frequent end point of CKD. There is an urgent need for more precise methods to identify patients at risk of CKD and cardiovascular disease. Alterations in microvascular structure and function contribute to the development of hypertension, diabetes, CKD, and their associated cardiovascular disease. Homology between the eye and the kidney suggests that noninvasive imaging of the retinal vessels can detect these microvascular alterations to improve targeting of at-risk patients ...

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    12. Predicting conversion to wet age-related macular degeneration using deep learning

      Predicting conversion to wet age-related macular degeneration using deep learning

      Progression to exudative ‘wet’ age-related macular degeneration (exAMD) is a major cause of visual deterioration. In patients diagnosed with exAMD in one eye, we introduce an artificial intelligence (AI) system to predict progression to exAMD in the second eye. By combining models based on three-dimensional (3D) optical coherence tomography images and corresponding automatic tissue maps, our system predicts conversion to exAMD within a clinically actionable 6-month time window, achieving a per-volumetric-scan sensitivity of 80% at 55% specificity, and 34% sensitivity at 90% specificity. This level of performance corresponds to true positives in 78% and 41% of individual eyes, and false ...

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    13. Widefield optical coherence tomography angiography for early detection and objective evaluation of proliferative diabetic retinopathy

      Widefield optical coherence tomography angiography for early detection and objective evaluation of proliferative diabetic retinopathy

      Purpose To evaluate the utility of widefield optical coherence tomography angiography (WF-OCTA) compared with clinical examination in grading diabetic retinopathy in patients diagnosed clinically with proliferative diabetic retinopathy (PDR) or severe non-proliferative diabetic retinopathy (NPDR). Design This retrospective observational case series included patients diagnosed clinically with PDR or severe NPDR. Patients underwent standard clinical examination and WF-OCTA imaging (PLEX Elite 9000, Carl Zeiss Meditec AG) using 12×12 montage scans between August 2018 and January 2019. Two trained graders identified neovascularisation at the disc (NVD) and neovascularisation elsewhere (NVE) on WF-OCTA which were compared with the clinical examination, and to ...

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    14. Automated Pupillometry using a Prototype Binocular Optical Coherence Tomography System

      Automated Pupillometry using a Prototype Binocular Optical Coherence Tomography System

      Purpose To determine the test-retest reliability and diagnostic accuracy of a binocular optical coherence tomography (OCT) prototype (Envision Diagnostics, USA) for pupillometry. Design Assessment of diagnostic reliability and accuracy. Methods Fifty participants with RAPD confirmed using the swinging flashlight method (mean age 49.6 years) and 50 healthy controls (mean age 31.3 years) were examined. Participants twice underwent an automated pupillometry exam using a binocular OCT system that presents a stimulus and simultaneously captures OCT images of the iris-pupil plane of both eyes. Participants underwent a single exam on the RAPDx (Konan Inc, USA), an automated infrared pupillometer. Pupil ...

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    15. Subclinical Macular Changes And Disease Laterality In Pediatric Coats Disease Determined By Quantitative Optical Coherence Tomography Angiography

      Subclinical Macular Changes And Disease Laterality In Pediatric Coats Disease Determined By Quantitative Optical Coherence Tomography Angiography

      Purpose: To determine vascular change at the macula in both eyes in unilateral pediatric Coats disease using optical coherence tomography angiography. Methods: Retrospective case-series. Thirteen eyes of pediatric patients with a diagnosis of unilateral Coats disease of various stages were compared with 13 fellow eyes. Optical coherence tomography angiography images were acquired using the RTVue XR Avanti. Scans were analyzed with novel projection artifact removal software and improved segmentation. Vascular density and foveal avascular zone area were calculated. Results: Vascular density was significantly decreased in eyes with Coats disease in comparison with fellow eyes in both the superficial capillary plexus ...

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    16. Optical coherence tomography (OCT) in unconscious and systemically unwell patients using a mobile OCT device: a pilot study

      Optical coherence tomography (OCT) in unconscious and systemically unwell patients using a mobile OCT device: a pilot study

      Objective This study aims to evaluate the feasibility of retinal imaging in critical care using a novel mobile optical coherence tomography (OCT) device. The Heidelberg SPECTRALIS FLEX module (Heidelberg Engineering, Heidelberg, Germany) is an OCT unit with a boom arm, enabling ocular OCT assessment in less mobile patients. Design We undertook an evaluation of the feasibility of using the SPECTRALIS FLEX for undertaking ocular OCT images in unconscious and critically ill patients. Setting This study was conducted in the critical care unit of a large tertiary referral unit in the United Kingdom. Participants 13 systemically unwell patients admitted to the ...

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    17. Objective evaluation of proliferative diabetic retinopathy using optical coherence tomography

      Objective evaluation of proliferative diabetic retinopathy using optical coherence tomography

      Purpose To present the routine use of optical coherence tomography (OCT) and OCT angiography (OCTA) for the objective diagnosis and monitoring of proliferative diabetic retinopathy (PDR). Design Retrospective observational case series. Subjects Patients with diabetic retinopathy imaged using a standardized PDR-protocol Methods Patients routinely imaged with a standardized PDR-protocol between March 2017 and January 2019 were included. This included a 12x9 mm structural OCT volume centered on the macula and a 6x6 mm OCTA scan centered on the optic nerve head obtained using a Topcon swept-source system (DRI OCT-1 Triton, Topcon, Tokyo, Japan). Ultra-widefield fluorescein angiography (FA) was also performed ...

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    18. OCT Angiography in Acute Posterior Multifocal Placoid Pigment Epitheliopathy

      OCT Angiography in Acute Posterior Multifocal Placoid Pigment Epitheliopathy

      BACKGROUND AND OBJECTIVE: To describe retinal and choroidal findings in different stages of acute posterior multifocal placoid pigment epitheliopathy (APMPPE). PATIENTS AND METHODS: Retrospective, noncomparative case series studied by fundus biomicroscopy, fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography (ICGA), spectral-domain optical coherence tomographic (SD-OCT), and swept-source OCT angiography (SS-OCTA). RESULTS: Six eyes of three patients with bilateral APMPPE were included. FAF showed multifocal, branched patches of hyperautofluorescence with areas of hypoautofluorescence; FA disclosed early hypofluorescence, with late-phase hyperfluorescence; ICGA showed early and late-phase hypofluorescence. SD-OCT imaging revealed bilateral retinal thinning, external limiting membrane (ELM) disruption, and severe alteration ...

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    19. Anterior segment optical coherence tomographic angiography assessment of acute chemical injury

      Anterior segment optical coherence tomographic angiography assessment of acute chemical injury

      Purpose To compare routine clinical examination with optical coherence tomography angiography (OCTA) for the assessment of limbal conjunctival ischemia following a chemical burn. Setting Validity analysis Methods We assessed ten participants (15 eyes) with an acute chemical injury. Clinical photographs were used to determine the extent of any limbal conjunctival epithelial defect and ischemia. These were compared with the extent of limbal ischemia identified on OCTA images of the ocular surface. Quantitative and longitudinal analysis using the OCTA software were also performed. Correlations with visual outcome were sought using clinical and OCTA-derived variables. Results The extent of clinically determined limbal ...

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    20. Effect of total anti-VEGF treatment exposure on patterns of choroidal neovascularisation assessed by optical coherence tomography angiography in age-related macular degeneration: a retrospective case series

      Effect of total anti-VEGF treatment exposure on patterns of choroidal neovascularisation assessed by optical coherence tomography angiography in age-related macular degeneration: a retrospective case series

      Objective To compare clinical characteristics of patients suffering from neovascular age-related macular degeneration (nAMD) with mature and immature choroidal neovascularisation (CNV) as assessed by optical coherence tomography angiography (OCTA). To explore the effect of total anti-vascular endothelial growth factor exposure on the occurrence of mature CNV when correcting for potential confounders. Methods and analysis In this retrospective case series, we included 40 eyes of 36 patients with nAMD with CNV assessed by OCTA at the Manchester Eye Hospital between June 2016 and June 2017. A retinal specialist masked to patient information graded CNV depicted on OCTA scans. For statistical comparisons ...

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      Mentions: Tufts University
    21. Test performance of optical coherence tomography angiography in detecting retinal diseases: a systematic review and meta-analysis

      Test performance of optical coherence tomography angiography in detecting retinal diseases: a systematic review and meta-analysis

      Objective To investigate the diagnostic accuracy of optical coherence tomography angiography (OCTA) in detecting vascular characteristics of chorio-retinal disease. Methods Evidence acquisition: We searched Web of Science, Scopus, and Medline by the citation of references and complemented these electronic searches by checking the list of references of included and review articles. Screening, selection, assessment, and extraction was performed in parallel by two authors. Results Evidence synthesis: Systematic review and exploratory meta-analysis. The ten studies that contributed to the meta-analysis enrolled 440 eyes and allowed constructing ten two-by-two tables. The tables reported on detection of choroidal neovascularization (CNV) in eyes suffering ...

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    22. Predicting optical coherence tomography-derived diabetic macular edema grades from fundus photographs using deep learning

      Predicting optical coherence tomography-derived diabetic macular edema grades from fundus photographs using deep learning

      Diabetic eye disease is one of the fastest growing causes of preventable blindness. With the advent of anti-VEGF (vascular endothelial growth factor) therapies, it has become increasingly important to detect center-involved diabetic macular edema. However, center-involved diabetic macular edema is diagnosed using optical coherence tomography (OCT), which is not generally available at screening sites because of cost and workflow constraints. Instead, screening programs rely on the detection of hard exudates as a proxy for DME on color fundus photographs, often resulting in high false positive or false negative calls. To improve the accuracy of DME screening, we trained a deep ...

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    23. Artificial intelligence and deep learning in ophthalmology

      Artificial intelligence and deep learning in ophthalmology

      Artificial intelligence (AI) based on deep learning (DL) has sparked tremendous global interest in recent years. DL has been widely adopted in image recognition, speech recognition and natural language processing, but is only beginning to impact on healthcare. In ophthalmology, DL has been applied to fundus photographs, optical coherence tomography and visual fields, achieving robust classification performance in the detection of diabetic retinopathy and retinopathy of prematurity, the glaucoma-like disc, macular oedema and age-related macular degeneration. DL in ocular imaging may be used in conjunction with telemedicine as a possible solution to screen, diagnose and monitor major eye diseases for ...

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    24. Clinically applicable deep learning for diagnosis and referral in retinal disease

      Clinically applicable deep learning for diagnosis and referral in retinal disease

      The volume and complexity of diagnostic imaging is increasing at a pace faster than the availability of human expertise to interpret it. Artificial intelligence has shown great promise in classifying two-dimensional photographs of some common diseases and typically relies on databases of millions of annotated images. Until now, the challenge of reaching the performance of expert clinicians in a real-world clinical pathway with three-dimensional diagnostic scans has remained unsolved. Here, we apply a novel deep learning architecture to a clinically heterogeneous set of three-dimensional optical coherence tomography scans from patients referred to a major eye hospital. We demonstrate performance in ...

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