Automated Image Quality Assessment for Anterior Segment Optical Coherence Tomograph

Optical Coherence Tomography (OCT) is a technique for diagnosing eye disorders. Image quality assessment (IQA) of OCT images is essential, but manual IQA is time consuming and subjective. Recently, automated IQA methods based on deep learning (DL) have achieved good performance. However, few of these methods focus on OCT images of the anterior segment of the eye (AS-OCT). Moreover, few of these methods identify the factors that affect the quality of the images (called "quality factors" in this paper). This could adversely affect the acceptance of their results. In this study, we define, for the first time to the best of our knowledge, the quality level and four quality factors of AS-OCT for the clinical context of anterior chamber inflammation. We also develop an automated framework based on multi-task learning to assess the quality and to identify the existing of quality factors in the AS-OCT images. The effectiveness of the framework is demonstrated in experiments

Incidence, aetiology and neurodisability associated with severe microcephaly: a national surveillance study

Objective To determine the incidence, causes and neurodevelopmental impact of severe microcephaly (head circumference <–3SD) up to age 2 years. Design Binational active paediatric surveillance study undertaken in 2017–2018 to identify and characterise new diagnoses of severe microcephaly. Setting UK and Ireland. Participants Infants aged under 12 months at diagnosis. Interventions Observational study. Main outcome measures Incidence, aetiology and neurodevelopmental outcomes at age 2 years. Results Fifty-nine infants met the case definition, of whom 30 (51%) were girls; 24 (41%) were born preterm (<37 weeks’ gestation); and 34 (58%) were of ‘white’ ethnicity. Eight (14%) children died before 12 months of age. Incidence of severe microcephaly was 5.5 per 100 000 infants (95% CI 4.0 to 7.3). Higher relative risk (RR) was associated with preterm birth (RR 7.7, 95% CI 3.8 to 15.1) and British Asian ethnicity (RR 3.6, 95% CI 1.6 to 7.8). Microcephaly was mainly due to genetic causes (59%), brain ischaemia/hypoxia (10%) and congenital infection (8%), and 19% remained undetermined. Each child was referred on average to eight specialists, and 75% had abnormal brain imaging. By 2 years of age, 55 children experienced neurodevelopmental abnormalities, including feeding problems (68%), motor delay (66%), visual impairment (37%), hearing loss (24%) and epilepsy (41%). Conclusions Although severe microcephaly is uncommon, it is associated with high mortality, complex multimorbidity and neurodisability, thus representing a significant ongoing burden for families and healthcare services. Potentially preventable causes include preterm birth, hypoxic/ischaemic brain injury and congenital infections. Clinical guidelines are essential to standardise aetiological investigation and optimise multidisciplinary management

Designing, developing and testing a chatbot for parents and carers of children and young people with rheumatological conditions (the IMPACT study): Protocol for a co-designed proof of concept study

Background: Paediatric Rheumatology is a term that encompasses over 80 conditions affecting different organs and systems. Children and young people with rheumatological chronic conditions are known to have high levels of mental health problems and therefore are at risk of poor health outcomes. Clinical psychologists can help children and young people manage the daily difficulties of living with one of these conditions, however, there are insufficient paediatric psychologists in the United Kingdom. We urgently need to consider other ways of providing early, essential support to improve current wellbeing. One such way of doing this would be to strengthen the networks around the child or young person and the people whom they look to everyday for support, their parents/carers. Objective: The aim of this co-designed proof-of-concept study is to design, develop and test a chatbot intervention to support parents/carers of children and young people with rheumatological conditions. Methods: This study will begin by exploring the needs and views of children and young people with rheumatological conditions, siblings and parents/carers of those with rheumatological conditions, and health care professionals working in paediatric rheumatology. We will ask approximately 100 participants in focus groups where they think the gaps are in current clinical care and what ideas they have for improving upon these. Creative Experience Based Co-Design (EBCD) workshops will then decide upon top priorities to develop further, whilst informing the appearance, functionality and practical delivery of a chatbot intervention. Upon completion of a minimum viable product, approximately 100 parents/carers will user-test the chatbot intervention in an iterative sprint methodology. Results: We have full ethical approval for the study and enrolment began at the end of November 2023, with 42 currently enrolled into our focus groups. The anticipated completion of the study is April 2026. The primary outcome is to develop a product that is accessible and acceptable for parents/carers, to provide enhanced support compared to current clinical practice, with each parent/carer acting as their own control. Conclusions: This study will provide evidence on the accessibility, acceptability and usability of a chatbot intervention for parents of children and young people with rheumatological conditions. If proven useful for parents/carers, it could lead to a future efficacy trial of one of the first chatbot interventions to provide targeted and user suggested support for parents/carers of children with chronic health conditions in healthcare services. This study is unique in that it will detail the needs and wants from children, young people, siblings, parents/carers in improving support given to families living with paediatric rheumatological conditions, conducted across the whole of the UK in all paediatric rheumatological conditions at all stages of disease trajectory

Protocol for a scoping review to map evidence from randomised controlled trials on paediatric eye disease to disease burden

Abstract Background Currently, about 2 per 1000 children in the industrialised world are severely visually impaired or blind (SVI/BL) due to diverse uncommon conditions that are usually present from early infancy. The impact of SVI/BL is lifelong and life-changing. Thus, children are a priority in the WHO-led global initiative against avoidable blindness. The aim of this scoping review is to assess the current evidence base on interventions to prevent or treat the major causes of childhood SVI/BL, specifically the degree of alignment between robust interventional research (RCTs) and the burden (relative frequency) of the key causative disorders, identifying gaps in the evidence base for tackling childhood blindness. Methods/design We will perform a scoping review of the published literature of randomised controlled trials (RCTs) for clinical interventions that prevent or treat eye and vision diseases in children (<18 years old). Major electronic databases MEDLINE (PUBMED), EMBASE and the Cochrane CENTRAL will be searched to identify published trials using a comprehensive paediatric specific strategy informed by previous searches. The outcome of our study, randomised clinical trial activity, will be measured by the total number of RCTs and total paediatric participants randomised. The quantity and distribution of activity across diseases will be classified in the broad categories of anatomical site affected (per WHO taxonomy). The degree of alignment between paediatric trial activity and burden of SVI/BL disease (relative proportion) will be measured using a test of association (Spearman’s correlation coefficient). Discussion Despite the global public health importance of childhood blindness, there has been no assessment of the completeness of the evidence base regarding clinical interventions to prevent or treat the causative disorders. This scoping review will measure the degree of alignment between the published evidence and the burden of disease to identify gaps in current knowledge and consider the underlying reasons, informing clinicians, policy makers and funders about research priorities

Under-utilisation of reproducible, child appropriate or patient reported outcome measures in childhood uveitis interventional research.

BACKGROUND Childhood uveitis is a collection of chronic rare inflammatory eye disorders which result in visual loss in at least one eye of one fifth of affected children. Despite the introduction of novel systemic immunochemotherapies, it remains a blinding disease. We have undertaken a systematic review of outcome measures used in interventional trials of children with, or at risk of uveitis, in order to investigate metric quality and heterogeneity, as possible barriers to the translation of clinical research into improved outcomes. METHODS Systematic review of trials registered within databases approved by the International Committee of Medical Journal Editors (ICMJE). Eligible trials for were those which involved participants aged under 18 years with or at risk of non-infectious uveitis. Data on date of study commencement, uveitis site, inclusion age criteria, and outcome measure characteristics including type, dimension and quality were extracted independently by two authors. Quality was determined using the reproducibility, validity and age-appropriateness of the metric. RESULTS Of 917 identified trials, 57 were eligible for inclusion. Twenty different domains across five dimensions were used as primary outcome measures. The structure most commonly used was multiple separate outcome measures. In a quarter of studies, outcomes were assessed less than 3 months following the intervention. Disease activity was the most commonly assessed dimension, with only 30 studies (60%) using reproducible methodologies to assess activity. Only 2/12 (18%) studies on intermediate or posterior uveitis used reproducible activity grading schemes. Of 18 studies involving children aged under 6 years old which used outcome measures related to visual function, only 8/18 (44%) described the use of age-appropriate acuity assessment measures. None of the studies used a vision related quality of life metrics which had been validated for use in childhood. CONCLUSION This review of outcome measures in childhood uveitis interventional trials has identified under-utilisation of reproducible or child appropriate measures, and considerable heterogeneity in metric type, and structure. Clinicians and researchers interested in improving outcomes for affected children must identify a patient and family centred core outcome set, and work to validate both objective and patient (or proxy) reported disease age appropriate outcome measures

Non-invasive Instrument-Based Tests for Quantifying Anterior Chamber Flare in Uveitis: A Systematic Review.

: Anterior chamber (AC) flare is a key sign for anterior uveitis. New instrument-based techniques for measuring AC flare can offer automation and objectivity. This review aims to identify objective instrument-based measures for AC flare.: In this systematic review, we identified studies reporting correlation between instrument-based tests versus clinician AC flare grading, and/or aqueous protein concentration, as well as test reliability.: Four index tests were identified in 11 studies: laser-flare photometry (LFP), optical coherence tomography, ocular flare analysis meter (OFAM) and the double-pass technique. The correlation between LFP and clinician grading was 0.40-0.93 and 0.87-0.94 for LFP and protein concentration. The double-pass technique showed no correlation with clinician grading and insufficient information was available for OFAM.: LFP shows moderate to strong correlation with clinician grading and aqueous protein concentration. LFP could be a superior reference test compared to clinician AC flare grading for validating new index tests

Instrument-based Tests for Measuring Anterior Chamber Cells in Uveitis: A Systematic Review.

: New instrument-based techniques for anterior chamber (AC) cell counting can offer automation and objectivity above clinician assessment. This review aims to identify such instruments and its correlation with clinician estimates. : Using standard systematic review methodology, we identified and tabulated the outcomes of studies reporting reliability and correlation between instrument-based measurements and clinician AC cell grading. : From 3470 studies, 6 reported correlation between an instrument-based AC cell count to clinician grading. The two instruments were optical coherence tomography (OCT) and laser flare-cell photometry (LFCP). Correlation between clinician grading and LFCP was 0.66-0.87 and 0.06-0.97 between clinician grading and OCT. OCT volume scans demonstrated correlation between 0.75 and 0.78. Line scans in the middle AC demonstrated higher correlation (0.73-0.97) than in the inferior AC (0.06-0.56). : AC cell count by OCT and LFP can achieve high levels of correlation with clinician grading, whilst offering additional advantages of speed, automation, and objectivity

Supporting positive patient experiences for rare disease care during disruptive times: findings from a national study

Aim: We describe the perceptions and experiences of healthcare services during the pandemic of those newly diagnosed with a rare, chronic eye disorder. Methods: A cross-sectional mixed-methods study nested within a multi-center inception cohort study. Participants were UK families and adolescents newly affected by childhood uveitis. Using a validated tool (Health Foundation COVID-19 Survey), we captured quantitative (analyzed using descriptive statistics) and qualitative (analyzed using content and thematic analysis) data. Results: Responses received from 60 families (September 2020–March 2022), of whom 92% felt comfortable accessing healthcare services, despite 40% reporting challenges in accessing medication. Thematic analysis identified five themes: the value of protected spaces; the positive role of digital health tools, negative experience of immature telemedicine, disintegration of care; and dealing with uncertainty. Conclusion: Our findings will support ongoing developments in care with an aim to making services more robust to future periods of disruption