A Clinical Review on The Holism of Ophthalmology - The Associations Between Systemic Diseases and Ocular Conditions

This is an up-to-date review on the holism of ophthalmology, covering the associations between eyes and systemic diseases. Ophthalmology teaching in the undergraduate medical curriculum is often very brief, which seems reasonable in view of other specialties such as internal medicine which have many life-and-death issues and numerous diseases across a wide spectrum of subspecialties. By contrast, ophthalmology gives the impression of being more specialized. However, the value which vision holds in people’s hearts is usually underestimated when compared to life or limb. Moreover, the severity of visual impairment in relation to its impact on daily life is also often not proportional; in other words, mild visual impairment may have a detrimental effect on daily life, functionally and emotionally.This review aims to provide an overview of ocular pathologies that are associated with systemic diseases with emphasis on cardiovascular and autoimmune conditions. In addition, we discuss the potential role of retinal microvascular analysis in the prevention and management of cardiovascular diseases, which has been gaining attention in recent years

Corneal blindness and current major treatment concern-graft scarcity

According to World Health Organization, the global prevalence of blindness in 2010 was 39 million people, among which 4% were due to corneal opacities. Often, the sole resort for visual restoration of patients with damaged corneas is corneal transplantation. However, despite rapid developments of surgical techniques, instrumentations and immunosuppressive agents, corneal blindness remains a prevalent global health issue. This is largely due to the scarcity of good quality corneal grafts. In this review, the causes of corneal blindness, its major treatment options, and the major contributory factors of corneal graft scarcity with potential solutions are discussed

Variability in Grading Diabetic Retinopathy Using Retinal Photography and Its Comparison with an Automated Deep Learning Diabetic Retinopathy Screening Software

Background: Diabetic retinopathy (DR) screening using colour retinal photographs is cost-effective and time-efficient. In real-world clinical settings, DR severity is frequently graded by individuals of different expertise levels. We aim to determine the agreement in DR severity grading between human graders of varying expertise and an automated deep learning DR screening software (ADLS). Methods: Using the International Clinical DR Disease Severity Scale, two hundred macula-centred fundus photographs were graded by retinal specialists, ophthalmology residents, family medicine physicians, medical students, and the ADLS. Based on referral urgency, referral grading was divided into no referral, non-urgent referral, and urgent referral to an ophthalmologist. Inter-observer and intra-group variations were analysed using Gwet’s agreement coefficient, and the performance of ADLS was evaluated using sensitivity and specificity. Results: The agreement coefficient for inter-observer and intra-group variability ranged from fair to very good, and moderate to good, respectively. The ADLS showed a high area under curve of 0.879, 0.714, and 0.836 for non-referable DR, non-urgent referable DR, and urgent referable DR, respectively, with varying sensitivity and specificity values. Conclusion: Inter-observer and intra-group agreements among human graders vary widely, but ADLS is a reliable and reasonably sensitive tool for mass screening to detect referable DR and urgent referable DR

Variability in grading diabetic retinopathy using retinal photography and its comparison with an automated deep learning diabetic retinopathy screening software

Background: Diabetic retinopathy (DR) screening using colour retinal photographs is cost-effective and time-efficient. In real-world clinical settings, DR severity is frequently graded by individuals of different expertise levels. We aim to determine the agreement in DR severity grading between human graders of varying expertise and an automated deep learning DR screening software (ADLS). Methods: Using the International Clinical DR Disease Severity Scale, two hundred macula-centred fundus photographs were graded by retinal specialists, ophthalmology residents, family medicine physicians, medical students, and the ADLS. Based on referral urgency, referral grading was divided into no referral, non-urgent referral, and urgent referral to an ophthalmologist. Inter-observer and intra-group variations were analysed using Gwet’s agreement coefficient, and the performance of ADLS was evaluated using sensitivity and specificity. Results: The agreement coefficient for inter-observer and intra-group variability ranged from fair to very good, and moderate to good, respectively. The ADLS showed a high area under curve of 0.879, 0.714, and 0.836 for non-referable DR, non-urgent referable DR, and urgent referable DR, respectively, with varying sensitivity and specificity values. Conclusion: Inter-observer and intra-group agreements among human graders vary widely, but ADLS is a reliable and reasonably sensitive tool for mass screening to detect referable DR and urgent referable DR

Racial differences and determinants of macular thickness profiles in multiethnic Asian population : the Singapore Epidemiology of Eye Diseases Study

Aim: To evaluate racial differences, and ocular and systemic determinants of macular thickness (MT), measured by spectral-domain optical coherence tomography (SD-OCT) in a normal multiethnic Asian population. Method: MT was measured from a 6×6 mm2 central macular area using the Cirrus high-definition OCT (HD-OCT) (Carl Zeiss Meditec, Dublin, CA). The associations between ocular and systemic factors with MT were evaluated using linear regression analyses with generalised estimating equation models to account for intereye correlation. Results: 7447 healthy eyes (2577 Chinese, 2072 Malays and 2798 Indians) of 4510 subjects were included. Multivariable analysis showed that older age (per decade, β=−4.39), female gender (β=−5.74), diabetes (β=−1.10), chronic kidney disease (CKD) (β=−3.21), longer axial length (per mm, β=−2.34), flatter corneal curvature (per mm, β=−1.79) and presence of cataract (β=−0.94) were associated with thinner overall average MT (OMT) (all p≤0.026); higher total cholesterol (β=0.44; p=0.010) was associated with thicker OMT. All these factors were also associated with thinner central subfield MT (CSMT) (all p≤0.001), except for cataract, total cholesterol and CKD. Meanwhile, longer axial length (β=2.51; p<0.001) was associated with thicker CSMT. OMT (mean±SD) was thickest in Chinese (279.9±12.5 µm), followed by Malays (276.5±13.7 µm) and Indians (272.4±13.1 µm), with p≤0.003 for all interethnic comparisons. Similar trend was observed for CSMT. Conclusion: There are interethnic differences in MT profile among Asians, particularly between Chinese and Indians. Ocular and systemic factors affect MT measurements as well. This Asian-specific information may be incorporated into existing clinical interpretation of macular OCT scans to aid in improving the diagnostic and monitoring accuracy of macular diseases among Asians.NMRC (Natl Medical Research Council, S’pore

A Prospective 10-year Observational Study of Reduction of Radiotherapy Clinical Target Volume and Dose in Early-stage Nasopharyngeal Carcinoma

10.1016/j.ijrobp.2020.03.029International Journal of Radiation Oncology - Biology - Physics1074672 - 68