Aplicațiile inteligenței artificiale în oftalmologie

Department of Ophtalmology, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi,Romania, Gheorghe Asachi” Technical University of Iasi, Faculty of Chemical Engineering and Environmental Protection 11 “Cristofor- Simionescu”, Department of Chemical EngineeringRezumat. Instrumentele inteligenței artificiale și, îndeosebi, rețelele neuronale artificiale, sunt tot mai des implicate în diagnosticul și managementul personalizat al bolilor oftalmologice. Imaginile OCT sunt utilizate pentru diagnosticul precoce, monitorizarea și managementul bolilor retinei, cum ar fi edem macular diabetic (EMD) și degenerescență maculară legată de vârstă (DMLV). Citirea automată a OCT a avut rezultate promițătoare în EMD și în identificarea formelor exudative ale DMLV. Cea mai frecventă utilizare a rețelelor neuronale în oftalmologie a fost în stabilirea precoce a diagnosticului de glaucom, atunci când sunt dubii de diagnostic. Rețelele neuronale au avut un rol important în stabilirea necesităţii iniţierii terapiei precoce antiglaucomatoase pentru a preveni progresia bolii. Numeroase studii din literatura de specialitate demonstrează folosirea cu succes a acestor instrumente ale inteligenței artificiale în oftalmologie, pe direcții cum ar fi: evaluarea câmpului vizual, a nervului optic, a stratului fibrelor nervoase retiniene, oferind astfel o mai bună precizie în identificarea progresiei în glaucom şi a modificărilor retiniene în diabet. În oftalmologie, Inteligenta artificiala are potențialul de a crește accesul pacientului la screening / diagnostic clinic și la scăderea costurilor enorme solicitate de asistența medicală, mai ales atunci când riscul apariției bolii este ridicat sau comunitățile se confruntă cu resurse financiare reduse. Reţelele neuronale artificiale sunt utile în stabilirea diagnosticului diferitelor boli, însă informaţiile obţinute au rolul de a ajuta decizia finală care va fi luată de clinician, dar nu va înlocui rolul acestuia.Artificial intelligence tools, and especially artificial neural networks, are increasingly involved in the diagnosis and personalized management of ophthalmic diseases. OCT images are used for early diagnosis, monitoring and management of retinal diseases such as diabetic macular edema (EMD) and age-related macular degeneration (DMLV). Automatic reading of OCT has had promising results in EMD and in identifying exudative forms of DMLV. The most common use of neural networks in ophthalmology has been in early diagnosis of glaucoma, when there is doubt about the diagnosis. Neural networks have played an important role in determining the need for early antiglaucoma therapy to prevent disease progression. Numerous studies in the literature demonstrate the successful use of these tools of artificial intelligence in ophthalmology, in directions such as: assessment of visual field, optic nerve, retinal nerve fiber layer, thus providing better accuracy in identifying progression in glaucoma. and retinal changes in diabetes. Conclusions. In ophthalmology, Artificial Intelligence has the potential to increase patient access to screening / clinical diagnosis and to reduce the enormous costs required by healthcare, especially when the risk of disease is high or communities face limited financial resources. Artificial neural networks are useful in diagnosing various diseases, but the information obtained is intended to help the final decision that will be made by the clinician, but will not replace his role

Multiple sclerosis and SARS-CoV-2 infection

Universitatea de Medicină și Farmacie „Grigore T. Popa” Iași, România, Clinica I Oftalmologie, Spitalul Clinic Județean de Urgență „Sf. Spiridon”, Iași, RomâniaSummary. We analyzed the case of a patient with multiple sclerosis associated with SARS-CoV-2 infection. The clinical appearance of the ophthalmologist does not justify the decrease in AV, which is why it is recommended to perform an MRI in an emergency. The patient accuses the decrease in visual acuity in the left eye. The appearance described is suggestive for multiple sclerosis. PCR testing was positive. After 14 days PCR test was negative but the ophthalmological evolution was unfavorable. Intravenous emergency treatment with Solumedrol was initiated for 5 days. The particularity of the case is due to the fulminant onset of multiple sclerosis in the context of SARS-CoV-2 infection and the unfavorable evolution in terms of AV, despite early treatment.Introducere. Pacientă, în vârstă de 16 ani, se prezintă în Clinica I Oftalmologie a Spitalului „Sf. Spiridon”, Iași, acuzând scăderea acuității vizuale la ochiul stâng cu debut acut. Pacienta nu prezintă alte antecedente personale patologice. AVOD=1 fc, AVOS= pmm., PIOAO=12mmHg. La examinarea polului anterior, nu se constată elemente patologice. La examinarea polului posterior, discul optic este normal colorat, are contur net, C/D=0,1, artere și vene cu calibru normal, maculă fără leziuni. Aspectul clinic oftalmologic nu justifică scăderea AV, motiv pentru care se recomandă efectuarea unui RMN în urgență. Se identifică leziuni în hipersemnal T2 și FLAIR cu restricție de difuzie localizată periventricular pe partea dreaptă, în contrast cu cornul posterior al ventriculului lateral drept cu diametru de 17/15 mm și două în centri senzoriali, una mai mare de 9,6mm parietal drept în substanța albă, periventricular, talamic drept, 9,6 mm în medulla oblongata de 13 mm. Aspectul descris este sugestiv pentru scleroză multiplă. Testarea PCR pentru SARS-CoV-2 a avut rezultat pozitiv, pacienta fiind asimptomatică. S-a format o echipă multidisciplinară alcătuită din oftalmologi, neurologi și medici infecționiști și s-a inițiat tratamentul în urgență intravenos cu Solumedrol timp de 5 zile, continuat cu Medrol per os. Evoluție. După 14 zile, testul PCR pentru SARSCoV- 2 s-a negativat, însă evoluția oftalmologică a fost nefavorabilă. Pacienta se prezintă după 3 luni, în urgență, acuzând percepția unui scotom central la OD. AVOD=0,6, iar AVOS a rămas pmm. La RMN leziunile au aspect staționar. După tratamentul intravenos cu Solumedrol 3 zile și per os cu Medrol, scotomul central de la OD se reduce în dimensiuni și AVOD se îmbunătățește la 0,8 fcnc. Discuții: Rămâne în discuție deschisă dacă infecția cu SARS-CoV-2 la persoane nevaccinate poate precipita debutul fulminant al unor patologii în stare latentă. Concluzii. Particularitatea cazului se datorează debutului fulminant al sclerozei multiple în contextul infecției cu SARS-CoV-2 și evoluției nefavorabile din punct de vedere al AV, în ciuda tratamentului instaurat precoce

Assessing Changes in Diabetic Retinopathy Caused by Diabetes Mellitus and Glaucoma Using Support Vector Machines in Combination with Differential Evolution Algorithm

The aim of this study is to evaluate the changes related to diabetic retinopathy (DR) (no changes, small or moderate changes) in patients with glaucoma and diabetes using artificial intelligence instruments: Support Vector Machines (SVM) in combination with a powerful optimization algorithm—Differential Evolution (DE). In order to classify the DR changes and to make predictions in various situations, an approach including SVM optimized with DE was applied. The role of the optimizer was to automatically determine the SVM parameters that lead to the lowest classification error. The study was conducted on a sample of 52 patients: particularly, 101 eyes with glaucoma and diabetes mellitus, in the Ophthalmology Clinic I of the “St. Spiridon” Clinical Hospital of Iaşi. The criteria considered in the modelling action were normal or hypertensive open-angle glaucoma, intraocular hypertension and associated diabetes. The patients with other types of glaucoma pseudoexfoliation, pigment, cortisone, neovascular and primitive angle-closure, and those without associated diabetes, were excluded. The assessment of diabetic retinopathy changes were carried out with Volk lens and Fundus Camera Zeiss retinal photography on the dilated pupil, inspecting all quadrants. The criteria for classifying the DR (early treatment diabetic retinopathy study—ETDRS) changes were: without changes (absence of DR), mild forma nonproliferative diabetic retinopathy (the presence of a single micro aneurysm), moderate form (micro aneurysms, hemorrhages in 2–3 quadrants, venous dilatations and soft exudates in a quadrant), severe form (micro aneurysms, hemorrhages in all quadrants, venous dilatation in 2–3 quadrants) and proliferative diabetic retinopathy (disk and retinal neovascularization in different quadrants). Any new clinical element that occurred in subsequent checks, which led to their inclusion in severe nonproliferative or proliferative forms of diabetic retinopathy, was considered to be the result of the progression of diabetic retinopathy. The results obtained were very good; in the testing phase, a 95.23% accuracy has been obtained, only one sample being wrongly classified. The effectiveness of the classification algorithm (SVM), developed in optimal form with DE, and used in predictions of retinal changes related to diabetes, was demonstrated

A Narrative Review of the Complex Relationship between Pregnancy and Eye Changes

Pregnancy is a condition often characterized by changes that occur in different parts of the body. Generally, the eyes suffer several changes during pregnancy that are usually transient but may become permanent at times. This may occur due to the release of placental hormones and those of maternal endocrine glands and fetal adrenal glands. Due to hormonal influences, physiological ocular changes during pregnancy have been shown in Caucasian women, so corneal sensitivity, refractive status, intraocular pressure, and visual acuity may change during pregnancy. Within this review, all studies that referred to physiological aspects and to changes of ocular pathology of pregnancy, the effect of the pregnancy on pre-existing (diabetic retinopathy, neuro-ophthalmic disorders) eye disorders, postpartum ocular changes, the intraocular pressure and the effect of hypotensive ophthalmic medicine during pregnancy, the connection between pregnancy and the neuro-ophthalmic pathology, as well as the role of anesthesia were analyzed

Clinical Study on the Ocular Manifestations in Patients with Obstructive Sleep Apnea Syndrome—Preliminary Results

Obstructive sleep apnea syndrome is a multisystemic disorder associated with a series of side effects. Obstructive sleep apnea syndrome (OSAS) includes hypoxemia and is correlated with an increased incidence for various neuronal conditions, including glaucoma, strokes, reduced mental ability, depressive disorders, peripheral neuropathy, and non-arteritic ischemic optic neuropathy. This study’s aims are the evaluation of the degree of ocular surface damage in obstructive sleep apnea patients (in the absence of the continuous positive airway pressure treatment) and the structural changes in the optic nerve, and to establish correlation between the degree of damage to the ocular surface (eye dryness by Schirmer test) and corneal biomechanics by ocular response analyzer. The subjects included in the study will be grouped as follows: a group of patients with glaucoma and obstructive sleep apnea syndrome that will be compared to patients with glaucoma only as well as identifying the evolution of structural changes in patients with glaucoma and sleep apnea syndrome. A prospective study included 65 eyes from 65 subjects diagnosed with obstructive sleep apnea (45 eyes of 45 subjects with glaucoma and OSAS as well as 20 subjects, 20 eyes with dry-eye syndrome and OSAS) who did not follow the continuous positive airway pressure treatment. The control group consisted of 45 subjects (45 eyes) with (mild or moderate) primary open-angle treated glaucoma without obstructive sleep apnea. All patients had ophthalmologic evaluations according to a standardized protocol. Moreover, respiratory functional parameters (apnea–hypopnea index—AHI) and the body mass index were recorded. Within the studied group, patients with mild or moderate primary open-angle glaucoma, with moderate or severe dry-eye syndrome, patients with floppy-eyelid syndrome, with optical non-arteritis ischemic neuropathy, and a patient with retinal central vein occlusion were identified. The increased rate of the apnea syndrome during sleep produces a severe disorder of the ocular surface and a retinal neuro-degenerative disorder. The eyes of patients with sleep apnea syndrome (SAS) and glaucoma have lower mean intraocular pressure than eyes with glaucoma without SAS. However, the mean C/D ratio in eyes with glaucoma correlates with the severity of SAS. There is a positive correlation between the severity of the apnea and the ocular disorder’s degree similar to the studies in the literature review. The joint cooperation between the sleep specialists and ophthalmologists can lead to the improvement of the vascular and ocular status for the obstructive sleep apnea patients

Evaluation of Iontophoretic Collagen Cross-linking for Early Stage of Progressive Keratoconus Compared to Standard Cross-linking: A Non-Inferiority Study

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