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 of glaucoma. Area under receiver operating curve (AROC) values of > 0.90 were achieved with every modality. Combining structural and functional inputs has been shown to even more improve the diagnostic ability. Regarding glaucoma progression, AI strategies can detect progression earlier than conventional methods or potentially from one single VF test. / Conclusions: AI algorithms applied to fundus photographs for screening purposes may provide good results using a simple and widely accessible test. However, for patients who are likely to have glaucoma more sophisticated methods should be used including data from OCT and perimetry. Outputs may serve as an adjunct to assist clinical decision making, whereas also enhancing the efficiency, productivity, and quality of the delivery of glaucoma care. Patients with diagnosed glaucoma may benefit from future algorithms to evaluate their risk of progression. Challenges are yet to be overcome, including the external validity of AI strategies, a move from a "black box" toward "explainable AI," and likely regulatory hurdles. However, it is clear that AI can enhance the role of specialist clinicians and will inevitably shape the future of the delivery of glaucoma care to the next generation. / Translational Relevance: The promising levels of diagnostic accuracy reported by AI strategies across the modalities used in clinical practice for glaucoma detection can pave the way for the development of reliable models appropriate for their translation into clinical practice. Future incorporation of AI into healthcare models may help address the current limitations of access and timely management of patients with glaucoma across the world

Long-term in vivo imaging and measurement of dendritic shrinkage of retinal ganglion cells

PURPOSE. To monitor and measure dendritic shrinkage of retinal ganglion cells (RGCs) in a strain of transgenic mice (Thy-1 YFP) that expresses yellow fluorescent proteins in neurons under the control of a Thy-1 promoter. METHODS. A total of 125 RGCs from 16 eyes of Thy-1 YFP transgenic mice were serially imaged with a confocal scanning laser ophthalmoscope for 6 months after optic nerve crush. Quantitative analysis of cell body area, axon diameter, dendritic field, number of terminal branches, total dendritic branch length, branching complexity, symmetry, and distance from the optic disc was used to characterize the morphology of RGCs, describe the patterns of axonal and dendritic degeneration, identify the morphologic predictors for cell survival, and estimate the rate of dendritic shrinkage. RESULTS. RGC damage was observed prospectively to begin with progressive dendritic shrinkage, followed by loss of the axon and the cell body. In a small proportion of RGCs, progressive axonal changes including fragmentation, beading, retraction, and bulb formation were also observed. RGCs with a larger dendritic field and a longer total dendritic branch length in general have a better survival probability. The rate of dendritic shrinkage was variable with a slower rate observed in cells having a larger dendritic field, a longer total dendritic branch length, and a greater distance from the optic disc. CONCLUSIONS. Estimating the probability of RGC survival and measuring the rate of dendritic shrinkage could become a new paradigm for investigating neuronal degeneration and evaluating the response of neuroprotective treatment. © 2011 The Association for Research in Vision and Ophthalmology, Inc.postprin

ISRCTN12125882 - Influence of topical anti-VEGF (Ranibizumab) on the outcome of filtration surgery for glaucoma - Study Protocol

<p>Abstract</p> <p>Background</p> <p>Excessive wound healing, with scarring of the episcleral tissue or encapsulation of the filtering bleb is the main reason for failure in trabeculectomy. Ranibizumab, an inhibitor of the Vascular Endothelial Growth Factor (VEGF), is seen as a promising candidate to prevent or treat extensive wound healing. We describe the design of a two phased study, i) assessing the local tolerability and safety of topical ranibizumab and ii) assessing the efficacy of topical ranibizumab against placebo in patients who underwent trabeculectomy with mitomycin C combined with phacoemulsification and intra ocular lens (IOL) implantation.</p> <p>Methods/Design</p> <p>In the first phase five patients that had trabeculectomy with mitomycin C combined with phacoemulsification and IOL implantation will be treated with topical ranibizumab (Lucentis^®) eye drops (2 mg/ml) four times daily for one month. The treatment will be started at the first postoperative day. Patients will be assessed for local and systemic side effects using a standardised schedule. In the second phase, after successful completion of phase 1, consenting eligible patients who underwent trabeculectomy with mitomycin C combined with phacoemulsification and IOL implantation will be randomised to either receive topical ranibizumab eye drops (2 mg/ml) four times daily for 1 month or placebo (BSS 4x/d for 1 month). Patients will be reviewed weekly for 4 weeks until conjunctival sutures are removed. Further follow up examinations are planned after 3 and six months. Assessment of differences in the intraocular eye pressure will be considered primary, and bleb appearance/vascularisation using a standardized photography and the Moorfields bleb grading system, postoperative intraocular pressure and conjunctival wound healing problems will be considered secondary outcome parameters.</p> <p>Discussion</p> <p>Anti-VEGF-antibodies might be more effective in preventing scaring and might have fewer toxic side effects than the currently used anti-metabolites and may replace them in the long term.</p> <p>Trial Registration</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN12125882">ISRCTN12125882</a></p

What are the competences in information system required by managers? Curriculum development for management and public administration degrees

[EN] This paper analyzes the competences required by executives to manage information system, and consequently, the competences that must define the information system subjects in non-technical degrees, degrees, such as Public Administration or Business Management. This work reviews the literature about business managers competences on Information Technologies (IT) and compares the theory with the traditional body of knowledge about information systems taught at business schools. By analyzing the executives function, their role in the information system management, and, above, all the importance of their decisions in the effective integration of IT in business processes, this work proposes specific development in seven knowledge areas that facilitate the acquisition of these types of executive competencesDevece Carañana, CA.; Peris-Ortiz, M.; Rueda Armengot, C. (2016). What are the competences in information system required by managers? Curriculum development for management and public administration degrees. Technology, Innovation and Education. 2(10):1-9. doi:10.1186/s40660-016-0016-2S19210Bassellier G, Benbasat I (2004) Business competence of IT professionals: conceptual development and influence on IT-business partnerships. MIS Q 28(4):673–694Bassellier G, Reich BH, Benbasat I (2001) Information technology competence of business managers: a definition and research model. J Manag Inf Syst 17(4):159–182Bassellier G, Benbasat I, Reich BH (2003) The influence of business managers’ IT competence on championing IT. Inf Syst Res 14(4):317–336Bettiol M, Di Maria E, Finotto V (2012) Marketing in SMEs: the role of entrepreneurial sensemaking. Int Entrep Manag J 8(2):223–248Boyatzis RE (1982) The competent manager a model for effective performance. Wiley, New YorkBoynton AC, Zmud RW, Jacobs GC (1994) The influence of IT management practice on IT use in large organizations. MIS Q 18(3):299–318Broadbent M, Weill P (1993) Improving business and information strategy alignment: learning from the banking industry. IBM Syst J 32(1):162–179Brown CV, Magill SL (1994) Alignment of the IS functions with the enterprise: toward a model of antecedents. MIS Q 18(4):371–403Busch EA, Jarvenpaa SL, Tractinsky N, Glick WH (1991) External versus internal perspectives in determining a firm’s progressive use of information technology. Proceedings of the 12th International Conference on Information Systems, New York, 1991:239–250Camisón C (2002) On the relevance of industry, competitive scope, strategic group, size and distinctive competences construct on explaining of organizational performance. Universitat jaume I, Castellón (Working Paper 1–02,Research Group on Strategy, Knowledge Management and Organizational Learning)Castanias RP, Helfat CE (1991) Managerial resources and rents. J Manag 17:155–171Cegarra-Navarro JG, Sánchez-Vidal ME, Cegarra-Leiva D (2011) Balancing exploration and exploitation of knowledge through an unlearning context: an empirical investigation in SMEs. Manag Decis 49(7):1099–1119Chan YE, Reich BH (2007) IT alignment: what have we learned? J Inf Tech 22:297–315Chan YE, Sabherwal R, Thatcher JB (2006) Antecedents and outcomes of strategic IS alignment: an empirical investigation. IEEE Trans Eng Manag 51(3):27–47Croteau AM, Bergeron F (2001) An information technology trilogy: business strategy, technological deployment and organizational performance. J Strateg Inf Syst 10:77–99Crowston K, Myers MD (2004) Information technology and the transformation of industries: three research perspectives. J Strateg Inf Syst 13(1):5–28Dent-Micallef A, Powell T (1998) Technologies de l’information: nécessités stratégiques ou sources d’avantage concurrentiel? Une étude empirique dans le secteur de la distribution aux Etats-Unis. Rev Can Sci Adm 15(1):39–64Devece C (2013) The value of business managers’ ‘information technology’ competence. Serv Ind J 33(7/8):720–733Doll WJ, Torkzadeh G (1987) The relationship of MIS steering committee to size of firm and formalization of mis planning. Commun ACM 30(11):972–978Earl MJ (1996) The risks of outsourcing IT. Sloan Manag Rev 37(3):26–32European Commission (2015) ECTS Users’ Guide 2015. Publications Office of the European Union, Luxembourg. doi: 10.2766/87592Hambrick DC, Brandon G (1988) Executive values. In: Hambrick DC (ed) The executive effect: concepts and methods for studying top managers. JAI Press, GreenwichHambrick DC, Mason PA (1984) Upper echelons: the organization as a reflection of its top managers. Acad Manag Rev 9(2):193–206Hotho S, Champion K (2011) Small businesses in the new creative industries: innovation as a people management challenge. Manag Decis 49(1):29–54Jarvenpaa SL, Ives B (1991) Executive involment and participation in the management of IT. MIS Q 15(2):52–69Lado AA, Wilson MC (1994) Human resource systems and sustained competitive advantage: a competency-based perspective. Acad Manag Rev 19(4):699–727Lado AA, Boyd NG, Wright P (1992) A competency-based model of sustainable competitive advantage: toward a conceptual integration. J Manag 18(1):77–91Lederer AL, Mendelow AL (1988) Information systems planning: top management takes control. Bus Horiz 31(3):73–78Oh W, Pinsonneault A (2007) On the assessment of the strategic value of information technologies: conceptual and analytical approaches. MIS Q 31(2):239–265Osbaldeston M, Barham K (1992) Using management development for competitive advantage. Long Range Plan 25(6):18–24Penrose ET (1959) The theory of the growth of the firm. Basil Blackwell, OxfordReich BH, Benbasat I (1996) Measuring the linkage between business and information technology objectives. MIS Q 20(1):55–81Reich BH, Benbasat I (2000) Factors that influence the social dimension of alignment between business and information techonology objectives. MIS Q 24(1):81–113Riegner C (2007) Word of mouth on the web: the impact of web 2.0 on consumer purchase decisions. J Advert Res 47(4):436–447Rockart JF (1988) The lines takes the leadership. Sloan Manag Rev 29(4):57–64Sabherwal R, Chan YE (2001) Alignment between business and IS strategies: a study of prospectors, analyzers, and defenders. Inf Syst Res 12(1):11–33Sanchez R, Heene A, Thomas H (1996) Towards the theory and practice of competence-based competition. In: Sanchez R, Heene A, Thomas H (eds) Dynamics of competence-based competition: theory and practice in the new strategic management. Elsevier, London, pp 1–35Senge PM (1990) The fifth discipline: the age and practice of the learning organization. Century Business, LondonSiegel DS, Renko M (2012) The role of market and technological knowledge in recognizing entrepreneurial opportunities. Manag Decis 50(5):797–816Stare M, Jaklic A, Kotnik P (2006) Exploiting ICT potential in service firms in transition economies. Serv Ind J 26(3):287–302Swanson EB (1974) Management information systems: appreciation and involvement. Manag Sci 21(2):178–188Torkzadeh G, Xia W (1992) Managing telecommunications by steering committee. MIS Q 16(2):187–199Westley F, Mintzberg H (1989) Visionary leadership and strategic management. Strateg Manag J 10:17–32Yang TT, Li CR (2011) Competence exploration and exploitation in new product development: the moderating effects of environmental dynamism and competitiveness. Manag Decis 49(9):1444–147

In vitro and in vivo delivery of a sustained release nanocarrier-based formulation of an MRTF/SRF inhibitor in conjunctival fibrosis

Abstract Background Sustained drug delivery is a large unmet clinical need in glaucoma. Here, we incorporated a Myocardin-Related Transcription Factor/Serum Response Factor inhibitor, CCG-222740, into slow release large unilamellar vesicles derived from the liposomes DOTMA (1,2-di-O-octadecenyl-3-trimethylammonium propane) and DOPC (1,2-dioleoyl-sn-glycero-3-phosphocholine), and tested their effects in vitro and in vivo. Results The vesicles were spherical particles of around 130 nm and were strongly cationic. A large amount of inhibitor could be incorporated into the vesicles. We showed that the nanocarrier CCG-222740 formulation gradually released the inhibitor over 14 days using high performance liquid chromatography. Nanocarrier CCG-222740 significantly decreased ACTA2 gene expression and was not cytotoxic in human conjunctival fibroblasts. In vivo, nanocarrier CCG-222740 doubled the bleb survival from 11.0 ± 0.6 days to 22.0 ± 1.3 days (p = 0.001), decreased conjunctival scarring and did not have any local or systemic adverse effects in a rabbit model of glaucoma filtration surgery. Conclusions Our study demonstrates proof-of-concept that a nanocarrier-based formulation efficiently achieves a sustained release of a Myocardin-Related Transcription Factor/Serum Response Factor inhibitor and prevents conjunctival fibrosis in an established rabbit model of glaucoma filtration surgery.https://deepblue.lib.umich.edu/bitstream/2027.42/146540/1/12951_2018_Article_425.pd

Wound Healing Modulation in Glaucoma Filtration Surgery-Conventional Practices and New Perspectives: The Role of Antifibrotic Agents (Part I).

Glaucoma filtration surgery is regularly performed for the treatment of glaucoma and trabeculectomy is often regarded as the 'gold standard' glaucoma operation. The biggest risk of failure of the operation is bleb scarring. The advent of anti-fibrotic agents, such as mitomycin C (MMC) and 5-fluorouracil (5FU) has vastly prolonged the longevity of the bleb, but concerns remain regarding the potential increase in postoperative complications. More selective therapeutic targets have therefore been explored. One of these is vascular endothelial growth factor (VEGF) inhibition. Vascular endothelial growth factor inhi bition has a role not only in sub conjunctival angiogenesis inhi bition but also it has direct anti-fibrotic properties. Newer phar macological compounds and materials have also been developed in recent years in attempt to modulate the wound healing in different ways after glaucoma surgery. These include physical barriers to scarring and vehicles for sustained release of pharmacological agents, and early promising results have been demonstrated. This two-part review will provide a discussion of the application of anti-fibrotic agents in glaucoma filtration surgery and evaluate the newer agents that have been developed. How to cite this article: Fan Gaskin JC, Nguyen DQ, Ang GS, O'Connor J, Crowston JG. Wound Healing Modulation in Glaucoma Filtration Surgery-Conventional Practices and New Pers pectives: The Role of Antifibrotic Agents (Part I). J Curr Glaucoma Pract 2014;8(2):37-45

Wound Healing Modulation in Glaucoma Filtration Surgery- Conventional Practices and New Perspectives: Antivascular Endothelial Growth Factor and Novel Agents (Part II).

Glaucoma filtration surgery is regularly performed for the treatment of glaucoma and trabeculectomy is often regarded as the 'gold standard' glaucoma operation. The biggest risk of failure of the operation is bleb scarring. The advent of antifibrotic agents, such as mitomycin C (MMC) and 5-fluorouracil (5FU) has vastly prolonged the longevity of the bleb, but concerns remain regarding the potential increase in postoperative complications. More selective therapeutic targets have therefore been explored. One of these is vascular endothelial growth factor (VEGF) inhibition. VEGF inhibition has a role not only in subconjunctival angiogenesis inhibition but also it has direct anti-fibrotic properties. Newer pharmacological compounds and materials have also been developed in recent years in attempt to modulate the wound healing in different ways after glaucoma surgery. These include physical barriers to scarring and vehicles for sustained release of pharmacological agents, and early promising results have been demonstrated. This two-part review will provide a discussion of the application of anti-fibrotic agents in glaucoma filtration surgery and evaluate the newer agents that have been developed. How to cite this article: Fan Gaskin JC, Nguyen DQ, Ang GS, O'Connor J, Crowston JG. Wound Healing Modulation in Glau coma Filtration Surgery-Conventional Practices and New Pers pectives: Antivascular Endothelial Growth Factor and Novel Agents (Part II). J Curr Glaucoma Pract 2014;8(2):46-53

A Comparison of Perimetric Results from a Tablet Perimeter and Humphrey Field Analyzer in Glaucoma Patients

PURPOSE: To determine the correlation between the perimetric outcomes from perimetry software Melbourne Rapid Fields (MRF) run on an Apple iPad tablet and those from the Humphrey Field Analyzer (HFA). METHODS: The MRF software was designed with features including variable fixation and fast thresholding using Bayes logic. Here, we report a cross-sectional study on 90 eyes from 90 participants: 12 had normal optic nerves and 78 had glaucoma with various degrees of visual field loss (41 mild and 37 moderate-severe). Exclusion criteria were patients with worse than 20/40 vision or recent intraocular surgery. The visual field outcomes of MRF were compared against those returned from the HFA 24-2 SITA standard. Participants were tested twice on the MRF to establish test-retest repeatability. RESULTS: The test durations were shorter on MRF than HFA (5.7 ± 0.1 vs. 6.3 ± 0.1 minutes, P < 0.001). MRF showed a high level of concordance in its outcomes with HFA (intraclass coefficient [ICC] = 0.93 for mean defect [MD] and 0.86 for pattern deviation [PD]) although the MRF tended to give a less negative MD (1.4 dB bias) compared with the HFA. MRF also showed levels of test-retest reliability comparable to HFA (ICC = 0.93 for MD and 0.89 for PD, 95% limits of agreement -4.5 to 4.3 dB). CONCLUSION: The perimetry results from the MRF have a strong correlation to the HFA outcomes. MRF also has test-retest reliability comparable to HFA. TRANSLATIONAL RELEVANCE: Portable tablet perimetry may allow accurate assessment of visual field when standard perimetry machines are unavailable or unsuitable