Deep Learning Predicts OCT Measures of Diabetic Macular Thickening From Color Fundus Photographs

Arcadu, Filippo; Benmansour, Fethallah; Maunz, Andreas; Michon, John; Hašková, Zdenka; McClintock, Dana; Adamis, Anthony P.; Willis, Jeffrey R.; Prunotto, Marco

doi:10.1167/iovs.18-25634

Cited by 65 publications

(50 citation statements)

References 35 publications

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“…Subsequent developments have included additional algorithms [275,277,278,297,300,301] and their ongoing validation producing potentially even higher sensitivities and specificities (reviewed by Grzbowski et al [295] in Table 1). While most available software uses colour fundus photographs to grade all retinopathy including maculopathy (with the ability to even predict quantitative disease metrics such as central subfield thickness from colour fundus photographs [302]) other recent automated image analysis systems examine OCT data [303]. The advances in automated analysis and the effects of deep learning on multimodal imaging would be powerful, particularly given the complexity of some DMO eyes that may be associated with OCT-A ischaemia and three-dimensional pathology such as vitreomacular traction.…”

Section: Section 11: Virtual Clinics and Artificial Intelligence In Dmomentioning

confidence: 99%

Diabetic retinopathy and diabetic macular oedema pathways and management: UK Consensus Working Group

Amoaku

Ghanchi

Bailey

et al. 2020

Eye

134

121

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The management of diabetic retinopathy (DR) has evolved considerably over the past decade, with the availability of new technologies (diagnostic and therapeutic). As such, the existing Royal College of Ophthalmologists DR Guidelines (2013) are outdated, and to the best of our knowledge are not under revision at present. Furthermore, there are no other UK guidelines covering all available treatments, and there seems to be significant variation around the UK in the management of diabetic macular oedema (DMO). This manuscript provides a summary of reviews the pathogenesis of DR and DMO, including role of vascular endothelial growth factor (VEGF) and non-VEGF cytokines, clinical grading/classification of DMO vis a vis current terminology (of centre-involving [CI-DMO], or non-centre involving [nCI-DMO], systemic risks and their management). The excellent UK DR Screening (DRS) service has continued to evolve and remains world-leading. However, challenges remain, as there are significant variations in equipment used, and reproducible standards of DMO screening nationally. The interphase between DRS and the hospital eye service can only be strengthened with further improvements. The role of modern technology including optical coherence tomography (OCT) and wide-field imaging, and working practices including virtual clinics and their potential in increasing clinic capacity and improving patient experiences and outcomes are discussed. Similarly, potential roles of home monitoring in diabetic eyes in the future are explored. The role of pharmacological (intravitreal injections [IVT] of anti-VEGFs and steroids) and laser therapies are summarised. Generally, IVT anti-VEGF are offered as first line pharmacologic therapy. As requirements of diabetic patients in particular patient groups may vary, including pregnant women, children, and persons with learning difficulties, it is important that DR management is personalised in such particular patient groups. First choice therapy needs to be individualised in these cases and may be intravitreal steroids rather than the standard choice of anti-VEGF agents. Some of these, but not all, are discussed in this document.

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Section: Section 11: Virtual Clinics and Artificial Intelligence In Dmomentioning

confidence: 99%

Diabetic retinopathy and diabetic macular oedema pathways and management: UK Consensus Working Group

Amoaku

Ghanchi

Bailey

et al. 2020

Eye

134

121

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“…Increasing application of artificial intelligence (AI) techniques such as "Deep Learning" for fundus and OCT images facilitates cost-effective, widespread, diabetic eye screenings via telemedicine. [242][243][244][245] Newer fundus imaging techniques, such as flavoprotein fluorescence (FPF) may allow the detection of metabolic improvements that precede structural improvements in DME patients receiving anti-VEGF injections. 246 Functional testing of macular sensitivity utilizing microperimetry and electroretinography is also being increasingly used in both DR and DME to assess both disease severity and response to therapy.…”

Section: Future Trends Diagnosticsmentioning

confidence: 99%

<p>The Evolving Treatment of Diabetic Retinopathy</p>

Mansour¹,

Browning²,

Wong³

et al. 2020

OPTH

176

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Purpose: To review the current therapeutic options for the management of diabetic retinopathy (DR) and diabetic macular edema (DME) and examine the evidence for integration of laser and pharmacotherapy. Methods: A review of the PubMed database was performed using the search terms diabetic retinopathy, diabetic macular edema, neovascularization, laser photocoagulation, intravitreal injection, vascular endothelial growth factor (VEGF), vitrectomy, pars plana vitreous surgery, antiangiogenic therapy. With additional cross-referencing, this yielded 835 publications of which 301 were selected based on content and relevance. Results: Many recent studies have evaluated the pharmacological, laser and surgical therapeutic strategies for the treatment and prevention of DR and DME. Several newer diagnostic systems such as optical coherence tomography (OCT), microperimetry, and multifocal electroretinography (mfERG) are also assisting in further refinements in the staging and classification of DR and DME. Pharmacological therapies for both DR and DME include both systemic and ocular agents. Systemic agents that promote intensive glycemic control, control of dyslipidemia and antagonists of the renin-angiotensin system demonstrate beneficial effects for both DR and DME. Ocular therapies include anti-VEGF agents, corticosteroids and nonsteroidal anti-inflammatory drugs. Laser therapy, both as panretinal and focal or grid applications continue to be employed in management of DR and DME. Refinements in laser devices have yielded more tissue-sparing (subthreshold) modes in which many of the benefits of conventional continuous wave (CW) lasers can be obtained without the adverse side effects. Recent attempts to lessen the burden of anti-VEGF injections by integrating laser therapy have met with mixed results. Increasingly, vitreoretinal surgical techniques are employed for less advanced stages of DR and DME. The development and use of smaller gauge instrumentation and advanced anesthesia agents have been associated with a trend toward earlier surgical intervention for diabetic retinopathy. Several novel drug delivery strategies are currently being examined with the goal of decreasing the therapeutic burden of monthly intravitreal injections. These fall into one of the five categories: non-biodegradable polymeric drug delivery systems, biodegradable polymeric drug delivery systems, nanoparticle-based drug delivery systems, ocular injection devices and with sustained release refillable devices. At present, there remains no one single strategy for the management of the particular stages of DR and DME as there are many options that have not been rigorously tested through large, randomized, controlled clinical trials. Conclusion: Pharmacotherapy, both ocular and systemic, will be the primary mode of intervention in the management of DR and DME in many cases when cost and treatment burden are less constrained. Conventional laser therapy has become a secondary intervention in these instances, but remains a first-line option when cost and ...

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“…Deep learning (DL; a type of AI) uses a computer-based neural network that can train itself on a large database to detect an outcome of interest. This approach is being increasingly used in health care to aid diagnosis and gain insights into disease processes [26]. DL is most advanced in the realm of computer vision (evaluation of images).…”

Section: Potential Solution: Ai-enabled Low-cost Remote Screeningmentioning

confidence: 99%

Building on the success of anti-vascular endothelial growth factor therapy: a vision for the next decade

Adamis¹,

Brittain²,

Dandekar³

et al. 2020

Eye

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This article aims to identify key opportunities for improvement in the diagnosis and treatment of retinal disease, and describe recent innovations that will potentially facilitate improved outcomes with existing intravitreal vascular endothelial growth factor (VEGF) therapies and lay the groundwork for new treatment approaches. The review begins with a summary of the key discoveries that led to the development of anti-VEGF therapies and briefly reviews their impact on clinical practice. Opportunities for improvements in diagnosis, real-world outcomes with existing therapies, long-acting therapeutics and personalised health care are discussed, as well as the need to identify new targets for therapeutic intervention. Low-cost, remote patient screening and monitoring using artificial intelligence (AI)-based technologies can help improve diagnosis rates and enable remote disease monitoring with minimal patient burden. AI-based tools can be applied to generate patient-level prognostic data and predict individual treatment needs, reducing the time needed to optimise a patient’s treatment regimen. Long-acting therapeutics can help improve visual outcomes by reducing the treatment burden. When paired with AI-generated prognoses, long-acting therapeutics enable the possibility of vision loss prevention. Dual-acting drugs may help improve efficacy and/or durability beyond what is possible with anti-VEGF agents alone. Recent developments and ongoing innovations will help build upon the success of anti-VEGF therapies to further reduce vision loss owing to retinal disease while lowering the overall burden of care.

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Deep Learning Predicts OCT Measures of Diabetic Macular Thickening From Color Fundus Photographs

Cited by 65 publications

References 35 publications

Diabetic retinopathy and diabetic macular oedema pathways and management: UK Consensus Working Group

Diabetic retinopathy and diabetic macular oedema pathways and management: UK Consensus Working Group

<p>The Evolving Treatment of Diabetic Retinopathy</p>

Building on the success of anti-vascular endothelial growth factor therapy: a vision for the next decade

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