Deep learning automated diagnosis and quantitative classification of cataract type and severity: quantifying the effectiveness and usability of deep learning-assisted disease diagnosis models with 14 ophthalmologists and multi-center validations

This study assessed the anterior chamber depth (ACD) and iridocorneal angle using a portable smart eye camera (SEC) compared to the conventional slit-lamp microscope and anterior-segment optical coherence tomography (AS-OCT). This retrospective case-control study included 170 eyes from 85 Japanese patients. The correlation between the ACD evaluations conducted with the SEC and conventional slit-lamp was high (r = 0.814). The correlation between the Van-Herick Plus grade obtained using two devices was also high (r = 0.919). A high kappa value was observed for the Van-Herick Plus grading (Kappa = 0.757). A moderate correlation was observed between the ACD measured using AS-OCT and the slit-lamp image acquired with the conventional slit-lamp microscope and SEC (r = 0.609 and 0.641). A strong correlation was observed between the trabecular-iris angle (TIA) measured using AS-OCT and Van-Herick Plus grade obtained with the conventional slit-lamp microscope and SEC (r = 0.702 and 0.764). Strong correlations of ACD evaluation and high kappa value of the Van-Herick Plus grading indicated the adequate subjective assessment function of the SEC. Moderate correlations between the ACD objective measurement and evaluation and strong correlation between the TIA and Van-Herick Plus grade suggested the good objective assessment function of the SEC. The SEC demonstrated adequate performance for ACD evaluation and angle estimation.

A Study Validating the Estimation of Anterior Chamber Depth and Iridocorneal Angle with Portable and Non-Portable Slit-Lamp Microscopy

Background:The current medical scenario is closely linked to recent progress in telecommunications, photodocumentation, and artificial intelligence (AI). Smartphone eye examination may represent a promising tool in the technological spectrum, with special interest for primary health care services. Obtaining fundus imaging with this technique has improved and democratized the teaching of fundoscopy, but in particular, it contributes greatly to screening diseases with high rates of blindness. Eye examination using smartphones essentially represents a cheap and safe method, thus contributing to public policies on population screening. This review aims to provide an update on the use of this resource and its future prospects, especially as a screening and ophthalmic diagnostic tool. Methods:In this review, we surveyed major published advances in retinal and anterior segment analysis using AI. We performed an electronic search on the Medical Literature Analysis and Retrieval System Online (MEDLINE), EMBASE, and Cochrane Library for published literature without a deadline. We included studies that compared the diagnostic accuracy of smartphone ophthalmoscopy for detecting prevalent diseases with an accurate or commonly employed reference standard. Results:There are few databases with complete metadata, providing demographic data, and few databases with sufficient images involving current or new therapies. It should be taken into consideration that these are databases containing images captured using different systems and formats, with information often being excluded without essential detailing of the reasons for exclusion, which further distances them from real-life conditions. The safety, portability, low cost, and reproducibility of smartphone eye images are discussed in several studies, with encouraging results. Conclusions:The high level of agreement between conventional and a smartphone method shows a powerful arsenal for screening and early diagnosis of the main causes of blindness, such as cataract, glaucoma, diabetic retinopathy, and age-related macular degeneration. In addition to streamlining the medical workflow and bringing benefits for public health policies, smartphone eye examination can make safe and quality assessment available to the population. 

Smartphone Eye Examination: Artificial Intelligence and Telemedicine.

Purpose Telemedicine-enabled, portable digital slit lamps can help to decentralize screening to close-to-patient contexts. We report a novel design for a portable, digital slit lamp using a smartphone. It works on an advanced optical design and has the capability of instantaneous, objective photodocumentation to capture anterior segment images and is telemedicine-enabled. Methods The device is constructed keeping its usability and the importance of design ergonomics for nonspecialized field personnel in mind. The optical design is described, and the resolution and magnification are compared with traditional desktop-based slit lamps. A Health Insurance Portability and Accountability Act (HIPAA)-compliant, patient management software is integrated to synchronize the captured images with a secure cloud server along with a sharpness algorithm to extract the best focused frames of the cornea, iris, and lens, from videos. We demonstrate its photodocumentation ability and teleophthalmology feasibility by capturing images in a pilot study from nine subjects. Results Images were obtained in various illumination, magnification, and filter settings. Synchronous and asynchronous teleophthalmology consults were conducted. The performance of the device was shown to be limited by the smartphone sensor resolution and not the optical design, because the Air Force target resolution was found to be the same on smartphone-mounted traditional slit lamps despite a lower magnification. Conclusions The novel, portable, digital slit lamp with advanced optical design using smartphones has the ability to screen for anterior segment pathologies using telemedicine. Translational Relevance A portable, telemedicine-friendly, ergonomically designed, slit lamp used by nonspecialist personnel allows for both synchronous and asynchronous modes of consultation at remote locations, facilitating mass screening programs.

Design and Performance Characterization of a Novel, Smartphone-Based, Portable Digital Slit Lamp for Anterior Segment Screening Using Telemedicine.

Introduction: Dry eye disease (DED) is a multifactorial disease of tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability leading to decrease of vision, productivity and quality of life, and blindness. DED diagnosis remains difficult and underdiagnosed regarding inconsistency between subjective symptoms and clinical findings. Tear break-up time (TBUT) is an objective indicator of tear film stability in diagnostic DED. A novel smartphone attachment, namely SEC (smart eye camera), could mimic conventional slit lamp to assess TBUT and beneficial in facilitating DED diagnosis. Reliability between a non and an ophthalmologist in TBUT assessment and DED diagnosis is observed in this study. Purpose: To determine interobserver reliability of TBUT measurement for diagnosing DED using SEC. Design: This a cross-sectional analytic study involving 99 participants (198 eyes) aged 40 years who visited Pratama Gema Santi Hospital, Nusa Penida, from September 2nd to 4th, 2022, with consecutive sampling technique. Methods: Fluoresceined eyes were filmed using the SEC device and apps, continued by masked ophthalmologist and resident assessing TBUT based on the video. The primary outcome is interobserver reliability for TBUT measurement and DED diagnosis. Results: The mean age of participants was 55.22± 9.78 years, 48.5% male and 51.5% female. The reliability of interobserver in assessing DED based on TBUT test is 0.78 (95% CI=0.31– 1.26, P -value=0.001), and interobserver reliability in diagnosing DED based on OSDI and TBUT showed good agreement (weighted kappa=0.71). Good interobserver reliability underscores that non-ophthalmologists can diagnose DED based on TBUT video using SEC. Conclusion: SEC video has good interobserver reliability to assess TBUT for DED diagnosis. SEC can be used as one of the methods in assessing DED in limited health care facilities. The high reliability of interobserver assessment indicates that DED diagnosis using video taken with SEC may be useful for telemedicine evaluation in remote areas. Graphical Abstract: Keywords: dry eye disease, smart eye camera, telemedicine 

Interobserver Reliability of Tear Break-Up Time Examination Using “Smart Eye Camera” in Indonesian Remote Area

The utility model relates to a testing device for lens, and especially relates to a hand-held blue ray filteration detector for analyzing and testing blue ray filteration performance. The hand-held blue ray filteration detector is composed of a main body front end, a main body middle part and a main body rear part, wherein the main body front end, the main body middle part and the main body rear part form a handgun shape; a groove is formed between the main body front end and the main body middle part; a light source generator is disposed inside the main body front end; a group of photodiodes, a photoelectric signal receiving circuit, a photoelectric signal processing circuit, a control unit and a power supply circuit are disposed inside the main body middle part; and a digital display circuit and a trigger are disposed inside the main body rear part. The beneficial effects of the hand-held blue ray filteration detector are that supports are detachable, calibration is required, a battery power supply mode is achieved, and the detector is small in size and is powered by 9V batteries. The detector can be normally used without being powered up by external power supplies, and is portable.

Hand-held blue ray filteration detector

The invention discloses a portable non-mydriatic fundus camera based on dual cameras of a mobile phone. The dual cameras of the mobile phone comprise a first camera and a second camera which respectively receive infrared light and visible light; the portable non-mydriatic fundus camera comprises an illuminating system and an imaging system, wherein the illuminating system is used for emitting infrared light or visible light; the imaging system comprises an infrared light subsystem and a visible light subsystem; the infrared light subsystem is fixedly connected with the second camera; the visible light subsystem is fixedly connected with the first camera; when the illuminating system emits the infrared light, the infrared light is reflected by retinas of eyes, then is imaged on a display screen of the mobile phone by the infrared light subsystem and the second camera and is used for selecting a target shooting position; after the target shooting position is selected, the illuminating system emits the visible light; after infrared light illumination is closed, the visible light is reflected by the retinas of the eyes and is imaged on the display screen of the mobile phone by the visible light system and the first camera for shooting the image of the target shooting position. The portable non-mydriatic fundus camera does not need mydriatic processing and is simple in operation andsmall in size.

Portable non-mydriatic fundus camera based on dual cameras of mobile phone

Purpose As part of plans to provide help to people in remote and poor areas who have no medical resources, a portable slit-lamp based on a smartphone was proposed. This would help in early screening of cataract diseases. Methods This means a microlens is designed that would work with a phone's camera. The phone's photo taking function is used in capturing the image of the eyes lens to replace the observation system of the desktop slit-lamp. A simplified slit light band was designed. In order for the light source part to meet the portable requirements of the slit-lamp, the adjustable and diffused light functions of the ligaments were removed in this design. Furthermore, the images collected by the smartphone are uploaded to the deep learning cataract screening system, which can achieve real-time and effective screening of cataract. Results Unlike the desktop slit-lamp, which needs skilled personnel to operate, this device can be easily operated by less-skilled or inexperienced doctors. This eliminates the concerns of inaccurate diagnosis based on the use of unskilled professionals. Due to the portability, ease of use, and simplicity in obtaining crystal images of this device, it serves as a promising platform for nonhospital screening and telemedicine. Conclusions In this paper, we invented a small portable device for screening cataract. This device is to make screening and diagnosis of cataract in remote areas very fast and effective. It will also solve the problem of inadequate specialized doctors and equipment in those areas as well. Translational Relevance. Smartphones can be used with portable slit-lamps to capture the images of the lens.

/pdf/portable-handheld-slit-lamp-based-on-a-smartphone-camera-for-2qt7kef7w5.pdf

Portable Handheld Slit-Lamp Based on a Smartphone Camera for Cataract Screening.

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Hand-held blue ray filteration detector

Portable non-mydriatic fundus camera based on dual cameras of mobile phone

Portable Handheld Slit-Lamp Based on a Smartphone Camera for Cataract Screening.