Gabriel Katz

Aim: To evaluate a real-world clinical integration of an autonomous artificial intelligence (AI) system (AEYE Diagnostic Screening (AEYE-DS), AEYE Health, USA) for diabetic retinopathy (DR) screening using the Topcon NW500 camera (Topcon, Japan) in an endocrinology clinic. Methods: Adults with type 1 or type 2 diabetes without previously reported DR attending routine endocrinology follow-up were invited to participate. Non-mydriatic, macula-centred fundus photographs were acquired by a novice, non-ophthalmic operator. Images were analysed by AEYE-DS to detect more-than-mild DR (mtmDR). AI-positive results prompted physician counselling and automated referral for internal confirmatory examination. Results: Definitive AEYE-DS results were obtained for 95.7% (245/256) of participants without pharmacological dilation. Seventy-six (29.6%) patients screened positive for mtmDR, of whom 34 (44.7%) completed confirmatory examination at the institution’s retina clinic; externally completed follow-up was not captured. Four patients (11.8% of those evaluated) required treatment with intravitreal anti-vascular endothelial growth factor therapy or panretinal photocoagulation. Additional previously unrecognised ocular conditions were identified among several AI-positive patients. Patient satisfaction was high, with >80% reporting the screening was easy to use, time-efficient and recommendable. Conclusions: In a real-world endocrinology clinic, autonomous AI screening for DR using AEYE-DS integrated with the Topcon NW500 enabled efficient DR screening and achieved high non-mydriatic imageability. A clinically relevant proportion of patients requiring ophthalmic evaluation has been captured. Internal referral for confirmatory testing enabled assessment of downstream outcomes. The findings support scalable, point-of-care autonomous screening and a stepped-referral approach for AI-positive patients.

Retinal vein occlusion (RVO) results in ischemia followed by an inflammatory response. Both processes affect tissue temperature in opposite directions. Here, we evaluate the effect of RVO on the ocular surface temperature (OST) profile. Subjects with RVO were prospectively recruited. Healthy subjects without any ocular disease served as controls. The OST was determined using the Therm-App thermal imaging camera, and image processing software was employed to compute the mean temperature values of the medial canthus, lateral canthus, and cornea. We obtained thermographic images from 30 RVO subjects (30 eyes) and 148 controls (148 eyes). A univariate analysis found that eyes with RVO had significantly elevated OSTs compared to the controls (mean difference of 0.6 ± 0.3 Celsius, p < 0.05). However, this distinction between the groups lost statistical significance upon adjusting for possible confounders, including patient and environmental factors. These findings were confirmed with a post hoc case–control matched comparison. In conclusion, RVO does not seem to affect the OST. This might be due to the balance between inflammatory thermogenesis and heat constriction from ischemia in RVO. It is also possible that, in our cohort, the RVO pathophysiological processes involved were localized and did not extend to the anterior segment. Patient and environmental factors must be considered when interpreting the OST.

Purpose Central serous chorioretinopathy (CSCR) patients are sometimes referred to Photodynamic Therapy (PDT) with very long-term disease. The purpose of this study was to analyze the results of PDT in CSCR eyes with long-standing disease. Methods The medical records of the patients that underwent PDT for CSCR between 2009 and 2019 were reviewed. Cases were divided into two groups based on the duration of disease before PDT treatment: early treatment (3 to 6 months) and delayed treatment (longer than 6 months). The treatment was defined as successful when the subfoveal fluid was absorbed during follow-up. Results The PDT treatment was successful in 76% and 77% of eyes in the early and delayed treatment groups, respectively. Both groups showed significant improvement in central retina measurements at the 3-months follow-up which persisted to the last follow-up visit. The visual acuity (VA) at baseline was significantly worse in the delayed treatment group (0.5 ± 0.26 vs. 0.3 ± 0.24, P = 0.042) and improved in both groups but remained low in the delayed treatment group during the study. Conclusion We suggest that if CSCR is not spontaneously improving over 3 months the patient should be offered PDT, to prevent VA loss from the long-term presence of subretinal fluid in the macula. PDT is not associated with loss of vision in eyes with chronic CSCR, and can be safely used in eyes with relatively good VA.

Purpose: Central serous chorioretinopathy (CSCR) patients are often referred to Photodynamic Therapy (PDT) with very long-term disease because of concerns about the potential negative effects of PDT on the retina and on the visual acuity. The purpose of this study was to analyze the results of PDT in CSCR eyes with long standing disease.Methods: The medical records of the patients that underwent PDT for CSCR between 2009 and 2019 were reviewed. Cases were divided into two groups based on the duration of disease before PDT treatment: early treatment (3 to 6 months), delayed treatment (longer than 6 months). The treatment was defined as successful when the subfoveal fluid was absorbed during follow up.Results: The PDT treatment was successful in 76% and 77% of eyes in the early and delayed treatment groups respectively. Both groups showed significant improvement in central retina measurements at the 3-months follow up which persisted to the last follow-up visit. The visual acuity (VA) at baseline was significantly worse in the delayed treatment group (0.5±0.26 vs 0.3±0.24, P=0.042) and improved in both groups but remained low in the delayed treatment group during the study.Conclusion: PDT is not associated with loss of vision in eyes with chronic CSCR, and can be safely used in eyes with relatively good VA. We suggest that if CSCR is not spontaneously improving over 3 months the patient should be offered PDT, to prevent VA loss from the long-term presence of subretinal fluid in the macula.

Response to Letter in regards to Anterior Chamber Depth After Phacovitrectomy [Letter]

Purpose: To evaluate the efficacy of switching from bevacizumab to ranibizumab in patients with diabetic macular edema (DME). Methods: This was a retrospective study of patients with DME initially treated with bevacizumab and switched to ranibizumab. Visual acuity (VA) and central retinal thickness (CRT) were retrieved at fixed timepoints prior to and after the switch. Results: Forty eyes of 32 patients were included in the study. The difference in VA between any of these fixed timepoints was not statistically significant. A significant gain in VA was found in eyes that lost more than 0.1 logMAR during treatment with the last 3 bevacizumab injections. The mean CRT was significantly lower after the first 3 ranibizumab injections and at the final follow-up (p<0.001), a 67 ± 14 μm and 78 ± 18 μm reduction in thickness, respectively. Conclusions: Switching to ranibizumab resulted in a significant decrease in the CRT of eyes with DME, and should be considered when there is a lack of response or deterioration while on bevacizumab injections. A significant gain in VA was observed in a subgroup of eyes that lost more than one line while receiving the last 3 bevacizumab injections prior to the switch.