Glaucoma screening skills among general ophthalmologists - How general should it be?

Purpose: To compare the glaucoma assessment skills among general ophthalmologists in their referral patients over 5 years. Methods: This was a retrospective auditing of the electronic medical record database. Details of consecutive new glaucoma patients seen in the glaucoma services of a tertiary eye care institute in 2013 and 2018 were collected. Details of each patient included the clinical presentation, baseline intra?ocular pressure (IOP), type and severity of glaucoma, referral details, gonioscopy, HVF (Humphrey visual field) data, and the number of medications. Statistical tests used were the Chi?square test and T test using SPSS version 22. Results: Of 28,886 medical records screened, 211 and 568 new glaucoma patients were retrieved in 2013 and 2018, respectively. The patients presenting in 2018 were younger (58.1 ± 15.4 years) at presentation than in 2013 (65.6 ± 15.2 years), P < 0.01, and also had higher baseline IOP (IOP ?40 mm Hg was found in 9.5% in 2018 versus 2.4% in 2013; P < 0.01). The percentage of eyes with presenting visual acuity worse than 20/400 or 20/600 was higher in the patients presenting in 2018 (22.2% vs. 15.1%; P = 0.03). Although primary glaucoma predominated in both periods, the number of eyes referred to as disc suspects showed an increase in 2018 (4.7% to 14.4%; P < 0.01). Among 195 and 517 referrals in 2013 and 2018, respectively, the documentation of clinical findings were dismally poor in both the groups in terms of absent gonioscopy (99% vs. 98.2%, P = 0.4), absent disc details (89.6% vs. 91%, P = 0.5), or absent visual field analysis (79.1% vs. 74.8%, P = 0.2). However, the missing IOP values were significantly better in the latter year (77.3% vs. 57.2%; P < 0.01). Conclusion: The increase in the number of new glaucoma patients and referrals did not show a corresponding improvement in documentation of findings except for IOP recording among general ophthalmologists. Hence, we need to re?emphasize the training of general ophthalmologists on basic glaucoma evaluation to improve their referral ability

Impact of artificial intelligence-assisted community-based screening for senile glaucoma on health expenses and medical insurance expenditures in rural areas: health economic evidence from Changjiang Li autonomous county, Hainan province / 中华实验眼科杂志

Objective:To predict the financial impact of artificial intelligence (AI)-assisted community-based screening for primary angle-closure glaucoma (PACG) among the elderly on health expenses and medical insurance expenditures in remote areas of China.Methods:A total of 19 395 people aged more than 65 years old from Changjiang Li autonomous county, Hainan province were enrolled.A health economic model for glaucoma screening in Wenzhou, Zhejiang province was adopted.PACG was classified as suspected primary angle closure, primary angle closure, PACG, monocular blindness and binocular blindness according to its severity.The model was adjusted in combination with the epidemiology, metastasis probability and treatment compliance, screening and referral compliance, sensitivity and specificity of AI screening from glaucoma related literature and using data on local epidemiology and health costs of glaucoma from the Changjiang Hospital of Integrated Traditional Chinese and Western Medicine from 2016 to 2019.The health outcome, total health expenses and medical insurance expenditures of AI-assisted community-based screening and no screening for PACG in 15 years were compared and analyzed.Results:It is found that the AI-assisted community-based screening would prevent disease progression and reduce the number of PACG patients by 43% (134 cases) and blind patients by 50% (9 cases) in 15 years in comparison with no screening.Under the AI-assisted community-based screening system, the early diagnosis and intervention of positive PACG patients will cause the dramatic increase of both total health expenses and medical insurance expenditures compared with no screening in the short term.It was predicted that the increasing trend of medical insurance expenditure would turn to a downward trend and show cost saving advantage at the third year, whereas the declining trend of total health expense would not occur until 10 years later.Without screening, a large number of PACG patients would progress to advanced stages, so the medical costs would continue to rise and exceed the medical costs of the screening system at the 14th year.Conclusions:The AI-assisted community-based screening for PACG is cost-effective and can prevent disease progression, save health expenses and medical insurance expenditures in the long run in remote areas of China.

Joint optic disc and cup segmentation based on residual multi-scale fully convolutional neural network / 生物医学工程学杂志

Glaucoma is the leading cause of irreversible blindness, but its early symptoms are not obvious and are easily overlooked, so early screening for glaucoma is particularly important. The cup to disc ratio is an important indicator for clinical glaucoma screening, and accurate segmentation of the optic cup and disc is the key to calculating the cup to disc ratio. In this paper, a full convolutional neural network with residual multi-scale convolution module was proposed for the optic cup and disc segmentation. First, the fundus image was contrast enhanced and polar transformation was introduced. Subsequently, W-Net was used as the backbone network, which replaced the standard convolution unit with the residual multi-scale full convolution module, the input port was added to the image pyramid to construct the multi-scale input, and the side output layer was used as the early classifier to generate the local prediction output. Finally, a new multi-tag loss function was proposed to guide network segmentation. The mean intersection over union of the optic cup and disc segmentation in the REFUGE dataset was 0.904 0 and 0.955 3 respectively, and the overlapping error was 0.178 0 and 0.066 5 respectively. The results show that this method not only realizes the joint segmentation of cup and disc, but also improves the segmentation accuracy effectively, which could be helpful for the promotion of large-scale early glaucoma screening.

Diurnal variation of central corneal thickness and intraocular pressure in eyes with pseudoexfoliation

Purpose: Pseudoexfoliation syndrome (PXS) is an age related microfibrillopathy characterized by deposition of whitish flaky material over various ocular tissues. PXS eyes are known to have thinner corneas and thus can lead to an underestimation in intraocular pressure measurement. The purpose of this study was to find if there is any variation in central corneal thickness and intraocular pressure in PXS eyes and if there was any relationship between them. Methods: A prospective observational study was done on 141 eyes of 85 patients with PXS without glaucoma between November 2015 to April 2017 in the department of Ophthalmology in a tertiary hospital. CCT and IOP were measured by a handheld ultrasonic pachymeter (DGH Technology INC. Pachette 2, USA) and Goldmann applanation tonometer respectively at 4 different times during office hours. Results: A significant reduction of about 10 ?m in mean CCT and 1.4 mmHg in mean IOP was noted over the 4 sessions which was statistically significant (P < 0.001). A significant correlation exists between IOP and CCT in PXS eyes at all times during the day (P < 0.001). Conclusion: The CCT measurements show significant thinning throughout the day, similar drop in IOP was also noted. Our study shows that there is a significant correlation between diurnal variation of CCT and IOP. Hence, it is prudent to measure CCT along with IOP at all times.

Socioeconomic Costs of Glaucoma in Korea

PURPOSE: The purpose of this study was to estimate the socioeconomic costs of glaucoma in Korea. It is to be used as an academic reference regarding policy making for the introduction of glaucoma screening tests in the national health check-ups. METHODS: We estimated the socioeconomic costs of glaucoma from a societal perspective, which included medical, nonmedical, and productivity costs. The medical costs consisted of official and nonofficial medical costs, and the nonmedical costs consisted of transportation, time, and nursing costs. We used the National Health Insurance Service-National Sample Cohort 2002–2013 and the Korea Health Panel study. RESULTS: The socioeconomic costs of glaucoma were estimated to be 3,000 billion Korean won (KRW) in 2013. These total costs were divided into 1,539 billion KRW (51.3%) for medical costs, 1,292 billion KRW (43.1%) for nonmedical costs, and 168 billion KRW (5.6%) for productivity costs. CONCLUSIONS: Glaucoma is a large economic burden from a societal perspective. The nonmedical and productivity costs, as well as the medical costs are especially high. Because the disease costs of glaucoma are expected to increase continuously, political support for early detection of glaucoma should be considered.

Screening efficiency of scanning peripheral anterior chamber depth analyzer for occludable angle——Handan Eye Study / 中华实验眼科杂志

Background Primary angle-closure glaucoma (PACG) is the most common type of glaucoma in China.A screening to identify the possible angle closure is important in the prevention and treatment of PACG.Objective This study was to determine the characteristics and the optimal parameters measured by the scanning peripheral anterior chamber depth analyzer (SPAC) in the screening of occludable angle of a sample of adult Chinese population.Methods A cross-sectional study was performed in Handan from February to April in 2013.One hundred and eighty Chinese adults were enrolled with the age of 40 years and older and acceptable criteria during 5-year following-up duration of the Handan Eye Study.Routine eye examinations were carried out in all subjects under the informed consent,including visual acuity,optometry,anterior ocular segment examination under the slit lamp microscope,and then SPAC measurement and gonioscopy were performed in a dark room.Occludable angle was defined as posterior trabecular meshwork being invisible in ≥ 180° range under the static gonioscope.Occludable angle by SPAC was estimated using available central chamber depth (ACD) and a combined indicator,numerical grade was 5 or fewer and/or the categorical grade was S or P,separately.Receiver operating characteristic (ROC) curve was calculated to assess the performance of these parameters in detecting eyes with occludable angle for the population-based sample,and area under curve (AUC) was drown to compare the screening efficiencies between available ACD and combined indicator.Results In 180 subjects,occludable angles were found in 62 and open angles were in 118.Compared to the subjects with open angle,the subjects with occludable angle showed the older age (P＜0.001),more females (P＜0.05),lower visual acuity (P＜0.001),greater hyperopic diopter (P＜0.05),smaller ACD value (P＜0.001) and shorter axial length(P＜0.001).In eyes with occludable angle by using SPAC,the ACD showed an AUC of 0.832.Using a cutoff of 2.7 mm for ACD,the sensitivity and specificity were 85.48％ and 68.64％,and under the cutoff of 2.8 mm,the sensitivity and specificity was 90.32％ and 61.02％,respectively.For the combined parameters,the sensitivity and specificity was 62.90％ and 90.68％,respectively and the AUC was 0.768.Conclusions When gonioscopy is used as a reference,a cutoff of 2.8 mm ACD by SPAC shows the highest sensitivity for the screening of occludable angle in Chinese population.

Glaucoma Screening: in the Outpatient Department and in the Homes for thee Aged

Glaucoma screening is an important means of detecting early cases of glaucoma. It is particularly valuable if targeted either at groups who otherwise do not have access to the health care system or at groups who have the risk factors for glaucoma such as aging, being male and having a medical history of diabetes or vascular diseases. We conducted glaucoma screenings by tonometry and direct ophthalmoscopy in the outpatient department of ophthalmology at Korea University Haewha Hospital and in the homes for the aged that are located in Seoul between Sep. 1987 and Sep. 1989. A total of 282 subjects were screened in the outpatient department and 198 subjects were screened in the homes for the aged. Referral rate was 6.7% and 3.0%, respectively. Groups who have the risk factors showed greater referral rates than groups who have not, but they are not statistically significant(p>0.05).

Glaucoma Screening: in the Outpatient Department and in the Homes for thee Aged

Glaucoma screening is an important means of detecting early cases of glaucoma. It is particularly valuable if targeted either at groups who otherwise do not have access to the health care system or at groups who have the risk factors for glaucoma such as aging, being male and having a medical history of diabetes or vascular diseases. We conducted glaucoma screenings by tonometry and direct ophthalmoscopy in the outpatient department of ophthalmology at Korea University Haewha Hospital and in the homes for the aged that are located in Seoul between Sep. 1987 and Sep. 1989. A total of 282 subjects were screened in the outpatient department and 198 subjects were screened in the homes for the aged. Referral rate was 6.7% and 3.0%, respectively. Groups who have the risk factors showed greater referral rates than groups who have not, but they are not statistically significant(p>0.05).