Advancing healthcare: the role and impact of AI and foundation models.

BACKGROUND: The integration of artificial intelligence (AI) into the healthcare domain is a monumental shift with profound implications for diagnostics, medical interventions, and the overall structure of healthcare systems. PURPOSE: This study explores the transformative journey of foundation AI models in healthcare, shedding light on the challenges, ethical considerations, and vast potential they hold for improving patient outcome and system efficiency. Notably, in this investigation we observe a relatively slow adoption of AI within the public sector of healthcare. The evolution of AI in healthcare is un-paralleled, especially its prowess in revolutionizing diagnostic processes. RESULTS: This research showcases how these foundational models can unravel hidden patterns within complex medical datasets. The impact of AI reverberates through medical interventions, encompassing pathology, imaging, genomics, and personalized healthcare, positioning AI as a cornerstone in the quest for precision medicine. The paper delves into the applications of generative AI models in critical facets of healthcare, including decision support, medical imaging, and the prediction of protein structures. The study meticulously evaluates various AI models, such as transfer learning, RNN, autoencoders, and their roles in the healthcare landscape. A pioneering concept introduced in this exploration is that of General Medical AI (GMAI), advocating for the development of reusable and flexible AI models. CONCLUSION: The review article discusses how AI can revolutionize healthcare by stressing the significance of transparency, fairness and accountability, in AI applications regarding patient data privacy and biases. By tackling these issues and suggesting a governance structure the article adds to the conversation about AI integration in healthcare environments.

Multimodal Imaging of a Case of Bilateral Frosted Branch Angiitis in a 5-Year-Old Boy Secondary to Epstein Barr Virus (EBV) Infection.

PURPOSE: To describe a rare case of bilateral frosted branch angiitis with macular exudates in a 5-year-old boy presumed to be secondary to an Epstein-Barr virus (EBV) infection. OBSERVATIONS: A 5-year-old boy presented with acute onset blurring of vision in both eyes, the best corrected visual acuity was 3/60 in both eyes. The anterior segment was unremarkable, fundus showed the presence of perivascular sheathing involving the macular vessels, exudates, and subretinal fluid at the fovea (OU). Serology was positive for EBV. Swept-source optical coherence tomography angiography showed areas of flow void in the superficial and deep capillary plexus that disappeared with reduction of inflammation following treatment with intravenous, oral and topical steroids, and oral valacyclovir. CONCLUSIONS: Frosted branch angiitis can present following an EBV infection.

Narrative review of artificial intelligence in diabetic macular edema: Diagnosis and predicting treatment response using optical coherence tomography.

Diabetic macular edema (DME), being a frequent manifestation of DR, disrupts the retinal symmetry. This event is particularly triggered by vascular endothelial growth factors (VEGF). Intravitreal injections of anti-VEGFs have been the most practiced treatment but an expensive option. A major challenge associated with this treatment is determining an optimal treatment regimen and differentiating patients who do not respond to anti-VEGF. As it has a significant burden for both the patient and the health care providers if the patient is not responding, any clinically acceptable method to predict the treatment outcomes holds huge value in the efficient management of DME. In such situations, artificial intelligence (AI) or machine learning (ML)-based algorithms come useful as they can analyze past clinical details of the patients and help clinicians to predict the patient's response to an anti-VEGF agent. The work presented here attempts to review the literature that is available from the peer research community to discuss solutions provided by AI/ML methodologies to tackle challenges in DME management. Lastly, a possibility for using two different types of data has been proposed, which is believed to be the key differentiators as compared to the similar and recent contributions from the peer research community.

Prevalence of rotavirus diarrhea among hospitalized under-five children.

OBJECTIVE: To estimate the prevalence of rotavirus diarrhea among hospitalized children less than 5 years of age in Kerala State and to determine the circulating strains of rotavirus in Kerala. DESIGN: Multicenter, cross-sectional study. SETTING: Eight representative hospitals in Kunnathunadu Thaluk, Ernakulam district, Kerala. PARTICIPANTS: Children in the age group under 5 years. METHODS: Hospitalized children admitted with acute diarrhea were examined and standardized case report form was used to collect demographic, clinical and health outcome. Stool specimens were collected and ELISA testing was done. ELISA rotavirus positive samples were tested by reverse transcription PCR for G and P typing (CMC Vellore). RESULTS: Among the 1827 children, 648 (35.9%) were positive for rotavirus by the Rotaclone ELISA test. The prevalence of rotavirus diarrhea in infants less than 6 months of age was 24.7%; 6- 11 months 31.9%; 12- 23 months 41.9%; 24- 35 months 46.9%; and 33.3% in 36- 59 months. Rotavirus infections were most common during the dry months from January through May. G1P[8] (49.7%) was the most common strain identified followed by G9P[8] (26.4%), G2P[4] (5.5%), G9P[4] (2.6%) and G12P[6] (1.3%). CONCLUSIONS: The prevalence of rotavirus diarrhea among hospitalized children less than 5 years is high in Ernakulam district, Kerala State.

Role of Mandelbaum-like effect in the differentiation of hyperopes and myopes using a hologram.

Recently, we tested the vision of spectacle corrected subjects using a special hologram (http://dx.doi.org/10.1364/BOE.3.001173). A subject viewing through this hologram sees the images of various numbers at different distances from the eye. Each of these images subtends an angle of 50' at the eye. Each image corresponds to a different amount of divergence or convergence at the eye. The limit of convergence (positive blur) with which a subject can recognize the numbers was measured. Hyperopes could recognize numbers with 0.9 D more of positive blur in comparison with myopes. This difference was not obtained with a standard test chart under white light illumination using positive lenses to provide the blur. The observed difference with the hologram is then attributed to the multivergence nature of the target in the hologram and/or the monochromaticity of the illumination used. Using a hologram of a logMAR chart at a single distance of infinity we have now found that the observed difference is induced by the multivergence target and is due to an effect that is similar to the Mandelbaum effect. We present the details of this experiment and compare the results obtained with our earlier experiment.

Case of Phthiriasis palpebrarum with blepheroconjunctivitis.

A 70-year-old woman came to ophthalmology outpatient department with complaints of repeated episodes of itching, redness and watering in both eyes of 3 months duration. She was treated with antibiotics elsewhere but had no improvement. Slit lamp examination showed lice and nits anchored to the eyelashes. Light microscopic examination of the matted eye lashes and crusts further helped in identification of the ectoparasites as Phthirus pubis (Pubic louse or Crab louse) with typical morphology.

An experimental investigation of the vision of hyperopes and myopes using a hologram.

A hologram of a specially designed multivergence target which displays real and virtual objects (numbers) simultaneously has been used to test the vision of various spectacle corrected subjects. Through the hologram, the subjects see standard '60-meter' numbers that have different amounts of blur. It is found that there is a difference between myopes and hyperopes in the amount of positive blur with which they can recognize numbers seen through the hologram and this difference is statistically significant. A similar study was then conducted in white light illumination using the '60-meter' numbers of a standard test chart at 6 meter distance and positive lenses to provide the blur at the eye. This study showed no difference between the refractive groups. Our results indicate that hyperopes may be relaxing their accommodation more than myopes in viewing through the hologram.

Simple method to measure the visual axis of the human eye.

We propose a simple method to measure the angle "α" that the visual axis (VA) makes with the optical axis of the human eye. In this method, we capture the images of the pupil from three different angles, one along the VA and the other two along angles that are symmetrical with respect to the VA. These views of the pupil are captured simultaneously by a camera in a single photograph using a pair of plane mirrors. Assuming a model eye and with the help of finite ray tracing, we compute the value of α from the measured diameters of the three images of the pupil. Having a simple means to measure the value of α can be useful for optical modeling and analysis of the human eye. Measurement of the VA may also be useful in monitoring progressive myopia.

Performance of the holographic multivergence target in the subjective measurement of spherical refractive error and amplitude of accommodation of the human eye.

We recently suggested the use of a holographic multivergence target to measure the spherical refractive error and the amplitude of accommodation of the human eye [K. V. Avudainayagam and C. S. Avudainayagam, Opt. Lett.28, 123 (2003)]. In this paper we report the performance of the holographic target in measuring real eyes. The holographic technique compared well with subjective refraction and autorefraction in the measurement of spherical refractive error. The performance of the holographic technique in measuring the amplitude of accommodation was similar to that of the minus lens to blur method and that of the push-up method. These results promote holography as a promising technique for testing human vision.

Holographic multivergence target for subjective measurement of the astigmatic error of the human eye.

In subjective refraction the spherical and cylindrical errors of the human eye are measured. Recently, we reported a technique by which the spherical error can be measured in one step using a hologram [K. V. Avudainayagam and C. S. Avudainayagam, Opt. Lett.28, 123 (2003)]. We have now developed a holographic target consisting of sunburst patterns to measure the astigmatic error of the human eye as well. Apart from being simple, quick, and low cost, holography offers the advantage of being an open field refraction system that is devoid of the problem of proximal accommodation. We describe the holographic target, its working principles, the measurement procedure, and the initial results obtained.

Holographic multivergence target for subjective measurement of the spherical power error of the human eye.

We have fabricated a single hologram with which to determine the spherical refractive error of the human eye in the range 5 to -2.5 diopters (D) with an accuracy of +/-0.25 D in a single step. The amplitude of accommodation is determined at the same time. The hologram is a record of 16 targets, each of which has a different image vergence in the range 5 to -2.5 D in steps of 0.5 D. This idea can be applied readily to any dioptric range. The measurement method is simple, fast, and reliable.

Lau fringes and subjective refraction.

Lau fringes formed in the far field of a pair of gratings illuminated by spatially incoherent light are known to disappear when one grating is rotated slightly (+/-3 degrees ) with respect to the other. We observed that a cylindrical lens that was appropriately rotated could restore the high-contrast Lau fringes by bringing together the rays that are coherent with respect to each other. We have developed a new refractometer based on this phenomenon, the details of which are presented. Measurement of the cylinder power and axis of the human eye is possible with good accuracy and repeatability with this instrument.

Sensitivity of Lau fringes to grating rotation: theoretical analysis.

Recently reported experimental results on the rotation sensitivity of Lau fringes to the spatial coherence of the source have been theoretically analyzed and explained on the basis of coherence theory. A theoretical plot of the rotation angle required for the Lau fringes to vanish is obtained as a function of the coherence length of the illumination used in the Lau experiment. The theoretical results compare well with the experimental observations. The analysis as well as the experiment could form the basis for a simple and easy measurement of the coherence length of the illumination in a plane.

Role of spatial coherence on the rotation sensitivity of Lau fringes: an experimental study.

A simple technique involving the use of a rotating and a stationary diffuser has been developed to vary the spatial coherence of light from a He-Ne laser. Using this technique an experimental investigation of the dependence of rotation sensitivity of Lau fringes on the spatial coherence of the illuminating wavefield has been carried out. It is observed that (i) the rotation sensitivity of Lau fringes varies in a well-defined manner as a function of the spatial coherence of the light used; (ii) the extremely good rotation sensitivity of Lau fringes can be used to great advantage (compared to the conventional double slit method) in the measurement of the spatial coherence of a wavefield; (iii) Lau fringes are formed at various levels of spatial coherence and as such it appears that the Lau effect need not be associated with an incoherent optical field.