RESUMO

Purpose: To evaluate the performance of artificial intelligence (AI) systems embedded in a mobile, handheld retinal camera, with a single retinal image protocol, in detecting both diabetic retinopathy (DR) and more-than-mild diabetic retinopathy (mtmDR). Design: Multicenter cross-sectional diagnostic study, conducted at 3 diabetes care and eye care facilities. Participants: A total of 327 individuals with diabetes mellitus (type 1 or type 2) underwent a retinal imaging protocol enabling expert reading and automated analysis. Methods: Participants underwent fundus photographs using a portable retinal camera (Phelcom Eyer). The captured images were automatically analyzed by deep learning algorithms retinal alteration score (RAS) and diabetic retinopathy alteration score (DRAS), consisting of convolutional neural networks trained on EyePACS data sets and fine-tuned using data sets of portable device fundus images. The ground truth was the classification of DR corresponding to adjudicated expert reading, performed by 3 certified ophthalmologists. Main Outcome Measures: Primary outcome measures included the sensitivity and specificity of the AI system in detecting DR and/or mtmDR using a single-field, macula-centered fundus photograph for each eye, compared with a rigorous clinical reference standard comprising the reading center grading of 2-field imaging protocol using the International Classification of Diabetic Retinopathy severity scale. Results: Of 327 analyzed patients (mean age, 57.0 ± 16.8 years; mean diabetes duration, 16.3 ± 9.7 years), 307 completed the study protocol. Sensitivity and specificity of the AI system were high in detecting any DR with DRAS (sensitivity, 90.48% [95% confidence interval (CI), 84.99%-94.46%]; specificity, 90.65% [95% CI, 84.54%-94.93%]) and mtmDR with the combination of RAS and DRAS (sensitivity, 90.23% [95% CI, 83.87%-94.69%]; specificity, 85.06% [95% CI, 78.88%-90.00%]). The area under the receiver operating characteristic curve was 0.95 for any DR and 0.89 for mtmDR. Conclusions: This study showed a high accuracy for the detection of DR in different levels of severity with a single retinal photo per eye in an all-in-one solution, composed of a portable retinal camera powered by AI. Such a strategy holds great potential for increasing coverage rates of screening programs, contributing to prevention of avoidable blindness. Financial Disclosures: F.K.M. is a medical consultant for Phelcom Technologies. J.A.S. is Chief Executive Officer and proprietary of Phelcom Technologies. D.L. is Chief Technology Officer and proprietary of Phelcom Technologies. P.V.P. is an employee at Phelcom Technologies.

Assuntos

RESUMO

BACKGROUND: Diabetic macular edema (DME) is a major cause of visual impairment and its treatment is a public health challenge. Even though anti-angiogenic drugs are the gold-standard treatment, they are not ideal and subthreshold laser (SL) remains a viable and promising therapy in selected cases. The aim of this study was to evaluate its efficacy in a real-life setting. METHODS: Retrospective case series of 56 eyes of 36 patients with center-involving DME treated with SL monotherapy. Treatment was performed in a single session with the EasyRet® photocoagulator with the following parameters: 5% duty cycle, 200-ms pulse duration, 160-µm spot size and 50% power of the barely visible threshold. A high-density pattern was then applied to the whole edematous area, using multispot mode. Best corrected visual acuity (BCVA) and optical coherence tomography (OCT) data were obtained at baseline and around 3 months after treatment. RESULTS: Fifty-six eyes of 36 patients were included (39% women, mean age 64.8 years old); mean time between treatment day and follow-up visit was 14 ± 6 weeks. BCVA (Snellen converted to logMAR) was 0.59 ± 0.32 and 0.43 ± 0.25 at baseline and follow-up, respectively (p = 0.002). Thirty-two percent had prior panretinal photocoagulation (p = 0.011). Mean laser power was 555 ± 150 mW and number of spots was 1,109 ± 580. Intraretinal and subretinal fluid (SRF) was seen in 96 and 41% of eyes at baseline and improved in 35 and 74% of those after treatment, respectively. Quantitative analysis of central macular thickness (CMT) change was performed in a subset of 23 eyes, 43% of which exhibited > 10% CMT reduction post-treatment. CONCLUSIONS: Subthreshold laser therapy is known to have RPE function as its main target, modulating the activation of heat-shock proteins and normalizing cytokine expression. In the present study, the DME cases associated with SRF had the best anatomical response, while intraretinal edema responded poorly to laser monotherapy. BCVA and macular thickness exhibited a mild response, suggesting the need for combined treatment in most patients. Given the effect on SRF reabsorption, subthreshold laser therapy could be a viable treatment option in selected cases.

RESUMO

A aderência é um fator importante tanto por influenciar resultados de pesquisas, como para a prática clínica. Durante um estudo sobre Fobia Social, detectou-se uma pobre aderência entre pacientes submetidos a psicoterapia em grupo, tendo os pacientes abandonado a terapia em etapas diferentes. Essa diferença sugeriu a possibilidade de tratar-se de grupos de pacientes com características diferentes entre si, que pudessem motivar esse abandono em etapas diferentes. Pacientes que abandonaram o tratamento antes de sua conclusão foram convocados para uma entrevista que visava à identificação de fatores que poderiam predizer a baixa aderência. Os dados colhidos pelas entrevistas foram categorizados e apontaram fatores comuns: pacientes com antecedentes de baixa aderência, percepção distorcida dos resultados do tratamento e de seu status clínico, falta de motivação para o tratamento e a atribuição dos sintomas à personalidade ao invés de encará-los como uma doença. A partir destas constatações, recomendam-se intervenções terapêuticas no sentido de melhorar a aderência como educar o paciente sobre aspectos de sua doença e do tratamento, fornecer ao paciente indícios objetivos de sua melhora, garantir a motivação dos pacientes e avaliar a aderência ao longo do tratamento de modo a detectar pacientes que poderão abandonar o tratamento (AU)

Assuntos

RESUMO

A aderência é um fator importante tanto por influenciar resultados de pesquisas, como para a prática clínica. Durante um estudo sobre Fobia Social, detectou-se uma pobre aderência entre pacientes submetidos a psicoterapia em grupo, tendo os pacientes abandonado a terapia em etapas diferentes. Essa diferença sugeriu a possibilidade de tratar-se de grupos de pacientes com características diferentes entre si, que pudessem motivar esse abandono em etapas diferentes. Pacientes que abandonaram o tratamento antes de sua conclusão foram convocados para uma entrevista que visava à identificação de fatores que poderiam predizer a baixa aderência. Os dados colhidos pelas entrevistas foram categorizados e apontaram fatores comuns: pacientes com antecedentes de baixa aderência, percepção distorcida dos resultados do tratamento e de seu status clínico, falta de motivação para o tratamento e a atribuição dos sintomas à personalidade ao invés de encará-los como uma doença. A partir destas constatações, recomendam-se intervenções terapêuticas no sentido de melhorar a aderência como educar o paciente sobre aspectos de sua doença e do tratamento, fornecer ao paciente indícios objetivos de sua melhora, garantir a motivação dos pacientes e avaliar a aderência ao longo do tratamento de modo a detectar pacientes que poderão abandonar o tratamento

Assuntos