Abstract: Artificial intelligence (AI) methods have become a focus of intense interest within the eye care community. This parallels a wider interest in AI, which has started impacting many facets of society. However, understanding across the community has not kept pace with technical developments. What is AI, and how does it relate to other terms like machine learning or deep learning? How is AI currently used within eye care, and how might it be used in the future? This review paper provides an overview of these concepts for eye care specialists. We explain core concepts in AI, describe how these methods have been applied in ophthalmology, and consider future directions and challenges. We walk through the steps needed to develop an AI system for eye disease, and discuss the challenges in validating and deploying such technology. We argue that among medical fields, ophthalmology may be uniquely positioned to benefit from the thoughtful deployment of AI to improve patient care.

Abstract: Pediatric uveitis is an inflammatory ocular disease that can lead to sight-threatening complications. Pediatric patients have distinct challenges in the diagnosis and management of uveitis, secondary to difficulties in performing ophthalmic examinations in young children, delayed diagnosis due to lack of adherence with recommended screening schedules, medication side-effects, and increased burden of disease into adulthood. Measurement of outcomes in pediatric uveitis has traditionally relied upon the ophthalmic examination and general quality of life (QOL) measures. However, the ophthalmic examination does not take into account the impact of uveitis on a child’s QOL and general QOL measures do not adequately assess the specific effects of vision. Several vision-related quality of life (VR-QOL) instruments have been used to measure outcomes in both adults and children including: the National Eye Institute Visual Function Questionnaire (NEI VFQ-25), Vision-related Quality of Life of Children and Young People (VQoL_CYP), the Children’s Visual Function Questionnaire (CVFQ), and the Effect of Youngsters’ Eyesight on Quality of Life (EYE-Q). However, the NEI VFQ-25 is not a valid or applicable measure in children, and the VQoL_CYP and CVFQ are not uveitis specific and may not characterize disease specific burdens. The EYE-Q is the only uveitis-specific pediatric questionnaire that measures visual functioning and VR-QOL in 5–18 years old children and adolescents with uveitis. It has been shown to be a valid and reliable assessment tool in several cohorts of children with uveitis. A comprehensive assessment of the impact of uveitis on a child that includes a vision-specific measure, such as the EYE-Q, allows for better understanding of the true burden of uveitis in children. For this review, we describe traditional outcome measures in uveitis studies, general QOL measures and vision-specific measures in adults and in children.

Background: To record the corneal, and anterior chamber depth changes after performing recession versus resection of horizontal recti muscles.

Methods: Consecutive patients who underwent isolated lateral rectus muscle recession or resection February 2014 to January 2015 were prospectively studied. Refractive error (spherical equivalent); K1, K2, and mean k reading, anterior and posterior corneal elevation; and anterior chamber depth were measured (Pentacam) before, 1 month, and 3 months after surgery. Patients who could not maintain reliable fixation and those with a history of eye surgery were excluded. Pre- and postoperative measurements were compared by analysis of variance.

Results: A total of 36 eyes of 23 patients (average age, 16 years) were included. Rectus muscle recession was performed in 24 eyes; and resection was performed in 12 eyes. Statistically significant changes in mean keratometry of recession group only. Central anterior elevation, and central anterior chamber depth were significant when both groups are compared at first month after surgery. Changes became regressive at the end of the third month. Although a significant change of central anterior elevation persisted.

Conclusions: In recession group, the mean K was the only statistically significant variable by the first postoperative month. Comparing the both groups, the anterior corneal elevation, and central anterior chamber depth revealed a significant difference by the end of the first postoperative month. After 3 months, all parameters showed a statistical insignificant difference between the recession and resection groups except the anterior corneal elevation.

Abstract: Age-related macular degeneration (AMD) remains a leading cause of severe visual impairment in developing countries. Although dry-type AMD and geographic atrophy (GA) are progressive conditions with the associated decrease of visual functions, no well-established treatment regimen was proposed for the disease. Wet-type AMD is effectively treated with intravitreal anti-angiogenic agents, but frequent injections are a major issue for the affected patients. Recent advances in AMD genetics have provided new insights into the pathogenesis and novel therapeutic targets of AMD, but the benefits of using genetic testing and genotype-based risk models for AMD development and progression still lacks evidence. Novel AMD treatments aim to increase the interval among intravitreal injections through new therapeutic agents and modern delivery devices. Simultaneously, gene therapy for dry and wet AMD is widely studied. Although gene therapy possesses a major superiority over other novel treatments regarding a persistent cure of disease, many challenges exist in the way of its broad impact on the ocular health of AMD patients.

Abstract: Several factors drive the need for increased efficiency in telemedicine screening programs directed toward diabetic retinopathy: continually increasing prevalence of diabetes worldwide, growing awareness among physicians and patients of the importance of early detection of retinal damage, and emerging technology in artificial intelligence that enables rapid identification of vision-threatening fundus features. In this context, optimizing workflows in teleretinopathy programs becomes a priority. Recent work has revealed opportunities for improvement in areas of logistics, in particular in finding the best way to get diabetic patients in front of screening cameras as conveniently as possible, as this improves compliance and, ultimately, achieves the widest reach for detection programs. The present review discusses particular aspects of mobile screening programs in which specialized retinal cameras are deployed in a van or similar type of vehicle so that they can reach patients anywhere in order to reduce barriers to access. The rationale for implementing such programs and practical considerations are presented, along with a view toward future expansion of screening and integration with artificial intelligence platforms. Lacking standardization of format and quality control among smartphone-linked approaches at present, translation of eye clinic-based photographic techniques to community-based screening offers a means of expanding the scope of impactful screening programs without the need for adoption of significantly new technology.

Abstract: Eyelid surgery is widely and extensively used in facial plastic and reconstructive surgeries. There are many categories of eyelid surgeries, the most common of which include blepharoplasty, ptosis surgery, and eyelid reconstruction. In many cases, these procedures are combined, and there are many different techniques for each type of operation. Upper eyelid blepharoplasty usually includes the excision of skin, preseptal orbicularis oculi muscle, and orbital fat. Common methods of lower eyelid blepharoplasty are the skin-muscle flap, the skin flap, and the transconjunctival. Ptosis surgery is mainly divided into three types: transcutaneous, transconjunctival, and sling surgery. Surgeons often used the Hughes or Cutler-Beard Bridge Flaps in eyelid reconstruction. Different types and methods of surgery have their own advantages and disadvantages, and postoperative complications may occur. Therefore, postoperative complications of eyelid surgeries, such as dry eye symptoms, should be taken into serious consideration. Relevant literature involving these complaints can be found in PubMed by searching the terms “dry eye”, “eyelid”, “surgery”, and other related keywords. Moreover, various ocular surface and tear film alterations may be detected using the Ocular Surface Disease Index (OSDI), tear film breakup time, Schirmer test, fluorescein staining, and lissamine green staining after various eyelid surgeries. As dry eye disease is prevalent in the general population, it is more urgent to figure out what we can learn from these complaints. Further exploration in this field may help surgeons to choose a better surgical method and give an accurate evaluation of the postoperative effect.

Perception is the ability to see, hear, or become aware of external stimuli through the senses. Visual stimuli are electromagnetic waves that interact with the eye and elicit a sensation. Sensations, indeed, imply the detection, resolution, and recognition of objects and images, and their accuracy depends on the integrity of the visual system. In clinical practice, evaluating the integrity of the visual system relies greatly on the assessment of visual acuity, that is to say on the capacity to identify a signal. Visual acuity, indeed, is of utmost importance for diagnosing and monitoring ophthalmological diseases. Visual acuity is a function that detects the presence of a stimulation (a signal) and resolves its detail(s). This is the case of a symbol like “E”: the stimulus is detected, then it is resolved as three horizontal bars and a vertical bar. In fact, within the clinical setting visual acuity is usually measured with alphanumeric symbols and is a three-step process that involves not only detection and resolution, but, due to the semantic content of letters and numbers, their recognition. Along with subjective (psychophysical) procedures, objective methods that do not require the active participation of the observer have been proposed to estimate visual acuity in non-collaborating subjects, malingerers, or toddlers. This paper aims to explain the psychophysical rationale underlying the measurement of visual acuity and revise the most common procedures used for its assessment.

Background: This study aims to investigate the current status and influencing factors of evidence-based practice (EBP) with knowledge, attitude and practice (KAP) of ophthalmic nursing staffs in south China.

Methods: Using a convenient sampling method, we selected 429 ophthalmic nursing staffs from 28 ophthalmology specialist hospitals or general hospitals in south China, and investigated their general information and implemented the evidence-based practice questionnaire (EBPQ).

Results: The scores of EBP and KAP of ophthalmic nursing staffs in south China from high to low were as follows: practical attitude (4.85±1.07 points), practical behavior (4.42±1.14 points), practical knowledge and skills (4.30±0.65 points). The single factor analysis results showed that the first graduation degree, technical title, scientific research achievements, whether or not participate in EBP training, the frequency of reading literature at ordinary time, and whether or not participate in EBP project were the influencing factors of EBP level; the multi-factor analysis results showed that EBP attitude, EBP knowledge and skills, whether or not participate in EBP training were independent influencing factors of EBP.

Conclusions: The ophthalmic nursing staffs in south China have a positive attitude towards EBP, however, their EBP knowledge, skills and behavioral capabilities need to be focused and improved. The ophthalmic nursing administrators should fully master the factors affecting the implementation of EBP, and take effective intervention measurement to improve the EBP abilities of ophthalmic nursing staffs, and promote the development of EBP in ophthalmology specialty.