背景：目前已有研究报道了一种MATLAB的定制算法，用于Triton光学相干断层扫描血管成像(optical coherence tomography angiography，OCTA)图像的中心凹无血管区(fovea avascular zone，FAZ)的自动测量。由于这种算法非开源，且难以获取，因而大大限制了其在临床实践和科学研究中的应用。本研究提出一种用于Triton OCTA图像的FAZ自动分割的开源算法，即Smooth Level Sets macro(SLSM)算法，并将其测量结果与MATL AB和人工方法相比较，评估该算法分割的准确性和可靠性。方法：纳入35位健康受试者的35只健眼，选用Triton OCTA机器中的3 mm×3 mm扫描模式，对其黄斑区进行连续4次扫描。分别用人工和自动方法(包括MATL AB和SLSM)，测量浅层毛细血管图像中FAZ的面积、周长和圆度。分析各种自动算法的准确性、重复性，以及与人工方法结果的一致性。结果：SLSM算法的准确性仅低于人工方法，而高于MATLAB算法(Dice系数：人工方法，0.9568；SLSM，0.9506；MATL AB，0.9483)。SLSM和MATL AB测量FAZ面积的重复性均很高[组内相关系数(intraclass correlation coefficient，ICC)：SLSM，0.987；MATLAB，0.983]。SLSM、MATLAB测量FAZ面积的结果均与人工方法呈很高的一致性(ICC：SLSM，0.973；MATL AB，0.968)。结论：SLSM在Triton OCTA图像的FAZ自动分割中的准确性高于MATL AB，其测量结果与人工测量结果很相近。作为免费和开源的资源，SLSM有望成为Triton OCTA图像中有效可靠的FAZ自动分割和测量方法。
Background: Previous studies have proposed an automated customized program named MATLAB used in the foveal avascular zone (FAZ) measurements in Triton optical coherence tomography angiography (OCTA) images. But it is not open-source and not easy to obtain, which will largely restrict its application in clinical practice and medical research. In this study, we aimed to investigate the feasibility of the Smooth Level Sets macro (SLSM), a free and open-source program, and compared with the manual measurements and MATLAB in the FAZ quantification in Triton OCTA. Methods: Thirty-five eyes of 35 healthy subjects were scanned four times continuously using Triton OCTA. Manual and automated methods including the SLSM and MATLAB were used in the FAZ metrics (area, perimeter, and circularity) of the superficial capillary plexus. The accuracy, repeatability of all methods, and agreement between automated and manual methods were analyzed. Results: The SLSM presented higher accuracy with a higher average Dice coefficient (0.9506) than MATLAB (0.9483), which was just second to the manual method (0.9568). Both the SLSM [intraclass correlation coefficient (ICC) =0.987; coefficient of variation (CoV) =3.935%] and MATLAB (ICC =0.983; CoV =4.165%) showed excellent repeatability for the FAZ area. They also had excellent agreement with manual measurement (SLSM, ICC =0.973; MATLAB, ICC =0.968). Conclusion: The SLSM exhibits better accuracy than MATLAB in the automated FAZ measurement in Triton OCTA, the results of which were comparable to those obtained by manual measurement. This free and open-source program may be an accessible and feasible option for automated FAZ segmentation on Triton OCTA images.
培养合格的眼科医师对于防盲治盲工作、为人民提供优质眼健康服务是十分重要的，不同地区的住院医师规范化培训各有特点。文章从各个方面比较了内地与香港眼科住院医师规范化培训体系的异同，包括培训对象、培训师资、轮转阶段和要求、考核机制。香港的培训体系时间为6年，大致上相当于住院医师规范化培训和专科医师规范化培训结合在一起。通过比较两者的差异，有助于我们结合自己的实际情况，改进内地的眼科学住院医师教育培养体系，也为下一步开展眼科专科医师规范化培训提供参考。
The training of qualified ophthalmologists holds paramount significance in preventing blindness, treating eye diseases, and delivering optimal eye health services to the people. Given the unique nature of standardized residency training across geographical regions, this study delves into the comparative analysis of ophthalmology residency standardized training systems in the Mainland and Hong Kong. Specifically, we examine the the similarities and disparities in multiple facets, encompassing trainees' profiles, faculty expertise, rotation phases and prerequisites, as well as assessment methodologies. Notably, the training system in Hong Kong has a duration of 6 years, approximating the combined length of standardized residency training and standardized specialist training. By comparing the differences, we aim to facilitate the refinement of ophthalmology residency education and training in Mainland China, tailored to our specific context, while also serving as a reference for advancing standardized ophthalmology specialist training initiatives.
Background: Previous studies have proposed an automated customized program named MATLAB used in the foveal avascular zone (FAZ) measurements in Triton optical coherence tomography angiography (OCTA) images. But it is not open-source and not easy to obtain, which will largely restrict its application in clinical practice and medical research. In this study, we aimed to investigate the feasibility of the Smooth Level Sets macro (SLSM), a free and open-source program, and compared with the manual measurements and MATLAB in the FAZ quantification in Triton OCTA.
Methods: Thirty-five eyes of 35 healthy subjects were scanned four times continuously using Triton OCTA. Manual and automated methods including the SLSM and MATLAB were used in the FAZ metrics (area, perimeter, and circularity) of the superficial capillary plexus. The accuracy, repeatability of all methods, and agreement between automated and manual methods were analyzed.
Results: The SLSM presented higher accuracy with a higher average Dice coefficient (0.9506) than MATLAB (0.9483), which was just second to the manual method (0.9568). Both the SLSM [intraclass correlation coefficient (ICC) =0.987; coefficient of variation (CoV) =3.935%] and MATLAB (ICC =0.983; CoV =4.165%) showed excellent repeatability for the FAZ area. They also had excellent agreement with manual measurement (SLSM, ICC =0.973; MATLAB, ICC =0.968).
Conclusion: The SLSM exhibits better accuracy than MATLAB in the automated FAZ measurement in Triton OCTA, the results of which were comparable to those obtained by manual measurement. This free and open-source program may be an accessible and feasible option for automated FAZ segmentation on Triton OCTA images.
Background: Previous studies have proposed an automated customized program named MATLAB used in the foveal avascular zone (FAZ) measurements in Triton optical coherence tomography angiography (OCTA) images. But it is not open-source and not easy to obtain, which will largely restrict its application in clinical practice and medical research. In this study, we aimed to investigate the feasibility of the Smooth Level Sets macro (SLSM), a free and open-source program, and compared with the manual measurements and MATLAB in the FAZ quantification in Triton OCTA.
Methods: Thirty-five eyes of 35 healthy subjects were scanned four times continuously using Triton OCTA. Manual and automated methods including the SLSM and MATLAB were used in the FAZ metrics (area, perimeter, and circularity) of the superficial capillary plexus. The accuracy, repeatability of all methods, and agreement between automated and manual methods were analyzed.
Results: The SLSM presented higher accuracy with a higher average Dice coefficient (0.9506) than MATLAB (0.9483), which was just second to the manual method (0.9568). Both the SLSM [intraclass correlation coefficient (ICC) =0.987; coefficient of variation (CoV) =3.935%] and MATLAB (ICC =0.983; CoV =4.165%) showed excellent repeatability for the FAZ area. They also had excellent agreement with manual measurement (SLSM, ICC =0.973; MATLAB, ICC =0.968).
Conclusion: The SLSM exhibits better accuracy than MATLAB in the automated FAZ measurement in Triton OCTA, the results of which were comparable to those obtained by manual measurement. This free and open-source program may be an accessible and feasible option for automated FAZ segmentation on Triton OCTA images.
眼科住院医师规范化培训(以下简称“规培”)是培养眼科医师的必要环节。我国规培模式日臻成熟，但眼科规培过程管理中仍存在诸多问题，包括专科医院和综合医院的规培协调问题、师资激励、规培学员类型多样、研究生和规培“双轨制”、如何开展显微手术技能培训等，很多具体方案和措施仍在摸索中。眼科专科医院学科体系建设相对完善，配备更充足的教学资源，有一定的规培经验，是眼科规培的主力军。汕头国际眼科中心结合国家要求创建了一套规培模式，注重规范化、标准化和个性化相结合，并通过借鉴香港及海外住院医师培训经验，丰富理论培训形式，优化操作培训环境，突出外语和科研能力训练，强调系统性临床思维。本文基于汕头国际眼科中心五年来开展眼科规培的实践经验与思考，总结当前眼科专科医院规培现状，并提出对策和建议。
Standardized training for ophthalmology residents is an essential stage during the development of ophthalmologists. The standardized training system has become more and more mature, while problems still exist in the aspects of coordination between specialized hospitals and general hospitals, teacher resources, unevenness of trainees, combination of postgraduate education and residency standardized training, microsurgical skills training, and so on. Therefore, programs and strategies of standardized training are still under exploration. Eye hospitals, with the excellent disciplinary system, adequate resources, and advanced experience, play a key role in standardized training for ophthalmology residents. Joint Shantou International Eye Center has set up a training model in accordance with national requirements, focusing on the combination of standardization, normalization, and individuation. Besides, by learning from the oversea experience of residents training, Joint Shantou International Eye Center has enriched the training forms, optimized the skill training environment, and highlighted the training of foreign language, scientific research, and systematic clinical thinking. This paper, based on the 5-year experience and reflection on standardized training for ophthalmology residents in Joint Shantou International Eye Center, summarizes the current status of standardized training and put forward some measures and suggestions.
[摘 要] 背景：目前已有研究报道了一种MATLAB的定制算法，用于Triton光学相干断层扫描血管成像(optical coherence tomography angiography，OCTA)图像的中心凹无血管区(fovea avascular zone，FAZ)的自动测量。由于这种算法非开源，且难以获取，因而大大限制了其在临床实践和科学研究中的应用。本研究提出一种用于Triton OCTA图像的FAZ自动分割的开源算法，即Smooth Level Sets macro(SLSM)算法，并将其测量结果与MATLAB和人工方法相比较，评估该算法分割的准确性和可靠性。方法：纳入35位健康受试者的35只健眼，选用Triton OCTA机器中的3 mm×3 mm扫描模式，对其黄斑区进行连续4次扫描。分别用人工和自动方法(包括MATLAB和SLSM)，测量浅层毛细血管图像中FAZ的面积、周长和圆度。分析各种自动算法的准确性、重复性，以及与人工方法结果的一致性。结果：SLSM算法的准确性仅低于人工方法，而高于MATLAB算法(Dice系数：人工方法，0.9568；SLSM，0.9506；MATLAB，0.9483)。SLSM和MATLAB测量FAZ面积的重复性均很高[组内相关系数(intraclass correlation coefficient，ICC)：SLSM，0.987；MATLAB，0.983]。SLSM、MATLAB测量FAZ面积的结果均与人工方法呈很高的一致性(ICC：SLSM，0.973；MATLAB，0.968)。结论：SLSM在Triton OCTA图像的FAZ自动分割中的准确性高于MATLAB，其测量结果与人工测量结果很相近。作为免费和开源的资源，SLSM有望成为Triton OCTA图像中有效可靠的FAZ自动分割和测量方法。
Abstract Background: Previous studies have proposed an automated customized program named MATLAB used in the foveal avascular zone (FAZ) measurements in Triton optical coherence tomography angiography (OCTA) images. But it is not open-source and not easy to obtain, which will largely restrict its application in clinical practice and medical research. In this study, we aimed to investigate the feasibility of the Smooth Level Sets macro (SLSM), a free and open-source program, and compared with the manual measurements and MATLAB in the FAZ quantification in Triton OCTA. Methods: Thirty-five eyes of 35 healthy subjects were scanned four times continuously using Triton OCTA. Manual and automated methods including the SLSM and MATLAB were used in the FAZ metrics (area, perimeter, and circularity) of the superficial capillary plexus. The accuracy, repeatability of all methods, and agreement between automated and manual methods were analyzed. Results: The SLSM presented higher accuracy with a higher average Dice coefficient (0.9506) than MATLAB (0.9483), which was just second to the manual method (0.9568). Both the SLSM [intraclass correlation coefficient (ICC) =0.987; coefficient of variation (CoV) =3.935%] and MATLAB (ICC =0.983; CoV =4.165%) showed excellent repeatability for the FAZ area. They also had excellent agreement with manual measurement (SLSM, ICC =0.973; MATLAB, ICC =0.968). Conclusion: The SLSM exhibits better accuracy than MATLAB in the automated FAZ measurement in Triton OCTA, the results of which were comparable to those obtained by manual measurement. This free and open-source program may be an accessible and feasible option for automated FAZ segmentation on Triton OCTA images.
目的：以光学相干断层扫描血管成像(optical coherence tomography angiography，OCTA)观察视网膜分支静脉阻塞(branch retinal vein occlusion，BRVO)抗血管内皮生长因子(vascular endothelial growth factor，VEGF)治疗前后的变化。方法：回顾性收集从2017年1月至2018年1 2月在汕头国际眼科中心的确诊为BRVO合并黄斑水肿的患者共3 1例3 2眼。患眼行玻璃体腔注射抗VEGF药物治疗，记录治疗前和治疗后1个月的最佳矫正视力(best corrected visual acuity，BCVA)，OCTA检查视网膜黄斑中心凹厚度(foveal macular thickness，FMT)、黄斑区血流密度。比较治疗前后各指标的变化。结果：治疗后BCVA较治疗前显著提高，差异有统计学意义(P<0.001)；FMT[(242.13±86.02) μm]较治疗前[(521.44±190.27) μm]明显下降，差异有统计学 意义(P<0.001)；中心凹浅层血流密度[(18.44±4.98)%]及中心凹旁浅层血流密度[(44.83±3.19)%]均较治疗前[(25.46±9.21)%，(46.06±5.25)%]相比明显下降，差异有统计学意义(P <0.001)。结论：玻璃体腔注射抗VEGF治疗BRVO合并黄斑水肿效果显著；OCTA能有效评价抗VEGF治疗BRVO合并黄斑水肿的临床疗效。
Objective: To evaluate the efficacy in patients with macular edema due to branch retinal vein occlusion (BRVO) treated with intravitreal anti-VEGF drug. Methods: In this retrospective study, 32 eyes of 31 patients with BRVO combined with macular edema at Joint Shantou international eye center of Shantou University and TheChinese University of Hong Kong during January 2017 to December 2018 were enrolled in this study. All the affected eyes received intravitreal anti-VEGF drug injections. BCVA (best corrective visual acuity) and optical coherence tomography angiography (OCTA) were performed before and one month after intravitreal anti-VEGF drug injections. Foveal macular thickness (FMT), macular blood flow density was measured in all eyes and compared. Results: The BCVA before therapy was (0.77±0.46) LogMAR and increased to (0.46±0.30) LogMAR in one month after therapy, which showed a statistical difference (P<0.001). The FMT, foveal superficial vascular plexus flow density and para foveal superficial vascular plexus flow density before therapy were (521.44±190.27) μm, (21.85±6.17)% and (46.29±2.70)%, respectively. The FMT, foveal superficial vascular plexus flow density and para foveal superficial vascular plexus flow density decreased to (242.13±86.02) μm, (18.40±5.18)% and (44.75±3.40)%, respectively. There was significant statistical difference for them (P<0.001). Conclusion: Intravitreal injection of anti-VEGF is effective in the treatment of BRVO combined with macular edema. OCTA can effectively evaluate the clinical efficacy of anti-VEGF in the treatment of BRVO combined with macular edema.
