综述

人工智能在白内障诊断的应用进展

Advances in artificial intelligence for cataract diagnosis

:160-168
 
白内障是世界范围内致盲的主要原因之一,占中低收入国家致盲病例的50%。随着人口老龄化程度的加深,到2050年中国白内障致盲病例预计达到2 000万。卫生支出占比低、医疗设备及眼科医生紧缺、筛查费用昂贵仍是中低收入国家无法开展大规模白内障筛查的主要原因。人工智能(artificial intelligence,AI)协助白内障诊断具有便捷、低成本、可远程进行等优点,有望减少甚至避免白内障致盲的发生。文章将对AI通过结合裂隙灯眼前节图像、眼底照片及扫频源光学相干层析图像进行白内障自动诊断等研究进行简要综述。
Cataract is a primary cause of blindness globally, particularly accounting for 50% of blindness cases in low- and middle- income countries. As the population ages, it is predicated that cataract blindness cases in China will rise to 20 million by 2050. However, low health expenditures, scarcity of medical equipment and ophthalmologists, and high screening costs continue to hinder mass cataract screening in these countries. Artificial intelligence(AI)-assisted cataract diagnosis offers significant advantages, including convenience, cost-effectiveness, and remote accessibility, potentially reducing or even eliminating cataract blindness. This review aims to concisely summarize the research on automatic cataract diagnosis utilizing AI, incorporating slit lamp images of anterior eye segment, fundus photographs, and swept source optical coherence tomography images.
综述

数字智能技术在斜视诊疗中的应用

The application of digital intelligent technologies in the diagnosis and treatment of strabismus

:839-847
 
斜视作为眼科的常见疾病之一,多发生于儿童群体。传统的诊疗手段高度依赖医生的个人经验,效率欠佳,患者依从性差,极易延误病情,严重影响患儿视功能及身心发育。近年来,人工智能(artificial intelligence, AI)与虚拟现实(virtual reality, VR)技术作为数字智能技术中的前沿科技手段,已广泛应用于眼科疾病的筛查、诊断和治疗环节,并正推动斜视诊疗体系向智能化转型。AI技术凭借强大的图像识别与分析能力可自动检测斜视类型和角度,更全面地评估病情。同时,通过分析大量数据预测手术参数,辅助制定个性化的手术方案,并且评估手术效果,大幅提升了斜视诊疗的精准度和效率;而VR技术则通过眼动追踪和动态场景模拟,实现更全面的眼位测量和动态分析。在手术中为医生提供清晰全面的眼部视图,借助模拟试验提升操作精准度,降低手术风险。借助沉浸式的视觉训练有效优化了斜视的康复效果。本文系统地回顾了数字智能技术在斜视诊疗方面的创新应用实例,深入探讨了AI和VR在斜视诊疗中独特的技术优势以及显著的临床价值。AI与VR技术的协同创新,为斜视诊疗模式带来了智能化的变革,在未来,有望为眼科医疗领域的发展注入新的动力,推动整个行业迈向新的高度。
Strabismus is a prevalent ophthalmic disorder predominantly affects children. For a long time, its diagnosis and treatment have heavily relied on traditional methods, which are highly dependent on clinical expertise. This reliance often leads to inefficiency, poor patient compliance, and delayed treatment. These issues can severely impair visual function and hinder psychosocial development. Recently, there have been significant advancements in artificial intelligence (AI) and virtual reality (VR), both of which are cutting-edge digital technologies. These innovations have brought about a revolution in the screening, diagnosis, and treatment of ophthalmic diseases, driving the intelligent transformation of strabismus management. AI demonstrates remarkable capabilities in the automated detection of strabismus types and deviation angles. It achieves this through robust image recognition and analysis techniques, enabling a comprehensive evaluation of the disease. By analyzing vast amounts of data, AI can predict surgical parameters, assists in personalized surgical planning, and objectively assesses postoperative outcomes. This significantly enhances diagnostic accuracy and therapeutic efficiency. At the same time, VR technology enables holistic ocular alignment measurements and dynamic analysis via eye-tracking and simulated dynamic environments. During surgical procedures, VR offers surgeons an enhanced visualization of ocular structures and improves operational accuracy through simulated trials. As a result, it helps reduce surgical risks. After surgery, immersive VR-based visual training programs can optimize rehabilitation outcomes. This review systematically examines innovative applications of AI and VR in strabismus care, highlighting their unique technical advantages and clinical value. The synergistic integration of AI and VR has catalyzed an intelligent paradigm shift in strabismus management. This shift promises to inject new momentum into ophthalmic medicine and propel the field towards unprecedented advancements.
论著

人工智能辅助诊断的闵行区视觉健康管理模式探索与实践

Exploration and practice of the visual health management mode based on artificial intelligence-assisted diagnosis in Minhang District

:272-282
 

目的探索和实践人工智能辅助诊断的闵行区视觉健康管理模式。方法介绍闵行区人工智能辅助诊断的视觉健康管理模式;分析对比传统视觉健康管理模式和人工智能辅助诊断视觉健康管理模式下,社区视觉健康筛查情况,眼病发现、需转诊、复诊情况等;工作人员配置、眼科门诊接诊情况、居民眼病知识率和视觉健康服务满意情况等。结果传统视觉健康管理模式和人工智能辅助诊断模式主要眼病(糖尿病视网膜病变、青光眼、年龄相关性黄斑变性、高度近视)发现率比较差异均有统计学意义(c2=954.03,0.01),需转诊率差异有统计学意义(c2=431.07,0.01)。人工智能辅助诊断管理模式与传统视觉健康管理模式的居民在青光眼的知晓率比较差异有统计学意义(c2=4.24,P0.05)。传统视觉健康管理模式和人工智能辅助诊断模式居民对视觉健康服务中的服务质量和服务时间的满意度比较差异有统计学意义(Z=-2.75,Z=-2.18,0.05)。结论人工智能辅助诊断视觉健康管理模式,糖尿病视网膜病变、青光眼等主要眼病发现率高于传统模式,需转诊率降低,居民对青光眼的知晓率提升,在服务质量和服务时间上的居民满意度较高。基于人工智能辅助诊断的视觉健康筛查与管理模式值得本区其他社区的推广和应用。

Objective To explore and practice the visual health management mode of Minhang District . Methods Introduce the visual health management mode of AI-assisted diagnosis in Minhang District; analyze and compare the traditional visual health management mode and AI-assisted visual health management mode, community visual health screening projects and completion conditions, screening files, eye disease discovery , referral, actual referral and return ; analyze and compare the visual health management mode, staff allocation, ophthalmic outpatient reception, and the satisfaction of visual health service. Results The difference in the discovery rate of major eye diseases (Diabetic Retinopathy,Glaucoma,Age-related Macular Degeneration,High Myopia) between the traditional model and artificial intelligence-assisted diagnosis mode in both communities (c2=954.03, P<0.01), the referral rate (c2=431.07, P<0.01). The awareness of AI-assisted diagnosis management improved in glaucoma in the two modes was statistically significant (c2=4.24, P<0.05). Traditional model and artificial intelligence assisted diagnosis model of visual health service quality and service time is statistically significant (Z=-2.75, Z=-2.18, P<0.05). Conclusion The visual health screening and management mode based on AI-assisted diagnosis is worthy of the promotion and application in other communities in the region.

综述

探索表皮玻璃疣:从多模式影像特点到临床诊疗的全方位解析

Exploration of cuticular drusen: comprehensive analysis from multi-modal imaging characteristics to clinical diagnosis and treatment

:208-214
 
随着多模式影像技术的应用,年龄相关性黄斑变性(age related macular degeneration, AMD)的一种特殊亚型:表皮玻璃疣(cuticular drusen)被发现,其与AMD尤其是非渗出性AMD又称干性(dry)AMD进展密切相关。但目前聚焦于AMD合并表皮玻璃疣的多模式影像特点等的相关文献较少,因此研究和阐明表皮玻璃疣的多模式影像特点、与其他AMD亚型玻璃疣的鉴别诊断、病理生理机制、治疗方法等具有重要的临床意义。运用多模式影像可以看到表皮玻璃疣呈双眼对称的无数散在的大小均匀的黄色视网膜下结节,典型的“星空状”荧光素钠眼底血管造影(fundus fluorescein angiography, FFA)表现, 以及光学相干断 层成像(optical coherence tomography, OCT)中视网膜色素上皮(retinal pigment epithelium, RPE)和Bruch膜之 间的锯齿状隆起。AMD合并表皮玻璃疣患者的分布特点个体差异很大,容易与AMD其他亚型的玻璃疣混淆,需要与硬性玻璃疣、软性玻璃疣、大胶质玻璃疣、Sorsby眼底营养不良(Sorsby's fundus dystrophy , SFD) 等相鉴别。研究表明表皮玻璃疣具有遗传性的类似动脉粥样硬化的发病机制,与RPE分泌的大型脂蛋白颗粒的堆积密切相关。未来可能会有针对补体系统的药物用于延缓表皮玻璃疣相关病变的进展。文章就表皮玻璃疣的临床表现、多模式影像的典型特点、鉴别诊断、遗传学基础、病理生理学发病机制、 并发症以及临床诊疗策略进行综述。

With the application of multimodal imaging techniques, a specific subtype of age-related macular degeneration (AMD),
known as cuticular drusen, has been identified. This subtype is closely associated with the progression of AMD, particularly non-exudative AMD, also referred to as dry AMD. However, there is a scarcity of literature focusing on the multimodal imaging characteristics of AMD combined with cuticular drusen. Therefore, studying and elucidating the multimodal imaging features of cuticular drusen, its differential diagnosis from other AMD subtypes of drusen, pathophysiological mechanisms, and treatment methods holds significant clinical importance. Multimodal imaging reveals cuticular drusenas numerous, symmetrical, evenly sized, yellow subretinal nodules in both eyes, exhibiting a typical "stars-in-the-sky" appearance on fluorescein angiography (FFA) and zigzag elevations between the retinal pigment epithelium (RPE) and Bruch's membrane on optical coherence tomography (OCT). The distribution characteristics of AMD patients with cuticular drusen vary greatly among individuals and can easily be confused with drusen from other AMD subtypes, so the differentiation from hard drusen, soft drusen, large colloidal drusen, and Sorsby's fundus dystrophy (SFD) is necessary. Studies suggest that cuticular drusen have a genetic, atherosclerosis- like pathogenesis which closely related to the accumulation of large lipoprotein particles secreted by the RPE. Future therapies targeting the complement system maybe employed to delay the progression of cuticulardrusen-related lesions. This article reviews the clinical manifestations, typical multimodal imaging features, differential diagnosis, genetic basis, pathophysiological mechanisms, complications, and clinical management strategies of cuticulardrusen.

综述

人工智能在泪器疾病诊疗中的应用:挑战与机遇

Application of artificial intelligence in the diagnosis and treatment of lacrimal disorders: challenges and opportunities

:53-66
 
泪器疾病是一类常见的眼科疾病,其诊疗过程复杂,治疗方法精细,涉及多种临床数据及影像资料。现有研究表明,随着人工智能(artificial intelligence,AI)技术,尤其是机器学习和深度学习的发展,AI在泪器疾病的早期筛查、精确诊断和个性化治疗中展现了巨大的应用潜力。AI能够通过高效的图像分析、多模态数据融合及深度学习算法,提供更加精确的疾病识别和治疗方案,并且能够对患者的病情进行定期监测和动态调整,提升治疗效果。然而,其仍面临诸多挑战,如多模态数据融合的复杂性、模型泛化能力的局限以及实时预测和动态调整的需求等,需要通过持续的技术创新、算法优化和跨学科合作来实现。文章对当前AI在泪器疾病诊疗中的应用现状进行了全面梳理和总结,深入分析了AI技术在诊断与治疗中的优势与局限,特别强调了AI与新兴技术的结合在优化临床决策支持系统方面的重要性。通过分析现有的挑战与技术融合策略,文章提出了AI在泪器疾病诊疗中的发展方向,旨在为未来的研究者提供创新性的思路,为眼科领域的临床实践提供有价值的参考,助力泪器疾病的精准医疗和个性化治疗的发展。
Lacrimal disorders are common ophthalmic conditions characterized by complex diagnostic and treatment processes, involving intricate therapeutic approaches and diverse clinical and imaging data. Recent studies have indicated that with the advancements in artificial intelligence (AI) technologies, particularly in machine learning and deep learning, AI demonstrates significant potential in the early screening, accurate diagnosis, and personalized treatment of lacrimal disorders. AI has the ability to provide more precise disease identification and treatment strategies through efficient image analysis, multimodal data fusion, and deep learning algorithms. Additionally, it enables regular monitoring and dynamic adjustment of patients' conditions, improving treatment outcomes. However, several challenges persist, such as the complexity of multimodal data integration, limitations in model generalization capabilities, and the need for real-time prediction and dynamic adjustments, all of which necessitate continuous technological innovations, algorithm optimization, and interdisciplinary collaborations. This paper provides a comprehensive review of the current status of AI applications in the diagnosis and treatment of lacrimal disorders, analyzing the advantages and limitations of AI in clinical practice. It especially emphasizes the importance of integrating AI with emerging technologies to optimize clinical decision support systems. By addressing the existing challenges and exploring strategies for technological integration, this paper proposes future directions for the development of AI in lacrimal disorder diagnosis and treatment, aiming to offer innovative perspectives for future researchers and valuable references for clinical practice in the field of ophthalmology, ultimately contributing to the advancement of precision medicine and personalized treatment for lacrimal disorders.
专家共识

血泪诊疗流程的中国专家共识(2024版)

Chinese expert consensus on the diagnosis and treatment procedures of bloody tears (2024)

:1-11
 
血泪是指因各种原因导致眼部流出血性泪液的症状,其病因和临床表现复杂多样,往往涉及多学科多专业。不同病因引起的血泪,无论是临床表现,还是诊治方法均差异很大。为了向临床医生提供可参考的血泪临床诊疗流程,中国医师协会眼科医师分会泪器病专业委员会及中国中西医结合学会眼科专业委员会泪器病学组组织有关专家以临床实践经验为基础,经过认真讨论建立本共识,对血泪的病因、临床特征及诊疗流程提出指导性意见。
Bloody tears refers to the symptoms of blooding tears flowing from the eye due to various reasons. Its etiology and clinical manifestations are complex and diverse, often involving multiple disciplines and specialties. In order to provide clinicians with a reference for the clinical diagnosis and treatment process of bloody tears, Lacrimal Diseases Professional Committee of Ophthalmologist Branch of Chinese Medical Doctor Association and Lacrimal Diseases Group of Ophthalmic Professional Committee of Chinese Association of Integrated Medicine organized relevant experts to establish this consensus based on clinical practice after serious discussion, and put forward guiding opinions on the etiology, clinical characteristics, and diagnosis and treatment process of bloody tears.
综述

Application of visual electrophysiology for the diagnosis and treatment of cataracts

Application of visual electrophysiology for the diagnosis and treatment of cataracts

:190-197
 
Visual electrophysiology is widely used in clinical ophthalmology. It is also of significant value in the objective assessment of visual function in adult and pediatric cataract patients and for the diagnosis of and research on retinal and visual pathway diseases. This article systematically reviews visual electrophysiology techniques, their applications in the diagnosis and treatment of adult and pediatric cataracts, and factors influencing the application of visual electrophysiology during surgical treatment for cataracts.
Visual electrophysiology is widely used in clinical ophthalmology. It is also of significant value in the objective assessment of visual function in adult and pediatric cataract patients and for the diagnosis of and research on retinal and visual pathway diseases. This article systematically reviews visual electrophysiology techniques, their applications in the diagnosis and treatment of adult and pediatric cataracts, and factors influencing the application of visual electrophysiology during surgical treatment for cataracts.
综述

原发性干燥综合征相关性干眼在眼科诊疗中的现状及研究进展

Current status and research advances in diagnosis and treatment of primary Sjogren’s syndrome associated dry eye disease in ophthalmology

:163-169
 

原发性干燥综合征 (primary Sjogren' s syndromeSS) 是一种主要累及外分泌腺体的自身免疫性疾病,患者通常因为严重的干眼症状首先就诊于眼科,大多数临床医师对原发性干燥综合征相关性干眼 (Sjogren' s syndrome dry eye diseaseSS-DED) 认识不足,可能导致漏诊和误诊。侵入性极小的客观检查及生物标志物的发展,将有助于发现 SS-DED 的真面目,并可能从新的角度阐释其发病机制,为其诊断、分类及治疗提供新的思路。SS-DED 的治疗没有特效的药物,大多数患者需接受多种方法的治疗,以了解哪些方法最有效。

Primary Sjogren' s syndrome is an autoimmune disease that mainly affects exocrine glands. Patients usually refer to ophthalmologists because of severe dry eye symptoms. Most clinicians have insufficient knowledge with dry eye disease associated with primary Sjogren' s syndrome probably leading to misdiagnosis or missing the diagnosis. The diagnosis of Sjogren' s syndrome dry eye disease (SS-DED) is difficult, but the extremely invasive objective examination and the development of biomarkers will help to understand this disease and explain its pathogenesis from a new perspective. There is no specific treatment for the SS-DED, and most patients should receive multiple treatments to select the optimal treatment. 

综述

眼移植物抗宿主病的临床诊疗新进展

Research progress on clinical diagnosis and treatment of ocular graft-versus-host disease

:299-305
 
随着移植技术逐年发展,异基因造血干细胞移植患者的生存期延长,长期并发症成为影响患者预后及生活质量的主要原因。眼移植物抗宿主病是异基因造血干细胞移植术后最常见的眼部并发症,发生率可高达50%以上。根据发病时间可分为急性及慢性眼移植物抗宿主病,临床上最常以慢性炎症及眼表组织纤维化为特点,主要表现为干眼和不同程度的角结膜炎,治疗较为棘手,可不同程度影响患者视觉质量及生活质量,严重可致盲。近年来眼移植物抗宿主病越来越受到国内外学者重视,其发病机制、临床特点、诊断及治疗相关研究逐渐深入,文章针对眼移植物抗宿主病的临床诊疗新进展进行综述。总体而言,眼移植物抗宿主病早期识别仍较为困难,早期诊断策略有待进一步探索。目前治疗对眼移植物抗宿主病的效果较为有限,或缺乏充足的循证医学证据,临床上缺乏针对不同严重程度及疾病活动度的分级诊疗策略,未来有待进一步探索新的治疗靶点及疾病活动监测指标,将有助于改善患者长期预后及生活质量。
Despite advancements in allogeneic hematopoietic stem cell transplantation techniques leading to improved overall survival rates, long-term complications have emerged as the primary contributors to poor prognosis and diminished quality of life. Ocular graft-versus-host disease (oGVHD), a prevalent complication affecting over 50% of patients post-transplantation, frequently manifests as refractory dry eye, often accompanied by keratoconjunctivitis. Patients with oGVHD routinely suffer from visual impairment and a decline in their quality of life.Currently, research into the mechanisms, clinical features, diagnosis, and treatment of oGVHD has progressively deepened. This article reviews the latest advancements in the clinical diagnosis and management of oGVHD. Notably, there is a pressing need for strategies focused on early diagnosis and treatment, as early recognition of oGVHD remains challenging. Existing treatments for oGVHD either exhibit limited efficacy or lack robust clinical evidence to support their use as the best available options.Further research is imperative to develop tiered diagnostic and treatment approaches, including the exploration of novel therapeutic targets and biomarkers for disease detection. Such endeavors hold the promise of enhancing patients' long-term prognosis and quality of life.
综述

原发性干燥综合征相关性干眼在眼科诊疗中的现状及研究进展

Current status and research advances in diagnosis and treatment of primary Sj?gren’s syndrome associated dry eye disease in ophthalmology

:163-169
 
原发性干燥综合征(primary Sj?gren’s syndrome,SS)是一种主要累及外分泌腺体的自身免疫性疾病,患者通常因为严重的干眼症状首先就诊于眼科,大多数临床医师对原发性干燥综合征相关性干眼(Sj?gren’s syndrome dry eye disease,SS-DED)认识不足,可能导致漏诊和误诊。侵入性极小的客观检查及生物标志物的发展,将有助于发现SS-DED的真面目,并可能从新的角度阐释其发病机制,为其诊断、分类及治疗提供新的思路。SS-DED的治疗没有特效的药物,大多数患者需接受多种方法的治疗,以了解哪些方法最有效。
Primary Sj?gren’s syndrome is an autoimmune disease that mainly affects exocrine glands. Patients usually refer to ophthalmologists because of severe dry eye symptoms. Most clinicians have insufficient knowledge with dry eye disease associated with primary Sj?gren’s syndrome probably leading to misdiagnosis or missing the diagnosis.The diagnosis of Sj?gren’s syndrome dry eye disease (SS-DED) is difficult, but the extremely invasive objective examination and the development of biomarkers will help to understand this disease and explain its pathogenesis from a new perspective. There is no specific treatment for the SS-DED, and most patients should receive multiple treatments to select the optimal treatment.
其他期刊
  • 眼科学报

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
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  • Eye Science

    主管:中华人民共和国教育部
    主办:中山大学
    承办:中山大学中山眼科中心
    主编:林浩添
    主管:中华人民共和国教育部
    主办:中山大学
    浏览