Ślepota i utrata wzroku – Rokowania, prognozy i postęp choroby

Ślepota i utrata wzroku
Rokowania, prognozy i postęp choroby

Utrata wzroku i ślepota stanowią globalny problem zdrowia publicznego, z prognozowanym wzrostem liczby przypadków o 55% do 2050 roku, obejmującym około 1,8 miliarda osób z różnymi stopniami upośledzenia widzenia. W USA około 12 milionów osób powyżej 40. roku życia ma upośledzenie widzenia, w tym 1 milion z całkowitą ślepotą, a liczba ta ma się podwoić do 2050 roku. Wczesna interwencja i leczenie są kluczowe, gdyż 90% przypadków utraty wzroku można zapobiec lub leczyć. Rokowanie zależy od etiologii, wieku pacjenta, czasu rozpoczęcia terapii oraz obecności chorób współistniejących, takich jak choroby siatkówki, jaskra czy blizny rogówki, które znacząco pogarszają wyniki po operacjach, np. usunięcia zaćmy. Opóźnienia w leczeniu, szczególnie w nAMD, mogą prowadzić do istotnego pogorszenia ostrości wzroku (np. wzrost odsetka oczu z VA ≤6/60 z 15,5% do 23,3% przy 3-miesięcznym opóźnieniu) i zwiększenia liczby przypadków ślepoty prawnej. W przypadku ostrego zapalenia nerwu wzrokowego rokowanie jest dobre, z 90% pacjentów odzyskujących ostrość wzroku ≥20/40 po roku, choć ryzyko rozwoju SM wynosi do 75% u kobiet. Funkcjonalna utrata wzroku (FVL) ma 80-90% szans na poprawę, ale 10-15% ryzyko nawrotu, natomiast mózgowe upośledzenie wzroku (CVI) u dzieci wymaga wsparcia edukacyjnego i rehabilitacyjnego, gdyż nie ma skutecznego leczenia.

Prognozy ślepoty i utraty wzroku – ogólna charakterystyka
Czynniki prognostyczne w utracie wzroku

Wpływ wieku i innych czynników demograficznych
Opóźnienia w leczeniu i ich wpływ na rokowanie

Prognozy dla różnych rodzajów utraty wzroku

Ostre zapalenie nerwu wzrokowego i stwardnienie rozsiane
Funkcjonalna utrata wzroku
Mózgowe upośledzenie wzroku
Otwarte urazy gałki ocznej

Nowe podejścia do prognozowania i zapobiegania utracie wzroku

Modele predykcyjne i sztuczna inteligencja
Skuteczność screeningu AI w zapobieganiu utracie wzroku
Terapie regeneracyjne i nowoczesne metody leczenia

Wyzwania w opiece nad pacjentami z utratą wzroku

Wyzwania w identyfikacji pacjentów zagrożonych progresją
Wyzwania w jaskrze i retinopatii barwnikowej

Perspektywy dla leczenia i przyszłość opieki nad pacjentami z utratą wzroku

Kolejne rozdziały

Prognozy ślepoty i utraty wzroku – ogólna charakterystyka

Utrata wzroku i ślepota stanowią poważny problem zdrowia publicznego na całym świecie. Według prognoz Międzynarodowej Agencji Zapobiegania Ślepocie (IAPB), do 2050 roku nastąpi wzrost przypadków utraty wzroku o około 55%, dotykając dodatkowo około 600 milionów osób. Szacuje się, że całkowita liczba osób z różnymi formami utraty wzroku osiągnie około 1,8 miliarda, w tym 866 milionów z utratą widzenia z bliska, 360 milionów z łagodną utratą wzroku, 474 miliony z umiarkowaną do ciężkiej utratą wzroku oraz 61 milionów przypadków ślepoty.¹ Co istotne, IAPB podaje, że 90% przypadków utraty wzroku można zapobiec lub leczyć, co wskazuje na ogromny potencjał w zakresie poprawy prognoz poprzez wczesną interwencję i odpowiednie leczenie.²

W Stanach Zjednoczonych około 12 milionów osób w wieku 40 lat i starszych ma upośledzenie widzenia, w tym 1 milion z całkowitą ślepotą. Według danych z 2012 roku, 4,2 miliona Amerykanów w wieku 40 lat lub starszych ma niemożliwą do skorygowania utratę wzroku, a liczba ta według prognoz ma się więcej niż podwoić do 2050 roku. Szacuje się również, że około 93 miliony dorosłych w USA jest narażonych na poważną utratę wzroku, ale tylko połowa z nich odwiedziła okulistę w ciągu ostatnich 12 miesięcy.³ Jest to szczególnie niepokojące, ponieważ wczesne wykrycie i terminowe leczenie schorzeń oczu, takich jak retinopatia cukrzycowa, jest skuteczne – 90% przypadków ślepoty u dorosłych w USA spowodowanych cukrzycą można zapobiec.⁴

Czynniki prognostyczne w utracie wzroku

Na rokowanie w przypadku utraty wzroku wpływa wiele czynników, w tym etiologia schorzenia, szybkość wystąpienia objawów, wiek pacjenta oraz czas rozpoczęcia leczenia. Schorzenia o nagłym początku, takie jak demielinizacyjne, zapalne, niedokrwienne i pourazowe, mają charakterystyczny przebieg kliniczny. Z kolei powolny przebieg wskazuje na przyczyny kompresyjne, toksyczne/żywieniowe i dziedziczne.⁵ Klasyczne objawy kliniczne neuropatii wzrokowej obejmują zaburzenia ostrości wzroku i pola widzenia, zaburzenia widzenia barwnego (dyschromatopsja) oraz nieprawidłową reakcję źrenic.⁶

Występowanie chorób współistniejących znacząco wpływa na rokowanie w przypadku utraty wzroku. Badania wykazały, że u pacjentów poddanych operacji usunięcia zaćmy małym cięciem (SICS), obecność chorób współistniejących oczu (OR 50,92; 95% CI 10,23, 253,37) oraz powikłania operacyjne (OR 16,59; 95% CI 3,54, 77,70) były istotnie związane z gorszymi wynikami widzenia.⁷ Szczególnie istotny związek zaobserwowano między chorobami siatkówki (aOR 50,92; 95% CI: 10,23, 253,37), jaskrą (aOR 13,75; 95% CI: 1,26, 150,06), blizną rogówki (aOR 23,55; 95% CI: 3,01, 184,02) a słabymi wynikami widzenia po operacji.⁸

Wpływ wieku i innych czynników demograficznych

Badania konsekwentnie wykazują, że wiek jest kluczowym czynnikiem prognostycznym w utracie wzroku. W badaniu Leiden 85-plus wykazano, że u bardzo starszych dorosłych, upośledzenie wzroku przewiduje przyspieszone pogorszenie funkcjonowania fizycznego. Uczestnicy z umiarkowanym i ciężkim upośledzeniem wzroku doświadczyli przyspieszonego pogorszenia w podstawowych czynnościach życia codziennego (odpowiednio o 0,27 punktu (p=0,017) i 0,35 punktu (p=0,018)) w porównaniu z uczestnikami bez upośledzenia wzroku.⁹ Ponadto ryzyko zgonu było 1,83 (95% CI 1,43, 2,35) u uczestników z ciężkim upośledzeniem wzroku w porównaniu z uczestnikami bez upośledzenia wzroku.¹⁰

10-letnie ryzyko śmiertelności wzrosło z 1,21 (p=0,089, 95% CI 0,97-1,50) w grupie z umiarkowanym upośledzeniem wzroku do 1,83 (p<0,001, 95% CI 1,43-2,35) w grupie z ciężkim upośledzeniem wzroku.¹¹ U osób bardzo starszych z upośledzeniem wzroku istnieje ryzyko niższego poziomu funkcjonowania fizycznego, poznawczego, psychologicznego i społecznego, a także obniżonej jakości życia. Upośledzenie wzroku jest również czynnikiem predykcyjnym przyspieszonego pogorszenia funkcjonowania fizycznego, głównie w zakresie codziennych czynności życiowych.¹²

Opóźnienia w leczeniu i ich wpływ na rokowanie

Opóźnienia w leczeniu mogą mieć istotny wpływ na rokowanie w przypadku utraty wzroku. W badaniu dotyczącym wysiękowej postaci zwyrodnienia plamki żółtej związanego z wiekiem (nAMD) oszacowano, że opóźnienie leczenia o 3 miesiące może prowadzić do 50% względnego wzrostu liczby oczu z ostrością wzroku ≤6/60 i 25% względnego spadku liczby oczu z ostrością wzroku umożliwiającą prowadzenie pojazdów (≥6/12) po roku.¹³ Symulowane jednoroczne wyniki widzenia dla 1000 oczu z nAMD z 3-miesięcznym opóźnieniem leczenia sugerowały wzrost odsetka oczu z ostrością wzroku ≤6/60 z 15,5% (13,2 do 17,9) do 23,3% (20,7 do 25,9) oraz spadek odsetka oczu z ostrością wzroku ≥6/12 (umożliwiającą prowadzenie pojazdów) z 35,1% (32,1 do 38,1) do 26,4% (23,8 do 29,2).¹⁴

Szacuje się, że opóźnienia w leczeniu nAMD mogą prowadzić do dodatkowych 234-470 przypadków ślepoty prawnej, jeśli drugie oko już wcześniej było poniżej progu.¹⁵ Te szacunki dotyczące utraty wzroku spowodowanej opóźnieniem leczenia są prawdopodobnie niedoszacowane, co podkreśla znaczenie pilnego komunikatu dotyczącego zdrowia publicznego o potrzebie terminowego leczenia.¹⁶

Prognozy dla różnych rodzajów utraty wzroku

Ostre zapalenie nerwu wzrokowego i stwardnienie rozsiane

Rokowanie w zakresie poprawy widzenia po ostrym zapaleniu nerwu wzrokowego jest bardzo dobre, nawet bez leczenia. Średnia ostrość wzroku rok po ataku niepowikłanego zapalenia nerwu wzrokowego wynosi 20/20, a mniej niż 10% pacjentów ma trwałą ostrość wzroku poniżej 20/40.¹⁷ Mimo ogólnie doskonałych rokowań dla ostrości wzroku po ataku ostrego zapalenia nerwu wzrokowego, niektórzy pacjenci mają utrzymującą się poważną utratę wzroku po pojedynczym epizodzie.¹⁸

Ryzyko rozwoju stwardnienia rozsianego (SM) u pacjenta, który doświadcza ataku ostrego zapalenia nerwu wzrokowego, wynosi około 75% u kobiet i 34% u mężczyzn w ciągu kolejnych 15-20 lat, przy czym ryzyko jest największe w pierwszych 5 latach po pierwszym ataku.¹⁹ Naturalny przebieg ostrego idiopatycznego zapalenia nerwu wzrokowego polega na pogorszeniu stanu przez kilka dni do 2 tygodni, a następnie na poprawie, zwykle szybkiej. Poprawa może nadal następować do roku po wystąpieniu objawów wzrokowych.²⁰

Funkcjonalna utrata wzroku

Funkcjonalna utrata wzroku (FVL) to stan charakteryzujący się pozorną ślepotą lub upośledzeniem wzroku bez jakichkolwiek organicznych lub strukturalnych nieprawidłowości w oku. Rokowanie dla powrotu do zdrowia jest generalnie korzystne, z oczekiwaną 80-90% szansą na poprawę, jednak istnieje 10-15% ryzyko nawrotu.²¹ Wielu pacjentów z funkcjonalną utratą wzroku nie poszukuje stale pomocy medycznej. Podczas gdy u niektórych może nastąpić spontaniczna poprawa, inni mogą pozostać niepełnosprawni z powodu utraty wzroku.²²

Mózgowe upośledzenie wzroku

Mózgowe upośledzenie wzroku (CVI) jest najczęstszą przyczyną upośledzenia wzroku u dzieci w krajach rozwiniętych. Często nie ma lekarstwa na cechy mózgowego upośledzenia wzroku; raczej wpływ dysfunkcji wzrokowej jest łagodzony poprzez przyjmowanie strategii i modyfikacji środowiska dziecka dostosowanych do unikalnej kombinacji trudności dziecka.²³ Ważne jest, aby wyjaśnić rodzicom, że chociaż nie ma lekarstwa na CVI, nie jest prawdą, że nic nie można zrobić. W niektórych przypadkach można zaobserwować poprawę funkcji z czasem, a wsparcie ze strony edukacji, habilitacji, terapii zajęciowej i rodziny może być transformacyjne, ponieważ dzieci uczą się strategii maksymalizacji wydajności ich wzroku, znajdując sposoby na ułatwienie widzenia.²⁴

Otwarte urazy gałki ocznej

Otwarte urazy gałki ocznej (OGI) stanowią główną możliwą do zapobieżenia przyczynę ślepoty i upośledzenia wzroku, szczególnie w krajach rozwijających się. Globalnie OGI wykazuje alarmującą roczną zapadalność na poziomie prawie 203 000 przypadków, przyczyniając się znacząco do trwałego upośledzenia wzroku i ślepoty.²⁵ Liczne czynniki wpływają na końcową ostrość wzroku (VA) u pacjentów z urazami oczu.²⁶

Modele predykcyjne oparte na uczeniu maszynowym wykazują doskonałą dokładność predykcyjną w prognozowaniu końcowej ostrości wzroku u pacjentów z otwartymi urazami gałki ocznej. Sztuczna sieć neuronowa (ANN) okazała się najlepszym modelem do przewidywania końcowej ostrości wzroku.²⁷ Takie modele mogą być pomocne w udzielaniu porad klinicznych pacjentom i podejmowaniu decyzji klinicznych dotyczących postępowania w przypadku otwartych urazów gałki ocznej.²⁸

Nowe podejścia do prognozowania i zapobiegania utracie wzroku

Modele predykcyjne i sztuczna inteligencja

Modele predykcyjne oparte na uczeniu maszynowym i sztucznej inteligencji (AI) są coraz częściej wykorzystywane do prognozowania i zapobiegania utracie wzroku. Model DRPTVL-UK został opracowany do przewidywania ryzyka wymagania leczenia lub utraty wzroku u pacjentów z retinopatią cukrzycową, co może pomóc w priorytetyzacji pacjentów o wysokim ryzyku utraty wzroku i określeniu odpowiednich odstępów między wizytami kontrolnymi w oparciu o indywidualne ryzyko.²⁹ Model wykazał umiarkowanie dobrą wydajność dyskryminacyjną (statystyka C=0,74) i bardzo niewielki optymizm (0,004) w walidacji wewnętrznej ze względu na dużą wielkość próby (13691 pacjentów).³⁰

Jeśli model ten sprawdzi się dobrze w przewidywaniu ryzyka w punktach czasowych do 2 lat w walidacji zewnętrznej, mógłby być używany do priorytetyzacji osób o wyższym ryzyku utraty wzroku i potencjalnie wpływać na długość odstępów między wizytami kontrolnymi po skierowaniu do specjalistycznych klinik.³¹ Model DRPTVL-UK może być również używany do przewidywania czasu, w którym dana osoba osiągnie określony próg ryzyka, co może być przydatne do określenia odpowiednich odstępów między wizytami kontrolnymi.³²

Skuteczność screeningu AI w zapobieganiu utracie wzroku

Skuteczność stosowania systemów sztucznej inteligencji do przeprowadzania badań przesiewowych siatkówki u diabetyków w zapobieganiu utracie wzroku jest coraz lepiej poznana. Oszacowana częstość występowania utraty wzroku po 5 latach wynosiła 1535 na 100 000 w grupie badanej za pomocą AI w porównaniu do 1625 na 100 000 w grupie objętej standardową opieką, co prowadzi do modelowanej różnicy ryzyka na poziomie 90 na 100 000.³³ Model CAREVL (Computer-Assisted REtinal Vessel Loss) oszacował, że autonomiczna strategia badań przesiewowych oparta na AI skutkowałaby 27 000 mniej Amerykanów z utratą wzroku po 5 latach w porównaniu ze standardową opieką.³⁴

Model CAREVL sugeruje, że wprowadzenie strategii badań przesiewowych opartej na AI jest 8,6 razy bardziej skuteczne w zapobieganiu utracie wzroku niż standardowa opieka, przy podstawowych założeniach.³⁵ Oczekiwane różnice między strategiami badań przesiewowych opartymi na standardowej opiece a autonomiczną AI są prawdopodobnie spowodowane kombinacją czynników.³⁶ Model CAREVL potwierdza, że poprawa przestrzegania zarówno obecnych metabolicznych, jak i okulistycznych metod leczenia jest kluczem do maksymalizacji sukcesu wdrażania strategii badań przesiewowych w kierunku chorób siatkówki u diabetyków.³⁷

Terapie regeneracyjne i nowoczesne metody leczenia

Nowe podejścia terapeutyczne, takie jak stymulacja prądem zmiennym (rtACS), są badane jako potencjalne metody częściowego przywrócenia wzroku po uszkodzeniu nerwu wzrokowego. W badaniu klinicznym grupa leczona rtACS miała średnią poprawę pola widzenia o 24,0%, co było znacznie większe niż po symulowanej stymulacji (2,5%).³⁸ Leczenie rtACS okazało się bezpiecznym i skutecznym środkiem do częściowego przywrócenia wzroku po uszkodzeniu nerwu wzrokowego, prawdopodobnie poprzez modulowanie plastyczności mózgu.³⁹

Różnice między FOLLOW-UP a BASELINE są nieco mniejsze niż różnice między POST a BASELINE, z utrzymującym się istotnym efektem w podstawowym pomiarze dokładności wykrywania w HRP (High-Resolution Perimetry) zarówno pod względem porównań wewnątrzgrupowych, jak i międzygrupowych, co wskazuje na stabilność zysków.⁴⁰ Poprawa resztkowego widzenia jest kluczowym czynnikiem przywrócenia wzroku.⁴¹

Wyzwania w opiece nad pacjentami z utratą wzroku

Wysoka częstość występowania ślepoty/upośledzenia wzroku w niektórych krajach, jak Nigeria, jest przypisywana wielu czynnikom, w tym niewystarczającym, nieskutecznym i źle rozmieszczonym zasobom ludzkim. Chociaż liczba okulistów w Nigerii (około 400; około jeden na 350 000 osób) przekracza minimum zalecane przez Zachodnioafrykańską Organizację Zdrowia, około 80% z nich ma siedziby w obszarach miejskich, podczas gdy ponad 70% populacji Nigerii mieszka na obszarach wiejskich.⁴² Niska produktywność okulistów i innych pracowników opieki nad wzrokiem dodatkowo pogarsza sytuację. W 2006 roku wskaźnik operacji zaćmy w Nigerii wynosił tylko około 300 zamiast docelowych 2000 dla Afryki.⁴³

Sytuację pogarsza mniej niż optymalna jakość usług okulistycznych w kraju, co wykazało badanie, w którym mniej niż jedna trzecia oczu operowanych z powodu zaćmy miała „dobry wynik”, nawet po korekcji optycznej odsetek „dobrych wyników” wynosił tylko 56,8%, znacznie poniżej 90% zalecanych przez WHO.⁴⁴ W badaniu przeprowadzonym w Nigerii szacowana częstość występowania ślepoty (VA≤3/60 w lepszym oku) przy użyciu prezentowanej VA (PVA) wynosiła 4,2% (95% CI: 3,8-4,6%), ale z najlepszą skorygowaną VA (BCVA) wynosiła 3,4% (95% CI: 3,0-3,8%).⁴⁵ Częstość występowania ciężkiego upośledzenia wzroku (VA 6/60 – 3/60; SVI) wynosiła 1,5% (95% CI: 1,3-1,7%) i z BCVA wynosiła 0,8% (95% CI: 0,7-1,0%).⁴⁶

Wyzwania w identyfikacji pacjentów zagrożonych progresją

Wielu specjalistów w dziedzinie jaskry zgadza się, że wielu pacjentów z jaskrą jest dzisiaj nadmiernie leczonych lub niedostatecznie leczonych. Nie jest to odzwierciedleniem naszych kompetencji, ale naszych ograniczeń, jeśli chodzi o identyfikację pacjentów z jaskrą, którzy najprawdopodobniej stracą wzrok i jak szybko. Rzeczywistość jest taka, że nie każdy z jaskrą będzie ślepy. W zależności od wieku i innych czynników, wielu pacjentów, którzy mają powolny wskaźnik progresji, może dobrze sobie radzić bez jakiegokolwiek leczenia. Z drugiej strony, młody pacjent, którego stan pogarsza się szybko, prawdopodobnie straci wzrok, jeśli pozostanie nieleczony.⁴⁷

Badania wspierają koncepcję, że dokładne przewidywanie przyszłej progresji w dużej mierze zależy od zwracania uwagi na uszkodzone obszary pola widzenia, a nie tylko na analizy globalne.⁴⁸ Systemy prognozowania oparte na dokładnej analizie pól widzenia mogą pomóc klinicystom rozróżnić między pacjentami z szybką i powolną progresją, kierując bardziej agresywne leczenie do tych pacjentów, którzy tego potrzebują, i pomagając zapobiec niepotrzebnym skutkom ubocznym leczenia i problemom u pacjentów, którzy tego nie potrzebują.⁴⁹

Wyzwania w jaskrze i retinopatii barwnikowej

W retinopatii barwnikowej (RP) efektywne prowadzenie odpowiednio zasilanych badań klinicznych jest utrudnione przez potrzebę badania przesiewowego stosunkowo dużej liczby pacjentów, aby znaleźć tych, którzy spełniają kryteria włączenia.⁵⁰ Korelacja struktura-funkcja oparta wyłącznie na obrazowaniu za pomocą konfokalne laserowej oftalmoskopii skaningowej u pacjentów z RP może być przewidywana przy użyciu głębokiego uczenia (DL).⁵¹

Algorytm DL może rozróżnić dwa poziomy ostrości wzroku (VA) z relatywnie wysoką czułością i specyficznością, używając tylko jednego przekroju transfowealnego OCT jako danych wejściowych. W szczególności, algorytm DL był w stanie wykryć upośledzenie wzroku na podstawie punktu odcięcia VA wynoszącego 20/40. Te dane ustalają wykonalność przewidywania korelacji struktura-funkcja na podstawie obrazów OCT u pacjentów z RP.⁵²

Perspektywy dla leczenia i przyszłość opieki nad pacjentami z utratą wzroku

Podkreślenie negatywnego związku między utratą wzroku a funkcjonowaniem może wywołać proaktywną postawę, koncentrującą się na zapobieganiu i leczeniu upośledzenia wzroku, potencjalnie pomagając poprawić niezależność fizyczną, dobrostan i pomyślne starzenie się w bardzo podeszłym wieku.⁵⁰ Wśród obiecujących kierunków rozwoju znajdują się zaawansowane modele prognozowania oparte na sztucznej inteligencji, terapie regeneracyjne oraz zintegrowane podejścia do opieki.

Prognozowanie, czy u pacjenta z retinopatią cukrzycową rozwinie się utrata wzroku, czy też będzie wymagał leczenia, może pomóc w podejmowaniu decyzji klinicznych i optymalizacji zasobów opieki zdrowotnej. Model DRPTVL-UK, gdy zostanie dokładnie zwalidowany, może być używany do priorytetyzacji osób o wyższym ryzyku utraty wzroku i potencjalnie informować o długości odstępów między wizytami kontrolnymi po skierowaniu do specjalistycznych klinik.⁵³

Podobnie, wyniki oceny wydajności predykcyjnej modelu DRPTVL-UK przy użyciu miar dyskryminacji (statystyka C Harrella i zależna od czasu statystyka C), kalibracji (nachylenie kalibracji, stosunek obserwowanych do oczekiwanych prawdopodobieństw, wykresy kalibracji w wielu punktach czasowych do 2 lat) i korzyści netto przy użyciu krzywych decyzyjnych, będą kluczowe dla zrozumienia jego przydatności klinicznej.⁵⁴ Plany rozpowszechniania obejmują publikację recenzowaną przez ekspertów, prezentację dla organizacji zawodowych/PPIE i opracowanie elektronicznego kalkulatora aplikacji, aby umożliwić priorytetyzację wizyt kontrolnych opartą na ryzyku, po bezpośrednim wprowadzeniu informacji klinicznych.⁵⁵

Kolejne rozdziały

Zapraszamy do dalszego czytania naszego leksykonu.

Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

Materiały źródłowe

#1 Chart: Vision Loss Predicted to Surge 55% by 2050 | Statista
https://www.statista.com/chart/31502/expected-number-of-people-with-vision-loss-globally/
Vision loss is predicted to increase by as much as 55 percent in the next 30 years, impacting some 600 million new people, according to the Vision Atlas report by the International Agency for the Prevention of Blindness (IAPB). […] By 2050, the overall figure is predicted to have risen to some 1.8 billion people, with a breakdown of 866 million people living with near vision loss, 360 million people with mild vision loss, 474 people with moderate to severe vision loss and 61 million cases of blindness. […] The IAPB states that 90 percent of vision loss is preventable or treatable.
#2 Chart: Vision Loss Predicted to Surge 55% by 2050 | Statista
https://www.statista.com/chart/31502/expected-number-of-people-with-vision-loss-globally/
Vision loss is predicted to increase by as much as 55 percent in the next 30 years, impacting some 600 million new people, according to the Vision Atlas report by the International Agency for the Prevention of Blindness (IAPB). […] By 2050, the overall figure is predicted to have risen to some 1.8 billion people, with a breakdown of 866 million people living with near vision loss, 360 million people with mild vision loss, 474 people with moderate to severe vision loss and 61 million cases of blindness. […] The IAPB states that 90 percent of vision loss is preventable or treatable.
#3 Fast Facts: Vision Loss | Vision and Eye Health | CDC
https://www.cdc.gov/vision-health/data-research/vision-loss-facts/index.html
Approximately 12 million people 40 years and over in the United States have vision impairment. This includes 1 million with blindness. […] As of 2012, 4.2 million Americans aged 40 or older have uncorrectable vision impairment. This number is predicted to more than double by 2050. […] An estimated 93 million adults in the United States have a high risk for serious vision loss, but only half visited an eye doctor in the past 12 months. This is important because when caught early, vision loss can often be prevented or delayed. […] Early detection and timely treatment of eye conditions such as diabetic retinopathy has been found to be effective. 90% of blindness in US adults caused by diabetes is preventable. […] Vision loss causes a substantial social and economic toll for millions of people. This includes significant disability, loss of productivity, and decreased quality of life.
#4 Fast Facts: Vision Loss | Vision and Eye Health | CDC
https://www.cdc.gov/vision-health/data-research/vision-loss-facts/index.html
Approximately 12 million people 40 years and over in the United States have vision impairment. This includes 1 million with blindness. […] As of 2012, 4.2 million Americans aged 40 or older have uncorrectable vision impairment. This number is predicted to more than double by 2050. […] An estimated 93 million adults in the United States have a high risk for serious vision loss, but only half visited an eye doctor in the past 12 months. This is important because when caught early, vision loss can often be prevented or delayed. […] Early detection and timely treatment of eye conditions such as diabetic retinopathy has been found to be effective. 90% of blindness in US adults caused by diabetes is preventable. […] Vision loss causes a substantial social and economic toll for millions of people. This includes significant disability, loss of productivity, and decreased quality of life.
#5 Visual Loss in Neuro-Ophthalmology | IntechOpen
https://www.intechopen.com/chapters/63205
Optic neuropathy is damage to the optic nerve from any cause. Damage and death of these nerve cells lead to characteristic features of optic neuropathy. The main symptom is loss of vision (visual acuity and visual field damages), with colors appearing subtly washed out in the affected eye. […] A rapid onset is typical of demyelinating, inflammatory, ischemic, and traumatic causes. A gradual course points to compressive, toxic/nutritional, and hereditary causes. […] The classic clinical signs of optic neuropathy are visual acuity and field defects, dyschromatopsia, and abnormal pupillary response. […] Long standing of optic neuropathy is described by pale optic disk or optic atrophy, which means damage and death of these nerve cells or neurons. […] Accurate medical history is very important information, helping to evaluate the etiology of visual loss.
#6 Visual Loss in Neuro-Ophthalmology | IntechOpen
https://www.intechopen.com/chapters/63205
Optic neuropathy is damage to the optic nerve from any cause. Damage and death of these nerve cells lead to characteristic features of optic neuropathy. The main symptom is loss of vision (visual acuity and visual field damages), with colors appearing subtly washed out in the affected eye. […] A rapid onset is typical of demyelinating, inflammatory, ischemic, and traumatic causes. A gradual course points to compressive, toxic/nutritional, and hereditary causes. […] The classic clinical signs of optic neuropathy are visual acuity and field defects, dyschromatopsia, and abnormal pupillary response. […] Long standing of optic neuropathy is described by pale optic disk or optic atrophy, which means damage and death of these nerve cells or neurons. […] Accurate medical history is very important information, helping to evaluate the etiology of visual loss.
#7 Visual outcome and associated risk factors in patients following small incision cataract surgery at the National Referral Hospital, Bhutan | medRxiv
https://www.medrxiv.org/content/10.1101/2024.11.23.24317844v1.full-text
The mean age of the patients was 68.36 (SD: 12.74 years), and 157 (50.6%) were male. 285 (91.94%) of the cataract-operated eyes had best-corrected vision greater than 6/60, while 25 (8.06%) of the eyes had vision less than 6/60. […] Analysis of multiple logistic regression showed that patients with preoperative ocular comorbidities (OR 50.92; 95% CI 10.23, 253.37) and those with operative complications (OR 16.59; 95% CI 3.54, 77.70) were significantly associated with poor visual outcome. […] The second RAAB survey conducted in the country in 2018 found that following SICS, the main cause of poor visual outcome was ocular comorbidities in 43.6%. […] Poor visual outcome was significantly associated with retinal disease (aOR 50.92; 95% CI: 10.23, 253.37), glaucoma (aOR 13.75; 95% CI: 1.26, 150.06), corneal scar (aOR 23.55; 95% CI: 3.01, 184.02), and others (aOR 12.14; 95% CI: 2.36, 62.33).
#8 Visual outcome and associated risk factors in patients following small incision cataract surgery at the National Referral Hospital, Bhutan | medRxiv
https://www.medrxiv.org/content/10.1101/2024.11.23.24317844v1.full-text
The mean age of the patients was 68.36 (SD: 12.74 years), and 157 (50.6%) were male. 285 (91.94%) of the cataract-operated eyes had best-corrected vision greater than 6/60, while 25 (8.06%) of the eyes had vision less than 6/60. […] Analysis of multiple logistic regression showed that patients with preoperative ocular comorbidities (OR 50.92; 95% CI 10.23, 253.37) and those with operative complications (OR 16.59; 95% CI 3.54, 77.70) were significantly associated with poor visual outcome. […] The second RAAB survey conducted in the country in 2018 found that following SICS, the main cause of poor visual outcome was ocular comorbidities in 43.6%. […] Poor visual outcome was significantly associated with retinal disease (aOR 50.92; 95% CI: 10.23, 253.37), glaucoma (aOR 13.75; 95% CI: 1.26, 150.06), corneal scar (aOR 23.55; 95% CI: 3.01, 184.02), and others (aOR 12.14; 95% CI: 2.36, 62.33).
#9 Visual impairment as a predictor for deterioration in functioning: the Leiden 85-plus Study
https://pmc.ncbi.nlm.nih.gov/articles/PMC9074345/
Visual impairment frequently occurs amongst older people. Therefore, the aim of this study was to investigate the predictive value of visual impairment on functioning, quality of life and mortality in people aged 85 years. […] At baseline, participants with visual impairment scored lower on physical, cognitive, psychological and social functioning and quality of life (p0.001). Compared to participants with no visual impairment, participants with moderate and severe visual impairment had an accelerated deterioration in basic activities of daily living (respectively 0.27-point (p=0.017) and 0.35 point (p=0.018)). In addition, compared to participants with no visual impairment, the mortality risk was 1.83 (95% CI 1.43, 2.35) for participants with severe visual impairment. […] In very older adults, visual impairment predicts accelerated deterioration in physical functioning. In addition, severely visually impaired adults had an increased mortality risk.
#10 Visual impairment as a predictor for deterioration in functioning: the Leiden 85-plus Study
https://pmc.ncbi.nlm.nih.gov/articles/PMC9074345/
Visual impairment frequently occurs amongst older people. Therefore, the aim of this study was to investigate the predictive value of visual impairment on functioning, quality of life and mortality in people aged 85 years. […] At baseline, participants with visual impairment scored lower on physical, cognitive, psychological and social functioning and quality of life (p0.001). Compared to participants with no visual impairment, participants with moderate and severe visual impairment had an accelerated deterioration in basic activities of daily living (respectively 0.27-point (p=0.017) and 0.35 point (p=0.018)). In addition, compared to participants with no visual impairment, the mortality risk was 1.83 (95% CI 1.43, 2.35) for participants with severe visual impairment. […] In very older adults, visual impairment predicts accelerated deterioration in physical functioning. In addition, severely visually impaired adults had an increased mortality risk.
#11 Visual impairment as a predictor for deterioration in functioning: the Leiden 85-plus Study | BMC Geriatrics | Full Text
https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-022-03071-x
Visual impairment frequently occurs amongst older people. Therefore, the aim of this study was to investigate the predictive value of visual impairment on functioning, quality of life and mortality in people aged 85 years. At baseline, participants with visual impairment scored lower on physical, cognitive, psychological and social functioning and quality of life (p0.001). Compared to participants with no visual impairment, participants with moderate and severe visual impairment had an accelerated deterioration in basic activities of daily living (respectively 0.27-point (p=0.017) and 0.35 point (p=0.018)). In addition, compared to participants with no visual impairment, the mortality risk was 1.83 (95% CI 1.43, 2.35) for participants with severe visual impairment. In very older adults, visual impairment predicts accelerated deterioration in physical functioning. In addition, severely visually impaired adults had an increased mortality risk. Visual impairment can affect daily functioning, social participation and cognitive state, highlighting the importance of improving health services to promote healthy aging. Impaired vision is associated with an increased fall risk, comprised mobility, poorer quality of life, isolation often resulting in depression, cognitive dysfunction and higher mortality rates. The 10-year mortality risk increased from 1.21 (p=0.089, 95% CI 0.971.50) in the group with moderate impaired vision to 1.83 (p0.001, 95% CI 1.432.35) in the group with severe impaired vision. In conclusion, in very old adults, people with visual impairment are at risk for a lower level in physical, cognitive, psychological and social level of functioning. Moreover, visual impairment is associated with a reduced quality of life at baseline and the mortality risks are higher when severely visually impaired. Visual impairment is a predictive factor for accelerated deterioration in physical functioning, mainly for activities in daily living. […] Highlighting this negative association could induce a pro-active attitude, focusing on preventing and treating visual impairment, possibly helping to improve physical independence, wellbeing and successful aging in very old age.
#12 Visual impairment as a predictor for deterioration in functioning: the Leiden 85-plus Study | BMC Geriatrics | Full Text
https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-022-03071-x
Visual impairment frequently occurs amongst older people. Therefore, the aim of this study was to investigate the predictive value of visual impairment on functioning, quality of life and mortality in people aged 85 years. At baseline, participants with visual impairment scored lower on physical, cognitive, psychological and social functioning and quality of life (p0.001). Compared to participants with no visual impairment, participants with moderate and severe visual impairment had an accelerated deterioration in basic activities of daily living (respectively 0.27-point (p=0.017) and 0.35 point (p=0.018)). In addition, compared to participants with no visual impairment, the mortality risk was 1.83 (95% CI 1.43, 2.35) for participants with severe visual impairment. In very older adults, visual impairment predicts accelerated deterioration in physical functioning. In addition, severely visually impaired adults had an increased mortality risk. Visual impairment can affect daily functioning, social participation and cognitive state, highlighting the importance of improving health services to promote healthy aging. Impaired vision is associated with an increased fall risk, comprised mobility, poorer quality of life, isolation often resulting in depression, cognitive dysfunction and higher mortality rates. The 10-year mortality risk increased from 1.21 (p=0.089, 95% CI 0.971.50) in the group with moderate impaired vision to 1.83 (p0.001, 95% CI 1.432.35) in the group with severe impaired vision. In conclusion, in very old adults, people with visual impairment are at risk for a lower level in physical, cognitive, psychological and social level of functioning. Moreover, visual impairment is associated with a reduced quality of life at baseline and the mortality risks are higher when severely visually impaired. Visual impairment is a predictive factor for accelerated deterioration in physical functioning, mainly for activities in daily living. […] Highlighting this negative association could induce a pro-active attitude, focusing on preventing and treating visual impairment, possibly helping to improve physical independence, wellbeing and successful aging in very old age.
#13 Estimating excess visual loss in people with neovascular age-related macular degeneration during the COVID-19 pandemic | medRxiv
https://www.medrxiv.org/content/10.1101/2020.06.02.20120642.full
Objectives To report the reduction in new neovascular age-related macular degeneration (nAMD) referrals during the COVID-19 pandemic and estimate the impact of delayed treatment on visual outcomes at one year. […] Simulated one-year visual outcomes for 1000 nAMD eyes with a 3-month treatment delay suggested an increase in the proportion of eyes with vision 6/60 from 15.5% (13.2 to 17.9) to 23.3% (20.7 to 25.9), and a decrease in the proportion of eyes with vision 6/12 (driving vision) from 35.1% (32.1 to 38.1) to 26.4% (23.8 to 29.2). […] As a conservative estimate, a treatment delay of 3 months could lead to a 50% relative increase in the number of eyes with vision 6/60 and 25% relative decrease in the number of eyes with driving vision at one year. […] The average simulated mean baseline VAs for the no delay, 3, 6 and 9-month delay models were 55.6 letters (0.6 SD), 49.9 letters (0.6 SD), 47.2 letters (0.6 SD) and 45.5 letters (0.6 SD) respectively.
#14 Estimating excess visual loss in people with neovascular age-related macular degeneration during the COVID-19 pandemic | medRxiv
https://www.medrxiv.org/content/10.1101/2020.06.02.20120642.full
Objectives To report the reduction in new neovascular age-related macular degeneration (nAMD) referrals during the COVID-19 pandemic and estimate the impact of delayed treatment on visual outcomes at one year. […] Simulated one-year visual outcomes for 1000 nAMD eyes with a 3-month treatment delay suggested an increase in the proportion of eyes with vision 6/60 from 15.5% (13.2 to 17.9) to 23.3% (20.7 to 25.9), and a decrease in the proportion of eyes with vision 6/12 (driving vision) from 35.1% (32.1 to 38.1) to 26.4% (23.8 to 29.2). […] As a conservative estimate, a treatment delay of 3 months could lead to a 50% relative increase in the number of eyes with vision 6/60 and 25% relative decrease in the number of eyes with driving vision at one year. […] The average simulated mean baseline VAs for the no delay, 3, 6 and 9-month delay models were 55.6 letters (0.6 SD), 49.9 letters (0.6 SD), 47.2 letters (0.6 SD) and 45.5 letters (0.6 SD) respectively.
#15 Estimating excess visual loss in people with neovascular age-related macular degeneration during the COVID-19 pandemic | medRxiv
https://www.medrxiv.org/content/10.1101/2020.06.02.20120642.full
The simulation is based on a large dataset of 20 825 eyes treated at sites across the UK over the past 10 years. […] A key assumption underlying the treatment delay models is that eyes receiving treatment late in the course of the disease will respond as well as if there had been no treatment delay. […] Overall, the presented estimates for visual loss incurred by a period of treatment delay are almost certainly underestimates of the true values. […] We estimate that this will lead to between 234 and 470 additional cases of legal blindness for nAMD, if the partner eye was already below the threshold. […] In summary, adopting a conservative model our estimates still indicate a substantial increase in visual loss (legal blindness, loss of driving vision) from delayed nAMD treatment, lending strong support to an important public health message.
#16 Estimating excess visual loss in people with neovascular age-related macular degeneration during the COVID-19 pandemic | medRxiv
https://www.medrxiv.org/content/10.1101/2020.06.02.20120642.full
The simulation is based on a large dataset of 20 825 eyes treated at sites across the UK over the past 10 years. […] A key assumption underlying the treatment delay models is that eyes receiving treatment late in the course of the disease will respond as well as if there had been no treatment delay. […] Overall, the presented estimates for visual loss incurred by a period of treatment delay are almost certainly underestimates of the true values. […] We estimate that this will lead to between 234 and 470 additional cases of legal blindness for nAMD, if the partner eye was already below the threshold. […] In summary, adopting a conservative model our estimates still indicate a substantial increase in visual loss (legal blindness, loss of driving vision) from delayed nAMD treatment, lending strong support to an important public health message.
#17 Visual Loss in Neuro-Ophthalmology | IntechOpen
https://www.intechopen.com/chapters/63205
The prognosis for visual recovery after acute optic neuritis is very good also without treatment. […] The mean visual acuity 1 year after an attack of otherwise uncomplicated optic neuritis is 20/20, and less than 10% of patients have permanent visual acuity less than 20/40. […] Although the overall prognosis for visual acuity after an attack of acute optic neuritis is extremely good, some patients have persistent severe visual loss after a single episode. […] The risk of developing MS in a patient who experiences an attack of acute optic neuritis is about 75% in women and 34% in men over the subsequent 15-20 years, with the risk being greatest in the first 5 years after the first attack. […] The ONTT results had another important aspect of treatment for acute optic neuritis regarding the possibility of having impact on the development of MS.
#18 Visual Loss in Neuro-Ophthalmology | IntechOpen
https://www.intechopen.com/chapters/63205
The prognosis for visual recovery after acute optic neuritis is very good also without treatment. […] The mean visual acuity 1 year after an attack of otherwise uncomplicated optic neuritis is 20/20, and less than 10% of patients have permanent visual acuity less than 20/40. […] Although the overall prognosis for visual acuity after an attack of acute optic neuritis is extremely good, some patients have persistent severe visual loss after a single episode. […] The risk of developing MS in a patient who experiences an attack of acute optic neuritis is about 75% in women and 34% in men over the subsequent 15-20 years, with the risk being greatest in the first 5 years after the first attack. […] The ONTT results had another important aspect of treatment for acute optic neuritis regarding the possibility of having impact on the development of MS.
#19 Visual Loss in Neuro-Ophthalmology | IntechOpen
https://www.intechopen.com/chapters/63205
The prognosis for visual recovery after acute optic neuritis is very good also without treatment. […] The mean visual acuity 1 year after an attack of otherwise uncomplicated optic neuritis is 20/20, and less than 10% of patients have permanent visual acuity less than 20/40. […] Although the overall prognosis for visual acuity after an attack of acute optic neuritis is extremely good, some patients have persistent severe visual loss after a single episode. […] The risk of developing MS in a patient who experiences an attack of acute optic neuritis is about 75% in women and 34% in men over the subsequent 15-20 years, with the risk being greatest in the first 5 years after the first attack. […] The ONTT results had another important aspect of treatment for acute optic neuritis regarding the possibility of having impact on the development of MS.
#20 Visual Loss in Neuro-Ophthalmology | IntechOpen
https://www.intechopen.com/chapters/63205
The natural history of acute idiopathic optic neuritis is to worsen over several days to 2 weeks and then to improve mostly rapidly. Improvement can continue to occur up to 1 year after the onset of visual symptoms. […] The ONTT since 1992 has made it clear that the risk of a recurrence or a new attack is substantially higher in patients treated with low-dose oral prednisone as opposed to patients who receive no treatment or who are treated according the ONTT.
#21 Functional Visual Loss | IntechOpen
https://www.intechopen.com/chapters/89266
Functional visual loss (FVL) is a condition characterized by apparent blindness or visual impairment without any organic or structural abnormalities in the eye. […] Prognosis for recovery is generally favorable, but recurrence risk underscores the need for ongoing support and follow-up care. […] While the prognosis for recovery is favorable, with an expected 80-90% chance of improvement, there remains a 10-15% risk of recurrence. […] Many patients with functional visual loss do not persistently seek medical attention. While some may experience spontaneous resolution, others may remain disabled due to their vision loss.
#22 Functional Visual Loss | IntechOpen
https://www.intechopen.com/chapters/89266
Functional visual loss (FVL) is a condition characterized by apparent blindness or visual impairment without any organic or structural abnormalities in the eye. […] Prognosis for recovery is generally favorable, but recurrence risk underscores the need for ongoing support and follow-up care. […] While the prognosis for recovery is favorable, with an expected 80-90% chance of improvement, there remains a 10-15% risk of recurrence. […] Many patients with functional visual loss do not persistently seek medical attention. While some may experience spontaneous resolution, others may remain disabled due to their vision loss.
#23 Clinical assessment, investigation, diagnosis and initial management of cerebral visual impairment: a consensus practice guide | Eye
https://www.nature.com/articles/s41433-022-02261-6
Cerebral Visual Impairment (CVI) is the commonest cause of visual impairment in children in the developed nations. […] A diagnosis of CVI is made based on professional clinical judgement and it is recognised that individual perspectives and local practice in the specific methodologies of assessment will vary. […] There is often no cure for the features of cerebral visual impairment: rather the impact of visual dysfunction is ameliorated by adopting strategies and modifications to the child’s environment tailored to the child’s unique combination of difficulties. […] It is important to explain to parents that while there is no cure for CVI, it is not true to say that nothing can be done. Improvements in function can be seen over time in some cases, and support from education, habilitation, occupational therapy, and family can be transformative as children learn strategies to maximise the efficiency of their vision, finding ways to make it easier to see.
#24 Clinical assessment, investigation, diagnosis and initial management of cerebral visual impairment: a consensus practice guide | Eye
https://www.nature.com/articles/s41433-022-02261-6
Cerebral Visual Impairment (CVI) is the commonest cause of visual impairment in children in the developed nations. […] A diagnosis of CVI is made based on professional clinical judgement and it is recognised that individual perspectives and local practice in the specific methodologies of assessment will vary. […] There is often no cure for the features of cerebral visual impairment: rather the impact of visual dysfunction is ameliorated by adopting strategies and modifications to the child’s environment tailored to the child’s unique combination of difficulties. […] It is important to explain to parents that while there is no cure for CVI, it is not true to say that nothing can be done. Improvements in function can be seen over time in some cases, and support from education, habilitation, occupational therapy, and family can be transformative as children learn strategies to maximise the efficiency of their vision, finding ways to make it easier to see.
#25 Development, comparison, and internal validation of prediction models to determine the visual prognosis of patients with open globe injuries using machine learning approaches | BMC Medical Informatics and Decision Making | Full Text
https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-024-02520-4
Globally, OGI exhibits an alarming annual incidence of nearly 203,000 cases, contributing substantially to permanent visual impairment and blindness. […] Numerous factors influence the final visual acuity (VA) in ocular trauma patients. […] The Ocular Trauma Score (OTS) is the most popular approach, which considers six factors, including the initial VA, endophthalmitis, retinal detachment, globe rupture, perforating injury, and relative afferent pupillary defect (RAPD) to provide prognostic assessments. […] The classification and regression tree (CART), introduced in 2008, offers another approach for predicting visual outcomes in OGI patients. […] Algorithms leveraging machine learning exhibit robust capabilities in processing medical decision-making data, particularly in the realm of clinical predictions.
#26 Development, comparison, and internal validation of prediction models to determine the visual prognosis of patients with open globe injuries using machine learning approaches | BMC Medical Informatics and Decision Making | Full Text
https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-024-02520-4
Globally, OGI exhibits an alarming annual incidence of nearly 203,000 cases, contributing substantially to permanent visual impairment and blindness. […] Numerous factors influence the final visual acuity (VA) in ocular trauma patients. […] The Ocular Trauma Score (OTS) is the most popular approach, which considers six factors, including the initial VA, endophthalmitis, retinal detachment, globe rupture, perforating injury, and relative afferent pupillary defect (RAPD) to provide prognostic assessments. […] The classification and regression tree (CART), introduced in 2008, offers another approach for predicting visual outcomes in OGI patients. […] Algorithms leveraging machine learning exhibit robust capabilities in processing medical decision-making data, particularly in the realm of clinical predictions.
#27 Development, comparison, and internal validation of prediction models to determine the visual prognosis of patients with open globe injuries using machine learning approaches | BMC Medical Informatics and Decision Making | Full Text
https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-024-02520-4
Open globe injuries (OGI) represent a main preventable reason for blindness and visual impairment, particularly in developing countries. The goal of this study is evaluating key variables affecting the prognosis of open globe injuries and validating internally and comparing different machine learning models to estimate final visual acuity. […] The artificial neural network (ANN) model had the best accuracy to predict the final VA. […] As classic and ensemble ML models were compared, results shows that the ANN model was the best. […] Excellent predictive accuracy was shown by the open globe injury model developed in this study, which should be helpful to provide clinical advice to patients and making clinical decisions concerning the management of open globe injuries. […] Open globe injury (OGI) is a potentially blinding ocular injury that is a full-thickness wound of the eye wall.
#28 Development, comparison, and internal validation of prediction models to determine the visual prognosis of patients with open globe injuries using machine learning approaches | BMC Medical Informatics and Decision Making | Full Text
https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-024-02520-4
Open globe injuries (OGI) represent a main preventable reason for blindness and visual impairment, particularly in developing countries. The goal of this study is evaluating key variables affecting the prognosis of open globe injuries and validating internally and comparing different machine learning models to estimate final visual acuity. […] The artificial neural network (ANN) model had the best accuracy to predict the final VA. […] As classic and ensemble ML models were compared, results shows that the ANN model was the best. […] Excellent predictive accuracy was shown by the open globe injury model developed in this study, which should be helpful to provide clinical advice to patients and making clinical decisions concerning the management of open globe injuries. […] Open globe injury (OGI) is a potentially blinding ocular injury that is a full-thickness wound of the eye wall.
#29 Diabetic retinopathy progression in patients under monitoring for treatment or vision loss: external validation and update of a multivariable prediction model | BMJ Open
https://bmjopen.bmj.com/content/13/4/e073015
The aim of the present study is to externally validate the DRPTVL-UK model in a secondary care setting, specifically in a population under care by HES. […] Therefore, this bottleneck urgently needs addressing. We propose to mitigate this risk of harm to patients by stratifying patients referred to HES according to their risk of requiring treatment or losing their vision using a clinical prediction model. […] Once validated, the Diabetic Retinopathy Progression model to Treatment or Vision Loss (DRPTVL-UK) model could help HES prioritise patients at high risk of vision loss, and to determine suitable follow-up intervals based on an individual’s risk. […] The DRPTVL-UK model demonstrated moderately good discriminative performance (C-statistic=0.74) and very little optimism (0.004) in the internal validation due to the large sample size (13691 patients).
#30 Diabetic retinopathy progression in patients under monitoring for treatment or vision loss: external validation and update of a multivariable prediction model | BMJ Open
https://bmjopen.bmj.com/content/13/4/e073015
The aim of the present study is to externally validate the DRPTVL-UK model in a secondary care setting, specifically in a population under care by HES. […] Therefore, this bottleneck urgently needs addressing. We propose to mitigate this risk of harm to patients by stratifying patients referred to HES according to their risk of requiring treatment or losing their vision using a clinical prediction model. […] Once validated, the Diabetic Retinopathy Progression model to Treatment or Vision Loss (DRPTVL-UK) model could help HES prioritise patients at high risk of vision loss, and to determine suitable follow-up intervals based on an individual’s risk. […] The DRPTVL-UK model demonstrated moderately good discriminative performance (C-statistic=0.74) and very little optimism (0.004) in the internal validation due to the large sample size (13691 patients).
#31 Diabetic retinopathy progression in patients under monitoring for treatment or vision loss: external validation and update of a multivariable prediction model | BMJ Open
https://bmjopen.bmj.com/content/13/4/e073015
If this model performs well for predicting risk at time points up to 2 years in the external validation using HES/surveillance clinic data, we propose that it could be used to prioritise individuals at higher risk of vision loss and potentially inform the length of the follow-up intervals after referral to HES/surveillance clinics. […] The primary outcome for this study is time to first treatment for DR or vision loss. Time will be calculated from referral to HES (baseline is first appointment) until the date of first treatment or vision loss. […] The DRPTVL-UK model can also be used to predict the time at which an individual reaches a particular risk threshold (to be agreed in a consensus meeting of clinical experts and patients planned after final analysis) which may be useful for determining appropriate follow-up intervals after referral to HES/surveillance clinics.
#32 Diabetic retinopathy progression in patients under monitoring for treatment or vision loss: external validation and update of a multivariable prediction model | BMJ Open
https://bmjopen.bmj.com/content/13/4/e073015
If this model performs well for predicting risk at time points up to 2 years in the external validation using HES/surveillance clinic data, we propose that it could be used to prioritise individuals at higher risk of vision loss and potentially inform the length of the follow-up intervals after referral to HES/surveillance clinics. […] The primary outcome for this study is time to first treatment for DR or vision loss. Time will be calculated from referral to HES (baseline is first appointment) until the date of first treatment or vision loss. […] The DRPTVL-UK model can also be used to predict the time at which an individual reaches a particular risk threshold (to be agreed in a consensus meeting of clinical experts and patients planned after final analysis) which may be useful for determining appropriate follow-up intervals after referral to HES/surveillance clinics.
#33 Effectiveness of artificial intelligence screening in preventing vision loss from diabetes: a policy model | npj Digital Medicine
https://www.nature.com/articles/s41746-023-00785-z
The effectiveness of using artificial intelligence (AI) systems to perform diabetic retinal exams (screening) on preventing vision loss is not known. […] The estimated incidence of vision loss at 5 years was 1535 per 100,000 in the AI-screened group compared to 1625 per 100,000 in the ECP group, leading to a modelled risk difference of 90 per 100,000. […] The base-case CAREVL model estimated that an autonomous AI-based screening strategy would result in 27,000 fewer Americans with vision loss at 5 years compared with ECP. […] Vision loss at 5 years remained lower in the AI-screened group compared to the ECP group, in a wide range of parameters including optimistic estimates biased toward ECP. […] Thus, CAREVL suggests that introduction of an AI-based screening strategy is 8.6 times more effective at preventing vision loss than ECP, under base-case assumptions.
#34 Effectiveness of artificial intelligence screening in preventing vision loss from diabetes: a policy model | npj Digital Medicine
https://www.nature.com/articles/s41746-023-00785-z
The effectiveness of using artificial intelligence (AI) systems to perform diabetic retinal exams (screening) on preventing vision loss is not known. […] The estimated incidence of vision loss at 5 years was 1535 per 100,000 in the AI-screened group compared to 1625 per 100,000 in the ECP group, leading to a modelled risk difference of 90 per 100,000. […] The base-case CAREVL model estimated that an autonomous AI-based screening strategy would result in 27,000 fewer Americans with vision loss at 5 years compared with ECP. […] Vision loss at 5 years remained lower in the AI-screened group compared to the ECP group, in a wide range of parameters including optimistic estimates biased toward ECP. […] Thus, CAREVL suggests that introduction of an AI-based screening strategy is 8.6 times more effective at preventing vision loss than ECP, under base-case assumptions.
#35 Effectiveness of artificial intelligence screening in preventing vision loss from diabetes: a policy model | npj Digital Medicine
https://www.nature.com/articles/s41746-023-00785-z
The effectiveness of using artificial intelligence (AI) systems to perform diabetic retinal exams (screening) on preventing vision loss is not known. […] The estimated incidence of vision loss at 5 years was 1535 per 100,000 in the AI-screened group compared to 1625 per 100,000 in the ECP group, leading to a modelled risk difference of 90 per 100,000. […] The base-case CAREVL model estimated that an autonomous AI-based screening strategy would result in 27,000 fewer Americans with vision loss at 5 years compared with ECP. […] Vision loss at 5 years remained lower in the AI-screened group compared to the ECP group, in a wide range of parameters including optimistic estimates biased toward ECP. […] Thus, CAREVL suggests that introduction of an AI-based screening strategy is 8.6 times more effective at preventing vision loss than ECP, under base-case assumptions.
#36 Effectiveness of artificial intelligence screening in preventing vision loss from diabetes: a policy model | npj Digital Medicine
https://www.nature.com/articles/s41746-023-00785-z
The expected differences between ECP and autonomous AI screening strategies are likely due to a combination of factors. […] The CAREVL model confirms that improving adherence with both the current metabolic and ophthalmic treatments is key to maximizing the success of implementing DRD screening strategies. […] The model suggests that when autonomous AI is used as a screening strategy, maximizing adherence with metabolic and ophthalmic treatments prevents vision loss in an additional 367 patients/100,000. […] This projected impact has important clinical and public health implications. […] The CAREVL model suggests that AI-based DRD screening is more effective at preventing vision loss from diabetes than ECP-based screening, and that this effectiveness can be further enhanced by optimizing processes of care.
#37 Effectiveness of artificial intelligence screening in preventing vision loss from diabetes: a policy model | npj Digital Medicine
https://www.nature.com/articles/s41746-023-00785-z
The expected differences between ECP and autonomous AI screening strategies are likely due to a combination of factors. […] The CAREVL model confirms that improving adherence with both the current metabolic and ophthalmic treatments is key to maximizing the success of implementing DRD screening strategies. […] The model suggests that when autonomous AI is used as a screening strategy, maximizing adherence with metabolic and ophthalmic treatments prevents vision loss in an additional 367 patients/100,000. […] This projected impact has important clinical and public health implications. […] The CAREVL model suggests that AI-based DRD screening is more effective at preventing vision loss from diabetes than ECP-based screening, and that this effectiveness can be further enhanced by optimizing processes of care.
#38 Alternating Current Stimulation for Vision Restoration after Optic Nerve Damage: A Randomized Clinical Trial | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0156134
Vision loss after optic neuropathy is considered irreversible. […] The rtACS-treated group had a mean improvement in visual field of 24.0% which was significantly greater than after sham-stimulation (2.5%). […] rtACS treatment is a safe and effective means to partially restore vision after optic nerve damage probably by modulating brain plasticity. […] The differences between FOLLOW-UP and BASELINE are somewhat smaller than the differences between POST and BASELINE with a persistent significant effect in the primary measure detection accuracy in HRP in terms of both within- and between-group comparisons, indicating the stability of the gains. […] A treatment outcome prediction model was used to predict the change in HRP visual fields based on BASELINE results. […] Improvements of residual vision are the key factor of vision restoration.
#39 Alternating Current Stimulation for Vision Restoration after Optic Nerve Damage: A Randomized Clinical Trial | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0156134
Vision loss after optic neuropathy is considered irreversible. […] The rtACS-treated group had a mean improvement in visual field of 24.0% which was significantly greater than after sham-stimulation (2.5%). […] rtACS treatment is a safe and effective means to partially restore vision after optic nerve damage probably by modulating brain plasticity. […] The differences between FOLLOW-UP and BASELINE are somewhat smaller than the differences between POST and BASELINE with a persistent significant effect in the primary measure detection accuracy in HRP in terms of both within- and between-group comparisons, indicating the stability of the gains. […] A treatment outcome prediction model was used to predict the change in HRP visual fields based on BASELINE results. […] Improvements of residual vision are the key factor of vision restoration.
#40 Alternating Current Stimulation for Vision Restoration after Optic Nerve Damage: A Randomized Clinical Trial | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0156134
Vision loss after optic neuropathy is considered irreversible. […] The rtACS-treated group had a mean improvement in visual field of 24.0% which was significantly greater than after sham-stimulation (2.5%). […] rtACS treatment is a safe and effective means to partially restore vision after optic nerve damage probably by modulating brain plasticity. […] The differences between FOLLOW-UP and BASELINE are somewhat smaller than the differences between POST and BASELINE with a persistent significant effect in the primary measure detection accuracy in HRP in terms of both within- and between-group comparisons, indicating the stability of the gains. […] A treatment outcome prediction model was used to predict the change in HRP visual fields based on BASELINE results. […] Improvements of residual vision are the key factor of vision restoration.
#41 Alternating Current Stimulation for Vision Restoration after Optic Nerve Damage: A Randomized Clinical Trial | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0156134
Vision loss after optic neuropathy is considered irreversible. […] The rtACS-treated group had a mean improvement in visual field of 24.0% which was significantly greater than after sham-stimulation (2.5%). […] rtACS treatment is a safe and effective means to partially restore vision after optic nerve damage probably by modulating brain plasticity. […] The differences between FOLLOW-UP and BASELINE are somewhat smaller than the differences between POST and BASELINE with a persistent significant effect in the primary measure detection accuracy in HRP in terms of both within- and between-group comparisons, indicating the stability of the gains. […] A treatment outcome prediction model was used to predict the change in HRP visual fields based on BASELINE results. […] Improvements of residual vision are the key factor of vision restoration.
#42
https://journals.lww.com/aoam/fulltext/2012/11030/review_of_the_publications_of_the_nigeria_national.1.aspx
The high prevalence of blindness/visual impairment in Nigeria is attributed to many factors including inadequate, ineffective and mal-distributed human resources. Even though the number of ophthalmologists in Nigeria (about 400; approximately one for every 350,000 people) exceeds the minimum recommended by the West Africa Health Organization, about 80% are based in urban areas whereas over 70% of the Nigerian population live in rural areas. Low productivity by the ophthalmologists and other eye care workers further worsens the situation. In 2006, the cataract surgical rate in Nigeria was only about 300 instead of the target of 2,000 for Africa. This is compounded by the less than optimal quality of the eye services in the country, as demonstrated in this study where less than a third of cataract operated eyes had a 'good outcome’, even after optical correction the proportion with 'good outcomes’ was only 56.8%, much below the 90% recommended by WHO.
#43
https://journals.lww.com/aoam/fulltext/2012/11030/review_of_the_publications_of_the_nigeria_national.1.aspx
The high prevalence of blindness/visual impairment in Nigeria is attributed to many factors including inadequate, ineffective and mal-distributed human resources. Even though the number of ophthalmologists in Nigeria (about 400; approximately one for every 350,000 people) exceeds the minimum recommended by the West Africa Health Organization, about 80% are based in urban areas whereas over 70% of the Nigerian population live in rural areas. Low productivity by the ophthalmologists and other eye care workers further worsens the situation. In 2006, the cataract surgical rate in Nigeria was only about 300 instead of the target of 2,000 for Africa. This is compounded by the less than optimal quality of the eye services in the country, as demonstrated in this study where less than a third of cataract operated eyes had a 'good outcome’, even after optical correction the proportion with 'good outcomes’ was only 56.8%, much below the 90% recommended by WHO.
#44
https://journals.lww.com/aoam/fulltext/2012/11030/review_of_the_publications_of_the_nigeria_national.1.aspx
The high prevalence of blindness/visual impairment in Nigeria is attributed to many factors including inadequate, ineffective and mal-distributed human resources. Even though the number of ophthalmologists in Nigeria (about 400; approximately one for every 350,000 people) exceeds the minimum recommended by the West Africa Health Organization, about 80% are based in urban areas whereas over 70% of the Nigerian population live in rural areas. Low productivity by the ophthalmologists and other eye care workers further worsens the situation. In 2006, the cataract surgical rate in Nigeria was only about 300 instead of the target of 2,000 for Africa. This is compounded by the less than optimal quality of the eye services in the country, as demonstrated in this study where less than a third of cataract operated eyes had a 'good outcome’, even after optical correction the proportion with 'good outcomes’ was only 56.8%, much below the 90% recommended by WHO.
#45
https://journals.lww.com/aoam/fulltext/2012/11030/review_of_the_publications_of_the_nigeria_national.1.aspx
The prevalence of blindness (VA3/60 in the better eye) using presenting VA (PVA) was 4.2% (95% CI: 3.8-4.6%), but with best corrected VA (BCVA) it was 3.4% (95% CI: 3.0-3.8%). The prevalence of severe visual impairment (VA 6/60 – 3/60; SVI) was 1.5% (95% CI: 1.3-1.7%) and with BCVA it was 0.8% (95% CI: 0.7-1.0%). The magnitude of blindness varied across the country. The North West (NW) GPZ harbors the largest number of blind adults (28.6%) because of high prevalence and large population. The survey estimated that a total 4.25 million adults aged 40 years suffer moderate VI or SVI or blindness. Cataract was the most common cause of blindness, (43%), followed by glaucoma (16.7%). Overall, 84% of blindness was 'avoidable’. Major causes of visual impairment (PVA of 6/18 to 3/60 in the better eye) were uncorrected refractive error (62%), followed by cataract (22.1%) and uncorrected aphakia (3.3%).
#46
https://journals.lww.com/aoam/fulltext/2012/11030/review_of_the_publications_of_the_nigeria_national.1.aspx
The prevalence of blindness (VA3/60 in the better eye) using presenting VA (PVA) was 4.2% (95% CI: 3.8-4.6%), but with best corrected VA (BCVA) it was 3.4% (95% CI: 3.0-3.8%). The prevalence of severe visual impairment (VA 6/60 – 3/60; SVI) was 1.5% (95% CI: 1.3-1.7%) and with BCVA it was 0.8% (95% CI: 0.7-1.0%). The magnitude of blindness varied across the country. The North West (NW) GPZ harbors the largest number of blind adults (28.6%) because of high prevalence and large population. The survey estimated that a total 4.25 million adults aged 40 years suffer moderate VI or SVI or blindness. Cataract was the most common cause of blindness, (43%), followed by glaucoma (16.7%). Overall, 84% of blindness was 'avoidable’. Major causes of visual impairment (PVA of 6/18 to 3/60 in the better eye) were uncorrected refractive error (62%), followed by cataract (22.1%) and uncorrected aphakia (3.3%).
#47 Using Visual Fields to Predict Progression
https://www.reviewofophthalmology.com/article/using-visual-fields-to-predict-progression-41673
I think most glaucoma specialists would agree that many glaucoma patients today are overtreated or undertreated. This is not a reflection of our competence, but of our limitations when it comes to identifying which glaucoma patients are most likely to lose vision and how quickly. The reality is that not everybody with glaucoma is going to go blind. Depending on their age and other factors, many patients who have a slow rate of progression may do well without any treatment at all. On the other hand, a young patient who is getting worse fast is likely to lose his vision if left untreated. These patients need more aggressive treatment. Without having reasonably accurate estimates of progression rates, we really don’t know which patients need intensive treatment and which don’t. […] Not only do our studies support the validity of the software program, they support the concept that accurate prediction of future progression depends largely on paying attention to the damaged areas of the visual field, not just global analyses. […] Once our system is thoroughly tested, its use should help clinicians distinguish between fast and slow progressors, directing more aggressive treatment to those patients who need it and helping to prevent unneeded treatment side effects and problems in patients who don’t.
#48 Using Visual Fields to Predict Progression
https://www.reviewofophthalmology.com/article/using-visual-fields-to-predict-progression-41673
I think most glaucoma specialists would agree that many glaucoma patients today are overtreated or undertreated. This is not a reflection of our competence, but of our limitations when it comes to identifying which glaucoma patients are most likely to lose vision and how quickly. The reality is that not everybody with glaucoma is going to go blind. Depending on their age and other factors, many patients who have a slow rate of progression may do well without any treatment at all. On the other hand, a young patient who is getting worse fast is likely to lose his vision if left untreated. These patients need more aggressive treatment. Without having reasonably accurate estimates of progression rates, we really don’t know which patients need intensive treatment and which don’t. […] Not only do our studies support the validity of the software program, they support the concept that accurate prediction of future progression depends largely on paying attention to the damaged areas of the visual field, not just global analyses. […] Once our system is thoroughly tested, its use should help clinicians distinguish between fast and slow progressors, directing more aggressive treatment to those patients who need it and helping to prevent unneeded treatment side effects and problems in patients who don’t.
#49 Using Visual Fields to Predict Progression
https://www.reviewofophthalmology.com/article/using-visual-fields-to-predict-progression-41673
I think most glaucoma specialists would agree that many glaucoma patients today are overtreated or undertreated. This is not a reflection of our competence, but of our limitations when it comes to identifying which glaucoma patients are most likely to lose vision and how quickly. The reality is that not everybody with glaucoma is going to go blind. Depending on their age and other factors, many patients who have a slow rate of progression may do well without any treatment at all. On the other hand, a young patient who is getting worse fast is likely to lose his vision if left untreated. These patients need more aggressive treatment. Without having reasonably accurate estimates of progression rates, we really don’t know which patients need intensive treatment and which don’t. […] Not only do our studies support the validity of the software program, they support the concept that accurate prediction of future progression depends largely on paying attention to the damaged areas of the visual field, not just global analyses. […] Once our system is thoroughly tested, its use should help clinicians distinguish between fast and slow progressors, directing more aggressive treatment to those patients who need it and helping to prevent unneeded treatment side effects and problems in patients who don’t.
#50 Prediction of visual impairment in retinitis pigmentosa using deep learning and multimodal fundus images | British Journal of Ophthalmology
https://bjo.bmj.com/content/107/10/1484
The efficient conduct of adequately powered clinical trials in retinitis pigmentosa (RP) is hampered by the need to screen relatively large numbers of patients to find those that fit the inclusion criteria. […] Structure-function correlation based solely on confocal scanning laser ophthalmoscopy imaging in patients with RP can be predicted using deep learning (DL). […] DL-based estimation of visual acuity using optical coherence tomography images may enable efficient screening of potential subjects in future RP research studies or clinical trials. […] Our algorithm showed robust performance in predicting visual impairment in patients with RP, thus providing proof-of-concept for predicting structure-function correlation based solely on cSLO imaging in patients with RP. […] A DL algorithm can discriminate between two levels of VA with relatively high sensitivity and specificity, using only a single-slice transfoveal OCT image as the input data. Specifically, the DL algorithm was able to detect visual impairment based on a VA cut-off of 20/40. The role of multimodal imaging input in improving algorithm performance is unclear at present. These data establish the feasibility of predicting structure-function correlation based on OCT images in patients with RP.
#50 Visual impairment as a predictor for deterioration in functioning: the Leiden 85-plus Study | BMC Geriatrics | Full Text
https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-022-03071-x
Visual impairment frequently occurs amongst older people. Therefore, the aim of this study was to investigate the predictive value of visual impairment on functioning, quality of life and mortality in people aged 85 years. At baseline, participants with visual impairment scored lower on physical, cognitive, psychological and social functioning and quality of life (p0.001). Compared to participants with no visual impairment, participants with moderate and severe visual impairment had an accelerated deterioration in basic activities of daily living (respectively 0.27-point (p=0.017) and 0.35 point (p=0.018)). In addition, compared to participants with no visual impairment, the mortality risk was 1.83 (95% CI 1.43, 2.35) for participants with severe visual impairment. In very older adults, visual impairment predicts accelerated deterioration in physical functioning. In addition, severely visually impaired adults had an increased mortality risk. Visual impairment can affect daily functioning, social participation and cognitive state, highlighting the importance of improving health services to promote healthy aging. Impaired vision is associated with an increased fall risk, comprised mobility, poorer quality of life, isolation often resulting in depression, cognitive dysfunction and higher mortality rates. The 10-year mortality risk increased from 1.21 (p=0.089, 95% CI 0.971.50) in the group with moderate impaired vision to 1.83 (p0.001, 95% CI 1.432.35) in the group with severe impaired vision. In conclusion, in very old adults, people with visual impairment are at risk for a lower level in physical, cognitive, psychological and social level of functioning. Moreover, visual impairment is associated with a reduced quality of life at baseline and the mortality risks are higher when severely visually impaired. Visual impairment is a predictive factor for accelerated deterioration in physical functioning, mainly for activities in daily living. […] Highlighting this negative association could induce a pro-active attitude, focusing on preventing and treating visual impairment, possibly helping to improve physical independence, wellbeing and successful aging in very old age.
#51 Prediction of visual impairment in retinitis pigmentosa using deep learning and multimodal fundus images | British Journal of Ophthalmology
https://bjo.bmj.com/content/107/10/1484
The efficient conduct of adequately powered clinical trials in retinitis pigmentosa (RP) is hampered by the need to screen relatively large numbers of patients to find those that fit the inclusion criteria. […] Structure-function correlation based solely on confocal scanning laser ophthalmoscopy imaging in patients with RP can be predicted using deep learning (DL). […] DL-based estimation of visual acuity using optical coherence tomography images may enable efficient screening of potential subjects in future RP research studies or clinical trials. […] Our algorithm showed robust performance in predicting visual impairment in patients with RP, thus providing proof-of-concept for predicting structure-function correlation based solely on cSLO imaging in patients with RP. […] A DL algorithm can discriminate between two levels of VA with relatively high sensitivity and specificity, using only a single-slice transfoveal OCT image as the input data. Specifically, the DL algorithm was able to detect visual impairment based on a VA cut-off of 20/40. The role of multimodal imaging input in improving algorithm performance is unclear at present. These data establish the feasibility of predicting structure-function correlation based on OCT images in patients with RP.
#52 Prediction of visual impairment in retinitis pigmentosa using deep learning and multimodal fundus images | British Journal of Ophthalmology
https://bjo.bmj.com/content/107/10/1484
The efficient conduct of adequately powered clinical trials in retinitis pigmentosa (RP) is hampered by the need to screen relatively large numbers of patients to find those that fit the inclusion criteria. […] Structure-function correlation based solely on confocal scanning laser ophthalmoscopy imaging in patients with RP can be predicted using deep learning (DL). […] DL-based estimation of visual acuity using optical coherence tomography images may enable efficient screening of potential subjects in future RP research studies or clinical trials. […] Our algorithm showed robust performance in predicting visual impairment in patients with RP, thus providing proof-of-concept for predicting structure-function correlation based solely on cSLO imaging in patients with RP. […] A DL algorithm can discriminate between two levels of VA with relatively high sensitivity and specificity, using only a single-slice transfoveal OCT image as the input data. Specifically, the DL algorithm was able to detect visual impairment based on a VA cut-off of 20/40. The role of multimodal imaging input in improving algorithm performance is unclear at present. These data establish the feasibility of predicting structure-function correlation based on OCT images in patients with RP.
#53 Diabetic retinopathy progression in patients under monitoring for treatment or vision loss: external validation and update of a multivariable prediction model | BMJ Open
https://bmjopen.bmj.com/content/13/4/e073015
The DRPTVL-UK model will be used to obtain the predicted probability of the outcome over time for every participant within each of the three trusts. Predictive performance of the model will be assessed using measures of discrimination (Harrells C-statistic and time-dependent C-statistic), calibration (calibration slope, ratio of observed to expected probabilities, calibration plots at multiple time points up to 2 years) and net benefit using decision curves. […] The consensus process will help us evaluate the list of options and combine them if an overlap is noted between different options. […] The plans for dissemination include peer reviewed publication, presentation to professional/PPIE bodies and development of an electronic calculator application to allow risk-based prioritisation of their follow-up, after direct entry of clinical information.
#54 Diabetic retinopathy progression in patients under monitoring for treatment or vision loss: external validation and update of a multivariable prediction model | BMJ Open
https://bmjopen.bmj.com/content/13/4/e073015
The DRPTVL-UK model will be used to obtain the predicted probability of the outcome over time for every participant within each of the three trusts. Predictive performance of the model will be assessed using measures of discrimination (Harrells C-statistic and time-dependent C-statistic), calibration (calibration slope, ratio of observed to expected probabilities, calibration plots at multiple time points up to 2 years) and net benefit using decision curves. […] The consensus process will help us evaluate the list of options and combine them if an overlap is noted between different options. […] The plans for dissemination include peer reviewed publication, presentation to professional/PPIE bodies and development of an electronic calculator application to allow risk-based prioritisation of their follow-up, after direct entry of clinical information.
#55 Diabetic retinopathy progression in patients under monitoring for treatment or vision loss: external validation and update of a multivariable prediction model | BMJ Open
https://bmjopen.bmj.com/content/13/4/e073015
The DRPTVL-UK model will be used to obtain the predicted probability of the outcome over time for every participant within each of the three trusts. Predictive performance of the model will be assessed using measures of discrimination (Harrells C-statistic and time-dependent C-statistic), calibration (calibration slope, ratio of observed to expected probabilities, calibration plots at multiple time points up to 2 years) and net benefit using decision curves. […] The consensus process will help us evaluate the list of options and combine them if an overlap is noted between different options. […] The plans for dissemination include peer reviewed publication, presentation to professional/PPIE bodies and development of an electronic calculator application to allow risk-based prioritisation of their follow-up, after direct entry of clinical information.