AI for Corneal Imaging: How Will This Help Us Take Care of Our Patients?

As artificial intelligence continues to evolve at a rapid pace, there is growing enthusiasm surrounding the potential for novel applications in corneal imaging. This article provides an overview of the potential for such applications, as well as the barriers we must overcome to realize it.

Stereo slit-scanning tomography of the anterior segment of the human eye.

We demonstrate a new tomographic imaging device for 2D cross-sectional and 3D volumetric images of the anterior eye segment. The optical system combines optical sectioning with a stereoscopic camera setup to determine the true spatial location of the ocular structures. Moreover, we propose a calibration procedure to estimate the triangulation function that links the stereo camera pixel indices with the eye-referenced 3D spatial coordinates.

Metastatic conjunctival squamous cell carcinoma presenting as infectious sclerokeratouveitis.

Purpose: We describe a case of metastatic conjunctival squamous cell carcinoma (SCC) presenting as an infectious sclerokeratouveitis in a patient with autoimmune disease.

Observations: A 63-year-old Caucasian female presented to the cornea service with a raised perilimbal scleral infiltrate, hypopyon, and corneal perforation concerning for infectious necrotizing sclerokeratoveitis. She had an ocular history of a recurrent "pyogenic granuloma" and her medical history was notable for well-controlled systemic lupus erythematosus and rheumatoid arthritis.

Computer Vision Identification of Trachomatous Inflammation-Follicular Using Deep Learning.

Purpose: Trachoma surveys are used to estimate the prevalence of trachomatous inflammation-follicular (TF) to guide mass antibiotic distribution. These surveys currently rely on human graders, introducing a significant resource burden and potential for human error. This study describes the development and evaluation of machine learning models intended to reduce cost and improve reliability of these surveys.

Biomarker Detection and Validation for Corneal Involvement in Patients With Acute Infectious Conjunctivitis.

Importance: Infectious conjunctivitis can lead to corneal involvement and result in ocular morbidity. The identification of biomarkers associated with corneal involvement has the potential to improve patient care.

Objective: To identify biomarkers in patients with acute infectious conjunctivitis.

Landolt Ring-Shaped Epithelial Keratopathy: A Novel Corneal Disease in a Non-Japanese White Patient.

Purpose: Landolt ring-shaped epithelial keratopathy is a corneal disease that has only been reported in 11 Japanese patients in 2014. 1 We describe the first case of Landolt ring-shaped epithelial keratopathy in the United States in a patient of European background.

Methods: This is a single case report with longitudinal care.

Locality is the strongest predictor of expert performance in image-based differentiation of bacterial and fungal corneal ulcers from India.

Purpose: This study sought to identify the sources of differential performance and misclassification error among local (Indian) and external (non-Indian) corneal specialists in identifying bacterial and fungal keratitis based on corneal photography.

Methods: This study is a secondary analysis of survey data assessing the ability of corneal specialists to identify acute bacterial versus fungal keratitis by using corneal photography. One-hundred images of 100 eyes from 100 patients with acute bacterial or fungal keratitis in South India were previously presented to an international cohort of cornea specialists for interpretation over the span of April to July 2021.

Real-time line-field optical coherence tomography for cellular resolution imaging of biological tissue.

A real-time line-field optical coherence tomography (LF-OCT) system is demonstrated with image acquisition rates of up to 5000 B-frames or 2.5 million A-lines per second for 500 A-lines per B-frame. The system uses a high-speed low-cost camera to achieve continuous data transfer rates required for real-time imaging, allowing the evaluation of future applications in clinical or intraoperative environments.

Assessing the Impact of Image Quality on Deep Learning Classification of Infectious Keratitis.

Objective: To investigate the impact of corneal photograph quality on convolutional neural network (CNN) predictions.

Design: A CNN trained to classify bacterial and fungal keratitis was evaluated using photographs of ulcers labeled according to 5 corneal image quality parameters: eccentric gaze direction, abnormal eyelid position, over/under-exposure, inadequate focus, and malpositioned light reflection.

Participants: All eligible subjects with culture and stain-proven bacterial and/or fungal ulcers presenting to Aravind Eye Hospital in Madurai, India, between January 1, 2021 and December 31, 2021.

Conjunctival Lesions Secondary to Systemic Varicella Zoster Virus Infection.

Purpose: To report and present images of a case in which discrete conjunctival lesions developed in the setting of primary varicella zoster virus infection (ie, chickenpox).

Methods: Case report and literature review.

Results: This report describes a young, unvaccinated male who developed an acutely painful, red eye in the setting of disseminated primary varicella zoster infection.

Rubella virus-associated necrotizing granulomatous inflammation with extensive eyelid, ocular, and orbital involvement.

We present a case of cutaneous granulomatous disease associated with rubella virus in a 4-year-old girl without an identifiable immunodeficiency. In this case, a combination of anti-inflammatory, anti-viral, and anti-neutrophil therapies successfully treated vision-threatening eyelid, conjunctival, scleral, and orbital inflammation.

Assistive applications of artificial intelligence in ophthalmology.

Purpose Of Review: Assistive (nonautonomous) artificial intelligence (AI) models designed to support (rather than function independently of) clinicians have received increasing attention in medicine. This review aims to highlight several recent developments in these models over the past year and their ophthalmic implications.

Recent Findings: Artificial intelligence models with a diverse range of applications in ophthalmology have been reported in the literature over the past year.

Human MPox (Monkeypox) Virus Membranous Keratoconjunctivitis With Transient Corneal Hypoesthesia and Late Symblepharon Formation: A Novel Case and Clinical Implications.

Purpose: The aim of this study was to describe a case of corneal involvement as an early manifestation of ocular disease in the 2022 human mpox (monkeypox) virus outbreak.

Methods: This is a single case report with longitudinal care.

Results: A 47-year-old immunocompetent man presented with viral conjunctivitis before development of skin lesions or systemic symptoms.

Deep Convolutional Neural Networks Detect no Morphological Differences Between Culture-Positive and Culture-Negative Infectious Keratitis Images.

Purpose: To determine whether convolutional neural networks can detect morphological differences between images of microbiologically positive and negative corneal ulcers.

Methods: A cross-sectional comparison of prospectively collected data consisting of bacterial and fungal cultures and smears from eyes with acute infectious keratitis at Aravind Eye Hospital. Two convolutional neural network architectures (DenseNet and MobileNet) were trained using images obtained from handheld cameras collected from culture-positive and negative images and smear-positive and -negative images.

Image-Based Differentiation of Bacterial and Fungal Keratitis Using Deep Convolutional Neural Networks.

Purpose: Develop computer vision models for image-based differentiation of bacterial and fungal corneal ulcers and compare their performance against human experts.

Design: Cross-sectional comparison of diagnostic performance.

Participants: Patients with acute, culture-proven bacterial or fungal keratitis from 4 centers in South India.

fungus growing on top of cyanoacrylate glue in a patient with perforated corneal ulcer.

Purpose: To demonstrate a case where fungus grew on top of cyanoacrylate glue used to seal a perforated corneal ulcer.

Observations: We document the clinical course of a rare case of keratitis over the course of 6 months. Despite the purported antifungal properties of cyanoacrylate glue demonstrated in vitro, this case provides in vivo evidence that this substance can serve as a scaffold on which pathogenic fungi may grow.

Practice Patterns and Clinician Opinions for Treatment of Ocular Rosacea.

Purpose: Management of ocular rosacea is challenged by the limited evidence-based systemic treatment guidelines and lack of elucidated mechanisms of treatment efficacy.

Methods: We conducted an online survey of clinicians who regularly treat ocular rosacea to elicit their opinions on treatment algorithms and understanding of the treatment's primary mechanism of action. Descriptive statistics and univariate comparisons were reported.

Corneal imaging with blue-light optical coherence microscopy.

Corneal imaging is important for the diagnostic and therapeutic evaluation of many eye diseases. Optical coherence tomography (OCT) is extensively used in ocular imaging due to its non-invasive and high-resolution volumetric imaging characteristics. Optical coherence microscopy (OCM) is a technical variation of OCT that can image the cornea with cellular resolution.

Neonatal corneal ulcer secondary to congenital entropion.

Purpose: To describe a case of central corneal ulceration in a newborn secondary to congenital entropion.

Observations: Corneal ulcers during infancy are rare and may occur secondary to congenital structural anomalies, including congenital entropion. Correct anatomic eyelid position in newborns is challenging to determine with closed eyelids, and eyelid squeezing during crying and discomfort adds to this challenge.

Very late onset LASIK flap Acremonium fungal keratitis confirmed by metagenomic deep sequencing.

Purpose: To describe a unique case of LASIK flap fungal keratitis confirmed by next generation sequencing.

Observations: A 56-year-old female presented with refractory keratitis involving her LASIK flap 21 years after surgery. Confocal was positive for filamentous structures.

Impact of Sample Collection Order on the Diagnostic Performance of Metagenomic Deep Sequencing for Infectious Keratitis.

Purpose: The purpose of this article was to evaluate the impact of sample collection order on the diagnostic yield of metagenomic deep sequencing (MDS) for determining the causative pathogen in infectious keratitis.

Methods: We performed a cross-sectional diagnostic test evaluation among subjects with infectious keratitis at Aravind Eye Hospital in Madurai, India. All subjects underwent corneal scrapings of the affected eye to obtain potassium hydroxide smear, Gram stain, bacterial culture, and fungal culture, in this order.

Expert Performance in Visual Differentiation of Bacterial and Fungal Keratitis.

This study quantifies the performance of an international cohort of cornea specialists in image-based differentiation of bacterial and fungal keratitis, identifying significant regional variation and establishing a reference standard for comparison against machine learning models.

Differentiation of Active Corneal Infections from Healed Scars Using Deep Learning.

Purpose: To develop and evaluate an automated, portable algorithm to differentiate active corneal ulcers from healed scars using only external photographs.

Design: A convolutional neural network was trained and tested using photographs of corneal ulcers and scars.

Participants: De-identified photographs of corneal ulcers were obtained from the Steroids for Corneal Ulcers Trial (SCUT), Mycotic Ulcer Treatment Trial (MUTT), and Byers Eye Institute at Stanford University.