A mhealth application for automated detection and diagnosis of strabismus

Mesquita, Michelline Joana Tenório Albuquerque Madruga; Valente, Thales Levi Azevedo; Almeida, João Dallyson Sousa de; Teixeira, Jorge Antonio Meireles; Medina, Flávio Mac Cord; Santos, Alcione Miranda dos

doi:10.1016/j.ijmedinf.2021.104527

“…Previous authors have attempted to automate strabismus using photographs [15][16] [17] and binocular OCT [18] . The former in particular has signi cant potential for large-scale strabismus screening, but fails to capture the nuances of the alternate prism cover test, including identi cation of phorias and abnormal retinal correspondence.…”

Section: Comparisons To Previous Researchmentioning

confidence: 99%

Feasibility study of an automated Strabismus Screening Test using Augmented Reality and Eye-tracking (STARE)

Nixon

¹

,

Thomas²,

Jones³

2023

Preprint

1

0

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Background New digital technologies (augmented reality headsets, eye-tracking) may potentially allow for automated assessments of ocular misalignment. Here, we evaluate the feasibility of a novel, open-source strabismus test (“STARE”) as an automated screening tool. Methods Work progressed in 2 phases. In phase 1 (“development”), we used Fresnel prisms to elicit horizontal misalignments of known magnitude (1–40 prism dioptres) in orthotropic controls. In phase 2 (“validation”), we applied the system to adults with an established diagnosis of strabismus, and quantified the ability of the test to distinguish between those with horizontal misalignment and those without. Agreement between the alternate prism cover test measurements and STARE measurements was computed using Bland-Altman plots and product-moment correlation coefficients. Results Seven orthotropic controls and nineteen patients with strabismus were recruited (mean age 58.7 ± 22.4 years). STARE was able to identify the presence of horizontal strabismus with an area under the curve of 1.00 (100% sensitivity and 100% specificity). The mean difference (bias) {95%CI} was 2.1 {-1.8, 9.9} prism dioptres, and the 95% coefficient of repeatability {95%CI} was ± 27.9 {14.8, 50.8} prism dioptres. The Pearson correlation between APCT and STARE was r24 = 0.62, P < 0.001. Conclusions STARE shows promise as a simple, automated tool for performing a screening assessment of strabismus. It is a rapid (60 second) test that can be performed using a consumer augmented reality headset with integrated eye-tracking, and might conceivably be used remotely by non-specialists in future as a means of highlighting individuals needing face-to-face specialist care.

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“…Recent studies report that the global prevalence of strabismus is as high as 1.93%, with a worldwide estimated pooled prevalence of 1.78% for those under 20 years of age and 3.29% for those over 20 years of age [ 1 – 3 ]. Surgery is a common treatment for strabismus.…”

Section: Introductionmentioning

confidence: 99%

Analysis of the Changes and Possible Reasons in Aberrations before and after Surgery in Patients with Concomitant Exotropia

Zhang

¹

,

Zhou

²

,

Li

³

et al. 2022

Computational Intelligence and Neuroscience

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Objective. The objective is to observe the changes in aberrations before and after surgery in patients with common horizontal strabismus and to analyze the possible reasons for the changes. Methods. Forty eyes of 40 cases with concomitant exotropia who underwent strabismus correction at the Ophthalmology Department of Nantong University Hospital from October 2020 to July 2021 were included in this study, all of whom underwent unilateral lateral rectus recession combined with a medial rectus resection in the same eye. Aberration parameters were measured 1 day before surgery and 1 week, 1 month, 3 months, and 6 months after surgery. Differences in the indicators at each time period were compared by analysis of variance (ANOVA) of repeated measures data for a single factor, and data were analyzed using SPSS 25.0 statistical application software. Results. 5 mm pupil diameter: the preoperative and postoperative RMS of total aberration showed statistically significant difference ( P < 0.01 ). Postoperation test (Bonferroni method) and preoperative comparison at each period after surgery showed statistically significant differences between 6 months after surgery ( P = 0.002 ) and preoperative comparison. The preoperative and postoperative comparison of RMS in LOAs was statistically significant ( P < 0.01 ); postoperative test (Bonferroni method) and preoperative comparison showed that there were statistically significant differences between 1 week ( P = 0.033 ) and 6 months ( P = 0.002 ) after operation. The difference of RMS of defocus before and after operation was statistically significant ( P < 0.01 ); postoperation test (Bonferroni method) and preoperative comparison showed that there was statistically significant difference between 6 months after operation ( P = 0.007 ) and preoperative comparison. There was statistically significant difference in preoperative and postoperative RMS of HOAs ( P = 0.013 ). Postoperative test (Bonferroni method) and preoperative comparison showed that there was statistically significant difference 6 months after surgery ( P = 0.03 ). The RMS of secondary astigmatism showed a statistically significant difference before and after operation ( P = 0.001 ), and the postoperation test (Bonferroni method) showed a statistically significant difference 6 months after operation ( P = 0.002 ). In 5 mm pupil diameter, the preoperative and postoperative RMS of total aberration showed statistically significant difference ( P < 0.01 ), postoperative test (Bonferroni method) was used to compare each period after surgery with that before surgery, and there were statistically significant differences between 1 week after surgery ( P = 0.034 ), 3 months after surgery ( P = 0.033 ), and 6 months after surgery ( P = 0.003 ). The preoperative and postoperative comparison of RMS in LOAs was statistically significant ( P < 0.01 ), postoperative test (Bonferroni method) was used to compare each period after surgery with that before surgery, and there were statistically significant differences between 1 week after surgery ( P = 0.04 ), 3 months after surgery ( P = 0.034 ), and 6 months after surgery ( P = 0.004 ). The difference of RMS of defocus before and after surgery was statistically significant ( P = 0.002 ), and the comparison between postoperation test (Bonferroni method) and preoperation showed that the difference was statistically significant 6 months after surgery ( P = 0.027 ). The RMS of astigmatism showed statistically significant difference before and after operation ( P = 0.002 ), and the postoperation test (Bonferroni method) showed statistically significant difference between 6 months after operation ( P = 0.009 ) and before operation. Conclusion. We found that horizontal rectus surgery had a transient effect on LOAs and almost no effect on HOAs. Long-term follow-up is recommended after strabismus surgery to observe eye position and binocular visual function. Because of the high prevalence of strabismus in adolescents, long-term observation of the eye axis and aberration is recommended.

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Home-based screening tools for amblyopia: a systematic review

Sii

¹

,

Chean

²

,

Kuht

³

et al. 2023

Eye

0

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Amblyopia is an important public health concern. While home-based screening may present an effective solution, this has not been rigorously assessed in a systematic review. A systematic review was performed using Ovid MEDLINE, PubMed, The Cochrane Library, Embase, Web of Science Core Collection, and Clinicaltrials.gov. All studies reporting the diagnostic accuracy of home-based screening tools for amblyopia among children were included. Studies involving orthoptist or ophthalmologist-led screening and adult subjects were excluded. The main outcome measure was the diagnostic accuracy expressed as sensitivity and specificity. Among 3670 studies identified, 28 were eligible for inclusion in our systematic review. The age range of patients were less than 1 month to 16 years old. 7 studies used internet-based tools, 16 used smartphone/tablet applications, 3 used digital cameras, and 3 used home-based questionnaires and visual acuity tools. All studies included a reference standard except one, which was a longitudinal study. 21 studies had full ophthalmological examination whilst 6 studies had validated visual acuity measurement tools as gold standards. Of the 27 studies which compared against a reference test, only 25 studies reported sensitivity and specificity values. Using the QUADAS-2 tool, 50% of studies were deemed to have applicability concern due to patient selection from tertiary centres and unclear methods for recruitment. There is a need to improve the quality of diagnostic accuracy studies, standardise thresholds for detecting amblyopia, and ensure consistent reporting of results. Further research is needed to evaluate the suitability of these tools for amblyopia screening.

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A mhealth application for automated detection and diagnosis of strabismus

Cited by 5 publications

References 27 publications

Feasibility study of an automated Strabismus Screening Test using Augmented Reality and Eye-tracking (STARE)

Feasibility study of an automated Strabismus Screening Test using Augmented Reality and Eye-tracking (STARE)

Analysis of the Changes and Possible Reasons in Aberrations before and after Surgery in Patients with Concomitant Exotropia

Home-based screening tools for amblyopia: a systematic review

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