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      Digital technology, tele-medicine and artificial intelligence in ophthalmology: A global perspective

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          Abstract

          The simultaneous maturation of multiple digital and telecommunications technologies in 2020 has created an unprecedented opportunity for ophthalmology to adapt to new models of care using tele-health supported by digital innovations. These digital innovations include artificial intelligence (AI), 5th generation (5G) telecommunication networks and the Internet of Things (IoT), creating an inter-dependent ecosystem offering opportunities to develop new models of eye care addressing the challenges of COVID-19 and beyond. Ophthalmology has thrived in some of these areas partly due to its many image-based investigations. Tele-health and AI provide synchronous solutions to challenges facing ophthalmologists and healthcare providers worldwide. This article reviews how countries across the world have utilised these digital innovations to tackle diabetic retinopathy, retinopathy of prematurity, age-related macular degeneration, glaucoma, refractive error correction, cataract and other anterior segment disorders. The review summarises the digital strategies that countries are developing and discusses technologies that may increasingly enter the clinical workflow and processes of ophthalmologists. Furthermore as countries around the world have initiated a series of escalating containment and mitigation measures during the COVID-19 pandemic, the delivery of eye care services globally has been significantly impacted. As ophthalmic services adapt and form a “new normal”, the rapid adoption of some of telehealth and digital innovation during the pandemic is also discussed. Finally, challenges for validation and clinical implementation are considered, as well as recommendations on future directions.

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          Virtually Perfect? Telemedicine for Covid-19

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            Prevalence of age-related macular degeneration in the United States.

            To estimate the prevalence and distribution of age-related macular degeneration (AMD) in the United States by age, race/ethnicity, and gender. Summary prevalence estimates of drusen 125 microm or larger, neovascular AMD, and geographic atrophy were prepared separately for black and white persons in 5-year age intervals starting at 40 years. The estimated rates were based on a meta-analysis of recent population-based studies in the United States, Australia, and Europe. These rates were applied to 2000 US Census data and to projected US population figures for 2020 to estimate the number of the US population with drusen and AMD. The overall prevalence of neovascular AMD and/or geographic atrophy in the US population 40 years and older is estimated to be 1.47% (95% confidence interval, 1.38%-1.55%), with 1.75 million citizens having AMD. The prevalence of AMD increased dramatically with age, with more than 15% of the white women older than 80 years having neovascular AMD and/or geographic atrophy. More than 7 million individuals had drusen measuring 125 microm or larger and were, therefore, at substantial risk of developing AMD. Owing to the rapidly aging population, the number of persons having AMD will increase by 50% to 2.95 million in 2020. Age-related macular degeneration was far more prevalent among white than among black persons. Age-related macular degeneration affects more than 1.75 million individuals in the United States. Owing to the rapid aging of the US population, this number will increase to almost 3 million by 2020.
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              Digital technology and COVID-19

              The past decade has allowed the development of a multitude of digital tools. Now they can be used to remediate the COVID-19 outbreak.
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                Author and article information

                Journal
                Prog Retin Eye Res
                Prog Retin Eye Res
                Progress in Retinal and Eye Research
                Published by Elsevier Ltd.
                1350-9462
                1873-1635
                6 September 2020
                6 September 2020
                : 100900
                Affiliations
                [a ]Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
                [b ]Beijing Tongren Hospital; Capital Medical University; Beijing Institute of Ophthalmology; Beijing, China
                [c ]Academic Ophthalmology, University of Nottingham, United Kingdom
                [d ]Keye Eye Center, Seoul, Republic of Korea
                [e ]University of Illinois Chicago, Chicago, USA
                [f ]Medical College of Wisconsin, Milwaukee, WI, USA
                [g ]NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
                [h ]Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Guangzhou, China
                [i ]Peking Union Medical College Hospital, Beijing, China
                [j ]Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
                [k ]Department of Ophthalmology, Tel Aviv Medical Centre, Israel
                [l ]C-MER Dennis Lam Eye Center, C-Mer International Eye Care Group Limited, Hong Kong, Hong Kong
                [m ]International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), Shenzhen, China
                [n ]Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, USA
                [o ]Singapore National Eye Center, Duke-NUS Medical School Singapore, Singapore
                [p ]USC Roski Eye Institute, University of Southern California (USC) Keck School of Medicine, Los Angeles, CA, USA
                Author notes
                []Corresponding author. Singapore National Eye Center, 11 Third Hospital Avenue, 168751, Singapore.
                Article
                S1350-9462(20)30072-0 100900
                10.1016/j.preteyeres.2020.100900
                7474840
                32898686
                447fc097-95a6-4e19-b4d6-a5ffdb211cfe
                © 2020 Published by Elsevier Ltd.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 5 June 2020
                : 25 August 2020
                : 31 August 2020
                Categories
                Article

                Vision sciences
                telemedicine,tele-ophthalmology,tele-screening,diabetic retinopathy screening,artificial intelligence,deep learning,digital transformation,digital innovations,covid-19,digital technology

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