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      Development and Application of an Intelligent Diagnosis System for Retinal Vein Occlusion Based on Deep Learning

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          Abstract

          This study is aimed at developing an intelligent algorithm based on deep learning and discussing its application for the classification and diagnosis of retinal vein occlusions (RVO) using fundus images. A total of 501 fundus images of healthy eyes and patients with RVO were used for model training and testing to investigate an intelligent diagnosis system. The images were first classified into four categories by fundus disease specialists: (i) healthy fundus (group 0), (ii) branch RVO (BRVO) (group 1), (iii) central RVO (CRVO) (group 2), and (iv) macular branch RVO (MBRVO) (group 3), before being diagnosed using the ResNet18 network model. Intelligent diagnoses were compared with clinical diagnoses. The specificity of the intelligent diagnosis system under each attention mechanism was 100% in group 0 and also revealed a high sensitivity of over 95%, F1 score of over 97%, and an accuracy of over 97% in this group. For the other three groups, the specificities of diagnosis ranged from 0.45 to 0.91 with different attention mechanisms, in which the ResNet18+coordinate attention (CA) model had the highest specificities of 0.91, 0.88, and 0.83 for groups 1, 2, and 3, respectively. It also provided a high accuracy of over 94% with a coordinate attention mechanism in all four groups. The intelligent diagnosis and classifier system developed herein based on deep learning can determine the presence of RVO and classify disease according to the site of occlusion. This proposed system is expected to provide a new tool for RVO diagnosis and screening and will help solve the current challenges due to the shortage of medical resources.

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          Most cited references24

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          Identifying Medical Diagnoses and Treatable Diseases by Image-Based Deep Learning

          The implementation of clinical-decision support algorithms for medical imaging faces challenges with reliability and interpretability. Here, we establish a diagnostic tool based on a deep-learning framework for the screening of patients with common treatable blinding retinal diseases. Our framework utilizes transfer learning, which trains a neural network with a fraction of the data of conventional approaches. Applying this approach to a dataset of optical coherence tomography images, we demonstrate performance comparable to that of human experts in classifying age-related macular degeneration and diabetic macular edema. We also provide a more transparent and interpretable diagnosis by highlighting the regions recognized by the neural network. We further demonstrate the general applicability of our AI system for diagnosis of pediatric pneumonia using chest X-ray images. This tool may ultimately aid in expediting the diagnosis and referral of these treatable conditions, thereby facilitating earlier treatment, resulting in improved clinical outcomes. VIDEO ABSTRACT.
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            Optical Coherence Tomography Angiography in Retinal Vein Occlusion: Evaluation of Superficial and Deep Capillary Plexa.

            To evaluate the optical coherence tomography angiography (OCT angiography) appearance of the superficial and deep capillary plexa in eyes with retinal vein occlusion (RVO) and to compare these findings with those of fluorescein angiography (FA) and spectral-domain optical coherence tomography (SD OCT).
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              RETINAL VASCULAR CYSTOID MACULAR EDEMA

              : Retinal vascular disease has the potential to affect hundreds of millions of people, with the inherent risk of vision loss related to cystoid macular edema. Although there have been histologic evaluation of eyes having cystoid macular edema, the most recent paper was published more than 30 years ago. In retinal vascular cystoid macular edema fluorescein angiography, a modality that images the superficial vascular plexus, shows increased leakage. Optical coherence tomography angiography has provided unprecedented resolution of retinal vascular flow in a depth resolved manner and demonstrates areas of decreased or absent flow in the deep vascular plexus colocalizing with the cystoid spaces. There has been a large amount of research on fluid management and edema in the brain, much of which may have analogues in the eye. Interstitial flow of fluid as managed by Müller cells may occur in the retina, comparable in some ways to the bulk flow in brain parenchyma, which is managed by astrocytes. Absent blood flow in the deep retinal plexus may restrict fluid management strategies in the retina, to include transport of excess fluid out of the retina into the blood by Müller cells. Application of this theory may help in increasing understanding of the pathophysiology of retinal vascular cystoid macular edema and may lead to new therapeutic approaches.
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                Author and article information

                Contributors
                Journal
                Dis Markers
                Dis Markers
                DM
                Disease Markers
                Hindawi
                0278-0240
                1875-8630
                2022
                24 August 2022
                : 2022
                : 4988256
                Affiliations
                1Department of Optometry, Jinling Institute of Technology, Nanjing, Jiangsu, China
                2Nanjing Key Laboratory of Optometric Materials and Application Technology, Nanjing, Jiangsu, China
                3The Laboratory of Artificial Intelligence and Big Data in Ophthalmology, Affiliated Eye Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
                4The First Affiliated Hospital of Huzhou University, Huzhou, Zhejiang, China
                5Shenzhen Eye Hospital, Jinan University, Shenzhen, Guangdong, China
                Author notes

                Academic Editor: Yi Shao

                Author information
                https://orcid.org/0000-0003-0185-9645
                https://orcid.org/0000-0001-7812-8555
                https://orcid.org/0000-0001-8049-1118
                https://orcid.org/0000-0001-5348-0712
                https://orcid.org/0000-0002-0763-7990
                https://orcid.org/0000-0002-1919-7953
                https://orcid.org/0000-0002-7209-614X
                Article
                10.1155/2022/4988256
                9433258
                36061353
                7657f9cd-68b2-43ff-8709-f786d04abeeb
                Copyright © 2022 Wei Xu et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 26 June 2022
                : 11 August 2022
                : 16 August 2022
                Funding
                Funded by: Medical Science and Technology Development Project Fund of Nanjing
                Award ID: YKK21262
                Categories
                Research Article

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