Photoscreening in the Medical Home. the Science / the Reality. Gerhard Cibis MD Clinical Prof. Opth. KU MED Emeritus Chief CMH KCMO

Transcription

1 Photoscreening in the Medical Home the Science / the Reality Gerhard Cibis MD Clinical Prof. Opth. KU MED Emeritus Chief CMH KCMO

2 Commercially available photoscreeners since 1990 MTI, Spot, iscreen Billing code for Photoscreening in primary care office since 1998 AAP and AAPOS recommend Photoscreening in Pediatricians office 2016 Why the delay? Why now?

3 Photoscreening capacity is improving with computerization, artificial intelligence, phone apps relying less on trained personnel. Recognition that 90% sensitivity /specificity is unobtainable by any current method leading to a rethinking of what the goals of screening for amblyogenic factors really are. Screening is only the first step in the solution. Getting identified at risk patients into complete exams and treatment needs solving.

4 Sean Donahue MD PhD Automated Vision Screening Outperforms Traditional Acuity Screening J. AAPOS 20/ Unlike cancer or AIDS lower specificity for Amblyogenic Factors is acceptable. Major challenge for the future is Getting risk identified patients to the Ophthalmologists/OD for complete examination Despite free complete exams for referred patients only 44% followed up Donahue s study

5 Photoscreeners analyze for the Brückner red reflex and eccentric photocrescents (a slope) Cibis-Tongue A, Cibis GW. Brückner test. Ophthalmology. 1981;88: Video vision development assessment (VVDA): combining the Brückner test with eccentric photorefraction for dynamic identification of amblyogenic factors in infants and children. Cibis GW. Trans Am Ophthalmol Soc. 1994;92:

6 Brückner Red Reflex the brighter eye is the deviating eye Patient with intermittent exotropia aligned (left) and deviating left eye (right). Note brightness difference in the deviated left eye ( right).

7 Alternating Microtropia 30 frames/second

8 Hyperopic crescents appear red from above and myopic crescents appear blue from below. Absence of crescent implies no significant refractive error for that pupil size (dead space).

9 Myopic crescent

10 All Automated Image Analysis utilizes algorithms to measure intensity slopes in multiple directions to determine refraction

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12 The Science of iscreen. The process utilizes a sophisticated set of rapidly timed flashes at different angles to capture red reflex images of the eye, creating light patterns on the images that trained technicians can analyze to screen for potentially serious vision problems in young children.

13 MTI Screener used polarized film and reading centers

14 Van Eenwyk J, Agah A, Giangiacomo J, Cibis GW: Artificial Intelligence Techniques for Automatic Screening of Amblyogenic Factors. Trans Am Ophthalmol Soc, Vol 106, SYSTEM SENSITIVITY SPECIFICITY ACCURACY NN, neural network. Case-based static 84.6% 58.6% 75.2% Case-based fuzzy 76.4% 68.6% 73.6% NN eye features 61.5% 63.6% 62.3% NN hybrid 72.3% 72.3% 72.3% C4.5 eye features (50%) C4.5 eye features (61%) 84.6% 61.4% 76.2% 76.2% 79.5% 77.4% C4.5 hybrid 80.8% 59.5% 73.1%

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16 Much Used but now Discontinued Suresight ( Welsch-Allen) Digital on site interpretation superceeded by Spot MTI Polaroid film needs reading center

17 Commercially Available Photoscreeners Plusoptix : Infrared light source digital on site interpretation Spot (Welsch-Allen) infrared light source,digital, on site WiFi connectivity iscreen Digital photoscreener images sent to central reading center

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22 Plusoptix

23 Gocheck = Gobiquity Smartphone Photoscreening App

24 1. Cibis GW. Video vision development assessment (VVDA): combining the Brückner test with eccentric photorefraction for dynamic identification of amblyogenic factors in infants and children. Trans Am Ophthalmol Soc. 1994;92: [PMC free article] [PubMed] 2. Cibis-Tongue A, Cibis GW. Brückner test. Ophthalmology. 1981;88: [PubMed] 3. Cibis GW, Waeltermann JM. Rapid strabismus screening for the pediatrician. Clin Pediatr. 1986;25: [PubMed] 4. Cibis GW. Video vision development assessment in diagnosis and documentation of microtropia. Binoc Vis Strabismus Q. 2005;20: [PubMed] 5. Wang T, Giangiacomo J, Cibis GW. Computerized video-based photoscreening for amblyopia-causing factors Available at: g_tsaipei-eyeball.ppt. 6. Wang T, Keller JM, Cibis GW. A fuzzy approach to find Hirschberg points and to determine fixation in digital images of infants. Proceedings of 12th International IEEE Conference on Fuzzy Systems. 2003;2:

25 7. Wang T. Eye Location and Fixation Estimation Techniques for Automated Video Vision Development Assessment. Columbia, Missouri: University of Missouri; [master s thesis] 8. Wang T. Investigation of Image Processing and Computer-assisted Diagnosis System for Automated Video Vision Development Assessment. Columbia, Missouri: University of Missouri; [PhD dissertation] 9. Van Eenwyk J. Using Artificial Intelligence Techniques to Automate Human Vision Screening. Lawrence, Kansas: University of Kansas; [master s thesis] 10. Aamodt A, Plaza E. Case-based reasoning: foundational issues, methodological variations, and system approaches. Artificial Intelligence Communications. 1994;7: Berikov V, Litvinenko A. Methods for statistical data analysis with decision trees, 2003, Novosibirsk, Russian Federation: Sobolev Institute of Mathematics. Available at: Quinlan JR. C4.5: Programs for Machine Learning. San Mateo, CA: Morgan Kaufmann; Patrick G. Clark, Christopher M. Gifford, Jonathan Van Eenwyk, Arvin Agah, and Gerhard W. Cibis. (2012). Applied machine learning and decision combination for identifying the lazy eye vision disorder. Proceedings of the 2012 International Conference on Artificial Intelligence, (ICAI 2012), Las Vegas, Nevada, July 2012.