New Horizons Forum: Diagnostic Advances in Glaucoma

By Lynda Charters

Researchers from several companies described their diagnostic offerings at the Glaucoma Research Foundation’s New Horizons 2021 Forum.

Advances, mainly focused on artificial intelligence (AI), stand out here.

PERG: useful for detecting very early damage to glaucoma
Pattern Electoretinography (PERG) rises to the next level, that is, outside the laboratory and in the clinic as a useful technology for detecting early metabolic changes, said Matthew Emmer, vice president of business development and clinical affairs. Diopsys Inc.

“The goal was to make PERG easier to use and less demanding for the doctor and technicians, with test times of less than 1 minute per eye,” he said.

The company has developed easily interpretable reference intervals and reports.

Trend graphs have also been developed, making PERG useful for the objective and functional understanding of early disease dysfunction, such as early retinal ganglion cell dysfunction (RGC). explain Emmer.

Numerous studies have reported that PERG is very sensitive to detecting functional loss and provides a window of opportunity before apoptosis.
is produced.

PERG can detect a decrease in RGC function years before structural loss in glaucoma suspects and is more sensitive than optical coherence tomography to detect dysfunctions in affected cells before the damage is irreversible in ocular hypertension.

PERG can also predict and control visual field loss and disease progression
effectiveness of treatment.

Diopsys first introduced ERG sensors that facilitated the development of a rating system for mean patient pattern responses to stimuli.

In the presence of early disease, the signal becomes less reproducible and is markedly different from a normal sinusoidal response.

The classification system allows clinicians to assign a number to the degree of dysfunction detected by the sensors taking into account response size, response speed, and reproducibility along with a reference range.

A trend plot shows changes over time.

“All of this information precedes structural changes,” Emmer explained.

Recent research indicates a strong correlation between PERG count and RGC and between PERG retinal vessel count and retinal vascular integrity, he noted.

The company publishes software that incorporates AI based on data from 800 patients; the application of the data algorithm to a subset of patients shows better sensitivity and specificity.

Use AI to prevent blindness
Kaushal Solanki, PhD, CEO and founder of Eyenuk Inc., is dedicated to detecting glaucoma early on to prevent vision loss.

Eyenuk markets an AI platform that can examine, diagnose, and control diseases based on ophthalmic imaging. With the image, AI can do it instantly
prepare a practical report without the need to dilate most patients.

“Through this platform various indications of diseases can be detected,” he stressed.

The use of AI and automation are the only ways we can achieve the goal of preventing vision loss, Solanki said.

The platform incorporates 3 components: EyeScreen, EyeArt and EyeMark.

EyeScreen is a diagnostic service for humans plus AI with which human graders review images as always, with AI performing a background check and marking possible errors.

EyeArt is a standalone AI that allows detection at the point of attention without the need for a specialist.

EyeMark is a “superpower” AI that performs an analysis to detect anomalies and a longitudinal control that detects and quantifies changes to create biomarkers that human experts cannot produce, he explained.

So far, Eyenuk has launched the platform aimed at diabetic retinopathy; EyeScreen and EyeArt are launched and EyeMark will be launched in 2021.

He reported that EyeArt is the first stand-alone artificial intelligence technology to detect more than mild diabetic retinopathy and diabetic retinopathy that threatens vision.

As for glaucoma, EyeScreen and EyeArt are being marketed and EyeMark is in development.

“AI will play a key role in enabling the timely detection and control of glaucoma through EyeScreen, EyeArt and EyeMark. Through this platform, we hope to significantly reduce glaucoma vision loss, ”Solanki concluded.

AI-based platform for diagnosis and augmentation

Millions of patients worldwide have visual field (VF) defects and / or double vision of glaucoma, stroke, macular degeneration, diabetes, and retinitis pigmentosa. Current treatments do not restore vision and only provide visual aids.

Heru has developed a cloud-based AI platform combined with downloadable applications in augmented and virtual reality headsets to provide both standalone vision diagnostics and personalized vision augmentation, according to Mohamed Abou Shousha, PhD, MD, MS, FRCS, CEO and founder, Heru, and associate professor, Bascom Palmer Eye Institute, Miami, Florida.

The company’s diagnostic set includes the following downloadable applications: autonomous PV, autonomic strabismus, visual distortion, eye image, and remote eye examination.

The VF app, an FDA-registered medical device, is self-administered, easy to use, portable, and cost-effective.

“A headset and software perform various tests,” he said, explaining that the test uses patients ’natural interactions to illuminate presented stimuli.
on the glasses to allow the app to map and quantify vision autonomously.

Telemedicine applications include PV, remote eye examination, and eye imaging functions; after the tests, the results are sent to a portal for review.

The AI ​​platform goes one step further by increasing the patient’s vision. In addition to diagnosing visual defects, visual distortion and double vision can be corrected and personalized PV can be corrected and expanded based on the patient’s profile.

“User vision is enhanced and enhanced and the environment around them is enhanced, providing greater safety and functionality to the patient,” Shousha said.

A clinical trial in Bascom Palmer comparing Heru VF measurements with Humphrey VF showed that the two are comparable in healthy and diseased eyes with excellent reproducibility.

A telehealth platform for sight
Elina Ianchulev, MBA, business director of KeepYourSight, described the company’s eye care platform for remote physiological and telehealth control.

Telehealth offers the opportunity for remote diagnosis and treatment of chronic eye diseases, which is important because 50% of cases of glaucoma and diabetic retinopathy are diagnosed late and in 50% of patients with age-related macular degeneration (AMD). ), treatment is late. , she explained.

The KeepYourSight platform provides clinical applications to remotely assess optic nerve / macula / acuity function and, later in 2021, ocular motility, ocular surface tear film and others.

Tests, all software-based, can be self-administered on tablets, personal computers, and smartphones.

In addition to monitoring existing patients, this platform offers clinicians the opportunity to expand their practices through screening in the community and among friends and family and referral channels, Ianchulev said.

Augmented reality technology
Ocutrx Vision Technologies is dedicated to providing augmented vision to
patients with AMD and low vision.

Oculenz augmented reality technology uses pixel manipulation to allow ophthalmic patients to see around their scotoma, according to Linda Lam, MD, MBA, chief scientist and strategist.

The technology works by first mapping the scotoma during a PV test. Eye tracking follows the patient’s gaze as the image and text move around the scotoma.

Data transmission to the doctor and telemedicine are also possible with this device, which facilitates after the enlargement of the scotoma and the possible progression of the disease and
previous intervention.

In addition to remote care, Ocutrx developed the OR-Bot, which is useful in the operating room to address challenges with ergonomics, space limitations imposed by current surgical systems and digital cameras, and resolution limitation. and poor quality 3D glasses.

The instrument offers a virtual reality microscope, a 3D monitor and augmented reality headphones.

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