Browsing by Author "Chiang, Michael F"
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- ItemAccuracy and reliability of remote retinopathy of prematurity diagnosis.(2006-03-14) Chiang, Michael F; Keenan, Jeremy D; Starren, Justin; Du, Yunling E; Schiff, William M; Barile, Gaetano R; Li, Joan; Johnson, Rose Anne; Hess, Ditte J; Flynn, John TTo determine the accuracy and reliability of retinopathy of prematurity ROP diagnosis using remote review of digital images by 3 masked ophthalmologist readers
- ItemAnti-Vascular Endothelial Growth Factor and the Evolving Management Paradigm for Retinopathy of Prematurity.(0000-00-00) Darwish, Dana; Chee, Ru-Ik; Patel, Samir N; Jonas, Karyn; Ostmo, Susan; Campbell, J Peter; Chiang, Michael F; Chan, R V PaulDiagnosis and management of pediatric retinal conditions such as retinopathy of prematurity ROP have been evolving significantly with the availability of new technology and treatments New imaging systems telemedicine tele education and anti vascular endothelial growth factor VEGF intravitreal pharmacotherapy are all changing the way we diagnose and deliver care to children with pediatric retinal disease Fluorescein angiography and optical coherence tomography have the potential to improve our diagnosis and management of disease and with improvements in retinal imaging telemedicine is becoming more feasible Telemedicine tele education and computer based image analysis may overcome many of the challenges we face in providing adequate care and access for children with pediatric retinal disease Treatment options have also expanded with the use of anti VEGF therapy Although the use of intravitreal anti VEGF for ROP has been documented in the literature for more than a decade many questions still remain about its safety in the pediatric patient population Several ongoing prospective studies are exploring the utility of anti VEGF agents for ROP with attention to the optimal dose of drug systemic safety and our understanding of recurrence of disease This review aims to provide an update on current diagnostic and therapeutic modalities focusing predominantly on the role of anti VEGF therapy for the management of ROP and other pediatric retinal vascular diseases
- ItemAssessment of image-based technology: impact of referral cutoff on accuracy and reliability of remote retinopathy of prematurity diagnosis.(2006-06-16) Chiang, Michael F; Keenan, Jeremy D; Du, Yunling E; Schiff, William; Barile, Gaetano; Li, Joan; Hess, Ditte J; Johnson, Rose Anne; Flynn, John T; Starren, JustinTelemedicine has potential to improve the delivery quality and accessibility of ophthalmic care for infants with Retinopathy of Prematurity ROP Using a telemedicine screening strategy three potential diagnostic cutoffs may be used to define disease that warrants ophthalmologic referral presence of any ROP presence of moderate type 2 prethreshold ROP or presence of severe ROP requiring treatment This study examines the relationship between accuracy and reliability of diagnosis by three masked ophthalmologist graders at each of these diagnostic cutoffs The sensitivity specificity inter grader reliability and intra grader reliability showed significant variation depending on the diagnostic cutoff with best results at cutoffs of type 2 prethreshold ROP or treatment requiring ROP Before the large scale adoption of telemedicine for image based screening of diseases such as ROP standards defining clinically relevant referral cutoffs must be established and diagnostic accuracy and reliability at these cutoffs must be characterized
- ItemComputer-based image analysis for plus disease diagnosis in retinopathy of prematurity.(2012-01-24) Wittenberg, Leah A; Jonsson, Nina J; Chan, R V Paul; Chiang, Michael FPresence of plus disease in retinopathy of prematurity ROP is an important criterion for identifying ROP requiring treatment Plus disease is defined by a standard published photograph selected more than 20 years ago by expert consensus However diagnosis of plus disease has been shown to be subjective and qualitative Computer based image analysis using quantitative methods has potential to improve the objectivity of plus disease diagnosis The objective was to review the published literature involving computer based image analysis for ROP diagnosis The PubMed and Cochrane library databases were searched for the keywords retinopathy of prematurity AND image analysis AND OR plus disease Reference lists of retrieved articles were searched to identify additional relevant studies All relevant English language studies were reviewed There are four main computer based systems ROPtool area under the receiver operating characteristic curve AUROC plus tortuosity 0 95 plus dilation 0 87 RISA AUROC arteriolar TI 0 71 venular diameter 0 82 Vessel Map AUROC arteriolar dilation 0 75 venular dilation 0 96 and CAIAR AUROC arteriole tortuosity 0 92 venular dilation 0 91 attempting to objectively analyze vessel tortuosity and dilation in plus disease in ROP Some show promise for identification of plus disease using quantitative methods This has potential to improve the diagnosis of plus disease and may contribute to the management of ROP using both traditional binocular indirect ophthalmoscopy and image based telemedicine approaches
- ItemCost-utility analysis of telemedicine and ophthalmoscopy for retinopathy of prematurity management.(2008-04-16) Jackson, Kevin M; Scott, Karen E; Graff Zivin, Joshua; Bateman, David A; Flynn, John T; Keenan, Jeremy D; Chiang, Michael FTo evaluate the cost effectiveness of telemedicine and standard ophthalmoscopy for retinopathy of prematurity ROP management
- ItemDiagnostic Accuracy of Ophthalmoscopy vs Telemedicine in Examinations for Retinopathy of Prematurity.(0000-00-00) Biten, Hilal; Redd, Travis K; Moleta, Chace; Campbell, J Peter; Ostmo, Susan; Jonas, Karyn; Chan, R V Paul; Chiang, Michael F; ,Importance Examinations for retinopathy of prematurity ROP are typically performed using binocular indirect ophthalmoscopy Telemedicine studies have traditionally assessed the accuracy of telemedicine compared with ophthalmoscopy as a criterion standard However it is not known whether ophthalmoscopy is truly more accurate than telemedicine Objective To directly compare the accuracy and sensitivity of ophthalmoscopy vs telemedicine in diagnosing ROP using a consensus reference standard Design Setting and Participants This multicenter prospective study conducted between July 1 2011 and November 30 2014 at 7 neonatal intensive care units and academic ophthalmology departments in the United States and Mexico included 281 premature infants who met the screening criteria for ROP Exposures Each examination consisted of 1 eye undergoing binocular indirect ophthalmoscopy by an experienced clinician followed by remote image review of wide angle fundus photographs by 3 independent telemedicine graders Main Outcomes and Measures Results of both examination methods were combined into a consensus reference standard diagnosis The agreement of both ophthalmoscopy and telemedicine was compared with this standard using percentage agreement and weighted statistics Results Among the 281 infants in the study 127 girls and 154 boys mean SD gestational age 27 1 2 4 weeks a total of 1553 eye examinations were classified using both ophthalmoscopy and telemedicine Ophthalmoscopy and telemedicine each had similar sensitivity for zone I disease 78 95 CI 71 84 vs 78 95 CI 73 83 P 99 n 165 plus disease 74 95 CI 61 87 vs 79 95 CI 72 86 P 41 n 50 and type 2 ROP stage 3 zone I or plus disease 86 95 CI 80 92 vs 79 95 CI 75 83 P 10 n 251 but ophthalmoscopy was slightly more sensitive in identifying stage 3 disease 85 95 CI 79 91 vs 73 95 CI 67 78 P 004 n 136 Conclusions and Relevance No difference was found in overall accuracy between ophthalmoscopy and telemedicine for the detection of clinically significant ROP although on average ophthalmoscopy had slightly higher accuracy for the diagnosis of zone III and stage 3 ROP With the caveat that there was variable accuracy between examiners using both modalities these results support the use of telemedicine for the diagnosis of clinically significant ROP
- ItemDiagnostic performance of a telemedicine system for ophthalmology: advantages in accuracy and speed compared to standard care.(2011-02-24) Chiang, Michael F; Wang, Lu; Kim, David; Scott, Karen; Richter, Grace; Kane, Steven; Flynn, John; Starren, JustinTelemedicine has potential to improve quality and delivery of medical care particularly in image oriented specialties where decisions are based on appearance of morphological features during examination In the ophthalmology domain nearly all published telemedicine studies have measured accuracy against a gold standard of ophthalmoscopic examination The purposes of this study are to examine difficulties in defining an absolute gold standard and to compare diagnostic speed in a representative disease retinopathy of prematurity We compare results from ophthalmoscopic and telemedicine examinations by the same physicians In 180 86 5 of 208 eyes the two examinations produced the same diagnosis In some discrepancies there was rationale suggesting that telemedicine may have provided a more accurate diagnosis than ophthalmoscopic examination The quantity and nature of these disagreements has important implications for evaluation of telemedicine systems in image based specialties and for the definition of gold standards in future studies
- ItemEvaluation of a deep learning image assessment system for detecting severe retinopathy of prematurity.(0000-00-00) Redd, Travis K; Campbell, John Peter; Brown, James M; Kim, Sang Jin; Ostmo, Susan; Chan, Robison Vernon Paul; Dy, Jennifer; Erdogmus, Deniz; Ioannidis, Stratis; Kalpathy-Cramer, Jayashree; Chiang, Michael F; ,BACKGROUND Prior work has demonstrated the near perfect accuracy of a deep learning retinal image analysis system for diagnosing plus disease in retinopathy of prematurity ROP Here we assess the screening potential of this scoring system by determining its ability to detect all components of ROP diagnosis METHODS Clinical examination and fundus photography were performed at seven participating centres A deep learning system was trained to detect plus disease generating a quantitative assessment of retinal vascular abnormality the i ROP plus score on a 1 9 scale Overall ROP disease category was established using a consensus reference standard diagnosis combining clinical and image based diagnosis Experts then ranked ordered a second data set of 100 posterior images according to overall ROP severity RESULTS 4861 examinations from 870 infants were analysed 155 examinations 3 had a reference standard diagnosis of type 1 ROP The i ROP deep learning DL vascular severity score had an area under the receiver operating curve of 0 960 for detecting type 1 ROP Establishing a threshold i ROP DL score of 3 conferred 94 sensitivity 79 specificity 13 positive predictive value and 99 7 negative predictive value for type 1 ROP There was strong correlation between expert rank ordering of overall ROP severity and the i ROP DL vascular severity score Spearman correlation coefficient 0 93 pUnder0 0001 CONCLUSION The i ROP DL system accurately identifies diagnostic categories and overall disease severity in an automated fashion after being trained only on posterior pole vascular morphology These data provide proof of concept that a deep learning screening platform could improve objectivity of ROP diagnosis and accessibility of screening
- ItemInterexpert agreement of plus disease diagnosis in retinopathy of prematurity.(2007-07-10) Chiang, Michael F; Jiang, Lei; Gelman, Rony; Du, Yunling E; Flynn, John TTo measure agreement of plus disease diagnosis among retinopathy of prematurity ROP experts
- ItemRetinal Telemedicine.(0000-00-00) Chee, Ru-Ik; Darwish, Dana; Fernandez-Vega, Alvaro; Patel, Samir; Jonas, Karyn; Ostmo, Susan; Campbell, J Peter; Chiang, Michael F; Chan, Rv PaulPurpose of Review An update and overview of the literature on current telemedicine applications in retina Recent Findings The application of telemedicine to the field of Ophthalmology and Retina has been growing with advancing technologies in ophthalmic imaging Retinal telemedicine has been most commonly applied to diabetic retinopathy and retinopathy of prematurity in adult and pediatric patients respectively Telemedicine has the potential to alleviate the growing demand for clinical evaluation of retinal diseases Subsequently automated image analysis and deep learning systems may facilitate efficient processing of large increasing numbers of images generated in telemedicine systems Telemedicine may additionally improve access to education and standardized training through tele education systems Summary Telemedicine has the potential to be utilized as a useful adjunct but not a complete replacement for physical clinical examinations Retinal telemedicine programs should be carefully and appropriately integrated into current clinical systems
- ItemRetinopathy of prematurity management using single-image vs multiple-image telemedicine examinations.(2008-07-28) Lajoie, Alexandra; Koreen, Susan; Wang, Lu; Kane, Steven A; Lee, Thomas C; Weissgold, David J; Berrocal, Audina M; Du, Yunling E; Coki, Osode; Flynn, John T; Starren, Justin; Chiang, Michael FTo compare performance of single image vs multiple image telemedicine examinations for retinopathy of prematurity ROP diagnosis
- ItemTelemedical diagnosis of retinopathy of prematurity intraphysician agreement between ophthalmoscopic examination and image-based interpretation.(2008-07-07) Scott, Karen E; Kim, David Y; Wang, Lu; Kane, Steven A; Coki, Osode; Starren, Justin; Flynn, John T; Chiang, Michael FTo evaluate the intraphysician agreement between ophthalmoscopic examination and image based telemedical interpretation for retinopathy of prematurity ROP diagnosis when performed by the same expert physician grader
- ItemTelemedical retinopathy of prematurity diagnosis: accuracy, reliability, and image quality.(2007-11-13) Chiang, Michael F; Wang, Lu; Busuioc, Mihai; Du, Yunling E; Chan, Patrick; Kane, Steven A; Lee, Thomas C; Weissgold, David J; Berrocal, Audina M; Coki, Osode; Flynn, John T; Starren, JustinTo prospectively measure accuracy reliability and image quality of telemedical retinopathy of prematurity ROP diagnosis