Cost-effectiveness and cost-utility of a digital technology-driven hierarchical healthcare screening pattern in China.

Utilization of digital technologies for cataract screening in primary care is a potential solution for addressing the dilemma between the growing aging population and unequally distributed resources. Here, we propose a digital technology-driven hierarchical screening (DH screening) pattern implemented in China to promote the equity and accessibility of healthcare. It consists of home-based mobile artificial intelligence (AI) screening, community-based AI diagnosis, and referral to hospitals. We utilize decision-analytic Markov models to evaluate the cost-effectiveness and cost-utility of different cataract screening strategies (no screening, telescreening, AI screening and DH screening). A simulated cohort of 100,000 individuals from age 50 is built through a total of 30 1-year Markov cycles. The primary outcomes are incremental cost-effectiveness ratio and incremental cost-utility ratio. The results show that DH screening dominates no screening, telescreening and AI screening in urban and rural China. Annual DH screening emerges as the most economically effective strategy with 341 (338 to 344) and 1326 (1312 to 1340) years of blindness avoided compared with telescreening, and 37 (35 to 39) and 140 (131 to 148) years compared with AI screening in urban and rural settings, respectively. The findings remain robust across all sensitivity analyses conducted. Here, we report that DH screening is cost-effective in urban and rural China, and the annual screening proves to be the most cost-effective option, providing an economic rationale for policymakers promoting public eye health in low- and middle-income countries.

Intraoperative OCT for the assessment of posterior capsular integrity in pediatric cataract surgery.

PURPOSE: To study the morphology of the posterior lens cortex and posterior capsules (PCs) in pediatric patients with posterior lens opacities using intraoperative optical coherence tomography (iOCT). SETTING: Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. DESIGN: Prospective observational study. METHODS: Pediatric patients with posterior lens opacities were imaged using iOCT during cataract surgery. The morphology of the posterior lens cortex and PC, along with the common patterns to indicate PC integrity, was assessed. Moreover, PC rent during surgery was observed. RESULTS: A total of 62 eyes from 53 patients were included. The mean age of patients was 3.8 years. 4 morphological variants of posterior lens opacity were observed: type I (34/62 [54.8%]) with an intact PC; type II (20/62 [32.3%]) with an intact PC, which protruded into the anterior vitreous; type III (3/62 [4.8%]) with a deficient PC and an inability to delineate the PC; and type IV (5/62 [8.1%]) with dense opacity and an inability to characterize the posterior cortex and PC. Phacoemulsification could be performed in types I and II. In types III and IV, manual nucleus removal was performed instead of phacoemulsification. 3 cases (100%) of type III PC dehiscence developed during surgery, whereas no cases developed PC dehiscence of other types. CONCLUSIONS: The morphology of the PC and posterior lens cortex in pediatric posterior lens opacities could be categorized, and PC integrity could be assessed using iOCT, which was useful to guide surgical strategies and increase safety in pre-existing PC dehiscence in pediatric cataract surgery.

Application of Surgical Decision Model for Patients With Childhood Cataract: A Study Based on Real World Data.

Reliable validated methods are necessary to verify the performance of diagnosis and therapy-assisted models in clinical practice. However, some validated results have research bias and may not reflect the results of real-world application. In addition, the conduct of clinical trials has executive risks for the indeterminate effectiveness of models and it is challenging to finish validated clinical trials of rare diseases. Real world data (RWD) can probably solve this problem. In our study, we collected RWD from 251 patients with a rare disease, childhood cataract (CC) and conducted a retrospective study to validate the CC surgical decision model. The consistency of the real surgical type and recommended surgical type was 94.16%. In the cataract extraction (CE) group, the model recommended the same surgical type for 84.48% of eyes, but the model advised conducting cataract extraction and primary intraocular lens implantation (CE + IOL) surgery in 15.52% of eyes, which was different from the real-world choices. In the CE + IOL group, the model recommended the same surgical type for 100% of eyes. The real-recommended matched rates were 94.22% in the eyes of bilateral patients and 90.38% in the eyes of unilateral patients. Our study is the first to apply RWD to complete a retrospective study evaluating a clinical model, and the results indicate the availability and feasibility of applying RWD in model validation and serve guidance for intelligent model evaluation for rare diseases.

Implementation of artificial intelligence in medicine: Status analysis and development suggestions.

The general public's attitudes, demands, and expectations regarding medical AI could provide guidance for the future development of medical AI to satisfy the increasing needs of doctors and patients. The objective of this study is to investigate public perceptions, receptivity, and demands regarding the implementation of medical AI. An online questionnaire was designed to investigate the perceptions, receptivity, and demands of general public regarding medical AI between October 13 and October 30, 2018. The distributions of the current achievements, public perceptions, receptivity, and demands among individuals in different lines of work (i.e., healthcare vs non-healthcare) and different age groups were assessed by performing descriptive statistics. The factors associated with public receptivity of medical AI were assessed using a linear regression model. In total, 2,780 participants from 22 provinces were enrolled. Healthcare workers accounted for 54.3 % of all participants. There was no significant difference between the healthcare workers and non-healthcare workers in the high proportion (99 %) of participants expressing acceptance of AI (p = 0.8568), but remarkable distributional differences were observed in demands (p < 0.001 for both demands for AI assistance and the desire for AI improvements) and perceptions (p < 0.001 for safety, validity, trust, and expectations). High levels of receptivity (approximately 100 %), demands (approximately 80 %), and expectations (100 %) were expressed among different age groups. The receptivity of medical AI among the non-healthcare workers was associated with gender, educational qualifications, and demands and perceptions of AI. There was a very large gap between current availability of and public demands for intelligence services (p < 0.001). More than 90 % of healthcare workers expressed a willingness to devote time to learning about AI and participating in AI research. The public exhibits a high level of receptivity regarding the implementation of medical AI. To date, the achievements have been rewarding, and further advancements are required to satisfy public demands. There is a strong demand for intelligent assistance in many medical areas, including imaging and pathology departments, outpatient services, and surgery. More contributions are imperative to facilitate integrated and advantageous implementation in medical AI.

Assessment of Tear Film Optical Quality Dynamics.

PURPOSE: To investigate tear film optical quality dynamics by analyzing the postblink temporal changes of objective scatter index (OSI). METHODS: A total of 109 myopic subjects without symptoms of dry eye and 32 myopic subjects diagnosed with dry eye disease were recruited in this cross-sectional study. The right eye for each subject was analyzed. Serial measurements of OSI were performed for 20 seconds in the interval of 0.5 second using a double-pass instrument, and 10 successive seconds of nonblinking immediately after a blink was selected to analyze the tear film optical quality dynamics. The tear breakup time (TBUT) was also measured. The mean OSI in 10 successive seconds and the correlation coefficient between OSI and time were analyzed. RESULTS: For subjects without symptoms of dry eye, 109 eyes were divided into two categories based on the correlation coefficient between OSI and time: category A (without positive correlation) and category B (with positive correlation). Categories A and B were further divided into four categories based on the mean OSI for 10 seconds: category A1 (36.7%, lower than 1.00); category A2 (33.0%, equal to or greater than 1.00); category B1 (13.8%, lower than 1.00), and category B2 (16.5%, equal to or greater than 1.00). Dry eye subjects were set as category C for comparison. There was no significant difference in the TBUT among the five categories (A1, A2, B1, B2, C) except between category C and category A1 (P < 0.01) and category C and category A2 (P < 0.05). CONCLUSIONS: Dynamic changes of OSI after blinking showed variations even in clinically asymptomatic subjects, and four categories of tear film were proposed based on the optical quality dynamics. The procedure using serial measurements of OSI as a noninvasive and objective method may have potential applications for detecting preclinical phase of dry eye disease in asymptomatic subjects.

Patient participation in free cataract surgery: a cross-sectional study of the low-income elderly in urban China.

OBJECTIVES: To explore the characteristics of the low-income elderly who underwent free cataract surgery and to determine the degree of patient satisfaction with the free cataract surgery programme in urban China. METHODS: A free cataract surgery management workflow was designed as a poverty relief project in Guangzhou. In this study, participants who underwent free cataract surgery between January and August 2014 received a telephone interview based on a structured questionnaire. Data were collected on patient demographics, resources, health conditions, reasons for undergoing the free surgery and overall evaluation of the free cataract surgery programme. RESULTS: Among the 833 participants, the mean surgical age was 76.85±7.46 years (95% CI 76.34 to 77.36), and the male to female ratio was 385:448. The majority (94.31%, 746/791) of patients resided in the main urban districts. Patients underwent surgery 61.08±60.15 months (95% CI 56.17 to 66.00) after becoming aware of the cataract, although 66.83% of them reported that their daily lives were influenced by cataracts. Only 21.5% of the respondents underwent physical examinations that included regular eye screening, and only 6.30% were highly educated patients. Financial problems were the primary reason cited by patients for participating in the free surgery programme. Those patients with a monthly family income of 1000-2999¥ (US$161-482) per capita constituted the largest patient population. The free clinics in the parks and the free cataract surgery were highly rated (9.46 and 9.11 of 10 points) by the beneficiaries. CONCLUSIONS: The telephone survey revealed a high level of patient satisfaction regarding the free cataract surgery programme. Most of the patients who participated in the programme resided in major urban districts and had poor health awareness and a low level of education. The information provided by this study is crucial for improving and expanding the management of free cataract surgery programmes. TRIAL REGISTRATION NUMBER: NCT02633865; Post-results.