The BONSAI (Brain and Optic Nerve Study with Artificial Intelligence) deep learning system can accurately identify pediatric papilledema on standard ocular fundus photographs.

BACKGROUND: Pediatric papilledema often reflects an underlying severe neurologic disorder and may be difficult to appreciate, especially in young children. Ocular fundus photographs are easy to obtain even in young children and in nonophthalmology settings. The aim of our study was to ascertain whether an improved deep-learning system (DLS), previously validated in adults, can accurately identify papilledema and other optic disk abnormalities in children. METHODS: The DLS was tested on mydriatic fundus photographs obtained in a multiethnic pediatric population (<17 years) from three centers (Atlanta-USA; Bucharest-Romania; Singapore). The DLS's multiclass classification accuracy (ie, normal optic disk, papilledema, disks with other abnormality) was calculated, and the DLS's performance to specifically detect papilledema and normal disks was evaluated in a one-vs-rest strategy using the AUC, sensitivity and specificity, with reference to expert neuro-ophthalmologists. RESULTS: External testing was performed on 898 fundus photographs: 447 patients; mean age, 10.33 (231 patients ≤10 years of age; 216, 11-16 years); 558 normal disks, 254 papilledema, 86 other disk abnormalities. Overall multiclass accuracy of the DLS was 89.6% (range, 87.8%-91.6%). The DLS successfully distinguished "normal" from "abnormal" optic disks (AUC 0.99 [0.98-0.99]; sensitivity, 87.3% [84.9%-89.8%]; specificity, 98.5% [97.6%-99.6%]), and "papilledema" from "normal and other" (AUC 0.99 [0.98-1.0]; sensitivity, 98.0% [96.8%-99.4%]; specificity, 94.1% (92.4%-95.9%)]. CONCLUSIONS: Our DLS reliably distinguished papilledema from normal optic disks and other disk abnormalities in children, suggesting it could be utilized as a diagnostic aid for the assessment of optic nerve head appearance in the pediatric age group.

Age related strabismus.

Age related binocular vision disorders (age related strabismus) could include all types of spontaneous strabismus appearing along the lifetime, which are directly connected with the aging process. Neurological strabismus is excluded. Functional and structural changes related to the aging process can induce phoria decompensation, convergence insufficiency decompensation and new onset strabismus as distance esotropia or vertical strabismus induced by the sagging eye syndrome. MRI studies sustain the hypothesis of age related structural changes of extraocular muscles pulleys and their influence on the eye position and motility nominated as sagging eye. Age Related Distance Esotropia, Age Related Divergence Insufficiency Esotropia are probably different names for the same type of strabismus. All types of age related binocular disorders require treatment because of the accompanying diplopia. Prisms or/ and surgery can improve the patients' life quality by eliminating diplopia in primary position and main gazes.

[Therapeutic options in III. nerve paralysis]. / Optiuni terapeutice în paralizia de nerv III.

The treatment of ocular motility disorders, which occur in paralytic strabismus, presents a therapeutic challenge. The goal of treatment is to create an area of single binocular vision that is centered around the primary-gaze position. Careful analysis of the ocular motility deficit is crucial in selecting the appropriate surgical procedure. Paralytic strabismus is difficult to treat because of the incomitance of the deviation depending on the direction of gaze, respectively an increase of the deviation in the gaze with limited motility. Moreover, the possibility that horizontal and vertical components may be present, like in third nerve palsies, is another obstacle. Finally, in patients with long-stand paralysis, the ocular motility defect may have a restrictive component due to contracture of the antagonist muscle. Recognition of this phenomenon is important because any planned surgical procedure must deal with the induced restriction.