Application of artificial intelligence in cataract management: current and future directions.

The rise of artificial intelligence (AI) has brought breakthroughs in many areas of medicine. In ophthalmology, AI has delivered robust results in the screening and detection of diabetic retinopathy, age-related macular degeneration, glaucoma, and retinopathy of prematurity. Cataract management is another field that can benefit from greater AI application. Cataract  is the leading cause of reversible visual impairment with a rising global clinical burden. Improved diagnosis, monitoring, and surgical management are necessary to address this challenge. In addition, patients in large developing countries often suffer from limited access to tertiary care, a problem further exacerbated by the ongoing COVID-19 pandemic. AI on the other hand, can help transform cataract management by improving automation, efficacy and overcoming geographical barriers. First, AI can be applied as a telediagnostic platform to screen and diagnose patients with cataract using slit-lamp and fundus photographs. This utilizes a deep-learning, convolutional neural network (CNN) to detect and classify referable cataracts appropriately. Second, some of the latest intraocular lens formulas have used AI to enhance prediction accuracy, achieving superior postoperative refractive results compared to traditional formulas. Third, AI can be used to augment cataract surgical skill training by identifying different phases of cataract surgery on video and to optimize operating theater workflows by accurately predicting the duration of surgical procedures. Fourth, some AI CNN models are able to effectively predict the progression of posterior capsule opacification and eventual need for YAG laser capsulotomy. These advances in AI could transform cataract management and enable delivery of efficient ophthalmic services. The key challenges include ethical management of data, ensuring data security and privacy, demonstrating clinically acceptable performance, improving the generalizability of AI models across heterogeneous populations, and improving the trust of end-users.

Sleeping posture and intraocular pressure.

INTRODUCTION: This prospective observational case series aimed to determine whether the lateral decubitus position, which is commonly adopted during sleep, has an effect on intraocular pressure (IOP) in normal controls. METHODS: Patients without glaucoma were recruited from those visiting outpatient clinics for non-glaucomatous conditions. The left eye of each patient was included. IOP was first measured using Tono-Pen® XL applanation tonometer in the supine position, following which a second measurement was immediately obtained for the left lateral head position. Measurements were obtained with the patient lying on one soft and one hard pillow for each position, and patients remained awake during these measurements. One tonometry reading was obtained for each position. Readings were recorded only when the average of four independent readings produced a statistical confidence index of 5%. Results were analysed using the paired Student's t-test for comparison of the means. RESULTS: IOP in the left lateral decubitus position (17.48 ± 3.18 mmHg) was significantly higher than in the supine position (14.48 ± 3.09 mmHg) when using soft pillows (p < 0.001). When hard pillows were used, IOP in the left lateral decubitus position also exceeded that measured in the supine position (16.65 ± 3.54 mmHg vs. 13.65 ± 3.58 mmHg; p < 0.001). There was no statistically significant difference in the IOPs measured for the same position when different kinds of pillows were used. CONCLUSION: The lateral decubitus position adopted during sleep is associated with changes in IOP in healthy volunteers.

Nodular scleritis and Sweet's syndrome.

The authors report a case of nodular scleritis in Sweet's syndrome. The patient was a 40-year-old Malay woman with a history of Sweet's syndrome presented with a 6-day history of a red and painful right eye associated with blurred vision. Clinical examination revealed nodular scleritis of the right eye which was deemed secondary to Sweet's syndrome after investigations for other systemic diseases were negative. The patient demonstrated good response to systemic corticosteroid therapy with complete resolution of scleritis in the right eye. However, her inflammatory skin condition worsened each time the systemic corticosteroids were tapered so colchicine and dapsone were added to treat the dermatologic disease. Ocular manifestations are uncommon in Sweet's syndrome but it is important to diagnose and treat them. This will prevent ocular morbidity and ensure a good clinical outcome.