Sophia Y. Wang

John Xiang, Rohith Ravindranath, Sophia Y. Wang

We evaluated whether a glaucoma risk assessment (GRA) model trained on All of Us national data can identify patients at high probability of glaucoma using only systemic electronic health records (EHR) at an independent institution. In this cross-sectional study, 20,636 Stanford patients seen from November 2013 to January 2024 were included (15% with glaucoma). A pretrained GRA model was fine-tuned on the Stanford cohort and tested on a held-out set using demographics, systemic diagnoses, medications, laboratory results, and physical examination measurements as inputs. The best model achieved AUROC 0.883 and PPV 0.657. Calibration was consistent with clinical risk: the highest prediction decile showed the greatest glaucoma diagnosis rate (65.7%) and treatment rate (57.0%). Performance improved with more trainable layers up to 15 and with additional data. An EHR-only GRA model may enable scalable and accessible pre-screening without specialized imaging.

Iyad Majid, Youchen Victor Zhang, Robert Chang et al.

Purpose: The purpose of this study was to develop and evaluate rule-based algorithms to enhance the extraction of text data, including retinal nerve fiber layer (RNFL) values and other ganglion cell count (GCC) data, from Zeiss Cirrus optical coherence tomography (OCT) scan reports. Methods: DICOM files that contained encapsulated PDF reports with RNFL or Ganglion Cell in their document titles were identified from a clinical imaging repository at a single academic ophthalmic center. PDF reports were then converted into image files and processed using the PaddleOCR Python package for optical character recognition. Rule-based algorithms were designed and iteratively optimized for improved performance in extracting RNFL and GCC data. Evaluation of the algorithms was conducted through manual review of a set of RNFL and GCC reports. Results: The developed algorithms demonstrated high precision in extracting data from both RNFL and GCC scans. Precision was slightly better for the right eye in RNFL extraction (OD: 0.9803 vs. OS: 0.9046), and for the left eye in GCC extraction (OD: 0.9567 vs. OS: 0.9677). Some values presented more challenges in extraction, particularly clock hours 5 and 6 for RNFL thickness, and signal strength for GCC. Conclusions: A customized optical character recognition algorithm can identify numeric results from optical coherence scan reports with high precision. Automated processing of PDF reports can greatly reduce the time to extract OCT results on a large scale.

Meng Wang, Tian Lin, Aidi Lin et al.

Previous foundation models for fundus images were pre-trained with limited disease categories and knowledge base. Here we introduce a knowledge-rich vision-language model (RetiZero) that leverages knowledge from more than 400 fundus diseases. For RetiZero's pretraining, we compiled 341,896 fundus images paired with texts, sourced from public datasets, ophthalmic literature, and online resources, encompassing a diverse range of diseases across multiple ethnicities and countries. RetiZero exhibits remarkable performance in several downstream tasks, including zero-shot disease recognition, image-to-image retrieval, AI-assisted clinical diagnosis,few-shot fine-tuning, and internal- and cross-domain disease identification. In zero-shot scenarios, RetiZero achieves Top-5 accuracies of 0.843 for 15 diseases and 0.756 for 52 diseases. For image retrieval, it achieves Top-5 scores of 0.950 and 0.886 for the same sets, respectively. AI-assisted clinical diagnosis results show that RetiZero's Top-3 zero-shot performance surpasses the average of 19 ophthalmologists from Singapore, China, and the United States. RetiZero substantially enhances clinicians' accuracy in diagnosing fundus diseases, in particularly rare ones. These findings underscore the value of integrating the RetiZero into clinical settings, where various fundus diseases are encountered.