Female Ophthalmologists create innovation in research
8 March 2021
For International Women’s Day we have asked lead female writers who have contributed to Eye Journal this year to share how their work is creating innovation within the ophthalmic community.
Usha Chakravarthy’s paper on the Impact of macular fluid volume fluctuations on visual acuity during anti-VEGF therapy in eyes with nAMD exemplifies the biases that exist in the analysis of nAMD outcomes.
Traditionally data from groups of participants are analysed as a whole and at specific outcome points. This type of traditional approach can mask the detection of important associations. On classifying patients using the standard deviation of each patient’s fluctuations of retinal thickness over time into quartiles we were able to show that marked fluctuations in retinal thickness was detrimental to function compared to eyes that had lesser degrees of fluctuation and that the location of fluid had a dramatic impact on this measure.
She tells us that “This approach to understanding antiVEGF mediated nAMD treatment response is novel and has created much excitement in the retina community.”
Shruti’s study reported on the Ten-year outcomes of antivascular endothelial growth factor therapy in neovascular age-related macular degeneration in the real-world. Multiple randomized controlled trials have presented data on the outcomes of wAMD, however this study results are a true reflection of patient and health provider experience over 10 years.
“My study confirms that regular follow-ups even in routine clinical practice can lead to trial equivalent visual outcomes in wAMD, nonetheless in the long-term, natural history of the disease takes over and injection frequency does not have a direct impact on visual acuity.” said Shruti.
The study, Anti-retinal autoantibodies in myopic macular degeneration: a pilot study hypothesized that development of lacquer cracks may expose retinal antigens to the immune system. We evaluated the frequency and types of anti-retinal autoantibodies in highly myopic patients. We reported that the number of anti-retinal antibodies significantly correlated with increasing axial length. Anti-carbonic anhydrase II was more common in patients with severe myopic macular degeneration than those without.
“Choroidal ischemia and Bruch’ membrane hole formation have been suggested to contribute towards the development of myopic macular degeneration.
The demonstration of a significant association between anti-retinal autoantibodies and severe myopic macular degeneration suggests that autoimmunity mediated by autoantibodies may be another mechanism that contribute towards the development of patchy atrophy of the retinal pigment epithelium and macular atrophy in highly myopic eyes.” said Gemmy.
Caroline MacEwen’s paper on the Impact of stereoacuity on simulated cataract surgery ability measures the effect of stereoacuity on the surgical skills performance of novices on a simulator.
The implications of stereoacuity on ophthalmic surgical ability and how this might affect both recruitment to the specialty and patient safety has long been debated. This paper adds to this knowledge objectively by identifying a clear cut off point (stereoacuity of worse than 120 arcsec) where the surgical performance of subjects was statistically significantly poorer than those with better stereoacuity.
“The lack of evidence about the effects of stereoacuity on surgical performance has been a hot topic – which has been an issue regarding the recruitment of ophthalmology trainees – the findings of this work may help to formulate a policy on stereoacuity standards required to commence microsurgical training and has implications for patient safety.” Said Caroline.
Priyanka explored the question Do topical ocular antihypertensives affect Dacryocystorhinostomy outcomes: The Coventry experience. This study assessed the impact of topical ocular antihypertensive treatment on surgical outcomes following endoscopic and external dacryocystorhinostomy surgery. This work explores an entirely novel concept of nasal mucosal scarring by extrapolating data on conjunctival scarring in glaucoma patients on antihypertensive drops.
Priyanka told us that the team had “ found data which suggests that glaucoma patients are at a higher risk of endoscopic DCR failure – a concept not previously recognised – which may enable surgeons to further optimise their strategy and achieve even better results for their patients.”
The expanding burden of idiopathic intracranial hypertension examines routinely collected hospital data to explore a relatively rare brain condition that affects the eyes, called idiopathic intracranial hypertension (IIH). The data showed us that not only was IIH becoming much more common, but for the first time highlighted the social inequality in the disease. It also detailed some unexplained practices including high numbers of emergency admissions and repeat admissions to hospital following diagnosis.
Susan said ‘We used this ‘big data’ to evaluate how much these relatively hidden practices cost the NHS, and predicted by 2030 costs could be as high as £462 million per annum, if we as a community do nothing.
Through the first consensus guidelines in IIH we have brought together patients, neurologists, neurosurgeons, ophthalmologists and radiologists to agree guidelines for investigation pathways and management options to help reduce unnecessary hospital admissions.
A major risk factor for development of IIH is weight gain which can be socially stigmatising. We are working with weight management experts, patients and artists to challenge the image of the condition and obesity stigma in both professionals and patients.”
Automated diabetic retinopathy detection in smartphone-based fundus photography using artificial intelligence is the first published study of use of Artificial Intelligence (AI) based algorithms with smartphone based retinal colour photography images for Diabetic Retinopathy (DR) detection.
The analysis of Remidio Fundus on smartphone-based retinal images and EyeArt AI software showed a very high sensitivity of 95.8% for detection of DR of any level of severity (95.8%) and over 99% sensitivity for detection of referable DR as well as sight threatening DR.
The deployment of artificial intelligence (AI) in the detection of diabetic retinopathy is augmenting diagnostic fundus imaging, which may soon lead to real-time deployment in telemedicine screening programs across the globe. Recent studies done real time have shown the feasibility of use of an AI assisted automated detection system in the detection of DR
Ramachandran said “The key challenges in implementing large scale models of screening for DR in low and middle country like India is the large numbers of people with diabetes to be screened and the affordable retinal imaging systems and the real time deployment of AI in clinical practice for DR screening.
Robust AI-based automated DR screening along with cost-effective fundus cameras would help increase timely referral of people with sight threatening DR, and reduce the risk of visual impairment in people with diabetes.”
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