Primary angle closure disease (PACD) is a leading cause of permanent vision loss worldwide, so early treatment of patients suffering from symptoms of PACD is crucial to prevent vision loss. Gonioscopy is the current clinical standard for diagnosing PACD. However, gonioscopy is a qualitative subjective assessment method. Thus, there is a need for a quantitative method to diagnose PACD. Anterior Segment Optical Coherence Tomography (AS-OCT) is an imaging modality which produces images of anterior structures such as the anterior chamber angle. Adoption of AS-OCT has been slow due to AS-OCT analysis not being standardized and inefficient. Currently, users must annotate each image by hand using proprietary software and use expert knowledge to diagnose PACD based on the key features annotated. Using an imaging-informatics based approach on a dataset of over 900 images we have developed a system to streamline and standardize AS-OCT analysis. This system will be DICOM compatible to promote standardization of AS-OCT images. This system will be attached to a HIPAA compliant database and will require a secure login to protect patient privacy. We have developed a streamlined approach towards annotating key features in AS-OCT images which will be used to validate the results of an automatic segmentation method. The automatic segmentation method will be integrated into the system to increase the efficiency of analyzing AS-OCT images and eliminate the need to annotate images for clinical diagnosis. These features will be used in the future to classify PACD based on the severity of the angle closure.
In this paper, we present the previous development and deployment of Fundus Analysis Software Tool (FAST) to enable the analysis of different anatomical features and pathologies within fundus images over time, and demonstrate its usefulness with three use cases. First, we utilized FAST to acquire 616 fundus images from a remote clinic in a HIPAAcompliant manner. An ophthalmologist at the clinic then used FAST to annotate 190 fundus images containing exudates at the pixelwise level in a time-efficient manner. In comparison with publicly available datasets, our dataset constitutes the largest pixelwise-labeled collection of images and the first exudate segmentation dataset with eye-matched pairs of images for a given patient. Second, we developed an optic disk CAD segmentation algorithm, where our algorithm achieved a mean intersection over union of 0.930, comparable to the disagreement between ophthalmologist annotations. We deployed this algorithm into FAST, where it segments and flushes the segmentation onto the computer screen while simultaneously filling out specified optic disk fields of a DICOM-SR report on the fundus image. Third, we integrated our software with the open-source EHR framework OpenMRS, where our software can upload both automatic and manual analyses of the fundus to a remote server using HL7 FHIR standard then retrieve historical reports for a patient chronologically. Finally, we discuss our design decisions in developing FAST, particularly those relating to its treatment of DICOM-SR reports based on fundus images and its usage of the FHIR standard and its next steps towards enabling effective analyses of fundus images.
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