Publications by authors named "Dennis S C Lam"

471 Publications

Development and clinical deployment of a smartphone-based visual field deep learning system for glaucoma detection.

NPJ Digit Med 2020 Sep 22;3(1):123. Epub 2020 Sep 22.

Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, People's Republic of China.

By 2040, ~100 million people will have glaucoma. To date, there are a lack of high-efficiency glaucoma diagnostic tools based on visual fields (VFs). Herein, we develop and evaluate the performance of 'iGlaucoma', a smartphone application-based deep learning system (DLS) in detecting glaucomatous VF changes. A total of 1,614,808 data points of 10,784 VFs (5542 patients) from seven centers in China were included in this study, divided over two phases. In Phase I, 1,581,060 data points from 10,135 VFs of 5105 patients were included to train (8424 VFs), validate (598 VFs) and test (3 independent test sets-200, 406, 507 samples) the diagnostic performance of the DLS. In Phase II, using the same DLS, iGlaucoma cloud-based application further tested on 33,748 data points from 649 VFs of 437 patients from three glaucoma clinics. With reference to three experienced expert glaucomatologists, the diagnostic performance (area under curve [AUC], sensitivity and specificity) of the DLS and six ophthalmologists were evaluated in detecting glaucoma. In Phase I, the DLS outperformed all six ophthalmologists in the three test sets (AUC of 0.834-0.877, with a sensitivity of 0.831-0.922 and a specificity of 0.676-0.709). In Phase II, iGlaucoma had 0.99 accuracy in recognizing different patterns in pattern deviation probability plots region, with corresponding AUC, sensitivity and specificity of 0.966 (0.953-0.979), 0.954 (0.930-0.977), and 0.873 (0.838-0.908), respectively. The 'iGlaucoma' is a clinically effective glaucoma diagnostic tool to detect glaucoma from humphrey VFs, although the target population will need to be carefully identified with glaucoma expertise input.
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http://dx.doi.org/10.1038/s41746-020-00329-9DOI Listing
September 2020

Challenges in Eye Care in the Asia-Pacific Region.

Asia Pac J Ophthalmol (Phila) 2021 Sep 8. Epub 2021 Sep 8.

Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, China Beijing Ophthalmology and Visual Sciences Key Laboratory, China Beijing Tongren Hospital, Capital Medical University, Beijing, China Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, Guangdong, China C-MER International Eye Research Center of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China.

The Asia-Pacific region is home to a 4.3-billion population and one of the most rapidly aging regions. Addressing the eye care needs in the region would greatly boost the progress toward achieving universal eye health. Over 20 countries/regions have actively engaged in the "VISION 2020" initiative launched since 1999, and remarkable achievements have been witnessed as demonstrated by an increase in both the number and density of ophthalmologists in almost all countries. Nevertheless, formidable and emerging challenges are to be overcome in the coming century. From 1990 to 2015, the absolute number of blind people increased by 17.9%, largely due to population growth and aging. The Asia-Pacific region, the most populous continent with a rapidly aging population, would inevitably be left to tackle this challenge. Furthermore, a high prevalence of blinding eye diseases imposes great pressure on current eye care services, with South Asia having the highest age-standardized prevalence of moderate to severe visual impairment (17.5%) and mild vision impairment (12.2%) globally, and high-income countries having the highest overall prevalence of myopia, reaching 53.4% with East Asia having the second-highest overall prevalence (51.6%). Moreover, the availability of ophthalmic resources varies greatly in the region, with the density of ophthalmologists ranging from over 114 ophthalmologists per million population in Japan to 0 in Micronesia, and a highly disproportionate urban-rural distribution. This article aims to shed light on challenges faced by the Asia-Pacific ophthalmic community and propose corresponding strategies to tackle those challenges.
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http://dx.doi.org/10.1097/APO.0000000000000391DOI Listing
September 2021

A Model to Achieve International Excellence in Ophthalmology Through a Multidisciplinary and Integrated Approach: An Example in Orbital Diseases Research and Surgery.

Asia Pac J Ophthalmol (Phila) 2021 Aug 27. Epub 2021 Aug 27.

C-MER International Eye Research Center of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, Guangdong, China Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karis-University, Mannheim, Germany.

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http://dx.doi.org/10.1097/APO.0000000000000434DOI Listing
August 2021

Laser-Induced Chorioretinal Anastomosis Can Be an Effective Permanent Treatment for Central Retinal Vein Occlusion.

Asia Pac J Ophthalmol (Phila) 2021 May-Jun 01;10(3):339-340

International Eye Research Institute of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China.

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http://dx.doi.org/10.1097/APO.0000000000000411DOI Listing
August 2021

Risk of SARS-CoV-2 Transmission via Corneal Transplant From Donors With COVID-19.

JAMA Ophthalmol 2021 08;139(8):922-923

The C-MER International Eye Research Center of the Chinese University of Hong Kong, Shenzhen, Shenzhen, China.

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http://dx.doi.org/10.1001/jamaophthalmol.2021.2148DOI Listing
August 2021

Making the Impossible Possible - Insights From the Eye Hospital of the Wenzhou Medical University.

Asia Pac J Ophthalmol (Phila) 2021 Mar 23;10(2):133-134. Epub 2021 Mar 23.

C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, Guangdong, China.

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http://dx.doi.org/10.1097/APO.0000000000000387DOI Listing
March 2021

Aerobic exercise reduces intraocular pressure and expands Schlemm's canal dimensions in healthy and primary open-angle glaucoma eyes.

Indian J Ophthalmol 2021 05;69(5):1127-1134

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

Purpose: Aerobic exercise (AE) has been reported to decrease intraocular pressure (IOP) in healthy subjects and there are concomitant morphological changes in the anterior segment of the eye including the Schlemm's canal (SC). However, its effects on IOP and SC morphology in glaucoma patients had not been studied before. We aim to investigate the effect of AE on the IOP and SC dimension in both healthy and primary open-angle glaucoma (POAG) eyes.

Methods: The area and diameter of SC and IOP were measured in 35 primary open-angle glaucoma (POAG) patients (59 eyes) and 36 healthy subjects (72 eyes) before and after performing moderate intensity of AE by running on a treadmill for 30 min. SC was imaged by swept-source optical coherence tomography (SS-OCT) for evaluation.

Results: In comparison with baseline values, mean IOP decreased significantly following AE in both POAG and healthy eyes (both P < 0.001), in which POAG eyes showed a greater degree of reduction compared to healthy eyes (P = 0.002). In comparison with baseline values, in both POAG and healthy eyes, the average cross-sectional area (POAG: 80.48 +/- 59.54 vs. 99.20 +/- 54.87 pixels; healthy: 151.84 +/- 52.76 vs. 198.23 +/- 53.70 pixels; both P < 0.001) and diameter (POAG: 3.73 +/- 1.69 vs. 4.33 +/- 1.74 pixels; healthy: 5.61 +/- 1.02 vs. 6.47 +/- 1.20 pixels; both P < 0.001) of SC significantly increased after AE. In POAG, both treated and untreated with IOP-lowering medications, a significant reduction in mean IOP and increase in SC dimensions following AE were observed (all P < 0.05), and there were no significant differences of such measurements between the two subgroups (all P > 0.05).

Conclusion: AE-induced reduction in IOP and an increase in SC dimensions in POAG eyes as in healthy eyes. Further studies to evaluate the long-term effect of AE on IOP control and SC morphology in POAG seem warranted.
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http://dx.doi.org/10.4103/ijo.IJO_2858_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8186587PMC
May 2021

Conjunctival Findings in Patients With Coronavirus Disease 2019.

JAMA Ophthalmol 2021 02;139(2):254-255

C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong.

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http://dx.doi.org/10.1001/jamaophthalmol.2020.5819DOI Listing
February 2021

Options and results in managing suction loss during small-incision lenticule extraction.

J Cataract Refract Surg 2021 Jul;47(7):933-941

From the Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong (Wan, Lam); Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong (Lin); C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong (Lai, Liu, Lam); International Eye Research Institute of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China (Lam); C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, China (Lam).

Suction loss is an intraoperative complication in small-incision lenticule extraction (SMILE) that presents a management challenge for the refractive surgeon. The purpose of this review is to evaluate the visual, refractive, and wavefront outcomes after suction loss across the different stages of SMILE with various respective surgical treatments. Surgical management options include immediate re-SMILE by redocking or delayed re-SMILE, with or without adjustment of the laser parameters, conversion to femtosecond laser in situ keratomileusis, transepithelial photorefractive keratectomy, refractive lenticule extraction, or pseudo-SMILE. The restart treatment module on VisuMax provides appropriate retreatment recommendation. Most retreatment options for suction loss, immediate or delayed, resulted in effective, safe, and predictable outcomes, and patients were satisfied with their outcomes. Based on available level II evidence, immediate re-SMILE with or without adjustment to the laser settings achieve favorable visual and refractive outcomes in handling this intraoperative complication across all stages of SMILE.
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http://dx.doi.org/10.1097/j.jcrs.0000000000000546DOI Listing
July 2021

Development and clinical deployment of a smartphone-based visual field deep learning system for glaucoma detection.

NPJ Digit Med 2020 22;3:123. Epub 2020 Sep 22.

Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, People's Republic of China.

By 2040, ~100 million people will have glaucoma. To date, there are a lack of high-efficiency glaucoma diagnostic tools based on visual fields (VFs). Herein, we develop and evaluate the performance of 'iGlaucoma', a smartphone application-based deep learning system (DLS) in detecting glaucomatous VF changes. A total of 1,614,808 data points of 10,784 VFs (5542 patients) from seven centers in China were included in this study, divided over two phases. In Phase I, 1,581,060 data points from 10,135 VFs of 5105 patients were included to train (8424 VFs), validate (598 VFs) and test (3 independent test sets-200, 406, 507 samples) the diagnostic performance of the DLS. In Phase II, using the same DLS, iGlaucoma cloud-based application further tested on 33,748 data points from 649 VFs of 437 patients from three glaucoma clinics. With reference to three experienced expert glaucomatologists, the diagnostic performance (area under curve [AUC], sensitivity and specificity) of the DLS and six ophthalmologists were evaluated in detecting glaucoma. In Phase I, the DLS outperformed all six ophthalmologists in the three test sets (AUC of 0.834-0.877, with a sensitivity of 0.831-0.922 and a specificity of 0.676-0.709). In Phase II, iGlaucoma had 0.99 accuracy in recognizing different patterns in pattern deviation probability plots region, with corresponding AUC, sensitivity and specificity of 0.966 (0.953-0.979), 0.954 (0.930-0.977), and 0.873 (0.838-0.908), respectively. The 'iGlaucoma' is a clinically effective glaucoma diagnostic tool to detect glaucoma from humphrey VFs, although the target population will need to be carefully identified with glaucoma expertise input.
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http://dx.doi.org/10.1038/s41746-020-00329-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7508974PMC
September 2020

Digital technology, tele-medicine and artificial intelligence in ophthalmology: A global perspective.

Prog Retin Eye Res 2021 05 6;82:100900. Epub 2020 Sep 6.

Singapore National Eye Center, Duke-NUS Medical School Singapore, Singapore. Electronic address:

The simultaneous maturation of multiple digital and telecommunications technologies in 2020 has created an unprecedented opportunity for ophthalmology to adapt to new models of care using tele-health supported by digital innovations. These digital innovations include artificial intelligence (AI), 5th generation (5G) telecommunication networks and the Internet of Things (IoT), creating an inter-dependent ecosystem offering opportunities to develop new models of eye care addressing the challenges of COVID-19 and beyond. Ophthalmology has thrived in some of these areas partly due to its many image-based investigations. Tele-health and AI provide synchronous solutions to challenges facing ophthalmologists and healthcare providers worldwide. This article reviews how countries across the world have utilised these digital innovations to tackle diabetic retinopathy, retinopathy of prematurity, age-related macular degeneration, glaucoma, refractive error correction, cataract and other anterior segment disorders. The review summarises the digital strategies that countries are developing and discusses technologies that may increasingly enter the clinical workflow and processes of ophthalmologists. Furthermore as countries around the world have initiated a series of escalating containment and mitigation measures during the COVID-19 pandemic, the delivery of eye care services globally has been significantly impacted. As ophthalmic services adapt and form a "new normal", the rapid adoption of some of telehealth and digital innovation during the pandemic is also discussed. Finally, challenges for validation and clinical implementation are considered, as well as recommendations on future directions.
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http://dx.doi.org/10.1016/j.preteyeres.2020.100900DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7474840PMC
May 2021

Death tolls of COVID-19: Where come the fallacies and ways to make them more accurate.

Glob Public Health 2020 10 13;15(10):1582-1587. Epub 2020 Aug 13.

Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.

The death toll of the coronavirus disease 2019 (COVID-19) sparked much controversy since its advent in December 2019. Underestimation because of under testing and deaths happening outside the hospitals were important causes. Bold revisions of the diagnostic criteria leading to dramatic changes in death tolls by different governments were observed in attempts to generate more accurate estimates. On the other hand, the influence, censorship and manipulation on case and death data from top political leaders of some countries could create important impacts on the death toll. Baseline mortality data of previous years may help make more accurate estimates of the actual death toll. The pitfalls and strategies during such processes could become valuable lessons to leaders and policymakers worldwide as more accurate statistics serve to navigate policies to combat this pandemic in the days and months to come.
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http://dx.doi.org/10.1080/17441692.2020.1808040DOI Listing
October 2020

Re: Chloroquine (CQ) and Hydroxychloroquine (HQ) Retinal Toxicity Consideration in the Treatment of the Coronavirus Disease 2019 (COVID-19).

Asia Pac J Ophthalmol (Phila) 2020 Jul-Aug;9(4):375-376

International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), Shenzhen, China.

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http://dx.doi.org/10.1097/APO.0000000000000316DOI Listing
August 2020

Impact of COVID-19 on Ophthalmology and Future Practice of Medicine.

Asia Pac J Ophthalmol (Phila) 2020 Jul-Aug;9(4):279-280

C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong.

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http://dx.doi.org/10.1097/APO.0000000000000305DOI Listing
August 2020

COVID-19: Ocular Manifestations and the APAO Prevention Guidelines for Ophthalmic Practices.

Asia Pac J Ophthalmol (Phila) 2020 Jul-Aug;9(4):281-284

Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.

The World Health Organization declared the Coronavirus Disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 a "Pandemic" on March 11, 2020. As of June 1, 2020, Severe Acute Respiratory Syndrome Coronavirus 2 has infected >6.2 million people and caused >372,000 deaths, including many health care personnel. It is highly infectious and ophthalmologists are at a higher risk of the infection due to a number of reasons including the proximity between doctors and patients during ocular examinations, microaerosols generated by the noncontact tonometer, tears as a potential source of infection, and some COVID-19 cases present with conjunctivitis. This article describes the ocular manifestations of COVID-19 and the APAO guidelines in mitigating the risks of contracting and/or spreading COVID-19 in ophthalmic practices.
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http://dx.doi.org/10.1097/APO.0000000000000308DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7480794PMC
August 2020

Chloroquine and Hydroxychloroquine Retinal Toxicity Consideration in the Treatment of COVID-19.

Asia Pac J Ophthalmol (Phila) 2020 Mar-Apr;9(2):85-87

International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), Shenzhen, China.

The proposed doses of chloroquine (CQ) and hydroxychloroquine (HCQ) for treatment of COVID-19 (1000 mg/day for 10 days, CQ; 800 mg first day then 400 mg/day for 5 days, HCQ) in many guidelines worldwide, are considerably higher than the maximum recommended daily safe doses of both agents (≤2.3 mg/kg/day, CQ; ≤5.0 mg/kg/day, HCQ) for development of retinal toxicity. Irreversible retinal damage can occur if the exposure to the safe doses is >5 years. It is not known whether exposure to high doses over a short period of time can also cause the damage. We recommend that before prescribing CQ or HCQ, history of ocular disease should be obtained to avoid the prescription if appropriate. If either agent is to be used, routine baseline ocular examination is not absolutely necessary. Patients who do not have ocular disease should also be informed about the potential risk of retinal toxicity. Both agents, however, have not yet been proven to be beneficial to COVID-19.
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http://dx.doi.org/10.1097/APO.0000000000000289DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7227199PMC
May 2020

COVID-19: Special Precautions in Ophthalmic Practice and FAQs on Personal Protection and Mask Selection.

Asia Pac J Ophthalmol (Phila) 2020 Mar-Apr;9(2):67-77

Retina Center of Ohio, Cleveland, OH, USA.

The Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory coronavirus-2, was first reported in December 2019. The World Health Organization declared COVID-19 a pandemic on March 11, 2020 and as of April 17, 2020, 210 countries are affected with >2,000,000 infected and 140,000 deaths. The estimated case fatality rate is around 6.7%. We need to step up our infection control measures immediately or else it may be too late to contain or control the spread of COVID-19. In case of local outbreaks, the risk of infection to healthcare workers and patients is high. Ophthalmic practice carries some unique risks and therefore high vigilance and special precautions are needed. We share our protocols and experiences in the prevention of infection in the current COVID-19 outbreak and the previous severe acute respiratory syndrome epidemic in Hong Kong. We also endeavor to answer the key frequently asked questions in areas of the coronaviruses, COVID-19, disease transmission, personal protection, mask selection, and special measures in ophthalmic practices. COVID-19 is highly infectious and could be life-threatening. Using our protocol and measures, we have achieved zero infection in our ophthalmic practices in Hong Kong and China. Preventing spread of COVID-19 is possible and achievable.
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http://dx.doi.org/10.1097/APO.0000000000000280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7227209PMC
May 2020

COVID-19 Pandemic: Ways Forward.

Asia Pac J Ophthalmol (Phila) 2020 Mar-Apr;9(2):59-60

C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong.

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http://dx.doi.org/10.1097/APO.0000000000000283DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7227197PMC
May 2020

Diagnostic Accuracy of Rapid Assessment of Avoidable Blindness: A Population-based Assessment.

Am J Ophthalmol 2020 05 14;213:235-243. Epub 2019 Dec 14.

Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China; State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, China; Project Vision Charitable Foundation, Hong Kong, China. Electronic address:

Objectives: To evaluate the diagnostic accuracy of rapid assessment of avoidable blindness (RAAB).

Design: Population-based diagnostic accuracy study.

Methods: A total of 2145 (95.3%, 2145/2250) subjects aged 50 years and older who participated in the RAAB survey were included. All the recruited participants underwent ophthalmic examination according to the RAAB protocol and then were reexamined with instruments in a mobile eye clinic set up in a village center on the same day. Examination in the mobile clinic included standardized visual acuity (VA) tests using logMAR charts, refraction, slit-lamp biomicroscopy, and dilated fundal examination with a binocular indirect ophthalmoscope. Blindness and economic blindness were defined as VA in the better-seeing eye <3/60 and <6/60, respectively. Visual impairment (VI) was defined as VA <6/18 in the better eye. The primary cause of blindness and VI was defined according to the cause of VI in the participant's better eye.

Main Outcome Measures: The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and area under the curve (AUC) of receiver operating characteristics of RAAB for detection of blindness and the principal causes of VI.

Results: A total of 1816 subjects (84.7%), including 686 men (37.8%) and 1130 women (62.2%), underwent ophthalmic examination in the mobile eye clinic. The mean (±standard deviation) age was 64.4 ± 9.6 years. The sensitivities, specificities, AUC, PLR, and NLR of RAAB were 90.3%, 99.3%, 0.948, 124.0, and 0.10, respectively, for detection of blindness (presenting visual acuity, PVA <3/60); 89.5%, 98.7%, 0.940, 69.2, and 0.11, respectively, for detection of economic blindness (PVA <6/60); and 90.3%, 97.7%, 0.940, 38.7, and 0.10, respectively, for detection of VI (PVA <6/18). The sensitivities, specificities, AUC, PLR, and NLR were 90.5%, 98.1%, 0.943, 48.1, and 0.10; and 60.4%, 98.7%, 0.796, 46.4, and 0.40 for detection of VI (PVA <6/18) owing to cataract and refractive error, respectively.

Conclusion: The diagnostic performances of RAAB were high for detecting the prevalence of blindness, VI, and VI owing to cataract.
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http://dx.doi.org/10.1016/j.ajo.2019.12.009DOI Listing
May 2020

Normal Pressure Glaucoma: The Challenge in Asia and the Scientific Contributions from Asia.

Asia Pac J Ophthalmol (Phila) 2019 Nov-Dec;8(6):419-421

Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY.

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http://dx.doi.org/10.1097/01.APO.0000605104.33282.14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6903333PMC
March 2020

Will SMILE Become the New Benchmark of Corneal Laser Refractive Surgery?

Asia Pac J Ophthalmol (Phila) 2019 Sep-Oct;8(5):351-354

International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), Shenzhen, P.R. China.

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http://dx.doi.org/10.1097/01.APO.0000579956.14784.91DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6784770PMC
January 2020

Review on Centration, Astigmatic Axis Alignment, Pupil Size and Optical Zone in SMILE.

Asia Pac J Ophthalmol (Phila) 2019 Sep-Oct;8(5):385-390

International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), Shenzhen, China.

The advent of "flapless" small-incision lenticule extraction (SMILE), employing all-in-one technology, has resulted in a revolutionary breakthrough in refractive surgeries. SMILE has been gaining popularity due to fewer potential complications, such as postoperative dry eyes and greater biomechanical stability, etc. However, attention must be given to 1) the centration on the corneal vertex, 2) the proper alignment of the astigmatic axis, and 3) the relationship between pupil size and treatment diameter, to achieve good SMILE results. There is no pupil-tracking system to ascertain the accuracy of centration during the SMILE surgery. To improve the centration accuracy, our center uses two corneal topographers (Pentacam and Sirius) to measure and determine corneal vertex. Proper predicted optical zone diameter is not clearly defined yet in SMILE. Some scholars insist that mesopic pupil size should be taken into consideration when setting the predicted optical zone. Meanwhile, the issue of "functional optical zone" still has many unresolved issues and warrants further studies.
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http://dx.doi.org/10.1097/01.APO.0000580144.22353.46DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6784779PMC
January 2020

Automatic differentiation of Glaucoma visual field from non-glaucoma visual filed using deep convolutional neural network.

BMC Med Imaging 2018 10 4;18(1):35. Epub 2018 Oct 4.

Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China.

Background: To develop a deep neural network able to differentiate glaucoma from non-glaucoma visual fields based on visual filed (VF) test results, we collected VF tests from 3 different ophthalmic centers in mainland China.

Methods: Visual fields obtained by both Humphrey 30-2 and 24-2 tests were collected. Reliability criteria were established as fixation losses less than 2/13, false positive and false negative rates of less than 15%.

Results: We split a total of 4012 PD images from 1352 patients into two sets, 3712 for training and another 300 for validation. There is no significant difference between left to right ratio (P = 0.6211), while age (P = 0.0022), VFI (P = 0.0001), MD (P = 0.0039) and PSD (P = 0.0001) exhibited obvious statistical differences. On the validation set of 300 VFs, CNN achieves the accuracy of 0.876, while the specificity and sensitivity are 0.826 and 0.932, respectively. For ophthalmologists, the average accuracies are 0.607, 0.585 and 0.626 for resident ophthalmologists, attending ophthalmologists and glaucoma experts, respectively. AGIS and GSS2 achieved accuracy of 0.459 and 0.523 respectively. Three traditional machine learning algorithms, namely support vector machine (SVM), random forest (RF), and k-nearest neighbor (k-NN) were also implemented and evaluated in the experiments, which achieved accuracy of 0.670, 0.644, and 0.591 respectively.

Conclusions: Our algorithm based on CNN has achieved higher accuracy compared to human ophthalmologists and traditional rules (AGIS and GSS2) in differentiation of glaucoma and non-glaucoma VFs.
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http://dx.doi.org/10.1186/s12880-018-0273-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6172715PMC
October 2018

Re: Maleki et al.: Selective laser trabeculoplasty in controlled uveitis with steroid-induced glaucoma (Ophthalmology. 2016;123:2630-2632).

Ophthalmology 2017 08;124(8):e63-e64

Dennis Lam & Partners Eye Center, Hong Kong; The C-MER International Research Eye Institute of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China; C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, China.

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http://dx.doi.org/10.1016/j.ophtha.2017.03.028DOI Listing
August 2017

Floaterectomy -- Risks, Safety, and Future.

Asia Pac J Ophthalmol (Phila) 2017 May-Jun;6(3):304

C-MER (Shenzhen) Dennis Lam Eye Hospital, Futian District, Shenzhen, China.

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http://dx.doi.org/10.22608/APO.2017182DOI Listing
November 2018

Formalin: a formaldehyde analogue.

Can J Ophthalmol 2017 04 5;52(2):229. Epub 2017 Apr 5.

The International Eye Research Institute of The Chinese University of Hong Kong (Shenzhen), Shenzhen, People's Republic of China; C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, People's Republic of China. Electronic address:

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http://dx.doi.org/10.1016/j.jcjo.2017.02.004DOI Listing
April 2017

Re: Internal limiting membrane (ILM) transplantation for unclosed and large macular holes (MH).

Graefes Arch Clin Exp Ophthalmol 2017 05 28;255(5):1047-1048. Epub 2017 Mar 28.

C-Mer (Shenzhen) Dennis Lam Eye Hospital, 1 Tairan 9th Rd, Futian, Shenzhen, Guangdong, People's Republic of China.

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http://dx.doi.org/10.1007/s00417-017-3628-7DOI Listing
May 2017
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