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PURPOSE To develop deep learning models for identification of sex and age from macular optical coherence tomography (OCT), and to analyze the features for differentiation of sex and age. DESIGN Algorithm development using database of macular OCT. SETTING One eye center in Taiwan. STUDY POPULATION 6147 sets of macular optical coherence tomography (OCT) images from the healthy eyes of 3134 persons. MAIN OUTCOME MEASURES Deep learning based algorithms were used to develop models for identification of sex and age, and 10-fold cross-validation was applied. Gradient-weighted class activation mapping (Grad-CAM) was used for feature analysis. RESULTS The accuracy for sex prediction using deep learning from macular OCT was 85.6±2.1%, compared to the accuracy of 61.9% by using macular thickness and 61.4±4.0% by using deep learning from infrared fundus photography (P

To provide real-world experiences of treating polypoidal choroidal vasculopathy (PCV) patients with photodynamic therapy (PDT) plus intravitreal injection of ranibizumab or intravitreal injection of aflibercept alone. Retrospective chart review of patients with PCV in a single tertiary referral center in Taiwan. Chart review of PCV patients treated with PDT and injection of ranibizumab or injection of aflibercept. A total of 101 eyes of 101 patients (38 females and 63 males) were reviewed. Of those, 48 and 53 eyes received primary/adjunctive PDT along with injections of ranibizumab or intravitreal injections of aflibercept only, respectively. Initial visual acuity (VA) and central subfield choroidal thickness were similar between the two groups (p > 0.05). In addition, changes in VA at 3, 6, and 12 months post treatment were similar. The central retinal thickness decreased with either treatment (p p > 0.05). In the subgroup analysis of pachychoroid and non-pachychoroid patients, better initial VA and post-treatment VA at 3 months and 6 months was noted in the latter group of patients treated with anti-vascular endothelial growth factor monotherapy (p

Objective The aim of this study was to evaluate the changes in the prevalence of myopia in Taiwanese schoolchildren over the past few decades and to analyze the risk factors for myopia. Design Analysis of eight consecutive population-based myopia surveys conducted from 1983 to 2017. Participants An average of 8916 (5019–11178) schoolchildren aged 3 to 18 years were selected using stratified systematic cluster sampling or by probability proportional to size sampling. Methods All participants underwent complete ophthalmic evaluations. Three drops of 0.5% tropicamide were used to obtain cycloplegic refractive status of each participant. Questionnaires were used to acquire participant data from the 1995, 2005, 2010, and 2016 surveys. Main Outcome Measures Prevalence of myopia (spherical equivalence of ≤−0.25 D) and high myopia (≤−6.0 D) was assessed. Multivariable analyses of risk factors were conducted. Results The prevalence of myopia among all age groups increased steadily. From 1983 to 2017, the weighted prevalence increased from 5.37% (95% confidence interval (CI), 3.5%-7.2%) to 25.4% (95% CI, 21.3%-29.6%) for seven-year-olds (P = .001 for trend), and from 30.7% (95% CI, 26.9%-34.4%) to 76.7% (95% CI, 72.9%-80.4%) for 12-year-olds (P = .001 for trend). The prevalence of high myopia also increased from 1.39% (95% CI, 0.4%-2.4%) to 4.26% (95% CI, 3.4%-5.2%) for 12-year-olds (P = .008 for trend) and from 4.37% (95% CI, 2.9%-5.8%) to 15.4% (95% CI, 13.8%-16.9%) for 15-year-olds (P = .039 for trend). In both the 2005 and 2016 survey samples, children who spent less than 180 minutes daily on near-work activities had significantly lower risks for developing myopia ( Conclusions The prevalence of myopia increased rapidly from 1983 to 2017 in Taiwan. The major risk factors for myopia among schoolchildren are older age and time spent on near-work activities; use of electronic devices increased the amount of time spent on near-work and may increase the risk of developing myopia.

PurposeThis study measured the anatomical characteristics of the macula in fellow eyes of patients with unilateral idiopathic epiretinal membrane (ERM) and compared them with normal control.DesignA retrospective observational study.ParticipantsA total of of 94 fellow eyes with unilateral idiopathic ERM were gathered as the study group, and their age and gender-matched subjects with no vitreomacular diseases were recruited as the control group.MethodsMacular structure parameters including foveal base width (FBW), central foveolar thickness (CFT), central subfield thickness (CST), area of foveal avascular zone (FAZ), and retinal artery trajectory (RAT) were measured using optical coherence tomography (OCT) and OCT angiography and were compared between two groups.Main outcome measuresMacular structure parameters were compared between the two groups. A wide-based foveal pit was defined as a FBW larger than the mean value plus one standard deviation of the normal population. Regression analysis was performed to evaluate factors that affect FBW.ResultsAmong the 94 fellow eyes of unilateral ERM; 71 eyes (75.5%) had a wide-based foveal pit. Both their FBW (418.9 ± 68.7 µm) and area of FAZ (0.38 ± 0.12 mm2) were significantly larger than those in the control group (323.2 ± 74.3 µm and 0.31± 0.17 mm2; p < 0.001 and p = 0.02, respectively), and they also had a thinner CFT and CST, and a wider RAT than the control group (p < 0.05 for all). In the control group, females had a wider FBW, a thinner CFT and CST, and a wider RAT than males (p < 0.05 for all). Regression analysis showed that female, a thinner CST and a larger FAZ were all associated with a larger FBW.ConclusionFellow eyes of the unilateral ERM had a larger FBW and FAZ, a thinner CFT and CST, and a wider RAT than the normal population. This implicates that centrifugal macular traction may result in the formation of idiopathic ERM. Females had a wider FBW, a thinner CST, and a wider RAT than males, which may explain the higher prevalence of idiopathic ERM in females.

AimsTo report the anatomical characteristics of wide-based foveal pit and its associations with macular diseases.MethodsWide-based foveal pit was defined as a foveal base width (FBW) larger than the mean value plus one standard deviation of normal population. Eyes with a wide-based foveal pit were retrospectively collected as the study group, and age- and sex-matched subjects with a normal FBW were recruited as the control group. FBW, area of foveal avascular zone (FAZ) and retinal artery trajectory (RAT) were compared between two groups. The characteristics of the fellow eyes in the study group were also described.ResultsFifty two eyes from 52 patients were identified as having a wide-based foveal pit; 43 (82.7%) were female. Both their FBW (474.7 ± 84.6μm) and area of FAZ (0.50 ± 0.11mm2) were significantly larger than in the control group (297.6 ± 42.3 μm and 0.29 ± 0.10 mm2, respectively; p < 0.001 for both), and they also had a wider RAT than the control group (p < 0.001). During follow-up, three eyes had developed idiopathic epiretinal membrane. As for their fellow eyes, they either also had a wide-based foveal pit (11 eyes) or had various macular diseases including idiopathic epiretinal membrane (27 eyes), macular hole (5 eyes) and others (16 eyes).ConclusionsEyes with a wide-based foveal pit also had a large FAZ and a wide RAT, and they might have a predisposition to idiopathic epiretinal membrane formation. Their fellow eyes also had a predisposition to epiretinal membrane and macular hole.SynopsisEyes with a wide-based foveal pit had a predisposition to idiopathic epiretinal membrane formation. Their fellow eyes might also have a wide-based foveal pit and had a predisposition to epiretinal membrane and macular hole.

To measure the anatomical characteristics of the macula in fellow eyes of patients with unilateral idiopathic epiretinal membrane (ERM) and to compare them with normal controls.A total of 83 fellow eyes with unilateral idiopathic ERM were gathered as the study group, and their age- and sex-matched subjects with no vitreomacular diseases were recruited as the control group. Macular structure parameters including foveal base width (FBW), central foveolar thickness (CFT), central subfield thickness (CST), area of foveal avascular zone (FAZ), and retinal artery trajectory (RAT) were measured using optical coherence tomography (OCT) and OCT angiography and were compared between two groups.For the study group, the FBW (463.8 ± 79.6 µm) and area of FAZ (0.39 ± 0.12 mm2) were significantly larger than those in the control group (334.3 ± 76.5 µm, 0.31 ± 0.13 mm2). Their CST was thinner and their RAT was wider than those of the control group (P0.05 for all). In the normal population, females had a wider FBW, a thinner CFT, and a wider RAT than males (P0.05 for all).Fellow eyes of the unilateral ERM had a larger FBW, a larger FAZ, a thinner CST, and a wider RAT than the normal population. This implicates that some centrifugal tractional force may exist on their macula, which eventually may result in the formation of idiopathic ERM. Females had a wider FBW, a thinner CFT, and a wider RAT than males, which may explain the higher prevalence of idiopathic ERM in females.

PURPOSE: Autologous serum eye drops are considered safe and efficient for the treatment of various ocular surface disorders, including dry eye diseases (DED) caused by the primary and secondary Sjogren syndrome (SS). However, the serum components in patients of SS may be different from those of normal patients and can thus lead to unpredictable therapeutic effects. This study divided the SS patients into active and inactive types based on the erythrocyte sedimentation rate and the presence or absence of active rheumatoid arthritis. METHODS: We compared the serum components of these two groups with standard and multiplex enzyme linked immunosorbent assay arrays and predicted the therapeutic effects of topical autologous serum for the treatment of DED with ocular surface disease index (OSDI) and Oxford Schema scale (OSS). RESULTS: Hyaluronic acid and transforming growth factor b1 levels were significantly higher in the active SS group compared to the inactive SS group (P < 0.01), whereas epidermal growth factors, insulin growth factor 1, and fibroblast growth factor b had no significant differences between these two groups. Active SS group had significantly higher expressions of interleukin (IL) 1 beta, IL 6, and tumor necrosis factor alpha compared to inactive SS patients (P < 0.05). There were no statistical differences in therapeutic effects between these two groups, as measured with the OSDI or OSS. CONCLUSION: Dividing the Sjogren dry eye patients into active and inactive groups may appear as a reasonable method to predict the quality of autologous serum eye drops, but there seems to be no significant predictability to the therapeutic effects.

The aim of this study was to evaluate the changes in the prevalence of myopia in Taiwanese schoolchildren over the past few decades and to analyze the risk factors for myopia.Analysis of 8 consecutive population-based myopia surveys conducted from 1983 through 2017.An average of 8917 (5019-11 656) schoolchildren 3 to 18 years of age were selected using stratified systematic cluster sampling or by probability proportional to size sampling.All participants underwent complete ophthalmic evaluations. Three drops of 0.5% tropicamide were used to obtain the cycloplegic refractive status of each participant. Questionnaires were used to acquire participant data from the 1995, 2005, 2010, and 2016 surveys.Prevalence of myopia (spherical equivalence of ≤-0.25 diopter [D]) and high myopia (≤-6.0 D) was assessed. Multivariate analyses of risk factors were conducted.The prevalence of myopia among all age groups increased steadily. From 1983 through 2017, the weighted prevalence increased from 5.37% (95% confidence interval [CI], 3.50%-7.23%) to 25.41% (95% CI, 21.27%-29.55%) for 7-year-olds (P = 0.001 for trend) and from 30.66% (95% CI, 26.89%-34.43%) to 76.67% (95% CI, 72.94%-80.40%) for 12-year-olds (P = 0.001 for trend). The prevalence of high myopia also increased from 1.39% (95% CI, 0.43%-2.35%) to 4.26% (95% CI, 3.35%-5.17%) for 12-year-olds (P = 0.008 for trend) and from 4.37% (95% CI, 2.91%-5.82%) to 15.36% (95% CI, 13.78%-16.94%) for 15-year-olds (P = 0.039 for trend). In both the 2005 and 2016 survey samples, children who spent less than 180 minutes daily on near-work activities showed significantly lower risks for myopia developing (60 minutes: odds ratio [OR], 0.48 and 0.56; 60-180 minutes: OR, 0.69 and 0.67). In the 2016 survey, spending more than 60 minutes daily on electronic devices was associated significantly with both myopia and high myopia (OR, 2.43 and 2.31).The prevalence of myopia among schoolchildren increased rapidly from 1983 through 2017 in Taiwan. The major risk factors are older age and time spent on near-work activities. Use of electronic devices increased the amount of time spent on near-work and may increase the risk of developing myopia.

OBJECTIVE: To evaluate the long-term results of gas tamponade without vitrectomy in patients with myopic foveoschisis (FS) and foveal detachment (FD). METHODS: Twenty eyes of 20 patients with myopic foveoschisis and foveal detachment were analysed retrospectively. All patients received an intravitreal injection of 0.2–0.3 mL C3F8 as an initial treatment. The patients were followed up for at least 18 months after the procedure. The refractive status, best-corrected visual acuity (BCVA), and anatomical abnormalities in macular area before and after the treatment were assessed and recorded. RESULTS: After initial gas tamponade, FD resolved completely (defined as responders) in 14 eyes, resolved partially in 2 eyes (defined as partial responders), and worsened in 4 eyes (non-responders) at the 3-month follow-up visit. Vitrectomy was performed in four eyes that showed increased detachment (two cases) or developed macular hole (two cases). Repeated gas injection was performed in two recurrent cases after initial success at the 3-month follow-up, and the foveal detachment once again resolved. Overall, 70% of our cases demonstrated resolution of FD at the 3-month follow-up and the long-term responders to gas injection was 65%. The risk factors for treatment failure were: (1) The presence of optical coherence tomography (OCT)-evident premacular membranes (p = 0.03) and (2) the height of FS measured >588 µm (p = 0.009). CONCLUSION: Our data supported that gas tamponade may be effective as an alternative treatment for selected cases of myopic FS with FD. The procedure may be especially beneficial in patients without OCT-evident premacular membranes and have low height of FS.

Background/purpose: To describe the clinical and histologic characteristics of ocular surface squamous neoplasia (OSSN) and evaluate factors significant in recurrence at a university hospital in North Taiwan. Methods: Patient charts, clinical features, and pathology records were retrospectively reviewed in patients with pathology-proved OSSN from January, 1994 to December, 2014. Clinicopathologic correlation was analyzed. Results: Thirty-six patients were recruited. Mean age was 63.4 ± 13.0 (ranging from 23 to 87) years old. OSSN was predominant in men (21/36). Clinical appearances included papilliform in 17 eyes, gelatinous in 11 eyes, leukoplakic in 3 eyes, and 5 eyes in corneal intraepithelial neoplasia (CIN). Of 31 conjunctival OSSN, there were 4 in CIN I, 11 in CIN II, 13 in CIN III, and 3 in squamous cell carcinoma. Superior location was associated with higher-grade OSSN. Although statistical analysis was not significant, papilliform and multifocal lesions showed a trend of high-grade OSSN. The stages of tumor were 4, 5, 26, and 1 eye(s) in T1 to T4, respectively. Recurrence of disease occurred in 9 cases (25%) with mean recurrence time of 20.6 (range: 4 to 65) months. Multifocal lesion has a higher tendency for recurrence. Conclusion: Superior location was associated with high-grade OSSN, and papilliform OSSN might have a tendency of severe and invasive lesions. Multifocal lesions might be associated with higher-grade OSSN and higher recurrence rates. Keywords: Carcinoma in situ, Conjunctival neoplasms, Intraepithelial neoplasms, Pathology, Recurrence

To present recurrent corneal erosion (RCE) caused by late suture exposure after blepharoplasty. Four patients who have unilateral RCE were found to have previous blepharoplasty. The RCE was associated with late suture exposure. The clinical courses, characteristics, methods to identify the suture exposure and treatment were presented. The clinical presentations including local erosion of upper bulbar conjunctiva, corneal abrasion lines, local corneal epithelial defects with rough border, and subepithelial opacity were noticed in all four patients. RCE symptoms exaggerated in eye blinking and did not respond to artificial tears treatment. Erosion recurred soon after the removal of therapeutic contact lenses. They underwent blepharoplasty 1–10 years before RCE emerged, and the RCE lasted 1–8 months before suture exposure was found. RCE healed within 1 week after suture removal. Suture exposure may occur several years after blepharoplasty and could cause RCE. Thorough exploration of the fornix by double eyelid eversion can identify the hidden sutures in such patients.

Using deep learning algorithm on retina OCT images, patient gender can be predicted with an accuracy of greater than 70%. With Grad-CAM visualization, it was found that the foveal structure is highly gender related.