Sepehrband, Farshid

ImportanceDetermining spectacle-corrected visual acuity (VA) is essential when managing many ophthalmic diseases. If artificial intelligence (AI) evaluations of macular images estimated this VA from a fundus image, AI might provide spectacle-corrected VA without technician costs, reduce visit time, or facilitate home monitoring of VA from fundus images obtained outside of the clinic.ObjectiveTo estimate spectacle-corrected VA measured on a standard eye chart among patients with diabetic macular edema (DME) in clinical practice settings using previously validated AI algorithms evaluating best-corrected VA from fundus photographs in eyes with DME.Design, Setting, and ParticipantsRetrospective cross-sectional evaluation of deidentified fundus photographs matched to spectacle-corrected VA determined by technicians on eye charts among patients with a history of DME based on optical coherence tomography and at least 2 visits within 1 to 6 months of each other at a university-based clinic between January 2014 and December 2022. Data were analyzed from January 2023 to October 2024.ExposurePreviously validated AI algorithm evaluation of fundus photographs.Main Outcomes and MeasuresAI-determined VA mean absolute error (MAE) compared with actual spectacle-corrected VA.ResultsAmong 141 patients, the mean (SD) age was 63 (13) years, 71 (50%) were male, 2 (1%) were Asian, 42 (30%) were Black or African American, and 88 (63%) were White. Among 282 eyes at visit 1, 66 had nonproliferative diabetic retinopathy (NPDR) and DME, 38 had proliferative diabetic retinopathy (PDR) and DME, 101 had NPDR and no DME, and 77 had PDR and no DME. Among 564 images (282 eyes) at both initial and follow-up visits, MAE (SD) among eyes with NPDR, with or without center-involved DME (CI-DME), was 1.16 (1.00) lines on the eye chart for VA between 20/10 and 20/20 (67 images), and 1.44 (1.15) lines for between VA 20/25 and 20/80 (231 images). MAE (SD) among eyes with PDR, with or without CI-DME, was 1.92 (1.08) lines for VA between 20/10 and 20/20 (50 images), and 1.42 (0.97) lines for spectacle-corrected VA between 20/25 and 20/80 (150 images). Only 65 images had VA 20/100 or worse, precluding meaningful analyses.Conclusions and RelevanceIn this cross-sectional study, AI evaluation of fundus photographs among patients with DME and VA 20/80 or better estimated spectacle-corrected VA within approximately 1 to 1.5 lines of actual spectacle-corrected VA. These results support use of AI evaluation of fundus photographs to determine spectacle-corrected VA among patients with DME globally, beyond ophthalmology offices.

ImportanceExposure to repetitive head impacts (RHI) is associated with increased risk for neurodegeneration. Accumulation of toxic proteins due to impaired brain clearance is suspected to play a role.ObjectiveTo investigate whether perivascular space (PVS) volume is associated with lifetime exposure to RHI in individuals at risk for RHI-associated neurodegeneration.Design, Setting, and ParticipantsThis cross-sectional study was part of the Diagnostics, Imaging, and Genetics Network for the Objective Study and Evaluation of Chronic Traumatic Encephalopathy (DIAGNOSE CTE) Research Project, a 7-year multicenter study consisting of 4 US study sites. Data were collected from September 2016 to February 2020 and analyses were performed between May 2021 and October 2023. After controlling for magnetic resonance image (MRI) and processing quality, former American football players and unexposed asymptomatic control participants were included in analyses.ExposurePrior exposure to RHI while participating in American football was estimated using the 3 cumulative head impact indices (CHII-G, linear acceleration; CHII-R, rotational acceleration; and CHII, number of head impacts).Main Outcomes and MeasuresIndividual PVS volume was calculated in the white matter of structural MRI. Cognitive impairment was based on neuropsychological assessment. Linear regression models were used to assess associations of PVS volume with neuropsychological assessments in former American football players. All analyses were adjusted for confounders associated with PVS volume.ResultsAnalyses included 224 participants (median [IQR] age, 57 [51-65] years), with 170 male former football players (114 former professional athletes, 56 former collegiate athletes) and 54 male unexposed control participants. Former football players had larger PVS volume compared with the unexposed group (mean difference, 0.28 [95% CI, 0.00-0.56]; P = .05). Within the football group, PVS volume was associated with higher CHII-R (β = 2.71 × 10−8 [95% CI, 0.50 × 10−8 to 4.93 × 10−8]; P = .03) and CHII-G (β = 2.24 × 10−6 [95% CI, 0.35 × 10−6 to 4.13 × 10−6]; P = .03). Larger PVS volume was also associated with worse performance on cognitive functioning in former American football players (β = −0.74 [95% CI, −1.35 to −0.13]; P = .04).Conclusions and RelevanceThese findings suggest that impaired perivascular brain clearance, as indicated by larger PVS volume, may contribute to the association observed between RHI exposure and neurodegeneration.