David Myung, MD, PhD

All Publications

• Development of a novel SupraChoroidal-to-Optic-NervE (SCONE) drug delivery system. Drug delivery Chiang, B., Heng, K., Jang, K., Dalal, R., Liao, Y. J., Myung, D., Goldberg, J. L. 2024; 31 (1): 2379369

  Abstract

  Targeted drug delivery to the optic nerve head may be useful in the preclinical study and later clinical management of optic neuropathies, however, there are no FDA-approved drug delivery systems to achieve this. The purpose of this work was to develop an optic nerve head drug delivery technique.Different strategies to approach the optic nerve head were investigated, including standard intravitreal and retroorbital injections. A novel SupraChoroidal-to-Optic-NervE (SCONE) delivery was optimized by creating a sclerotomy and introducing a catheter into the suprachoroidal space. Under direct visualization, the catheter was guided to the optic nerve head. India ink was injected. The suprachoroidal approach was performed in New Zealand White rabbit eyes in vivo (25 animals total). Parameters, including microneedle size and design, catheter design, and catheter tip angle, were optimized ex vivo and in vivo.Out of the candidate optic nerve head approaches, intravitreal, retroorbital, and suprachoroidal approaches were able to localize India ink to within 2 mm of the optic nerve. The suprachoroidal approach was further investigated, and after optimization, was able to deposit India ink directly within the optic nerve head in up to 80% of attempts. In eyes with successful SCONE delivery, latency and amplitude of visual evoked potentials was not different than the naïve untreated eye.SCONE delivery can be used for targeted drug delivery to the optic nerve head of rabbits without measurable toxicity measured anatomically or functionally. Successful development of this system may yield novel opportunities to study optic nerve head-specific drug delivery in animal models, and paradigm-shifting management strategies for treating optic neuropathies.Here we demonstrate data on a new method for targeted delivery to the optic nerve head, addressing a significant unmet need in therapeutics for optic neuropathies.

  View details for DOI 10.1080/10717544.2024.2379369

  View details for PubMedID 39010743

• Gelatin nanofibers coated with hyaluronic acid as a mesenchymal stromal cell scaffold for corneal regeneration. International journal of pharmaceutics da Silva, G. R., Song, E., Chen, K. M., Chen, F., Jiang, L., Kim, H., Kang, N. W., Myung, D. 2024: 125009

  Abstract

  Electrospun gelatin nanofibers coated with hyaluronic acid (GelNF-HA) were synthesized as a scaffold for delivering human corneal mesenchymal stromal cells (C-MSCs) directly to deep corneal injuries. Aligned GelNFs were produced by electrospinning, crosslinked using vapor of glutaraldehyde, coated with HA, and crosslinked with EDC/NHS. The GelNF-HA was characterized by SEM, mechanical, and optical properties. It was then investigated as a substrate for C-MSC proliferation and migration in vitro and in a rabbit cornea culture model. The expression of α-smooth muscle actin (α-SMA) was determined in the ex vivo model. SEM showed that the GelNF-HA scaffold was composed of aligned GelNFs with 75 % of the fibers oriented against the same angle. It exhibited a Young's modulus of 1.66 ± 0.59 MPa and approximately 93 % transmittance of visible light. The GelNF-HA membranes supported C-MSC proliferation in vitro. In a scratch migration assay, it facilitated complete wound closure after 48 h in culture. C-MSC-laden GelNF-HA scaffolds supported corneal wound healing in an ex vivo model as well, expressing a lower percentage of stromal α-SMA compared to both the no-treatment keratectomy-only and C-MSC groups (p < 0.05). The C-MSC-supportive GelNF-HA scaffolds hold therapeutic potential for stromal regeneration in the treatment of deep corneal defects.

  View details for DOI 10.1016/j.ijpharm.2024.125009

  View details for PubMedID 39613275

• Use of Artificial Intelligence-Based Detection of Diabetic Retinopathy in the US. JAMA ophthalmology Shah, S. A., Sokol, J. T., Wai, K. M., Rahimy, E., Myung, D., Mruthyunjaya, P., Parikh, R. 2024

  View details for DOI 10.1001/jamaophthalmol.2024.4493

  View details for PubMedID 39480408

• Photoactivated growth factor release from bio-orthogonally crosslinked hydrogels for the regeneration of corneal defects. Bioactive materials Kang, N., Seo, Y. A., Jackson, K. J., Jang, K., Song, E., Han, U., Chen, F., Heilshorn, S. C., Myung, D. 2024; 40: 417-429

  Abstract

  In situ-forming hydrogels are an attractive option for corneal regeneration, and the delivery of growth factors from such constructs have the potential to improve re-epithelialization and stromal remodeling. However, challenges persist in controlling the release of therapeutic molecules from hydrogels. Here, an in situ-forming bio-orthogonally crosslinked hydrogel containing growth factors tethered via photocleavable linkages (PC-HACol hydrogel) was developed to accelerate corneal regeneration. Epidermal growth factor (EGF) was conjugated to the hydrogel backbone through photo-cleavable (PC) spacer arms and was released when exposed to mild intensity ultraviolet (UV) light (2-5mW/cm2, 365nm). The PC-HACol hydrogel rapidly gelled within a few minutes when applied to corneal defects, with excellent transparency and biocompatibility. After subsequent exposure to UV irradiation, the hydrogel promoted the proliferation and migration of corneal epithelial cells in vitro. The rate of re-epithelialization was positively correlated to the frequency of irradiation, verified through ex vivo rabbit cornea organ culture studies. In an in vivo rat corneal wound healing study, the PC-HACol hydrogel exposed to UV light significantly promoted re-epithelialization, the remodeling of stromal layers, and exhibited significant anti-scarring effects, with minimal alpha-SMA and robust ALDH3A1 expression. Normal differentiation of the regenerated epithelia after healing was evaluated by expression of the corneal epithelial biomarker, CK12. The remodeled cornea exhibited full recovery of corneal thickness and layer number without hyperplasia of the epithelium.

  View details for DOI 10.1016/j.bioactmat.2024.05.045

  View details for PubMedID 39022184

• Dexamethasone acetate loaded poly(ε-caprolactone) nanofibers for rat corneal chemical burn treatment. Scientific reports Kim, D. R., Park, S. K., Kim, E. J., Kim, D. K., Yoon, Y. C., Myung, D., Lee, H. J., Na, K. S. 2024; 14 (1): 21806

  Abstract

  Topical eye drop approaches to treat ocular inflammation in dry eyes often face limitations such as low efficiency and short duration of drug delivery. Nanofibers serve to overcome the limitation of the short duration of action of topical eye drops used against ocular inflammation in dry eyes. Several attempts to develop suitable nanofibers have been made; however, there is no ideal solution. Here, we developed polycaprolactone (PCL) nanofibers loaded with dexamethasone acetate (DEX), prepared by electrospinning, as a potential ocular drug delivery platform for corneal injury treatment. Thirty-nine Sprague Dawley rats (7 weeks old males) were divided into four treatment groups after alkaline burns of the cornea; negative control (no treatment group); dexamethasone eyedrops (DEX group); PCL fiber (PCL group); dexamethasone loaded PCL (PCL + DEX group). We evaluated therapeutic efficacy of PCL + DEX by examining the epithelial wound healing effect, the extent of corneal opacity and neovascularization. Additionally, various inflammatory factors, including IL-1β, were investigated through immunochemistry, western blot analysis, and quantitative real-time RT-PCR (qRT-PCR). PCL + DEX group showed histologically alleviated signs of corneal inflammation compared with DEX group, which showed a decrease in IL-1β and MMP9 in the corneal stroma. The quantitative expression on day 1 after alkaline burn of pro-inflammatory markers, including IL-1β and IL-6, in the PCL + DEX group was significantly lower than that in the DEX group. Notably, PCL + DEX treatment significantly suppressed neovascularization, and enhanced the anti-inflammatory function of DEX during the acute phase of ocular inflammation. Collectively, these findings suggest that PCL + DEX may be a promising approach to effective drug delivery in corneal burn injuries.

  View details for DOI 10.1038/s41598-024-62026-x

  View details for PubMedID 39300144

  View details for PubMedCentralID PMC11413004

• Bilateral Light-Adjustable Lens Implantation in a Patient With 50-Cut Radial Keratotomy. Cornea open Jiang, A. C., Coulter, A., Myung, D., Schallhorn, J. M., Pasricha, N. D. 2024; 3 (3)

  Abstract

  Purpose: To report a case of Light Adjustable Lens (LAL, RxSight, Aliso Viejo, CA) implantation in a patient with bilateral 50-cut radial keratotomy (RK) and discuss related preoperative, intraoperative, and postoperative considerations.Methods: A 78-year-old patient with history of bilateral 50-cut RK underwent phacoemulsification with implantation of LALs in both eyes one month apart. Although LAL technology was not approved specifically for addressing limitations in intraocular lens calculation post-RK due to corneal topography irregularity, the patient opted for this lens due to its ability to make post-operative adjustments to its refractive power. At postoperative month one following the second eye surgery, YAG capsulotomy was performed in both eyes. At postoperative month two following the second eye surgery, the patient began LAL adjustments spaced 1-2 weeks apart for a total of 2 LAL adjustments and 2 lock-in sessions.Results: Our patient achieved a final refraction of -0.25 +0.25 * 110 with an UDVA of 20/20-2 in the right eye and -0.25 +0.50 * 135 with an UDVA 20/25-1 in the left eye.Conclusions: The LAL may be a promising option for patients undergoing cataract surgery after RK, although further studies are needed to understand long-term changes in eyes with RK and the inability of LAL to address all aspects of corneal aberration.

  View details for DOI 10.1097/coa.0000000000000045

  View details for PubMedID 39513024

• In Situ-Forming, Bioorthogonally Cross-linked, Nanocluster-Reinforced Hydrogel for the Regeneration of Corneal Defects. ACS nano Kang, N. W., Jang, K., Song, E., Han, U., Seo, Y. A., Chen, F., Wungcharoen, T., Heilshorn, S. C., Myung, D. 2024

  Abstract

  Corneal defects can lead to stromal scarring and vision loss, which is currently only treatable with a cadaveric corneal transplant. Although in situ-forming hydrogels have been shown to foster regeneration of the cornea in the setting of stromal defects, the cross-linking, biomechanical, and compositional parameters that optimize healing have not yet been established. This, Corneal defects are also almost universally inflamed, and their rapid closure without fibrosis are critical to preserving vision. Here, an in situ forming, bioorthogonally cross-linked, nanocluster (NC)-reinforced collagen and hyaluronic acid hydrogel (NCColHA hydrogel) with enhanced structural integrity and both pro-regenerative and anti-inflammatory effects was developed and tested within a corneal defect model in vivo. The NCs serve as bioorthogonal nanocross-linkers, providing higher cross-linking density than polymer-based alternatives. The NCs also serve as delivery vehicles for prednisolone (PRD) and the hepatocyte growth factor (HGF). NCColHA hydrogels rapidly gel within a few minutes upon administration and exhibit robust rheological properties, excellent transparency, and negligible swelling/deswelling behavior. The hydrogel's biocompatibility and capacity to support cell growth were assessed using primary human corneal epithelial cells. Re-epithelialization on the NCColHA hydrogel was clearly observed in rabbit eyes, both ex vivo and in vivo, with expression of normal epithelial biomarkers, including CD44, CK12, CK14, α-SMA, Tuj-1, and ZO-1, and stratified, multilayered morphology. The applied hydrogel maintained its structural integrity for at least 14 days and remodeled into a transparent stroma by 56 days.

  View details for DOI 10.1021/acsnano.4c02345

  View details for PubMedID 39106436

• Elucidating the roles of electrolytes and hydrogen bonding in the dewetting dynamics of the tear film. Proceedings of the National Academy of Sciences of the United States of America Borkar, S., Baumli, P., Vance, T., Sharma, E., Shi, X., Wu, J. Y., Yao, G., Myung, D., Fuller, G. G. 2024; 121 (31): e2407501121

  Abstract

  This study explores the impact of electrostatic interactions and hydrogen bonding on tear film stability, a crucial factor for ocular surface health. While mucosal and meibomian layers have been extensively studied, the role of electrolytes in the aqueous phase remains unclear. Dry eye syndrome, characterized by insufficient tear quantity or quality, is associated with hyperosmolality, making electrolyte composition an important factor that might impact tear stability. Using a model buffer solution on a silica glass dome, we simulated physiologically relevant tear film conditions. Sodium chloride alone induced premature dewetting through salt crystal nucleation. In contrast, trace amounts of solutes with hydroxyl groups (sodium phosphate dibasic, potassium phosphate monobasic, and glucose) exhibited intriguing phenomena: quasi-stable films, solutal Marangoni-driven fluid influx increasing film thickness, and viscous fingering due to Saffman-Taylor instability. These observations are rationalized by the association of salt solutions with increased surface tension and the propensity of hydroxyl-group-containing solutes to engage in significant hydrogen bonding, altering local viscosity. This creates a viscosity contrast between the bulk buffer solution and the film region. Moreover, these solutes shield the glass dome, counteracting sodium chloride crystallization. These insights not only advance our understanding of tear film mechanics but also pave the way for predictive diagnostics in dry eye syndrome, offering a robust platform for personalized medical interventions based on individual tear film composition.

  View details for DOI 10.1073/pnas.2407501121

  View details for PubMedID 39042697

• Development of a targeted drug delivery approach to the optic nerve head Chiang, B., Heng, K., Jang, K., Dalal, R., Liao, Y., Myung, D., Goldberg, J. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2024

  View details for Web of Science ID 001313316201327

• In -vivo analysis of the effect of epidermal growth factor -loaded collagen gels on corneal regeneration Sco, Y., Kang, N., Jackson, K., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2024

  View details for Web of Science ID 001312227700138

• Dexamethasone acetate loaded poly(ε-ecaprolactone) nanofibers for the treatment of rat corneal chemical burn Kim, D., Kim, D., Park, S., Kim, E., Yoon, Y., Myung, D., Lee, H., Na, K. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2024

  View details for Web of Science ID 001312227701192

• Verteporfin Restores Corneal Transparency after Injury Liu, W. W., Chen, F., Wungcharoen, T., Kang, N., Garcia, J., Basco, C., Seo, Y., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2024

  View details for Web of Science ID 001313316208346

• Bio-Orthogonal Chemistry and Hyaluronan Enhance Corneal Restoration of Collagen Gel: 2-Month Response <i>in Vivo</i> Chen, F., Han, U., Seo, Y., Heilshorn, S., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2024

  View details for Web of Science ID 001313316203121

• Quantifying particle concentration via AI-enhanced optical coherence tomography. Nanoscale Ye, S., Xing, L., Myung, D., Chen, F. 2024

  Abstract

  Efficient and robust quantification of the number of nanoparticles in solution is not only essential but also insufficient in nanotechnology and biomedical research. This paper proposes to use optical coherence tomography (OCT) to quantify the number of gold nanorods, which exemplify the nanoparticles with high light scattering signals. Additionally, we have developed an AI-enhanced OCT image processing to improve the accuracy and robustness of the quantification result.

  View details for DOI 10.1039/d4nr00195h

  View details for PubMedID 38511606

• Design and ex vivo development of a suprachoroidal spacer implant to treat glaucoma. Research square Chiang, B., Jang, K., Goldberg, J., Myung, D. 2024

  Abstract

  Glaucoma is a leading cause of visual impairment and blindness in the United States and worldwide. Elevated intraocular pressure (IOP) has been identified as the only modifiable risk factor in glaucoma, and there exists a need for a glaucoma procedure that is safe, efficacious, and can be performed in the outpatient clinic setting. Suprachoroidal expansion has been explored as a method to lower IOP previously. The purpose of this work was to design a monolithic hydrogel implant that would not clear or degrade to potentially achieve long term (possibly permanent) IOP reduction. Here, we developed and showed ex vivo testing of a novel photo-crosslinked polyethylene glycol (PEG) suprachoroidal spacer implant delivered via a custom-designed injector system. We optimized the composition, shape, and mechanics of the implant to be suitable for implantation with the suprachoroidal space. We developed a microneedle injector system to deliver this implant. We showed precise control over implant location and volume occupied within the suprachoroidal space. Further preclinical testing is needed to demonstrate efficacy.

  View details for DOI 10.21203/rs.3.rs-3895533/v1

  View details for PubMedID 38352508

• Electrospun Nanofiber Membrane for Cultured Corneal Endothelial Cell Transplantation. Bioengineering (Basel, Switzerland) Song, E., Chen, K. M., Margolis, M. S., Wungcharoen, T., Koh, W., Myung, D. 2024; 11 (1)

  Abstract

  The corneal endothelium, comprising densely packed corneal endothelial cells (CECs) adhering to Descemet's membrane (DM), plays a critical role in maintaining corneal transparency by regulating water and ion movement. CECs have limited regenerative capacity within the body, and globally, there is a shortage of donor corneas to replace damaged corneal endothelia. The development of a carrier for cultured CECs may address this worldwide clinical need. In this study we successfully manufactured a gelatin nanofiber membrane (gelNF membrane) using electrospinning, followed by crosslinking with glutaraldehyde (GA). The fabricated gelNF membrane exhibited approximately 80% transparency compared with glass and maintained a thickness of 20 m. The gelNF membrane demonstrated desirable permeability and degradability for a Descemet's membrane analog. Importantly, CECs cultured on the gelNF membrane at high densities showed no cytotoxic effects, and the expression of key CEC functional biomarkers was verified. To assess the potential of this gelNF membrane as a carrier for cultured CEC transplantation, we used it to conduct Descemet's membrane endothelial keratoplasty (DMEK) on rabbit eyes. The outcomes suggest this gelNF membrane holds promise as a suitable carrier for cultured CEC transplantation, offering advantages in terms of transparency, permeability, and sufficient mechanical properties required for successful transplantation.

  View details for DOI 10.3390/bioengineering11010054

  View details for PubMedID 38247931

• Embedded 3d Bioprinting of Collagen Inks into Microgel Baths to control hydrogel Microstructure and Cell Spreading. Advanced healthcare materials Brunel, L. G., Christakopoulos, F., Kilian, D., Cai, B., Hull, S. M., Myung, D., Heilshorn, S. C. 2023: e2303325

  Abstract

  Microextrusion-based 3D bioprinting into support baths has emerged as a promising technique to pattern soft biomaterials into complex, macroscopic structures. We hypothesized that interactions between inks and support baths, which are often composed of granular microgels, could be modulated to control the microscopic structure within these macroscopic-printed constructs. Using printed collagen bioinks crosslinked either through physical self-assembly or bioorthogonal covalent chemistry, we demonstrate that microscopic porosity is introduced into collagen inks printed into microgel support baths but not bulk gel support baths. The overall porosity is governed by the ratio between the ink's shear viscosity and the microgel support bath's zero-shear viscosity. By adjusting the flow rate during extrusion, the ink's shear viscosity was modulated, thus controlling the extent of microscopic porosity independent of the ink composition. For covalently crosslinked collagen, printing into support baths comprised of gelatin microgels (15-50 µm) resulted in large pores (∼40 µm) that allowed human corneal mesenchymal stromal cells to readily spread, while control samples of cast collagen or collagen printed in non-granular support baths did not allow cell spreading. Taken together, these data demonstrate a new method to impart controlled microscale porosity into 3D printed hydrogels using granular microgel support baths. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1002/adhm.202303325

  View details for PubMedID 38134346

• AI-Human Hybrid Workflow Enhances Teleophthalmology for the Detection of Diabetic Retinopathy. Ophthalmology science Dow, E. R., Khan, N. C., Chen, K. M., Mishra, K., Perera, C., Narala, R., Basina, M., Dang, J., Kim, M., Levine, M., Phadke, A., Tan, M., Weng, K., Do, D. V., Moshfeghi, D. M., Mahajan, V. B., Mruthyunjaya, P., Leng, T., Myung, D. 2023; 3 (4): 100330

  Abstract

  Detection of diabetic retinopathy (DR) outside of specialized eye care settings is an important means of access to vision-preserving health maintenance. Remote interpretation of fundus photographs acquired in a primary care or other nonophthalmic setting in a store-and-forward manner is a predominant paradigm of teleophthalmology screening programs. Artificial intelligence (AI)-based image interpretation offers an alternative means of DR detection. IDx-DR (Digital Diagnostics Inc) is a Food and Drug Administration-authorized autonomous testing device for DR. We evaluated the diagnostic performance of IDx-DR compared with human-based teleophthalmology over 2 and a half years. Additionally, we evaluated an AI-human hybrid workflow that combines AI-system evaluation with human expert-based assessment for referable cases.Prospective cohort study and retrospective analysis.Diabetic patients ≥ 18 years old without a prior DR diagnosis or DR examination in the past year presenting for routine DR screening in a primary care clinic.Macula-centered and optic nerve-centered fundus photographs were evaluated by an AI algorithm followed by consensus-based overreading by retina specialists at the Stanford Ophthalmic Reading Center. Detection of more-than-mild diabetic retinopathy (MTMDR) was compared with in-person examination by a retina specialist.Sensitivity, specificity, accuracy, positive predictive value, and gradability achieved by the AI algorithm and retina specialists.The AI algorithm had higher sensitivity (95.5% sensitivity; 95% confidence interval [CI], 86.7%-100%) but lower specificity (60.3% specificity; 95% CI, 47.7%-72.9%) for detection of MTMDR compared with remote image interpretation by retina specialists (69.5% sensitivity; 95% CI, 50.7%-88.3%; 96.9% specificity; 95% CI, 93.5%-100%). Gradability of encounters was also lower for the AI algorithm (62.5%) compared with retina specialists (93.1%). A 2-step AI-human hybrid workflow in which the AI algorithm initially rendered an assessment followed by overread by a retina specialist of MTMDR-positive encounters resulted in a sensitivity of 95.5% (95% CI, 86.7%-100%) and a specificity of 98.2% (95% CI, 94.6%-100%). Similarly, a 2-step overread by retina specialists of AI-ungradable encounters improved gradability from 63.5% to 95.6% of encounters.Implementation of an AI-human hybrid teleophthalmology workflow may both decrease reliance on human specialist effort and improve diagnostic accuracy.Proprietary or commercial disclosure may be found after the references.

  View details for DOI 10.1016/j.xops.2023.100330

  View details for PubMedID 37449051

  View details for PubMedCentralID PMC10336195

• Artificial Intelligence Improves Patient Follow-Up in a Diabetic Retinopathy Screening Program. Clinical ophthalmology (Auckland, N.Z.) Dow, E. R., Chen, K. M., Zhao, C. S., Knapp, A. N., Phadke, A., Weng, K., Do, D. V., Mahajan, V. B., Mruthyunjaya, P., Leng, T., Myung, D. 2023; 17: 3323-3330

  Abstract

  We examine the rate of and reasons for follow-up in an Artificial Intelligence (AI)-based workflow for diabetic retinopathy (DR) screening relative to two human-based workflows.A DR screening program initiated September 2019 between one institution and its affiliated primary care and endocrinology clinics screened 2243 adult patients with type 1 or 2 diabetes without a diagnosis of DR in the previous year in the San Francisco Bay Area. For patients who screened positive for more-than-mild-DR (MTMDR), rates of follow-up were calculated under a store-and-forward human-based DR workflow ("Human Workflow"), an AI-based workflow involving IDx-DR ("AI Workflow"), and a two-step hybrid workflow ("AI-Human Hybrid Workflow"). The AI Workflow provided results within 48 hours, whereas the other workflows took up to 7 days. Patients were surveyed by phone about follow-up decisions.Under the AI Workflow, 279 patients screened positive for MTMDR. Of these, 69.2% followed up with an ophthalmologist within 90 days. Altogether 70.5% (N=48) of patients who followed up chose their location based on primary care referral. Among the subset of patients that were seen in person at the university eye institute under the Human Workflow and AI-Human Hybrid Workflow, 12.0% (N=14/117) and 11.7% (N=12/103) of patients with a referrable screening result followed up compared to 35.5% of patients under the AI Workflow (N=99/279; χ2df=2 = 36.70, p < 0.00000001).Ophthalmology follow-up after a positive DR screening result is approximately three-fold higher under the AI Workflow than either the Human Workflow or AI-Human Hybrid Workflow. Improved follow-up behavior may be due to the decreased time to screening result.

  View details for DOI 10.2147/OPTH.S422513

  View details for PubMedID 38026608

  View details for PubMedCentralID PMC10665027

• SCONE: Development of optic nerve head delivery technology Chiang, B., Dalal, R., Heng, K., Liao, Y., Goldberg, J. L., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023

  View details for Web of Science ID 001053758307248

• Real world outcomes from artificial intelligence to detect diabetic retinopathy in the primary care setting: 12 month experience Knapp, A. N., Dow, E., Chen, K., Khan, N. C., Do, D. V., Mahajan, V., Mruthyunjaya, P., Leng, T., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023

  View details for Web of Science ID 001053758300331

• Impact of crosslinking chemistry on corneal tissue regeneration after in situforming collagen-hyaluronate matrix therapy Wungcharoen, T., Chen, F., Seo, Y., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023

  View details for Web of Science ID 001053758306295

• Automated Detection of Dysthyroid Optic Neuropathy in Graves' Ophthalmopathy with Computed Tomography (CT) Scans by Convolutional Neural Networks Hung, J., Luo, A., Deng, Y., Chung, C., Fuh, C., Perera, C., Myung, D., Kossler, A., Liao, S. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023

  View details for Web of Science ID 001053758307020

• Collagen Gels Crosslinked by Photoactivation of Riboflavin for the Repair and Regeneration of Corneal Defects. ACS applied bio materials Fernandes-Cunha, G. M., Brunel, L. G., Arboleda, A., Manche, A., Seo, Y. A., Logan, C., Chen, F., Heilshorn, S. C., Myung, D. 2023

  Abstract

  Bioengineered corneal tissue is a promising therapeutic modality for the treatment of corneal blindness as a substitute for cadaveric graft tissue. In this study, we fabricated a collagen gel using ultraviolet-A (UV-A) light and riboflavin as a photosensitizer (PhotoCol-RB) as an in situ-forming matrix to fill corneal wounds and create a cohesive interface between the crosslinked gel and adjacent collagen. The PhotoCol-RB gels supported corneal epithelialization and exhibited higher transparency compared to physically crosslinked collagen. We showed that different riboflavin concentrations yielded gels with different mechanical and biological properties. In vitro experiments using human corneal epithelial cells (hCECs) showed that hCECs are able to proliferate on the gel and express corneal cell markers such as cytokeratin 12 (CK12) and tight junctions (ZO-1). Using an ex vivo burst assay, we also showed that the PhotoCol-RB gels are able to seal corneal perforations. Ex vivo organ culture of the gels filling lamellar keratectomy wounds showed that the epithelium that regenerated over the PhotoCol-RB gels formed a multilayer compared to just a double layer for those that grew over physically cross-linked collagen. These gels can be formed either in situ directly on the wound site to conform to the geometry of a defect, or can be preformed and then applied to the corneal wound. Our results indicate that PhotoCol-RB gels merit further investigation as a way to stabilize and repair deep and perforating corneal wounds.

  View details for DOI 10.1021/acsabm.3c00015

  View details for PubMedID 37126648

• In Situ-Forming Collagen-Hyaluronate Semi-Interpenetrating Network Hydrogel Enhances Corneal Defect Repair. Translational vision science & technology Chen, F., Mundy, D. C., Le, P., Seo, Y. A., Logan, C. M., Fernandes-Cunha, G. M., Basco, C. A., Myung, D. 2022; 11 (10): 22

  Abstract

  Purpose: Millions worldwide suffer vision impairment or blindness from corneal injury, and there remains an urgent need for a more effective and accessible way to treat corneal defects. We have designed and characterized an in situ-forming semi-interpenetrating polymer network (SIPN) hydrogel using biomaterials widely used in ophthalmology and medicine.Methods: The SIPN was formed by cross-linking collagen type I with bifunctional polyethylene glycol using N-hydroxysuccinimide ester chemistry in the presence of linear hyaluronic acid (HA). Gelation time and the mechanical, optical, swelling, and degradation properties of the SIPN were assessed. Cytocompatibility with human corneal epithelial cells and corneal stromal stem cells (CSSCs) was determined in vitro, as was the spatial distribution of encapsulated CSSCs within the SIPN. In vivo wound healing was evaluated by multimodal imaging in an anterior lamellar keratectomy injury model in rabbits, followed by immunohistochemical analysis of treated and untreated tissues.Results: The collagen-hyaluronate SIPN formed in situ without an external energy source and demonstrated mechanical and optical properties similar to the cornea. It was biocompatible with human corneal cells, enhancing CSSC viability when compared with collagen gel controls and preventing encapsulated CSSC sedimentation. In vivo application of the SIPN significantly reduced stromal defect size compared with controls after 7 days and promoted multilayered epithelial regeneration.Conclusions: This in situ-forming SIPN hydrogel may be a promising alternative to keratoplasty and represents a step toward expanding treatment options for patients suffering from corneal injury.Translational Relevance: We detail the synthesis and initial characterization of an SIPN hydrogel as a potential alternative to lamellar keratoplasty and a tunable platform for further development in corneal tissue engineering and therapeutic cell delivery.

  View details for DOI 10.1167/tvst.11.10.22

  View details for PubMedID 36239965

• Effect of Recombinant Human Lubricin on Model Tear Film Stability. Translational vision science & technology Cui, K. W., Xia, V. X., Cirera-Salinas, D., Myung, D., Fuller, G. G. 2022; 11 (9): 9

  Abstract

  Purpose: To investigate and quantify the effect of recombinant human lubricin (rh-lubricin) on model tear film stability.Methods: A custom-built, interferometry-based instrument called the Interfacial Dewetting and Drainage Optical Platform was used to create and record the spatiotemporal evolution of model acellular tear films. Image segmentation and analysis was performed in MATLAB to extract the most essential features from the wet area fraction versus time curve, namely the evaporative break-up time and the final wet area fraction (A10). These two parameters indicate the tear film stability in the presence of rh-lubricin in its unstressed and stressed forms.Results: Our parameters successfully captured the trend of increasing tear film stability with increasing rh-lubricin concentration, and captured differences in rh-lubricin efficacy after various industrially relevant stresses. Specifically, aggregation and fragmentation caused by a 4-week, high temperature stress condition negatively impacted rh-lubricin's ability to maintain model tear film stability. Adsorbed rh-lubricin alone was not sufficient to resist break-up and maintain full area coverage of the model tear film surface.Conclusions: Our results demonstrate that fragmentation and aggregation can negatively impact rh-lubricin's ability to maintain a stable tear film. In addition, the ability of rh-lubricin to maintain wetted area coverage is due to both freely dispersed and adsorbed rh-lubricin.Translational Relevance: Our platform and analysis method provide a facile, intuitive, and clinically relevant means to quantify the effect of ophthalmic drugs and formulations intended for improving tear film stability, as well as capture differences between variants related to drug stability and efficacy.

  View details for DOI 10.1167/tvst.11.9.9

  View details for PubMedID 36112103

• Tear Film Stability as a Function of Tunable Mucin Concentration Attached to Supported Lipid Bilayers JOURNAL OF PHYSICAL CHEMISTRY B Cui, K. W., Myung, D. J., Fuller, G. G. 2022

  View details for DOI 10.1021/acs.jpcb.2c04154AJ

  View details for Web of Science ID 000842923500001

• In Situ-forming Collagen Hydrogels Crosslinked by Multifunctional Polyethylene Glycol as a Matrix Therapy for Corneal Defects: 2-Month Follow-Up In Vivo. Cornea Logan, C. M., Fernandes-Cunha, G. M., Chen, F., Le, P., Mundy, D., Na, K. S., Myung, D. 2022

  Abstract

  PURPOSE: We recently showed that in situ-forming collagen gels crosslinked through multifunctional polyethylene glycol (PEG) supported corneal epithelialization 7 days after treatment of lamellar keratectomy wounds. In this study, we aimed to evaluate the longer-term regenerative effects of this gel in animals.METHOD: Corneal wound healing was assessed 60 days after lamellar keratectomy and gel treatment using slitlamp examination, optical coherence tomography (OCT), pachymetry, corneal topography, an ocular response analyzer, and tonometry. The corneas were evaluated for the presence of beta-tubulin, cytokeratin 3, zonula occludens-1, and alpha smooth muscle actin (SMA) markers. Gene expression of aldehyde dehydrogenase 3A1 (ALDH3A1), cluster of differentiation 31, CD163, alpha-SMA, hepatocyte growth factor, and fibroblast growth factor 2 (FGF-2) and protein expression of CD44 and collagen VI were evaluated.RESULTS: Intraocular pressure, corneal thickness, and hysteresis for the corneas treated with collagen-PEG gels did not significantly change compared with the saline group. However, placido disk topography revealed greater regularity of the central cornea in the gel-treated group compared to the saline group. The gel-treated group exhibited a lower degree of epithelial hyperplasia than the saline group. Immunohistochemical and gene expression analysis showed that the gel-treated corneas exhibited lower alpha-SMA expression compared with the saline group. CD163 and CD44 were found to be elevated in the saline-treated group compared with normal corneas.CONCLUSIONS: The in situ-forming collagen-PEG gel promoted epithelialization that improved central corneal topography, epithelial layer morphology, and reduced expression of fibrotic and inflammatory biomarkers after 60 days compared to the saline group.

  View details for DOI 10.1097/ICO.0000000000003104

  View details for PubMedID 35965399

• Predicting Systemic Health Features from Retinal Fundus Images Using Transfer-Learning-Based Artificial Intelligence Models. Diagnostics (Basel, Switzerland) Khan, N. C., Perera, C., Dow, E. R., Chen, K. M., Mahajan, V. B., Mruthyunjaya, P., Do, D. V., Leng, T., Myung, D. 2022; 12 (7)

  Abstract

  While color fundus photos are used in routine clinical practice to diagnose ophthalmic conditions, evidence suggests that ocular imaging contains valuable information regarding the systemic health features of patients. These features can be identified through computer vision techniques including deep learning (DL) artificial intelligence (AI) models. We aim to construct a DL model that can predict systemic features from fundus images and to determine the optimal method of model construction for this task. Data were collected from a cohort of patients undergoing diabetic retinopathy screening between March 2020 and March 2021. Two models were created for each of 12 systemic health features based on the DenseNet201 architecture: one utilizing transfer learning with images from ImageNet and another from 35,126 fundus images. Here, 1277 fundus images were used to train the AI models. Area under the receiver operating characteristics curve (AUROC) scores were used to compare the model performance. Models utilizing the ImageNet transfer learning data were superior to those using retinal images for transfer learning (mean AUROC 0.78 vs. 0.65, p-value < 0.001). Models using ImageNet pretraining were able to predict systemic features including ethnicity (AUROC 0.93), age > 70 (AUROC 0.90), gender (AUROC 0.85), ACE inhibitor (AUROC 0.82), and ARB medication use (AUROC 0.78). We conclude that fundus images contain valuable information about the systemic characteristics of a patient. To optimize DL model performance, we recommend that even domain specific models consider using transfer learning from more generalized image sets to improve accuracy.

  View details for DOI 10.3390/diagnostics12071714

  View details for PubMedID 35885619

• Smart contact lens containing hyaluronate-rose bengal conjugate for biophotonic myopia vision correction. Biomaterials science Mun, J., Kim, T. Y., Myung, D., Hahn, S. K. 2022

  Abstract

  As the collagen layer weakens with increasing age or certain diseases such as keratoconus and myopia, the mechanical property of the collagen layer decreases with corneal deformation. To circumvent these problems, the corneal collagen has been crosslinked with the photosensitizer riboflavin under UV light after de-epithelialization. However, this treatment with riboflavin and UV light can cause notable damage to the eye. Here, the biocompatible rose bengal (RB) dye was conjugated to hyaluronic acid (HA) to enhance the corneal permeability, which can be activated by safe green light with a wavelength of 530 nm. Two-photon microscopy revealed the deep tissue penetration of the HA-RB conjugate in comparison with RB. Collagen fibrillogenesis, ex vivo tensile test, and ex vivo histological analysis confirmed the effective collagen crosslinking by HA-RB conjugate and the light irradiation. Furthermore, we developed a smart contact lens for on-demand HA-RB conjugate delivery from the reservoir embedded in the contact lens. Taken together, we could envision the feasibility of a smart contact lens for biophotonic myopia vision correction.

  View details for DOI 10.1039/d2bm00584k

  View details for PubMedID 35815427

• Integration of Artificial Intelligence into a Telemedicine-Based Diabetic Retinopathy Screening Program Chen, K., Dow, E. R., Khan, N. C., Levine, M., Perera, C., Phadke, A., Dang, J., Weng, K., Do, D. V., Mahajan, V. B., Mruthyunjaya, P., Mishra, K., Leng, T., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022

  View details for Web of Science ID 000844401304101

• Collagen hydrogels covalently crosslinked by bioorthogonal click chemistry resist cell-induced contraction while preserving encapsulated corneal stromal cell phenotype Brunel, L. G., Hull, S. M., Johansson, P. K., Myung, D., Heilshorn, S. C. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022

  View details for Web of Science ID 000844401300100

• Biocompatibility of photoactivated collagen-riboflavin hydrogels for corneal regeneration Arboleda, A., Cunha, G., Manche, A., Seo, Y., Logan, C., Heilshorn, S. C., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022

  View details for Web of Science ID 000844401300106

• Hyaluronic acid hydrogels crosslinked via blue light-induced thiol-ene reaction for the treatment of rat corneal alkali burn. Regenerative therapy Park, S. K., Ha, M., Kim, E. J., Seo, Y. A., Lee, H. J., Myung, D., Kim, H., Na, K. 2022; 20: 51-60

  Abstract

  To assess corneal inflammation from alkali chemical burns, we examined the therapeutic effects of in situ-forming hyaluronic acid (HA) hydrogels crosslinked via blue light-induced thiol-ene reaction on a rat corneal alkali burn model. Animals were divided into three groups (n=7 rats per group): untreated, treated with 0.1% HA eye drops, and treated with crosslinked HA hydrogels. Crosslinking of HA hydrogel followed by the administration of HA eye drops and crosslinked HA hydrogels were carried out once a day from days 0-4. Corneal re-epithelialization, opacity, neovascularization, thickness, and histology were evaluated to compare the therapeutic effects of the three groups. Further investigation was conducted on the transparency of HA hydrogels to acquire the practical capabilities of hydrogel as a reservoir for drug delivery. Compared to untreated animals, animals treated with crosslinked HA hydrogels exhibited greater corneal re-epithelialization on days 1, 2, 4, and 7 post-injury (p=0.004, p=0.007, p=0.008, and p=0.034, respectively) and the least corneal neovascularization (p=0.008). Histological analysis revealed lower infiltration of stromal inflammatory cells and compact collagen structure in crosslinked HA hydrogel-treated animals than in untreated animals. These findings corresponded with immunohistochemical analyses indicating that the expression of inflammatory markers such as alpha-SMA, MMP9, and IL1-beta was lower in animals treated with crosslinked HA hydrogels than untreated animals and animals treated only with 0.1% HA eye drops. With beneficial pharmacological effects such as re-epithelization and anti-inflammation, in situ-forming hyaluronic acid (HA) hydrogels may be a promising approach to effective drug delivery in cases of corneal burn injuries.

  View details for DOI 10.1016/j.reth.2022.03.005

  View details for PubMedID 35402662

• Effect of hepatocyte growth factor-loaded collagen-PEG gels on corneal wound healing Naranjo, A., Cunha, G., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022

  View details for Web of Science ID 000844437004076

• Inorganic polyphosphate-collagen complexes improve corneal epithelial cell function under glucose starvation and enhance corneal wound healing Rogers, G., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022

  View details for Web of Science ID 000844437002299

• Epidermal growth factor-loaded collagen gels to enhance corneal wound healing: Effect of matrix crosslinking chemistry Seo, Y., Rogers, G., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022

  View details for Web of Science ID 000844437002278

• A Pilot Study on Novel Ptotic Eye Dataset: Automated Prediction of Horizontal Corneal Diameter on Digital Photos of Taiwanese Ptotic Patients by Convolutional Neural Networks (CNNs) Hung, J., Chen, K., Chandrashan, P., Myung, D., Kossler, A., Fuh, C., Liao, S., Hsu, C. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022

  View details for Web of Science ID 000844401302062

• Predicting systemic health features from retinal fundus images using transfer-learning based AI models Khan, N. C., Perera, C., Dow, E. R., Leng, T., Mahajan, V. B., Mruthyunjaya, P., Do, D. V., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022

  View details for Web of Science ID 000844437002058

• A Mucin-Deficient Ocular Surface Mimetic Platform for Interrogating Drug Effects on Biolubrication, Antiadhesion Properties, and Barrier Functionality. ACS applied materials & interfaces Madl, A. C., Liu, C., Cirera-Salinas, D., Fuller, G. G., Myung, D. 2022

  Abstract

  Dry eye disease (DED) affects more than 100 million people worldwide, causing significant patient discomfort and imposing a multi-billion-dollar burden on global health care systems. In DED patients, the natural biolubrication process that facilitates pain-free blinking goes awry due to an imbalance of lipids, aqueous medium, and mucins in the tear film, resulting in ocular surface damage. Identifying strategies to reduce adhesion and shear stresses between the ocular surface and the conjunctival cells lining the inside of the eyelid during blink cycles is a promising approach to improve the signs and symptoms of DED. However, current preclinical models for screening ocular lubricants rely on scarce, heterogeneous tissue samples or model substrates that do not capture the complex biochemical and biophysical cues present at the ocular surface. To recapitulate the hierarchical architecture and phenotype of the ocular interface for preclinical drug screening, we developed an in vitro mucin-deficient DED model platform that mimics the complexity of the ocular interface and investigated its utility in biolubrication, antiadhesion, and barrier protection studies using recombinant human lubricin, a promising investigational therapy for DED. The biomimetic platform recapitulated the pathological changes in biolubrication, adhesion, and barrier functionality often observed in mucin-deficient DED patients and demonstrated that recombinant human lubricin can reverse the damage induced by mucin loss in a dose- and conformation-dependent manner. Taken together, these results highlight the potential of the platform─and recombinant human lubricin─in advancing the standard of care for mucin-deficient DED patients.

  View details for DOI 10.1021/acsami.1c22280

  View details for PubMedID 35416028

• Bimetallic Nanocatalysts Immobilized in Nanoporous Hydrogels for Long-Term Robust Continuous Glucose Monitoring of Smart Contact Lens. Advanced materials (Deerfield Beach, Fla.) Kim, S., Lee, G., Jeon, C., Han, H. H., Kim, S., Mok, J. W., Joo, C., Shin, S., Sim, J., Myung, D., Bao, Z., Hahn, S. K. 2022: e2110536

  Abstract

  Smart contact lenses for continuous glucose monitoring (CGM) have great potential for huge clinical impact. To date, their development has been limited by challenges in accurate detection of glucose without hysteresis for tear glucose monitoring to track the blood glucose levels. Here, long-term robust CGM in diabetic rabbits is demonstrated by using bimetallic nanocatalysts immobilized in nanoporous hydrogels in smart contact lenses. After redox reaction of glucose oxidase, the nanocatalysts facilitate rapid decomposition of hydrogen peroxide and nanoparticle-mediated charge transfer with drastically improved diffusion via rapid swelling of nanoporous hydrogels. The ocular glucose sensors result in high sensitivity, fast response time, low detection limit, low hysteresis, and rapid sensor warming-up time. In diabetic rabbits, smart contact lens can detect tear glucose levels consistent with blood glucose levels measured by a glucometer and a CGM device, reflecting rapid concentration changes without hysteresis. The CGM in a human demonstrates the feasibility of smart contact lenses for further clinical applications. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1002/adma.202110536

  View details for PubMedID 35194844

• An Outperforming Artificial Intelligence Model to Identify Referable Blepharoptosis for General Practitioners. Journal of personalized medicine Hung, J., Chen, K., Perera, C., Chiu, H., Hsu, C., Myung, D., Luo, A., Fuh, C., Liao, S., Kossler, A. L. 2022; 12 (2)

  Abstract

  The aim of this study is to develop an AI model that accurately identifies referable blepharoptosis automatically and to compare the AI model's performance to a group of non-ophthalmic physicians. In total, 1000 retrospective single-eye images from tertiary oculoplastic clinics were labeled by three oculoplastic surgeons as having either ptosis, including true and pseudoptosis, or a healthy eyelid. A convolutional neural network (CNN) was trained for binary classification. The same dataset was used in testing three non-ophthalmic physicians. The CNN model achieved a sensitivity of 92% and a specificity of 88%, compared with the non-ophthalmic physician group, which achieved a mean sensitivity of 72% and a mean specificity of 82.67%. The AI model showed better performance than the non-ophthalmic physician group in identifying referable blepharoptosis, including true and pseudoptosis, correctly. Therefore, artificial intelligence-aided tools have the potential to assist in the diagnosis and referral of blepharoptosis for general practitioners.

  View details for DOI 10.3390/jpm12020283

  View details for PubMedID 35207771

• Artificial Intelligence for Retinopathy of Prematurity: Validation of a Vascular Severity Scale against International Expert Diagnosis. Ophthalmology Campbell, J. P., Chiang, M. F., Chen, J. S., Moshfeghi, D. M., Nudleman, E., Ruambivoonsuk, P., Cherwek, H., Cheung, C. Y., Singh, P., Kalpathy-Cramer, J., Ostmo, S., Eydelman, M., Chan, R. V., Capone, A. J., CCOI Executive Committee and the CCOI Retinopathy of Prematurity Workgroup 2022

  Abstract

  OBJECTIVE: To validate a vascular severity score as an appropriate output for artificial intelligence (AI) Software as a Medical Device (SaMD) for retinopathy of prematurity (ROP) through comparison with ordinal disease severity labels for stage and plus disease assigned by the International Classification of ROP, 3rd edition (ICROP3) committee.DESIGN: Validation study of an AI-based ROP vascular severity score Subjects, Participants, and/or Controls: 34 ROP experts from the ICROP3 committee.METHODS: Two separate datasets of 30 fundus photographs each for stage (0-5) and plus disease (plus, pre-plus, neither) were labeled by members of the ICROP3 committee using an open-source platform. Averaging these results produced a continuous label for plus (1-9) and stage (1-3) for each image. Experts were also asked to compare each image to each other in terms of relative severity for plus disease. Each image was also labelled with a vascular severity score from the Imaging and Informatics in ROP deep learning (i-ROP DL) system, which was compared with each grader's diagnostic labels for correlation, as well as the ophthalmoscopic diagnosis of stage.MAIN OUTCOME MEASURES: Weighted kappa and Pearson correlation coefficients (CC) were calculated between each pair of grader classification labels for stage and plus disease. The Elo algorithm was also used to convert pairwise comparisons for each expert into an ordered set of images from least to most severe.RESULTS: The mean weighted kappa and CC for all inter-observer pairs for plus disease image comparison was 0.67 and 0.88 respectively. The vascular severity score was found to be highly correlated with both the average plus disease classification (CC = 0.90, p < 0.001) and the ophthalmoscopic diagnosis of stage (p < 0.001 by ANOVA) among all experts.CONCLUSIONS: The ROP vascular severity score correlates well with the ICROP committee member's labels for plus disease and stage, which had significant inter-grader variability. Generation of a consensus for a validated scoring system for ROP SaMD can facilitate global innovation and regulatory authorization of these technologies.

  View details for DOI 10.1016/j.ophtha.2022.02.008

  View details for PubMedID 35157950

• The Collaborative Community on Ophthalmic Imaging: Accelerating Global Innovation and Clinical Utility OPHTHALMOLOGY Blumenkranz, M. S., Tarver, M. E., Myung, D., Eydelman, M. B., Collaborative Community Ophthalmic 2022; 129 (2): E9-E13

  View details for DOI 10.1016/j.ophtha.2021.10.001

  View details for Web of Science ID 000747770500001

  View details for PubMedID 34774340

• A Smartphone-Based Near-Vision Testing System: Design, Accuracy, and Reproducibility Compared With Standard Clinical Measures OPHTHALMIC SURGERY LASERS & IMAGING RETINA Kim, D., Webel, A. D., Blumenkranz, M. S., Kim, Y., Yang, J., Yu, S., Kwak, H., Palanker, D., Toy, B., Myung, D. 2022; 53 (2): 79-84

  Abstract

  Ophthalmologic telemedicine has emerged during the COVID-19 pandemic. The objective of this study is to assess the accuracy and reproducibility of a smartphone-based home vision monitoring system (Sightbook) and to compare it with existing clinical standards.Near Snellen visual acuity (VA) was measured with Sightbook and compared with conventional measurements for distance and near VA at an academic medical center ophthalmology clinic in 200 patients with a variety of different specified preexisting ocular conditions. Measurements of contrast sensitivity were also compared by using an existing commercially available chart system in 15 normal patients and 15 patients with age-related macular degeneration.Sightbook VA tests were reproducible (SD = ±0.054 logMAR), and correlation with standard VA methods was significant (R > 0.87 and P < .001). Sightbook contrast sensitivity measurements were reproducible (SD/mean ratio, 0.02 to 0.04), yielding results similar to those of standard tests (R2 > 0.87 and P < .001).Smartphone-based VA and contrast sensitivity are highly correlated with standard charts and may be useful in augmenting limited inoffice care. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:79-84.].

  View details for DOI 10.3928/23258160-20220121-05

  View details for Web of Science ID 000768759200002

  View details for PubMedID 35148218

• In vivo biocompatibility evaluation of in situ-forming polyethylene glycol-collagen hydrogels in corneal defects. Scientific reports Chun, Y. H., Park, S., Kim, E. J., Lee, H. J., Kim, H., Koh, W., Cunha, G. F., Myung, D., Na, K. 1800; 11 (1): 23913

  Abstract

  The available treatment options include corneal transplantation for significant corneal defects and opacity. However, shortage of donor corneas and safety issues in performing corneal transplantation are the main limitations. Accordingly, we adopted the injectable in situ-forming hydrogels of collagen type I crosslinked via multifunctional polyethylene glycol (PEG)-N-hydroxysuccinimide (NHS) for treatment and evaluated in vivo biocompatibility. The New Zealand White rabbits (N=20) were randomly grouped into the keratectomy-only and keratectomy with PEG-collagen hydrogel-treated groups. Samples were processed for immunohistochemical evaluation. In both clinical and histologic observations, epithelial cells were able to migrate and form multilayers over the PEG-collagen hydrogels at the site of the corneal stromal defect. There was no evidence of inflammatory or immunological reactions or increased IOP for PEG-collagen hydrogel-treated corneas during the four weeks of observation. Immunohistochemistry revealed the presence of alpha-smooth muscle actin (alpha-SMA) in the superior corneal stroma of the keratectomy-only group (indicative of fibrotic healing), whereas low stromal alpha-SMA expression was detected in the keratectomy with PEG-collagen hydrogel-treated group. Taken together, we suggest that PEG-collagen may be used as a safe and effective alternative in treating corneal defect in clinical setting.

  View details for DOI 10.1038/s41598-021-03270-3

  View details for PubMedID 34903788

• Fusogenic liposome-enhanced cytosolic delivery of magnetic nanoparticles. RSC advances Chen, F., Bian, M., Nahmou, M., Myung, D., Goldberg, J. L. 2021; 11 (57): 35796-35805

  Abstract

  Magnetic nanoparticles (MNPs) are widely used in cell sorting, organelle selection, drug delivery, cell delivery, and cell tracking applications. However, organelle manipulation in living cells has been limited due to the endocytic uptake and sequestration of MNPs. Here, we introduce a method for modifying MNPs with fusogenic liposomes that facilitate MNP passage directly into the cytosol. MNPs were enclosed in fusogenic liposomes that exhibit a core-shell structure under a transmission electron microscope (TEM). The lipid-to-MNP ratio was optimized for one layer of liposome coating around each MNP, so that MNPs were delivered to the cytosol without endosomal or liposomal coatings. After incubation with the retinal pigment epithelial cell line ARPE-19, single-layer liposome-coated MNPs exhibited the highest MNP delivery efficiency. Although uncoated MNPs are taken up through endocytosis, less than 15% of the fusogenic liposome-coated MNPs co-localized with early endosomes. MNPs delivered by fusogenic liposomes showed cytosolic localization early on and increased lysosomal localization at later time points. The movement of intracellular MNPs could be manipulated with an external magnet to estimate cytosolic viscosity. Bypassing endocytosis in this way allowed efficient delivery of MNPs to the cytosol, potentially allowing for the targeting of specific organelles and controlling their motion in living cells.

  View details for DOI 10.1039/d1ra03094a

  View details for PubMedID 35492766

  View details for PubMedCentralID PMC9043121

• Fusogenic liposome-enhanced cytosolic delivery of magnetic nanoparticles RSC ADVANCES Chen, F., Bian, M., Nahmou, M., Myung, D., Goldberg, J. L. 2021; 11 (57): 35796-35805

  View details for DOI 10.1039/d1ra03094a

  View details for Web of Science ID 000714410600001

• A Simple Inner-Stopper Guarded Trephine for Creation of Uniform Keratectomy Wounds in Rodents. Journal of ophthalmic & vision research Le, P. B., Chen, F., Myung, D. 2021; 16 (4): 544-551

  Abstract

  Creating controllable, reproducible keratectomy wounds in rodent corneas can be a challenge due to their small size, thickness, and the lack of usual tools available for human eyes such as a vacuum trephine. The purpose of this work is to provide a consistent, reproducible corneal stromal defect in rats using a simple, economical, and customized inner-stopper guarded trephine.The inner-stopper guarded trephine is used to induce a circular wound in rat corneas. After trephination, the corneal flap can be removed by manual dissection using a blunt spatula. We used optical coherence topography (OCT) to measure the defect wound depth induced in ex vivo rat eyes.Despite a minor learning curve, this simple device enables depth control, reduces variability of manual keratectomy wound depth in rats, and decreases the risk for corneal perforation during keratectomy. Corneal defect creation was highly reproducible across different researchers and was independent of their surgical training.This inner-stopper guarded trephine can be utilized and applied to pre-clinical testing of a wide range of corneal wound healing therapies, including but not limited to biotherapeutics, corneal prosthetics, and regenerative technologies.

  View details for DOI 10.18502/jovr.v16i4.9743

  View details for PubMedID 34840676

  View details for PubMedCentralID PMC8593534

• Supramolecular Host-Guest Hydrogels for Corneal Regeneration. Gels (Basel, Switzerland) Madl, A. C., Myung, D. 2021; 7 (4)

  Abstract

  Over 6.2 million people worldwide suffer from moderate to severe vision loss due to corneal disease. While transplantation with allogenic donor tissue is sight-restoring for many patients with corneal blindness, this treatment modality is limited by long waiting lists and high rejection rates, particularly in patients with severe tissue damage and ocular surface pathologies. Hydrogel biomaterials represent a promising alternative to donor tissue for scalable, nonimmunogenic corneal reconstruction. However, implanted hydrogel materials require invasive surgeries and do not precisely conform to tissue defects, increasing the risk of patient discomfort, infection, and visual distortions. Moreover, most hydrogel crosslinking chemistries for the in situ formation of hydrogels exhibit off-target effects such as cross-reactivity with biological structures and/or result in extractable solutes that can have an impact on wound-healing and inflammation. To address the need for cytocompatible, minimally invasive, injectable tissue substitutes, host-guest interactions have emerged as an important crosslinking strategy. This review provides an overview of host-guest hydrogels as injectable therapeutics and highlights the potential application of host-guest interactions in the design of corneal stromal tissue substitutes.

  View details for DOI 10.3390/gels7040163

  View details for PubMedID 34698163

• A Simple Inner-Stopper Guarded Trephine for Creation of Uniform Keratectomy Wounds in Rodents JOURNAL OF OPHTHALMIC & VISION RESEARCH Le, P. B., Chen, F., Myung, D. 2021; 16 (4): 544-551

  View details for DOI 10.18502/jovr.v16i4.9743

  View details for Web of Science ID 000711575800004

• Supramolecular host-guest hyaluronic acid hydrogels enhance corneal wound healing through dynamic spatiotemporal effects. The ocular surface Fernandes-Cunha, G. M., Jeong, S. H., Logan, C. M., Le, P., Mundy, D., Chen, F., Chen, K. M., Kim, M., Lee, G., Na, K., Hahn, S. K., Myung, D. 2021

  Abstract

  Large abrasions and deeper ulcers of the cornea can lead to corneal scarring, ulceration and thinning if not promptly and adequately treated. Hyaluronic acid (HA) has been investigated for the treatment of corneal wounds due to its remarkable biocompatibility, transparency and mucoadhesive properties. However, intact linear HA has low retention time on the cornea and chemical crosslinkers to synthesize HA hydrogels can cause toxicity limiting their clinical ocular applications. Here, we used supramolecular HA hydrogels formed by non-covalent host-guest interactions between HA-cyclodextrin and HA-adamantane to evaluate the impact of the hydrogels on corneal wound healing. Supramolecular HA hydrogels facilitated adhesion and spreading of encapsulated human corneal epithelial cells ex vivo and improved corneal wound healing in vivo as an in situ-formed, acellular therapeutic membrane. The HA hydrogels were absorbed within the corneal stroma over time, modulated mesenchymal cornea stromal cell secretome production, reduced cellularity and inflammation of the anterior stroma, and significantly mitigated corneal edema compared to treatment with linear HA and untreated control eyes. Taken together, our results demonstrate supramolecular HA hydrogels as a promising and versatile biomaterial platform for corneal wound healing.

  View details for DOI 10.1016/j.jtos.2021.09.002

  View details for PubMedID 34537415

• Detection of Optic Disc Abnormalities in Color Fundus Photographs Using Deep Learning. Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society Liu, T. Y., Wei, J., Zhu, H., Subramanian, P. S., Myung, D., Yi, P. H., Hui, F. K., Unberath, M., Ting, D. S., Miller, N. R. 2021; 41 (3): 368-374

  Abstract

  BACKGROUND: To date, deep learning-based detection of optic disc abnormalities in color fundus photographs has mostly been limited to the field of glaucoma. However, many life-threatening systemic and neurological conditions can manifest as optic disc abnormalities. In this study, we aimed to extend the application of deep learning (DL) in optic disc analyses to detect a spectrum of nonglaucomatous optic neuropathies.METHODS: Using transfer learning, we trained a ResNet-152 deep convolutional neural network (DCNN) to distinguish between normal and abnormal optic discs in color fundus photographs (CFPs). Our training data set included 944 deidentified CFPs (abnormal 364; normal 580). Our testing data set included 151 deidentified CFPs (abnormal 71; normal 80). Both the training and testing data sets contained a wide range of optic disc abnormalities, including but not limited to ischemic optic neuropathy, atrophy, compressive optic neuropathy, hereditary optic neuropathy, hypoplasia, papilledema, and toxic optic neuropathy. The standard measures of performance (sensitivity, specificity, and area under the curve of the receiver operating characteristic curve (AUC-ROC)) were used for evaluation.RESULTS: During the 10-fold cross-validation test, our DCNN for distinguishing between normal and abnormal optic discs achieved the following mean performance: AUC-ROC 0.99 (95 CI: 0.98-0.99), sensitivity 94% (95 CI: 91%-97%), and specificity 96% (95 CI: 93%-99%). When evaluated against the external testing data set, our model achieved the following mean performance: AUC-ROC 0.87, sensitivity 90%, and specificity 69%.CONCLUSION: In summary, we have developed a deep learning algorithm that is capable of detecting a spectrum of optic disc abnormalities in color fundus photographs, with a focus on neuro-ophthalmological etiologies. As the next step, we plan to validate our algorithm prospectively as a focused screening tool in the emergency department, which if successful could be beneficial because current practice pattern and training predict a shortage of neuro-ophthalmologists and ophthalmologists in general in the near future.

  View details for DOI 10.1097/WNO.0000000000001358

  View details for PubMedID 34415271

• Foundational Considerations for Artificial Intelligence Utilizing Ophthalmic Images. Ophthalmology Abramoff, M. D., Cunningham, B., Patel, B., Eydelman, M. B., Leng, T., Sakamoto, T., Blodi, B., Grenon, S. M., Wolf, R. M., Manrai, A. K., Ko, J. M., Chiang, M. F., Char, D., Collaborative Community on Ophthalmic Imaging Executive Committee and Foundational Principles of Ophthalmic Imaging and Algorithmic Interpretation Working Group 2021

  Abstract

  IMPORTANCE: The development of Artificial Intelligence (AI) and other machine diagnostic systems, also known as Software as a Medical Device (SaMD), and its recent introduction into clinical practice, requires a deeply-rooted foundation in bioethics, for consideration by regulatory agencies and other stakeholders around the globe.OBJECTIVES: Initiate a dialogue on the issues to consider when developing a bioethically sound foundation for AI in medicine, based on images of eye structures, for discussion with all stakeholders.EVIDENCE REVIEW: The scope of the issues and summaries of the discussions under consideration by the Foundational Principles of Ophthalmic Imaging and Algorithmic Interpretation Working Group, as first presented during the Collaborative Community on Ophthalmic Imaging inaugural meeting on September 7, 2020, and afterwards in the working group.FINDINGS: AI has the potential to fundamentally improve the access to healthcare and patient outcomes, while decreasing disparities, lowering cost, as well as enhancing the care team. Nevertheless, substantial concerns exist. Ethicists, AI algorithm experts, as well as the Food and Drug Administration (FDA) and other regulatory agencies, industry, patient advocacy groups, clinicians and their professional societies, other provider groups, payors, and other healthcare stakeholders working together in collaborative communities to resolve such issues as non-maleficence, autonomy and equity, is essential to attain this potential, and impacts all levels of the design, validation and implementation of AI in medicine. Design, validation and implementation of AI warrant meticulous attention.CONCLUSIONS AND RELEVANCE: The development of a bioethically sound foundation may be possible if it is based in non-maleficence, autonomy and equity, for considerations for the design, validation and implementation for AI systems. Achieving such a foundation will be helpful for continuing successful introduction into medicine, before consideration by regulatory agencies around the globe.Fundamental improvements in accessibility and quality of healthcare, decrease in health disparities, and lower cost can thereby be achieved. These considerations should be discussed with all stakeholders and expanded upon as a useful initiation of this dialogue.

  View details for DOI 10.1016/j.ophtha.2021.08.023

  View details for PubMedID 34478784

• Mucin-Like Glycoproteins Modulate Interfacial Properties of a Mimetic Ocular Epithelial Surface. Advanced science (Weinheim, Baden-Wurttemberg, Germany) Liu, C., Madl, A. C., Cirera-Salinas, D., Kress, W., Straube, F., Myung, D., Fuller, G. G. 2021: e2100841

  Abstract

  Dry eye disease (DED) has high personal and societal costs, but its pathology remains elusive due to intertwined biophysical and biochemical processes at the ocular surface. Specifically, mucin deficiency is reported in a subset of DED patients, but its effects on ocular interfacial properties remain unclear. Herein a novel in vitro mucin-deficient mimetic ocular surface (Mu-DeMOS) with a controllable amount of membrane-tethered mucin molecules is developed to represent the diseased ocular surfaces. Contact angle goniometry on mimetic ocular surfaces reveals that high surface roughness, but not the presence of hydrophilic mucin molecules, delivers constant hydration over native ocular surface epithelia. Live-cell rheometry confirms that the presence of mucin-like glycoproteins on ocular epithelial cells reduces shear adhesive strength at cellular interfaces. Together, optimal surface roughness and surface chemistry facilitate sustainable lubrication for healthy ocular surfaces, while an imbalance between them contributes to lubrication-related dysfunction at diseased ocular epithelial surfaces. Furthermore, the restoration of low adhesive strength at Mu-DeMOS interfaces through a mucin-like glycoprotein, recombinant human lubricin, suggests that increased frictional damage at mucin-deficient cellular surfaces may be reversible. More broadly, these results demonstrate that Mu-DeMOS is a promising platform for drug screening assays and fundamental studies on ocular physiology.

  View details for DOI 10.1002/advs.202100841

  View details for PubMedID 34184839

• Magnetic nanoparticles for subcellular organelle manipulation Bian, M., Chen, F., Nahmou, M., Myung, D., Goldberg, J. L. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021

  View details for Web of Science ID 000690761600204

• In vitro characterization of a novel in situ-forming semi-interpenetrating polymer network of crosslinked collagen and glycosaminoglycans for corneal defect repair Mundy, D., Chen, F., Le, P., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021

  View details for Web of Science ID 000690760500859

• Collagen gels crosslinked by photoactivation of riboflavin for corneal defect repair Seo, Y., Fernandes-Cunha, G., Chen, F., Le, P., Logan, C., Mundy, D., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021

  View details for Web of Science ID 000690760500751

• In situ-forming semi-interpenetrating network hydrogels for corneal regeneration: in vivo biological response Chen, F., Le, P., Fernandes-Cunha, G., Mundy, D., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021

  View details for Web of Science ID 000690760500744

• In situ forming collagen-PEG hydrogel as a matrix therapy for corneal defects: 2 month in vivo response Rogers, G., Chen, F., Le, P., Mundy, D., Logan, C., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021

  View details for Web of Science ID 000690760500752

• A corneal tissue opacity model for the evaluation of corneal wound healing technologies Le, P., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021

  View details for Web of Science ID 000690761100024

• Supramolecular host-guest hyaluronic acid hydrogels for corneal endothelial cell delivery and epithelial wound healing Logan, C. M., Fernandes-Cunha, G., Jung, S., Le, P., Mundy, D. C., Kim, M., Lee, G., Hahn, S., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021

  View details for Web of Science ID 000690761100027

• Bio-orthogonally Crosslinked Matrix Therapies for Corneal Defect Repair Myung, D., Chen, F., Fernandes-Cunha, G., Le, P., Hull, S., Heilshorn, S. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021

  View details for Web of Science ID 000690761100026

• A novel device for descemetorhexis creation: 3D Printed Prototype Design and Ex Vivo Evaluation Buickians, D., Mbagwu, M., Lin, C. C., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021

  View details for Web of Science ID 000690761100057

• Smart Contact Lenses with a Transparent Silver Nanowire Strain Sensor for Continuous Intraocular Pressure Monitoring. ACS applied bio materials Kim, T. Y., Shin, S., Choi, H., Jeong, S. H., Myung, D., Hahn, S. K. 2021; 4 (5): 4532-4541

  Abstract

  Continuous intraocular pressure (IOP) monitoring can provide a paradigm shift in the management of patients with glaucoma as a facile alternative to conventional diagnostic methods. However, the low sensitivity and functional instability of current IOP sensors have limited their clinical utility in the management of glaucoma. Here, we have developed a smart contact lens integrated with a transparent silver nanowire IOP strain sensor and wireless circuits for noninvasive, continuous IOP monitoring. After confirming the robust stability of the IOP sensor within the smart contact lens in the presence of tears and repeated eyelid blink model cycles, we were able to monitor IOP changes on polydimethylsiloxane model eyes in vitro. In vivo tests demonstrated that our fully integrated wireless smart contact lens could successfully monitor the change in IOP in living rabbit eyes, which was clearly validated by the conventional invasive tonometer IOP test. Taken together, we could confirm the feasibility of our smart contact lens as a noninvasive platform for continuous IOP monitoring of glaucoma patients.

  View details for DOI 10.1021/acsabm.1c00267

  View details for PubMedID 35006789

• Smart Contact Lenses with a Transparent Silver Nanowire Strain Sensor for Continuous Intraocular Pressure Monitoring ACS APPLIED BIO MATERIALS Kim, T., Shin, S., Choi, H., Jeong, S., Myung, D., Hahn, S. 2021; 4 (5): 4532-4541

  View details for DOI 10.1021/acsabm.1c00267

  View details for Web of Science ID 000653545300069

• Comparison of Telemedicine Screening of Diabetic Retinopathy by Mydriatic Smartphone-Based vs Nonmydriatic Tabletop Camera-Based Fundus Imaging. Journal of vitreoretinal diseases Han, Y. S., Pathipati, M., Pan, C., Leung, L., Blumenkranz, M. S., Myung, D., Toy, B. C. 2021; 5 (3): 199-207

  Abstract

  Purpose: To compare dilated smartphone-based imaging with a nonmydriatic, tabletop fundus camera as a teleophthalmology screening tool for diabetic retinopathy (DR).Methods: This was a single-institutional, cross-sectional, comparative-instrument study. Fifty-six patients at a safety-net hospital underwent teleophthalmology screening for DR using standard, nonmydriatic fundus photography with a tabletop camera (Nidek NM-1000) and dilated fundus photography using a smartphone camera with lens adapter (Paxos Scope, Verana Health). Masked graders performed standardized photo grading. Quantitative comparisons were performed employing descriptive, kappa, Bland-Altman, and receiver operating characteristic analyses.Results: Posterior segment photography was of sufficient quality to grade in 89% of mydriatic smartphone-imaged eyes and in 86% of nonmydriatic tabletop camera-imaged eyes (P = .03). Using the tabletop camera as the reference to detect moderate nonproliferative DR or worse (referral-warranted DR), mydriatic smartphone-acquired photographs were found to be 82% sensitive and 96% specific. Dilated smartphone imaging detected referral-warranted DR in 3 eyes whose tabletop camera imaging did not demonstrate referral-warranted DR. Secondary masked review of medical records for the discordances in referral-warranted status from the two imaging modalities was performed, and it revealed revised sensitivity and specificity values of 95% and 98%, respectively. Overall, there was good agreement between tabletop camera and smartphone-acquired photo grades (kappa = 0.91 ± 0.1, P < .001; area under the receiver operating characteristic curve = 0.99, 95% CI, 0.98-1.00).Conclusions: Mydriatic smartphone-based imaging resulted in fewer ungradable photos compared to nonmydriatic table-top camera imaging and detected more patients with referral-warranted DR. Our study supports the use of mydriatic smartphone teleophthalmology as an alternative method to screen for DR.

  View details for DOI 10.1177/2474126420958304

  View details for PubMedID 34632255

• Effect of mesenchymal stromal cells encapsulated within polyethylene glycol-collagen hydrogels formed in situ on alkali-burned corneas in an ex vivo organ culture model. Cytotherapy Na, K., Fernandes-Cunha, G. M., Varela, I. B., Lee, H. J., Seo, Y. A., Myung, D. 2021

  Abstract

  BACKGROUND AIMS: Corneal inflammation after alkali burns often results in vision loss due to corneal opacification and neovascularization. Mesenchymal stem cells (MSCs) and their secreted factors (secretome) have been studied for their anti-inflammatory and anti-angiogenic properties with encouraging results. However, topical instillation of MSCs or their secretome is often accompanied by issues related to delivery or rapid washout. Polyethylene glycol (PEG) and collagen are well-known biomaterials used extensively in scaffolds for tissue engineering. To effectively suppress alkaline burn-induced corneal injury, the authors proposed encapsulating MSCs within collagen gels cross-linked with multi-functional PEG-succinimidyl esters as a means to deliver the secretome of immobilized MSCs.METHODS: Human MSCs were added to a neutralized collagen solution and mixed with a solution of four-arm PEG-N-hydroxysuccinimide. An ex vivo organ culture was conducted using rabbit corneas injured by alkali burn. MSCs were encapsulated within PEG-collagen hydrogels and injected onto the wounded cornea immediately following alkali burn and washing. Photographs of the ocular surface were taken over a period of 7 days after the alkali burn and processed for immunohistochemical evaluation. Samples were split into three groups: injury without treatment, MSCs alone, and MSCs encapsulated within PEG-collagen hydrogels.RESULTS: All corneas in ex vivo organ culture lost their transparency immediately after alkali burn, and only the groups treated with MSCs and MSCs encapsulated within PEG-collagen hydrogels recovered some transparency after 7 days. Immunohistochemical analysis revealed increased expression of vimentin in the anterior corneal stroma of the group without treatment indicative of fibrotic healing, whereas less stromal vimentin was detected in the group containing MSCs encapsulated within the PEG-collagen hydrogels.CONCLUSIONS: PEG-collagen hydrogels enable the encapsulation of viable MSCs capable of releasing secreted factors onto the ocular surface. Encapsulating MSCs within PEG-collagen hydrogels may be a promising method for delivering their therapeutic benefits in cases of ocular inflammatory diseases, such as alkali burn injuries.

  View details for DOI 10.1016/j.jcyt.2021.02.001

  View details for PubMedID 33752960

• 3D Bioprinting using UNIversal Orthogonal Network (UNION) Bioinks. Advanced functional materials Hull, S. M., Lindsay, C. D., Brunel, L. G., Shiwarski, D. J., Tashman, J. W., Roth, J. G., Myung, D., Feinberg, A. W., Heilshorn, S. C. 2021; 31 (7)

  Abstract

  Three-dimensional (3D) bioprinting is a promising technology to produce tissue-like structures, but a lack of diversity in bioinks is a major limitation. Ideally each cell type would be printed in its own customizable bioink. To fulfill this need for a universally applicable bioink strategy, we developed a versatile, bioorthogonal bioink crosslinking mechanism that is cell compatible and works with a range of polymers. We term this family of materials UNIversal, Orthogonal Network (UNION) bioinks. As demonstration of UNION bioink versatility, gelatin, hyaluronic acid (HA), recombinant elastin-like protein (ELP), and polyethylene glycol (PEG) were each used as backbone polymers to create inks with storage moduli spanning 200 to 10,000 Pa. Because UNION bioinks are crosslinked by a common chemistry, multiple materials can be printed together to form a unified, cohesive structure. This approach is compatible with any support bath that enables diffusion of UNION crosslinkers. Both matrix-adherent human corneal mesenchymal stromal cells and non-matrix-adherent human induced pluripotent stem cell-derived neural progenitor spheroids were printed with UNION bioinks. The cells retained high viability and expressed characteristic phenotypic markers after printing. Thus, UNION bioinks are a versatile strategy to expand the toolkit of customizable materials available for 3D bioprinting.

  View details for DOI 10.1002/adfm.202007983

  View details for PubMedID 33613150

  View details for PubMedCentralID PMC7888563

• 3D Printable, Modified Trephine Designs for Consistent Anterior Lamellar Keratectomy Wounds in Rabbits. Current eye research Chen, F., Buickians, D., Le, P., Xia, X., Montague-Alamin, S. Q., Blanco Varela, I. B., Mundy, D. C., Logan, C. M., Myung, D. 2021: 1–10

  Abstract

  Purpose: Our goal is to develop a low-cost tool that can be used to create consistent, partial-thickness defects in rabbit and other large animals with minimal surgical training and that can facilitate pre-clinical testing of lamellar and in situ-forming biosynthetic matrix materials for corneal repair. Materials & Methods: In this study, three modified trephines were designed to create deep corneal wound defects with consistent depth in large animals. The modified trephines incorporated either 3D-printed parts made from photopolymerizable resins, or custom-cut commercially available Teflon sheets. Wound defects were imaged with optical coherence tomography (OCT), and the depth was analyzed based on the OCT images. Results: The results revealed that an inner-stopper guard trephine had the best performance in creating consistent and precise wound defect depth compared to modified vacuum trephine and custom guard vacuum trephine. A 75% ± 10% cut of the cornea was achieved with the inner-stopper guard trephine. The wound defect depth by created by the inner-stopper guard trephine was independent of the corneal thickness or size of the globes. Although the cut depth of the inner-stopper guard trephine differed by the experience-level of its users, the consistency (standard deviation) of the depth was independent of experience. Conclusions: Our studies provided three cost-efficient animal trephines that can create corneal wounds of consistent depth by lab researchers without extensive training in keratectomy.

  View details for DOI 10.1080/02713683.2020.1868010

  View details for PubMedID 33474996

• A deep learning approach to identify blepharoptosis by convolutional neural networks. International journal of medical informatics Hung, J. Y., Perera, C. n., Chen, K. W., Myung, D. n., Chiu, H. K., Fuh, C. S., Hsu, C. R., Liao, S. L., Kossler, A. L. 2021; 148: 104402

  Abstract

  Blepharoptosis is a known cause of reversible vision loss. Accurate assessment can be difficult, especially amongst non-specialists. Existing automated techniques disrupt clinical workflow by requiring user input, or placement of reference markers. Neural networks are known to be effective in image classification tasks. We aim to develop an algorithm that can accurately identify blepharoptosis from a clinical photo.A total of 500 clinical photographs from patients with and without blepharoptosis were sourced from a tertiary ophthalmic center in Taiwan. Images were labeled by two oculoplastic surgeons, with an independent third oculoplastic surgeon to adjudicate disagreements. These images were used to train a series of convolutional neural networks (CNNs) to ascertain the best CNN architecture for this particular task.Of the models that trained on the dataset, most were able to identify ptosis images with reasonable accuracy. We found the best performing model to use the DenseNet121 architecture without pre-training which achieved a sensitivity of 90.1 % with a specificity of 82.4 %, compared to the worst performing model which was used a Resnet34 architecture with pre-training, achieving a sensitivity of 74.1 %, and specificity of 63.6 %. Models with and without pre-training performed similarly (mean accuracy 82.6 % vs. 85.8 % respectively, p = 0.06), though models with pre-training took less time to train (1-minute vs. 16 min, p < 0.01).We report the use of AI to accurately diagnose blepharoptosis from a clinical photograph with no external reference markers or user input requirement. Most current-generation CNN architectures performed reasonably on this task, with the DenseNet121, and Resnet18 architectures without pre-training performing best in our dataset.

  View details for DOI 10.1016/j.ijmedinf.2021.104402

  View details for PubMedID 33609928

• Automatic Identification of Referral-Warranted Diabetic Retinopathy Using Deep Learning on Mobile Phone Images. Translational vision science & technology Ludwig, C. A., Perera, C., Myung, D., Greven, M. A., Smith, S. J., Chang, R. T., Leng, T. 2020; 9 (2): 60

  Abstract

  Purpose: To evaluate the performance of a deep learning algorithm in the detection of referral-warranted diabetic retinopathy (RDR) on low-resolution fundus images acquired with a smartphone and indirect ophthalmoscope lens adapter.Methods: An automated deep learning algorithm trained on 92,364 traditional fundus camera images was tested on a dataset of smartphone fundus images from 103 eyes acquired from two previously published studies. Images were extracted from live video screenshots from fundus examinations using a commercially available lens adapter and exported as a screenshot from live video clips filmed at 1080p resolution. Each image was graded twice by a board-certified ophthalmologist and compared to the output of the algorithm, which classified each image as having RDR (moderate nonproliferative DR or worse) or no RDR.Results: In spite of the presence of multiple artifacts (lens glare, lens particulates/smudging, user hands over the objective lens) and low-resolution images achieved by users of various levels of medical training, the algorithm achieved a 0.89 (95% confidence interval [CI] 0.83-0.95) area under the curve with an 89% sensitivity (95% CI 81%-100%) and 83% specificity (95% CI 77%-89%) for detecting RDR on mobile phone acquired fundus photos.Conclusions: The fully data-driven artificial intelligence-based grading algorithm herein can be used to screen fundus photos taken from mobile devices and identify with high reliability which cases should be referred to an ophthalmologist for further evaluation and treatment.Translational Relevance: The implementation of this algorithm on a global basis could drastically reduce the rate of vision loss attributed to DR.

  View details for DOI 10.1167/tvst.9.2.60

  View details for PubMedID 33294301

• Modeling and Restoring the Tear Film CURRENT OPHTHALMOLOGY REPORTS Madl, A. C., Fuller, G. F., Myung, D. 2020; 8 (4): 281-300

  View details for DOI 10.1007/s40135-020-00258-6

  View details for Web of Science ID 000702475800011

• Management of acute corneal hydrops with intracameral gas injection. American journal of ophthalmology case reports Sayadi, J. J., Lam, H., Lin, C. C., Myung, D. 2020; 20: 100994

  Abstract

  Purpose: To report two cases of severe acute corneal hydrops that were resolved by intracameral gas injection alone.Observations: Case 1 is a 27-year-old woman with bilateral severe keratoconus who developed sequential acute corneal hydrops in the right eye followed by the left eye that were each successfully treated using intracameral 20% sulfur hexafluoride gas injection. Case 2 is a 62-year-old man that developed a large fluid cleft beneath a pre-existing LASIK flap, which resolved with intracameral 20% sulfur hexafluoride gas injection without the need for corneal transplantation.Conclusions and importance: In acute corneal hydrops, intracameral gas injection to tamponade Descemet's membrane tears with decompression of stromal fluid can be an effective intervention to delay or avoid keratoplasty in individuals whose corneal hydrops does not improve with conventional medical management.

  View details for DOI 10.1016/j.ajoc.2020.100994

  View details for PubMedID 33319122

• 3D Bioprinting using UNIversal Orthogonal Network (UNION) Bioinks ADVANCED FUNCTIONAL MATERIALS Hull, S. M., Lindsay, C. D., Brunel, L. G., Shiwarski, D. J., Tashman, J. W., Roth, J. G., Myung, D., Feinberg, A. W., Heilshorn, S. C. 2020

  View details for DOI 10.1002/adfm.202007983

  View details for Web of Science ID 000590660600001

• Development, Validation, and Innovation in Ophthalmic Laser-Based Imaging: Report From a US Food and Drug Administration-Cosponsored Forum. JAMA ophthalmology Brodie, F., Repka, M., Burns, S. A., Prakalapakorn, S. G., Morse, C., Schuman, J. S., Duenas, M. R., Afshari, N., Pollack, J. S., Thorne, J. E., Vitale, A., Sen, H. N., Myung, D., Blumenkranz, M. S., Tu, E., Hammer, D. X., Tarver, M., Cunningham, B., Kagemann, L., Sadda, S., Sarraf, D., Jaffe, G. J., Eydelman, M. 2020

  Abstract

  In April 2019, the US Food and Drug Administration, in conjunction with 11 professional ophthalmic, vision science, and optometric societies, convened a forum on laser-based imaging. The forum brought together the Food and Drug Administration, clinicians, researchers, industry members, and other stakeholders to stimulate innovation and ensure that patients in the US are the first in the world to have access to high-quality, safe, and effective medical devices. This conference focused on the technology, clinical applications, regulatory issues, and reimbursement issues surrounding innovative ocular imaging modalities. Furthermore, the emerging role of artificial intelligence in ophthalmic imaging was reviewed. This article summarizes the presentations, discussion, and future directions.

  View details for DOI 10.1001/jamaophthalmol.2020.4994

  View details for PubMedID 33211074

• Gold nanoparticles to enhance ophthalmic imaging. Biomaterials science Chen, F., Si, P., de la Zerda, A., Jokerst, J. V., Myung, D. 2020

  Abstract

  The use of gold nanoparticles as diagnostic tools is burgeoning, especially in the cancer community with a focus on theranostic applications to both cancer diagnosis and treatment. Gold nanoparticles have also demonstrated great potential for use in diagnostic and therapeutic approaches in ophthalmology. Although many ophthalmic imaging modalities are available, there is still a considerable unmet need, in particular for ophthalmic molecular imaging for the early detection of eye disease before morphological changes are more grossly visible. An understanding of how gold nanoparticles are leveraged in other fields could inform new ways they could be utilized in ophthalmology. In this paper, we review current ophthalmic imaging techniques and then identify optical coherence tomography (OCT) and photoacoustic imaging (PAI) as the most promising technologies amenable to the use of gold nanoparticles for molecular imaging. Within this context, the development of gold nanoparticles as OCT and PAI contrast agents are reviewed, with the most recent developments described in detail.

  View details for DOI 10.1039/d0bm01063d

  View details for PubMedID 33057463

• Simultaneous Interpenetrating Polymer Network of Collagen and Hyaluronic Acid as an In Situ-Forming Corneal Defect Filler. Chemistry of materials : a publication of the American Chemical Society Chen, F., Le, P., Lai, K., Fernandes-Cunha, G. M., Myung, D. 2020; 32 (12): 5208-5216

  Abstract

  Timely treatment of corneal injuries injury can help to prevent corneal scarring, blindness, and the need for corneal transplantation. This work describes a novel hydrogel that can fill corneal defects and assist in corneal regeneration. This hydrogel is a simultaneous interpenetrating polymer network (IPN) composed of collagen cross-linked via strain-promoted azide-alkyne cycloaddition reaction and hyaluronic acid cross-linked via thiol-ene Michael click reaction. The formation of the IPN gel was confirmed via FTIR spectra, UV-vis spectra, and morphological changes. We compared the gelation time, mechanical properties, transmittance, and refractive index of the IPN gel to the collagen gel, hyaluronic acid gel, and semi-IPN gel. The IPN combined the advantages of collagen and hyaluronic acid gels and supported corneal epithelial cell growth on its surface. When applied to corneal stromal defects in vivo, the IPN avoided epithelial hyperplasia, decreased stromal myofibroblast formation, and increased tight junction formation in the regenerated epithelium.

  View details for DOI 10.1021/acs.chemmater.0c01307

  View details for PubMedID 33603277

  View details for PubMedCentralID PMC7888987

• Simultaneous Interpenetrating Polymer Network of Collagen and Hyaluronic Acid as an In Situ-Forming Corneal Defect Filler CHEMISTRY OF MATERIALS Chen, F., Le, P., Lai, K., Fernandes-Cunha, G. M., Myung, D. 2020; 32 (12): 5208–16

  View details for DOI 10.1021/acs.chemmater.0c01307

  View details for Web of Science ID 000543738500033

• Bioengineered, In Situ-Crosslinked Collagen Gels for Suture-Free Stromal Defect Reconstruction of the Cornea Myung, D., Djalilian, A. R., Heilshorn, S., Chen, F., Le, P., Hull, S., Fernandes-Cunha, G., Na, K. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020

  View details for Web of Science ID 000554528301263

• Optimization of an in situ-forming interpenetrating polymer network of collagen and hyaluronic acid hydrogel independently and simultaneously crosslinked by click chemistries Le, P., Chen, F., Cunha, G., Lai, K., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020

  View details for Web of Science ID 000554495700138

• Design and development of a novel electroretinogram-microperimetry system with superimposed multifocal arrays Suzuki, N., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020

  View details for Web of Science ID 000554495701225

• In situ-forming bio-orthogonally crosslinked collagen-hyaluronate co-polymeric hydrogel to treat deep corneal stromal defects: in vivo biological response Chen, F., Le, P., Cunha, G., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020

  View details for Web of Science ID 000554495702200

• Supramolecular guest-host hyaluronic acid hydrogels for epithelial cell delivery to the cornea Chen, K., Cunha, G., Jung, S., Hahn, S., Lee, G., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020

  View details for Web of Science ID 000554495700275

• Encapsulation of Corneal Stromal Stem Cells within Supramolecular Host-Guest Hyaluronic Acid Gels Seo, Y., Chen, K., Fernandes-Cunha, G., Jung, S., Lee, G., Hahn, S., Djalilian, A. R., Jabbehdari, S., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020

  View details for Web of Science ID 000554495700132

• Assessment of Eye Disease and Visual Impairment in the Nursing Home Population Using Mobile Health Technology OPHTHALMIC SURGERY LASERS & IMAGING RETINA Lai, K. Y., Pathipati, M. P., Blumenkranz, M. S., Leung, L., Moshfeghi, D. M., Toy, B. C., Myung, D. 2020; 51 (5): 262–70

  Abstract

  To characterize the burden of eye disease and the utility of teleophthalmology in nursing home patients, a population with ophthalmic needs not commensurate with care received.Informed consent was obtained from 78 California Bay Area skilled nursing facility patients. Near visual acuity (VA) and anterior/posterior segment photographs were taken with a smartphone-based VA app and ophthalmic camera system. The Nursing Home Vision-Targeted Health-Related Quality of Life questionnaire was also administered. Risk factors for visual impairment were assessed. Institutional review board approval was obtained from Stanford University.Cataracts (51%), diabetic retinopathy (DR) (12%), optic neuropathy (12%), and age-related macular degeneration (AMD) (10%) were common findings; 11.7% had other referral-warranted findings. AMD and DR correlated with a higher risk of poor VA, with adjusted odds ratios of 22 (P = .01) and 43 (P = .004).This study demonstrated a high prevalence of poor VA and ophthalmic disease in the nursing home population impacting quality of life. Smartphone-based teleophthalmology platforms have the potential to increase access to eye care for nursing home patients. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:262-270.].

  View details for DOI 10.3928/23258160-20200501-03

  View details for Web of Science ID 000539315500003

  View details for PubMedID 32511729

• Injectable Cucurbit[8]uril-Based Supramolecular Gelatin Hydrogels for Cell Encapsulation ACS MACRO LETTERS Madl, A. C., Madl, C. M., Myung, D. 2020; 9 (4): 619–26

  View details for DOI 10.1021/acsmacrolett.0c00184

  View details for Web of Science ID 000527769900029

• Wireless smart contact lens for diabetic diagnosis and therapy SCIENCE ADVANCES Keum, D., Kim, S., Koo, J., Lee, G., Jeon, C., Mok, J., Mun, B., Lee, K., Kamrani, E., Joo, C., Shin, S., Sim, J., Myung, D., Yun, S., Bao, Z., Hahn, S. 2020; 6 (17): eaba3252

  Abstract

  A smart contact lens can be used as an excellent interface between the human body and an electronic device for wearable healthcare applications. Despite wide investigations of smart contact lenses for diagnostic applications, there has been no report on electrically controlled drug delivery in combination with real-time biometric analysis. Here, we developed smart contact lenses for both continuous glucose monitoring and treatment of diabetic retinopathy. The smart contact lens device, built on a biocompatible polymer, contains ultrathin, flexible electrical circuits and a microcontroller chip for real-time electrochemical biosensing, on-demand controlled drug delivery, wireless power management, and data communication. In diabetic rabbit models, we could measure tear glucose levels to be validated by the conventional invasive blood glucose tests and trigger drugs to be released from reservoirs for treating diabetic retinopathy. Together, we successfully demonstrated the feasibility of smart contact lenses for noninvasive and continuous diabetic diagnosis and diabetic retinopathy therapy.

  View details for DOI 10.1126/sciadv.aba3252

  View details for Web of Science ID 000530628100044

  View details for PubMedID 32426469

  View details for PubMedCentralID PMC7182412

• Multifunctional materials for implantable and wearable photonic healthcare devices NATURE REVIEWS MATERIALS Lee, G., Moon, H., Kim, H., Lee, G., Kwon, W., Yoo, S., Myung, D., Yun, S., Bao, Z., Hahn, S. 2020

  View details for DOI 10.1038/s41578-019-0167-3

  View details for Web of Science ID 000508153800001

• Microsurgical Resection of an Orbital Arteriovenous Malformation With Intraoperative Digital Subtraction Angiography. Ophthalmic plastic and reconstructive surgery Rosenblatt, T. R., Myung, D. n., Fischbein, N. J., Steinberg, G. K., Kossler, A. L. 2020

  View details for DOI 10.1097/IOP.0000000000001815

  View details for PubMedID 32976328

• In situ-forming collagen hydrogel crosslinked via multi-functional PEG as a matrix therapy for corneal defects. Scientific reports Fernandes-Cunha, G. M., Chen, K. M., Chen, F. n., Le, P. n., Han, J. H., Mahajan, L. A., Lee, H. J., Na, K. S., Myung, D. n. 2020; 10 (1): 16671

  Abstract

  Visually significant corneal injuries and subsequent scarring collectively represent a major global human health challenge, affecting millions of people worldwide. Unfortunately, less than 2% of patients who could benefit from a sight-restoring corneal transplant have access to cadaveric donor corneal tissue. Thus, there is a critical need for new ways to repair corneal defects that drive proper epithelialization and stromal remodeling of the wounded area without the need for cadeveric donor corneas. Emerging therapies to replace the need for donor corneas include pre-formed biosynthetic buttons and in situ-forming matrices that strive to achieve the transparency, biocompatibility, patient comfort, and biointegration that is possible with native tissue. Herein, we report on the development of an in situ-forming hydrogel of collagen type I crosslinked via multi-functional polyethylene glycol (PEG)-N-hydroxysuccinimide (NHS) and characterize its biophysical properties and regenerative capacity both in vitro and in vivo. The hydrogels form under ambient conditions within minutes upon mixing without the need for an external catalyst or trigger such as light or heat, and their transparency, degradability, and stiffness are modulated as a function of number of PEG arms and concentration of PEG. In addition, in situ-forming PEG-collagen hydrogels support the migration and proliferation of corneal epithelial and stromal cells on their surface. In vivo studies in which the hydrogels were formed in situ over stromal keratectomy wounds without sutures showed that they supported multi-layered surface epithelialization. Overall, the in situ forming PEG-collagen hydrogels exhibited physical and biological properties desirable for a corneal stromal defect wound repair matrix that could be applied without the need for sutures or an external trigger such as a catalyst or light energy.

  View details for DOI 10.1038/s41598-020-72978-5

  View details for PubMedID 33028837

• Bio-orthogonally crosslinked hyaluronate-collagen hydrogel for suture-free corneal defect repair. Biomaterials Chen, F. n., Le, P. n., Fernandes-Cunha, G. M., Heilshorn, S. C., Myung, D. n. 2020; 255: 120176

  Abstract

  Biomaterials that mimic corneal stroma could decrease the need for donor corneal tissue and could decrease the prevalence of complications associated with corneal transplantation, including infection and rejection. We developed a bio-orthogonally crosslinked hyaluronate-collagen hydrogel which can fill corneal defects in situ without the need for any sutures, initiators, or catalysts. We studied the effects of biorthogonal crosslinking on the light transmittance of the hydrogel, which was greater than 97% water. The transmittance of the optimized hydrogel in the visible light range was over 94%. We also investigated the mechanical properties, refractive index, morphology, biocompatibility, and corneal re-epithelialization capacity of the hyaluronate-collagen hydrogel. Our in vitro, in vivo, and ex vivo results demonstrated that this bio-orthogonally crosslinked hyaluronate-collagen hydrogel has excellent potential as a biomaterial for cornea repair and regeneration.

  View details for DOI 10.1016/j.biomaterials.2020.120176

  View details for PubMedID 32559566

• Nonmydriatic Photographic Screening for Diabetic Retinopathy in Pregnant Patients with Pre-Existing Diabetes in a Safety Net Population Women's Health Reports Veerappan Pasricha, M., So, J., Myung, D., Jelks, A., Pan, C. K. 2020; 1 (1): 436-443

  View details for DOI 10.1089/whr.2020.0082

• Smartphone-Based Ophthalmic Imaging Compared to Spectral Domain Optical Coherence Tomography Assessment of Vertical Cup-to-Disc Ratio among Adults in Southwestern Uganda. Journal of glaucoma Idriss, B. R., Tran, T. M., Atwine, D. n., Chang, R. T., Myung, D. n., Onyango, J. n. 2020; Publish Ahead of Print

  Abstract

  Using optical coherence tomography measurements as a reference standard for vertical cup-to-disc ratio (vCDR), a smartphone-based ophthalmic camera has a sensitivity of 67.7% and specificity of 96.7% to detect a vCDR greater than 0.5.The purpose of this study was to assess the performance of a smartphone-based ophthalmic camera system using an Apple iPhone 6S and an adapter, Paxos Scope, to obtain adequate dilated fundus photos in order to measure clinically useful vertical cup-to-disc ratio (vCDR) cutoffs.Adult patients from a government tertiary level eye hospital in southwestern Uganda were prospectively recruited from January to April 2019. All patients experienced a comprehensive eye examination, dilated posterior segment indirect ophthalmoscope imaging with the Paxos Scope, and spectral domain optical coherence tomography (SDOCT) imaging with a Cirrus HD-OCT to measure vCDR. Patients' eyes excluded had media opacities or existing disease precluding a view of the fundus. Fundus images underwent a single masked review to assign vCDR at increments of 0.1. Descriptive statistics, parametric and Chi2 tests for significance, repeated measures correlation, kappa, receiver operating characteristics (ROC), and Bland-Altman were used to assess the data.Among 467 (consecutive) individuals, fundus photographs acquired with the Paxos Scope demonstrated a 67.7% (95%CI 63.0-72.0) sensitivity and 96.7% (95%CI 94.2-98.3) specificity to detect a vCDR >0.5, using OCT as the reference standard. 138 eyes were excluded due to poor imaging acquisition, such as dense cataract, rendering 796 eyes for analysis. The vCDR from graded Paxos Scope images and OCT correlated well with repeated measures correlation of 0.82 (95%CI, 0.77-0.86, P<0.001) and agreement, dichotomized as >0.5 or ≤0.5, was 80.9% (kappa=0.63±0.034, P<0.001). Among glaucoma and glaucoma suspects (85 eyes), the sensitivity and specificity dichotomized using vCDR >0.5 were 97.5% (95%CI, 91.3-99.7) and 80.0% (95%CI, 28.4-99.5), respectively. The area under the receiver operating characteristics curve (AROC) was 0.92 (95% CI, 0.89-0.94) for all eyes and 0.98 (95%CI, 0.78-1.0) for glaucoma and glaucoma suspects.The Paxos Scope produced images that can be reliably used to estimate vCDR, which closely aligned with the automated algorithm from OCT optic disc cube scan. The low cost, ready-to-integrate adapter, and minimal training requirements make it a viable option for population-based screening in low-resourced settings.

  View details for DOI 10.1097/IJG.0000000000001779

  View details for PubMedID 33394852

• Nonmydriatric Photographic Screening for Diabetic Retinopathy in Pregnant Patients with Pre-existing Diabetes in a County Population Veerappan, M., Myung, D., Jelks, A., Pan, C. K. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2019

  View details for Web of Science ID 000488800705014

• An engineered dimeric fragment of hepatocyte growth factor improves corneal epithelial wound healing in vitro Carter, K., Ye, A., Fernandes-Cunha, G., Cochran, J. R., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2019

  View details for Web of Science ID 000488628107322

• Enhanced wound healing effects of secretome derived from human mesenchymal stem cells cultured on electrospun fibers Myung, D., Fernandes-Cunha, G., Lee, H., Djalilian, A. R. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2019

  View details for Web of Science ID 000488800703177

• Biophysical characterization of a simultaneous interpenetrating polymer network composed of crosslinked collagen and hyaluronic acid Lai, K., Lee, H., Hull, S., Fernandes-Cunha, G., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2019

  View details for Web of Science ID 000488800701274

• Effects of mesenchymal stem cells encapsulated within crosslinked collagen carrier gels on alkali burns in a corneal organ culture model Blanco, I., Fernandes-Cunha, G., Hull, S., Lee, H., Na, K., Djalilian, A. R., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2019

  View details for Web of Science ID 000488800703038

• Characterization of bioorthogonally crosslinked collagen gels with encapsulated corneal stromal stem cells Hull, S., Fernandes-Cunha, G., Putra, I., Eslani, M., Djalilian, A. R., Heilshorn, S., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2019

  View details for Web of Science ID 000488800701286

• Engineering an electrospun nanofiber to direct corneal epithelial cell proliferation and morphology Vo, C., Lee, H., Fernandes-Cunha, G., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2019

  View details for Web of Science ID 000488628102086

• A novel device for secondary intraocular lens placement: Design and Ex Vivo Evaluation Buickians, D., Myung, D., Blumenkranz, M. S., Brodie, F. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2019

  View details for Web of Science ID 000488628101085

• Corneal Wound Healing Effects of Mesenchymal Stem Cell Secretome Delivered Within a Viscoelastic Gel Carrier STEM CELLS TRANSLATIONAL MEDICINE Fernandes-Cunha, G., Na, K., Putra, I., Lee, H., Hull, S., Cheng, Y., Blanco, I., Eslani, M., Djalilian, A. R., Myung, D. 2019; 8 (5): 478–89

  View details for DOI 10.1002/sctm.18-0178

  View details for Web of Science ID 000465337000008

• Evaluating New Ophthalmic Digital Devices for Safety and Effectiveness in the Context of Rapid Technological Development. JAMA ophthalmology Bodnar, Z. M., Schuchard, R. n., Myung, D. n., Tarver, M. E., Blumenkranz, M. S., Afshari, N. A., Humayun, M. S., Morse, C. n., Nischal, K. n., Repka, M. X., Sprunger, D. n., Trese, M. n., Eydelman, M. B. 2019

  Abstract

  The US Food and Drug Administration's medical device regulatory pathway was initially conceived with hardware devices in mind. The emerging market for ophthalmic digital devices necessitates an evolution of this paradigm.To facilitate innovation in ophthalmic digital health with attention to safety and effectiveness.This article presents a summary of the presentations, discussions, and literature review that occurred during a joint Ophthalmic Digital Health workshop of the American Academy of Ophthalmology, the American Academy of Pediatrics, the American Association for Pediatric Ophthalmology and Strabismus, the American Society of Cataract and Refractive Surgery, the American Society of Retina Specialists, the Byers Eye Institute at Stanford and the US Food and Drug Administration.Criterion standards and expert graders are critically important in the evaluation of automated systems and telemedicine platforms. Training at all levels is important for the safe and effective operation of digital health devices. The risks associated with automation are substantially increased in rapidly progressive diseases. Cybersecurity and patient privacy warrant meticulous attention.With appropriate attention to safety and effectiveness, digital health technology could improve screening and treatment of ophthalmic diseases and improve access to care.

  View details for DOI 10.1001/jamaophthalmol.2019.1576

  View details for PubMedID 31169870

• Characterizing the impact of 2D and 3D culture conditions on the therapeutic effects of human mesenchymal stem cell secretome on corneal wound healing in vitro and ex vivo. Acta biomaterialia Carter, K. n., Lee, H. J., Na, K. S., Fernandes-Cunha, G. M., Blanco, I. J., Djalilian, A. n., Myung, D. n. 2019

  Abstract

  The therapeutic effects of secreted factors (secretome) produced by bone marrow-derived human mesenchymal stem cells (MSCs) were evaluated as a function of their growth in 2D culture conditions and on 3D electrospun fiber scaffolds. Electrospun fiber scaffolds composed of polycaprolactone and gelatin were fabricated to provide a 3D microenvironment for MSCs, and their mechanical properties were optimized to be similar to corneal tissue. The secretome produced by the MSCs cultured on 3D fiber matrices versus 2D culture dishes were analyzed by Luminex immunoassay, and the secretome of MSCs cultured on the 3D versus 2D substrates showed substantial compositional differences. Concentrations of factors such as HGF and ICAM-1 were increased over 5 times in 3D cultures compared to 2D cultures. In vitro proliferation and scratch-based wound healing assays were performed to compare the effects of the secretome on corneal fibroblast cells (CFCs) when delivered synchronously from co-cultured MSCs through a trans-well co-culture system versus asynchronously after harvesting the factors separately and adding them to the media. Cell viability of CFCs was sustained for 6 days when co-cultured with MSCs seeded on the fibers but decreased with time under other conditions. Scratch assays showed 95% closure at 48 hr when CFCs were co-cultured with MSCs seeded on fibers, while the control group only exhibited 50% closure at 48 hr. Electrospun fibers seeded with MSCs were then applied to a wounded rabbit corneal organ culture system, and MSCs seeded on fibers promoted faster epithelialization and less scarring. Corneas were fixed and stained for alpha smooth muscle actin (α-SMA), and then analyzed by confocal microscopy. Immunostaining showed that expression of alpha-SMA was lower in corneas treated with MSCs seeded on fibers, suggesting suppression of myofibroblastic transformation. MSCs cultured on electrospun fibers facilitate wound healing in CFCs and on explanted corneas through differential secretome profiles compared to MSCs cultured on 2D substrates. Future work is merited to further understand the nature and basis of these differences and their effects in animal models. Statement of Significance: Previous studies have shown that the secretome of bone marrow-derived mesenchymal stem cells (MSC) is beneficial to corneal wound healing by facilitating improved wound closure rates and reduction of scarring and neovascularization. The present research is significant because it provides evidence for the modulation of the secretome as a function of the MSC culture environment. This leads to differential expression of therapeutic factors secreted, which can impact corneal epithelial and stromal healing after severe injury. In addition, this article shows that the co-continuous delivery of the MSC secretome improves cell migration and proliferation over aliquoted delivery, and that MSCs grown on three-dimensional electrospun fiber constructs may provide a favorable microenvironment for cultured MSCs and as a carrier to deliver their secreted factors to the ocular surface.

  View details for DOI 10.1016/j.actbio.2019.09.022

  View details for PubMedID 31539656

• Teleophthalmology through handheld mobile devices: a pilot study in rural Nepal. Journal of mobile technology in medicine Hong, K. n., Collon, S. n., Chang, D. n., Thakalli, S. n., Welling, J. n., Oliva, M. n., Peralta, E. n., Gurung, R. n., Ruit, S. n., Tabin, G. n., Myung, D. n., Thapa, S. n. 2019; 8 (1)

  Abstract

  To compare screening referral recommendations made by remotely located ophthalmic technicians with those of an ophthalmologist examining digital photos obtained by a portable ophthalmic camera system powered by an iOS handheld mobile device (iPod Touch).Dilated screening eye exams were performed by ophthalmic technicians in four remote districts of Nepal. Anterior and posterior segment photographs captured with a Paxos Scope ophthalmic camera system attached to an iPod Touch 6th generation device were uploaded to a secure cloud database for review by an ophthalmologist in Kathmandu. The ophthalmic technicians' referral decisions based on slit-lamp exam were compared to the ophthalmologist's recommendation based on the transmitted images.Using the transmitted images, the ophthalmologist recommended referral for an additional 20% of the 346 total subjects screened who would not have been referred by the ophthalmic technician. Of those subjects, 34% were referred to the retina clinic. Conversely, among the 101 patients referred by the technician, the ophthalmologist concurred with the appropriateness of referral in more than 97% of cases but thought eight (2.8%) of those patients had variants of normal eye pathology.An ophthalmologist who reviewed data and photos gathered with the mobile device teleophthalmology system identified a significant number of patients whose need for referral was not identified by the screening technician. Posterior segment pathology was most frequently found by the remote reader and not by the technician performing dilated slit lamp examinations. These results are promising for further clinical implementation of handheld mobile devices as tools for teleophthalmic screening in resource-limited settings.

  View details for DOI 10.7309/jmtm.8.1.1

  View details for PubMedID 32728400

  View details for PubMedCentralID PMC7388679

• Bio-Orthogonally Crosslinked, In Situ Forming Corneal Stromal Tissue Substitute ADVANCED HEALTHCARE MATERIALS Lee, H., Fernandes-Cunha, G. M., Na, K., Hull, S. M., Myung, D. 2018; 7 (19)

  View details for DOI 10.1002/adhm.201800560

  View details for Web of Science ID 000446822600013

• In situ-forming hyaluronic acid hydrogel through visible light-induced thiolene reaction REACTIVE & FUNCTIONAL POLYMERS Lee, H., Fernandes-Cunha, G. M., Myung, D. 2018; 131: 29–35

  View details for DOI 10.1016/j.reactfunctpolym.2018.06.010

  View details for Web of Science ID 000448225200004

• In situ-forming hyaluronic acid hydrogel through visible light-induced thiol-ene reaction. Reactive & functional polymers Lee, H. J., Fernandes-Cunha, G. M., Myung, D. 2018; 131: 29-35

  Abstract

  Here we present hyaluronic acid (HA) hydrogels crosslinked via thiol-ene reaction initiated by visible blue light exposure in the presence of riboflavin phosphate (RFP). The gelation procedure is rapid and proceeds as effectively with exposure to blue light as it does with UV light. We successfully initiated the thiol-ene reaction by RFP with blue light, which triggered gelation that proceeds over about 5 min at 36 °C after an initial small change in modulus upon light exposure. Gel transparency was also evaluated, and the HA gel exhibited over 80% transmittance in the visible spectrum. The degradation and protein release kinetics of the photo-crosslinked HA hydrogel are also presented. The capacity of blue light to initiate thiol-ene reaction was equal to or more effective than UV light of the same energy. The cytocompatibility of hydrogels was evaluated using corneal fibroblasts, and the light-induced fabrication procedure and resultant gel materials did not affect cell viability. The results indicate that an RFP-based, BL-initiated photo-reaction to gelate HA may be an effective and promising modality for applications where in situ gelation is desired.

  View details for DOI 10.1016/j.reactfunctpolym.2018.06.010

  View details for PubMedID 32256185

  View details for PubMedCentralID PMC7111509

• Mechanical properties of collagen gels crosslinked by copper-free click chemistry and their effects on encapsulated keratocytes Lee, H., Fernandes-Cunha, G., Heilshorn, S., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2018

  View details for Web of Science ID 000442912506258

• Suppression of alkali burn-induced corneal injury by mesenchymal stem cells encapsulated within crosslinked collagen gels Na, K., Cunha, G., Lee, H., Djalilian, A. R., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2018

  View details for Web of Science ID 000442932803217

• Synergistic corneal wound healing effects of human mesenchymal stem cell secreted factors and hyaluronic acid-based viscoelastic gel Rogers, G., Putra, I., Lee, H., Cheng, Y., Eslani, M., Djalilian, A. R., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2018

  View details for Web of Science ID 000442912509017

• Effects of engineered cellular microenvironments on the secretome of human mesenchymal stem cells Hull, S., Fernandes-Cunha, G., Lee, H., Heilshorn, S., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2018

  View details for Web of Science ID 000442912506282

• Clinical Application of a Smartphone-Based Ophthalmic Camera adapter in Under-Resourced Settings in Nepal. Journal of mobile technology in medicine Mercado, C., Welling, J., Oliva, M., Li, J., Gurung, R., Ruit, S., Tabin, G., Chang, D., Thapa, S., Myung, D. 2017; 6 (3): 34-42

  Abstract

  The ability to obtain high quality ocular images utilizing smartphone technology is of special interest in under-resourced parts of the world where traditional ocular imaging devices are cost-prohibitive, difficult to transport, and require a trained technician for operation.The purpose of this study was to explore potential anterior and posterior segment ocular imaging use cases for a smartphone-based ophthalmic camera adapter (Paxos Scope, Digisight Technologies, San Francisco, CA, USA) in under-resourced settings in Nepal.From September to November of 2015 we utilized the Paxos Scope smartphone camera adapter coupled with an iPhone 5 to explore anterior and posterior segment clinical applications for this mobile technology. We used the device at a tertiary eye care facility, a rural eye hospital and a rural cataract outreach camp. We tested the device's capability for high quality photo-documentation in clinic, in the operating room, and in the outreach camp setting. Images were automatically uploaded to a secure, cloud-based electronic medical record system that facilitated sharing of images with other providers for telemedicine purposes.Herein we present 17 ocular images documenting a wide variety of anterior and posterior segment pathology using the Paxos Scope from clinical cases seen in a variety of settings in Nepal.We found the quality of both the anterior and posterior segment images to be excellent in the clinic, the operating room, and the outreach camp settings. We found the device to be versatile and user-friendly, with a short learning curve. The Paxos Scope smartphone camera adapter may provide an affordable, high-quality, mobile ocular imaging option for under-resourced parts of the world.

  View details for DOI 10.7309/jmtm.6.3.6

  View details for PubMedID 33603897

  View details for PubMedCentralID PMC7888986

• Novel approaches to anchoring therapeutic factors to corneal stroma to promote wound healing. Myung, D., Djalilian, A. R., Heilshorn, S., Goldberg, J. L., Kreymerman, A., Kumar, A., Madl, C., Eslani, M., Shen, X., Putra, I., Fernandes-Cunha, G., Koh, W., Lee, H. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2017

  View details for Web of Science ID 000432170300117

• Surface analytical studies of growth factor coupling to collagen by copper-free click chemistry Lee, H., Fernandes-Cunha, G., Koh, W., Goldberg, J. L., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2017

  View details for Web of Science ID 000432170300192

• Growth factor immobilization in situ by copper-free click chemistry: in vitro binding, cytocompatibility, and cell proliferation studies Cunha, G., Lee, H., Kumar, A., Kreymerman, A., Goldberg, J. L., Myung, D. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2017

  View details for Web of Science ID 000432170306344

• Training time and quality of smartphone-based anterior segment screening in rural India. Clinical ophthalmology (Auckland, N.Z.) Ludwig, C. A., Newsom, M. R., Jais, A. n., Myung, D. J., Murthy, S. I., Chang, R. T. 2017; 11: 1301–7

  Abstract

  We aimed at evaluating the ability of individuals without ophthalmologic training to quickly capture high-quality images of the cornea by using a smartphone and low-cost anterior segment imaging adapter (the "EyeGo" prototype).Seven volunteers photographed 1,502 anterior segments from 751 high school students in Varni, India, by using an iPhone 5S with an attached EyeGo adapter. Primary outcome measures were median photograph quality of the cornea and anterior segment of the eye (validated Fundus Photography vs Ophthalmoscopy Trial Outcomes in the Emergency Department [FOTO-ED] study; 1-5 scale; 5, best) and the time required to take each photograph. Volunteers were surveyed on their familiarity with using a smartphone (1-5 scale; 5, very comfortable) and comfort in assessing problems with the eye (1-5 scale; 5, very comfortable). Binomial logistic regression was performed using image quality (low quality: <4; high quality: ≥4) as the dependent variable and age, comfort using a smartphone, and comfort in assessing problems with the eye as independent variables.Six of the seven volunteers captured high-quality (median ≥4/5) images with a median time of ≤25 seconds per eye for all the eyes screened. Four of the seven volunteers demonstrated significant reductions in time to acquire photographs (P1=0.01, P5=0.01, P6=0.01, and P7=0.01), and three of the seven volunteers demonstrated significant improvements in the quality of photographs between the first 100 and last 100 eyes screened (P1<0.001, P2<0.001, and P6<0.01). Self-reported comfort using a smartphone (odds ratio [OR] =1.25; 95% CI =1.13 to 1.39) and self-reported comfort diagnosing eye conditions (OR =1.17; 95% CI =1.07 to 1.29) were significantly associated with an ability to take a high-quality image (≥4/5). There was a nonsignificant association between younger age and ability to take a high-quality image.Individuals without ophthalmic training were able to quickly capture a high-quality magnified view of the anterior segment of the eye by using a smartphone with an attached imaging adapter.

  View details for PubMedID 28761328

• Tethering Growth Factors to Collagen Surfaces Using Copper-free Click Chemistry: Surface Characterization and In Vitro Biological Response. ACS applied materials & interfaces Lee, H. J., Fernandes-Cunha, G. n., Putra, I. n., Koh, W. G., Myung, D. n. 2017

  Abstract

  Surface modifications with tethered growth factors have mainly been applied to synthetic polymeric biomaterials in well-controlled, acellular settings, followed by seeding with cells. The known bio-orthogonality of copper-free click chemistry provides an opportunity to not only use it in vitro to create scaffolds or pro-migratory tracks in the presence of living cells, but also potentially apply it to living tissues directly as a coupling modality in situ. In this study, we studied the chemical coupling of growth factors to collagen using biocompatible copper-free click chemistry and its effect on the enhancement of growth factor activity in vitro. We verified the characteristics of modified epidermal growth factor (EGF) using mass spectrometry and EGF/EGF receptor binding assay, and chemical immobilization of EGF on collagen was also evaluated by copper-free click chemistry using surface x-ray photoelectron spectroscopy (XPS), surface plasmon resonance (SPR) spectroscopy, and enzyme-linked immunosorbent assay (ELISA). We found that the anchoring was non-cytotoxic, biocompatible, and sufficiently rapid for clinical application. Moreover, the surface-immobilized EGF has significant effects on epithelial cell attachment and proliferation. Our results demonstrate the possibility of copper-free click chemistry as a tool for covalent bonding of growth factors to extracellular matrix collagen and the potential effectiveness of immobilized EGF in this setting. This approach is a novel and potentially clinically useful application of copper-free click chemistry as a way of directly anchoring growth factors to collagen and foster epithelial wound healing.

  View details for PubMedID 28598594

• Immobilization of growth factors to collagen surfaces using visible light. Biomacromolecules Fernandes Cunha, G. M., Lee, H. J., Kumar, A. n., Kreymerman, A. n., Heilshorn, S. C., Myung, D. n. 2017

  Abstract

  In the treatment of traumatic injuries, burns, and ulcers of the eye, inadequate epithelial tissue healing remains a major challenge. Wound healing is a complex process involving the temporal and spatial interplay between cells and their extracellular milieu. It can be impaired by a variety of causes including infection, poor circulation, loss of critical cells and/or proteins, and a deficiency in normal neural signaling (e.g. neurotrophic ulcers). Ocular anatomy is particularly vulnerable to lasting morbidity from delayed healing, whether it be scarring or perforation of the cornea, destruction of the conjunctival mucous membrane, or cicatricial changes to the eyelids and surrounding skin. Therefore, there is a major clinical need for new modalities for controlling and accelerating wound healing, particularly in the eye. Collagen matrices have long been explored as scaffolds to support cell growth as both two-dimensional coatings and substrates, as well as three-dimensional matrices. Meanwhile, the immobilization of growth factors to various substrates has also been extensively studied as a way to promote enhanced cellular adhesion and proliferation. Herein we present a new strategy for photochemically immobilizing growth factors to collagen using riboflavin as a photosensitizer and exposure to visible light (~458 nm). epidermal growth factor (EGF) was successfully bound to collagen-coated surfaces as well as directly to endogenous collagen from porcine corneas. The initial concentration of riboflavin and EGF, as well as the blue light exposure time, were keys to the successful binding of growth factor to these surfaces. The photocrosslinking reaction increased EGF residence time on collagen surfaces over seven days. EGF activity was maintained after the photocrosslinking reaction with a short duration of pulsed blue light exposure time. Bound EGF accelerated in vitro corneal epithelial cell proliferation and migration and maintained normal cell phenotype. Additionally, the treated surfaces were cytocompatible, and the photocrosslinking reaction was proven to be safe, preserving nearly 100% cell viability. These results suggest that this general approach is safe and versatile may be used for targeting and immobilizing bioactive factors onto collagen matrices in a variety of applications, including in the presence of live, seeded cells or in vivo onto endogenous extracellular matrix collagen.

  View details for PubMedID 28799757

• Clinical Application of a Smartphone-Based Ophthalmic Camera Adapter in Under-Resourced Settings in Nepal Journal of Mobile Technology in Medicine Mercado, C., Welling, J., Oliva, M., Li, J., Gurung, R., Ruit, S., Tabin, G., Chang, D., Thapa, S., Myung, D. 2017; 6 (3): 34-42

  View details for DOI 10.7309/jmtm.6.3.6

• Smartphone-based Ophthalmic Imaging with Paxos Scope (TM) to Expand and Improve Eye Care in Rural Nepal Myung, D., Welling, J., Oliva, M., Chang, D., Tabin, G. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2016

  View details for Web of Science ID 000394174004078

• SMARTPHONE-BASED DILATED FUNDUS PHOTOGRAPHY AND NEAR VISUAL ACUITY TESTING AS INEXPENSIVE SCREENING TOOLS TO DETECT REFERRAL WARRANTED DIABETIC EYE DISEASE RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Toy, B. C., Myung, D. J., He, L., Pan, C. K., Chang, R. T., Polkinhorne, A., Merrell, D., Foster, D., Blumenkranz, M. S. 2016; 36 (5): 1000-1008

  Abstract

  To compare clinical assessment of diabetic eye disease by standard dilated examination with data gathered using a smartphone-based store-and-forward teleophthalmology platform.100 eyes of 50 adult patients with diabetes from a health care safety-net ophthalmology clinic. All patients underwent comprehensive ophthalmic examination. Concurrently, a smartphone was used to estimate near visual acuity and capture anterior and dilated posterior segment photographs, which underwent masked, standardized review. Quantitative comparison of clinic and smartphone-based data using descriptive, kappa, Bland-Altman, and receiver operating characteristic analyses was performed.Smartphone visual acuity was successfully measured in all eyes. Anterior and posterior segment photography was of sufficient quality to grade in 96 and 98 eyes, respectively. There was good correlation between clinical Snellen and smartphone visual acuity measurements (rho = 0.91). Smartphone-acquired fundus photographs demonstrated 91% sensitivity and 99% specificity to detect moderate nonproliferative and worse diabetic retinopathy, with good agreement between clinic and photograph grades (kappa = 0.91 ± 0.1, P < 0.001; AUROC = 0.97, 95% confidence interval, 0.93-1).The authors report a smartphone-based telemedicine system that demonstrated sensitivity and specificity to detect referral-warranted diabetic eye disease as a proof-of-concept. Additional studies are warranted to evaluate this approach to expanding screening for diabetic retinopathy.

  View details for Web of Science ID 000375482100029

  View details for PubMedID 26807627

• A novel smartphone ophthalmic imaging adapter: User feasibility studies in Hyderabad, India INDIAN JOURNAL OF OPHTHALMOLOGY Ludwig, C. A., Murthy, S. I., Pappuru, R. R., Jais, A., Myung, D. J., Chang, R. T. 2016; 64 (3): 191-200

  Abstract

  To evaluate the ability of ancillary health staff to use a novel smartphone imaging adapter system (EyeGo, now known as Paxos Scope) to capture images of sufficient quality to exclude emergent eye findings. Secondary aims were to assess user and patient experiences during image acquisition, interuser reproducibility, and subjective image quality.The system captures images using a macro lens and an indirect ophthalmoscopy lens coupled with an iPhone 5S. We conducted a prospective cohort study of 229 consecutive patients presenting to L. V. Prasad Eye Institute, Hyderabad, India. Primary outcome measure was mean photographic quality (FOTO-ED study 1-5 scale, 5 best). 210 patients and eight users completed surveys assessing comfort and ease of use. For 46 patients, two users imaged the same patient's eyes sequentially. For 182 patients, photos taken with the EyeGo system were compared to images taken by existing clinic cameras: a BX 900 slit-lamp with a Canon EOS 40D Digital Camera and an FF 450 plus Fundus Camera with VISUPAC™ Digital Imaging System. Images were graded post hoc by a reviewer blinded to diagnosis.Nine users acquired 719 useable images and 253 videos of 229 patients. Mean image quality was ≥ 4.0/5.0 (able to exclude subtle findings) for all users. 8/8 users and 189/210 patients surveyed were comfortable with the EyeGo device on a 5-point Likert scale. For 21 patients imaged with the anterior adapter by two users, a weighted κ of 0.597 (95% confidence interval: 0.389-0.806) indicated moderate reproducibility. High level of agreement between EyeGo and existing clinic cameras (92.6% anterior, 84.4% posterior) was found.The novel, ophthalmic imaging system is easily learned by ancillary eye care providers, well tolerated by patients, and captures high-quality images of eye findings.

  View details for DOI 10.4103/0301-4738.181742

  View details for Web of Science ID 000376126800003

  View details for PubMedID 27146928

• Vacuum-mediated transepithelial delivery of riboflavin to the cornea Myung, D., Zaler, G., Abbate, A., DiGiore, D., Eaton, D., Manche, E. E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2015

  View details for Web of Science ID 000362882207178

• Comparative In vitro Cytotoxicity of Artificial Tears JSM Ophthalmology Zhen, L., Myung, D., Yu, C. Q., Ta, C. N. 2015; 3 (1): 1-6
• iPhone Photography of Eye Pathology for Remote Triage He, L., Myung, D., Pershing, S., Chang, R. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2014

  View details for Web of Science ID 000433205502040

• Grafting of Cross-Linked Hydrogel Networks to Titanium Surfaces ACS APPLIED MATERIALS & INTERFACES Muir, B. V., Myung, D., Knoll, W., Frank, C. W. 2014; 6 (2): 958-966

  Abstract

  The performance of medical implants and devices is dependent on the biocompatibility of the interfacial region between tissue and the implant material. Polymeric hydrogels are attractive materials for use as biocompatible surface coatings for metal implants. In such systems, a factor that is critically important for the longevity of an implant is the formation of a robust bond between the hydrogel layer and the implant metal surface and the ability for this assembly to withstand physiological conditions. Here, we describe the grafting of cross-linked hydrogel networks to titanium surfaces using grit-blasting and subsequent chemical functionalization using a silane-based adhesion promoter. Metal surface characterization was carried out using profilometry, scanning electron microscopy (SEM), and energy dispersive X-ray spectroscopy (EDX) analysis. Hydrogel layers composed of poly(ethylene glycol)-dimethacrylate (PEG-DMA), poly(2-hydroxyethylmethacrylate) (PHEMA), or poly(ethylene glycol)/poly(acrylic acid) (PEG/PAA) semi-interpenetrating polymer networks (semi-IPNs) have been prepared. The mechanical properties of these hydrogel-metal assemblies have been characterized using lap-shear measurements, and the surface morphology was studied by SEM and EDX. We have shown that both high surface roughness and chemical functionalization are critical for adhesion of the hydrogel layer to the titanium substrate.

  View details for DOI 10.1021/am404361v

  View details for Web of Science ID 000330201900031

  View details for PubMedID 24364560

• Simple, Low-Cost Smartphone Adapter for Rapid, High Quality Ocular Anterior Segment Imaging: A Photo Diary Journal of Mobile Technology and Medicine Myung, D., Jais, A., He, L., Chang, R. T. 2014; 3 (1)
• 3D Printed Smartphone Indirect Lens Adapter for Rapid, High Quality Retinal Imaging Journal of Mobile Technology in Medicine Myung, D., Jais, A., He, L., Blumenkranz, M., Chang, R. 2014; 3 (1)
• Pupil Size and LASIK: A Review JOURNAL OF REFRACTIVE SURGERY Myung, D., Schallhorn, S., Manche, E. E. 2013; 29 (11): 734-?

  Abstract

  To provide a literature review on the evidence both for and against pupil size as an independent predictor of adverse visual outcomes after LASIK.Peer-reviewed publications on the effect of pupil size on LASIK outcomes since 2002 are reviewed. Particular attention was paid to the following attributes of each publication: type of study, number of patients or eyes, mean age, mean level of myopia, mean pupil size, testing conditions, ablation zone diameter, presence or absence of blend zones, and mean follow-up period.Among the 19 studies examined, none correlates a persistent relationship between pupil size and night vision complaints (NVCs) beyond 3 months when LASIK was performed with a 6.0-mm optical zone or larger ablation. The studies that did explicitly determine a correlation either included some or all patients with ablation zones smaller than 6.0 mm or did not specify ablation diameter at all. Among the studies that had drawn more mixed conclusions, the studies either covered short follow-up intervals (1 to 3 months) or showed a progressive improvement in NVCs over time in a relatively small patient cohort.As keratorefractive technology continues to evolve, the role of pupil size warrants further investigation; however, based on the literature reviewed herein, modern LASIK has negated the role of the low light pupil in predicting adverse visual outcomes after LASIK outside of the early postoperative period.

  View details for DOI 10.3928/1081597X-20131021-02

  View details for Web of Science ID 000329186600002

  View details for PubMedID 24203804

• In vivo biocompatibility of two PEG/PAA interpenetrating polymer networks as corneal inlays following deep stromal pocket implantation JOURNAL OF MATERIALS SCIENCE-MATERIALS IN MEDICINE Tan, X. W., Hartman, L., Tan, K. P., Poh, R., Myung, D., Zheng, L. L., Waters, D., Noolandi, J., Beuerman, R. W., Frank, C. W., Ta, C. N., Tan, D. T., Mehta, J. S. 2013; 24 (4): 967-977

  Abstract

  This study compared the effects of implanting two interpenetrating polymer networks (IPNs) into rabbit corneas. The first (Implant 1) was based on PEG-diacrylate, the second (Implant 2) was based on PEG-diacrylamide. There were inserted into deep stromal pockets created using a manual surgical technique for either 3 or 6 months. The implanted corneas were compared with normal and sham-operated corneas through slit lamp observation, anterior segment optical coherence tomography, in vivo confocal scanning and histological examination. Corneas with Implant 1 (based on PEG-diacrylate) developed diffuse haze, ulcers and opacities within 3 months, while corneas with Implant 2 (based on PEG-diacrylamide) remained clear at 6 months. They also exhibited normal numbers of epithelial cell layers, without any immune cell infiltration, inflammation, oedema or neovascularisation at post-operative 6 month. Morphological studies showed transient epithelial layer thinning over the hydrogel inserted area and elevated keratocyte activity at 3 months; however, the epithelium thickness and keratocyte morphology were improved at 6 months. Implant 2 exhibited superior in vivo biocompatibility and higher optical clarity than Implant 1. PEG-diacrylamide-based IPN hydrogel is therefore a potential candidate for corneal inlays to correct refractive error.

  View details for DOI 10.1007/s10856-012-4848-3

  View details for Web of Science ID 000318509100013

  View details for PubMedID 23354737

  View details for PubMedCentralID PMC3620449

• Surface Modification of High-Strength Interpenetrating Network Hydrogels for Biomedical Device Applications HANDBOOK OF BIOFUNCTIONAL SURFACES Myung, D., Kourtis, L., Noolandi, J., Cochran, J., Ta, C. N., Frank, C. W., Knoll, W. 2013: 407–46

  View details for Web of Science ID 000328542300011

• Biocompatibility of poly(ethylene glycol)/poly(acrylic acid) interpenetrating polymer network hydrogel particles in RAW 264.7 macrophage and MG-63 osteoblast cell lines. Journal of biomedical materials research. Part A Yim, E. S., Zhao, B., Myung, D., Kourtis, L. C., Frank, C. W., Carter, D., Smith, R. L., Goodman, S. B. 2009; 91 (3): 894-902

  Abstract

  Hydrogel polymers comprise a novel category of synthetic materials being investigated for use in cartilage replacement. One candidate compound, a poly(ethylene glycol)/poly(acrylic acid) (PEG/PAA) interpenetrating polymer network (IPN), was developed for use in corneal prostheses and was recently engineered for potential orthopedic use. The current study examined the effects of particles of this compound on two cell lines (MG-63 osteoblast-like cells and RAW 264.7 macrophages) over a 48-h time course. To mimic the effects of wear debris, particles of the compound were generated and introduced to the cells. In the MG-63 cell line, the particles had no significant effect on cell viability measured by PicoGreen assay and trypan blue exclusion. In contrast, a significant decrease in cell viability was detected in the Raw 264.7 macrophage cells at the final timepoint with the highest concentration of hydrogel (3.0% v:v). A concentration- and time-dependent increase in TNF-alpha release characteristic of other known biocompatible materials was also detected in RAW 264.7 cells, but nitric oxide and interleukin (IL)-1beta showed no response. In addition, the MG-63 cell line demonstrated no IL-6 response. Particles of the PEG/PAA IPN thus seem to stimulate biological responses similar to those in other biocompatible materials.

  View details for DOI 10.1002/jbm.a.32311

  View details for PubMedID 19072924

• Bioactive interpenetrating polymer network hydrogels that support corneal epithelial wound healing. Journal of biomedical materials research. Part A Myung, D., Farooqui, N., Zheng, L. L., Koh, W., Gupta, S., Bakri, A., Noolandi, J., Cochran, J. R., Frank, C. W., Ta, C. N. 2009; 90 (1): 70-81

  Abstract

  The development and characterization of collagen-coupled poly(ethylene glycol)/poly(acrylic acid) (PEG/PAA) interpenetrating polymer network hydrogels is described. Quantitative amino acid analysis and FITC-labeling of collagen were used to determine the amount and distribution of collagen on the surface of the hydrogels. The bioactivity of the coupled collagen was detected by a conformation-specific antibody and was found to vary with the concentration of collagen reacted to the photochemically functionalized hydrogel surfaces. A wound healing assay based on an organ culture model demonstrated that this bioactive surface supports epithelial wound closure over the hydrogel but at a decreased rate relative to sham wounds. Implantation of the hydrogel into the corneas of live rabbits demonstrated that epithelial cell migration is supported by the material, although the rate of migration and morphology of the epithelium were not normal. The results from the study will be used as a guide toward the optimization of bioactive hydrogels with promise in corneal implant applications such as a corneal onlay and an artificial cornea.

  View details for DOI 10.1002/jbm.a.32056

  View details for PubMedID 18481785

• Progress in the development of interpenetrating polymer network hydrogels POLYMERS FOR ADVANCED TECHNOLOGIES Myung, D., Waters, D., Wiseman, M., Duhamel, P., Noolandi, J., Ta, C. N., Frank, C. W. 2008; 19 (6): 647-657

  Abstract

  Interpenetrating polymer networks (IPNs) have been the subject of extensive study since their advent in the 1960s. Hydrogel IPN systems have garnered significant attention in the last two decades due to their usefulness in biomedical applications. Of particular interest are the mechanical enhancements observed in "double network" IPN systems which exhibit nonlinear increases in fracture properties despite being composed of otherwise weak polymers. We have built upon pioneering work in this field as well as in responsive IPN systems to develop an IPN system based on end-linked poly-(ethylene glycol) (PEG) and loosely crosslinked poly(acrylic acid) (PAA) with hydrogen bond-reinforced strain-hardening behavior in water and high initial Young's moduli under physiologic buffer conditions through osmotically induced pre-stress. Uniaxial tensile tests and equilibrium swelling measurements were used to study PEG/PAA IPN hydrogels having second networks prepared with varying crosslinking and photoinitiator content, pH, solids content, and comonomers. Studies involving the addition of non-ionic comonomers and neutralization of the second network showed that template polymerization appears to be important in the formation of mechanically enhanced IPNs.

  View details for DOI 10.1002/pat.1134

  View details for Web of Science ID 000257014100025

  View details for PubMedCentralID PMC2745247

• Development of hydrogel-based keratoprostheses: A materials perspective 234th National Meeting of the American-Chemical-Society Myung, D., Duhamel, P., Cochran, J. R., Noolandi, J., Ta, C. N., Frank, C. W. WILEY-BLACKWELL. 2008: 735–41

  Abstract

  Research and development of artificial corneas (keratoprostheses) in recent years have evolved from the use of rigid hydrophobic materials such as plastics and rubbers to hydrophilic, water-swollen hydrogels engineered to support not only peripheral tissue integration but also glucose diffusion and surface epithelialization. The advent of the AlphaCor core-and-skirt hydrogel keratoprosthesis has paved the way for a host of new approaches based on hydrogels and other soft materials that encompass a variety of materials preparation strategies, from synthetic homopolymers and copolymers to collagen-based bio-copolymers and, finally, interpenetrating polymer networks. Each approach represents a unique strategy toward the same goal: to develop a new hydrogel that mimics the important properties of natural donor corneas. We provide a critical review of these approaches from a materials perspective and discuss recent experimental results. While formidable technical hurdles still need to be overcome, the rapid progress that has been made by investigators with these approaches is indicative that a synthetic donor cornea capable of surface epithelialization is now closer to becoming a clinical reality.

  View details for DOI 10.1021/bp070476n

  View details for PubMedID 18422366

• Progress in the development of interpenetrating polymer network hydrogels. Polymers for advanced technologies Myung, D., Waters, D., Wiseman, M., Duhamel, P. E., Noolandi, J., Ta, C. N., Frank, C. W. 2008; 19 (6): 647-657

  Abstract

  Interpenetrating polymer networks (IPNs) have been the subject of extensive study since their advent in the 1960s. Hydrogel IPN systems have garnered significant attention in the last two decades due to their usefulness in biomedical applications. Of particular interest are the mechanical enhancements observed in "double network" IPN systems which exhibit nonlinear increases in fracture properties despite being composed of otherwise weak polymers. We have built upon pioneering work in this field as well as in responsive IPN systems to develop an IPN system based on end-linked poly-(ethylene glycol) (PEG) and loosely crosslinked poly(acrylic acid) (PAA) with hydrogen bond-reinforced strain-hardening behavior in water and high initial Young's moduli under physiologic buffer conditions through osmotically induced pre-stress. Uniaxial tensile tests and equilibrium swelling measurements were used to study PEG/PAA IPN hydrogels having second networks prepared with varying crosslinking and photoinitiator content, pH, solids content, and comonomers. Studies involving the addition of non-ionic comonomers and neutralization of the second network showed that template polymerization appears to be important in the formation of mechanically enhanced IPNs.

  View details for DOI 10.1002/pat.1134

  View details for PubMedID 19763189

  View details for PubMedCentralID PMC2745247

• Glucose-permeable interpenetrating polymer network hydrogels for corneal implant applications: A pilot study CURRENT EYE RESEARCH Myung, D., Farooqui, N., Waters, D., Schaber, S., Koh, W., Carrasco, M., Noolandi, J., Frank, C. W., Ta, C. N. 2008; 33 (1): 29-43

  Abstract

  Epithelialization of a keratoprosthesis requires that the implant material be sufficiently permeable to glucose. We have developed a poly(ethylene glycol)/poly(acrylic acid) (PEG/PAA) interpenetrating polymer network (IPN) hydrogel that can provide adequate passage of glucose from the aqueous humor to the epithelium in vivo. A series of PEG/PAA IPNs with varying PEG macromonomer molecular weights were synthesized and evaluated through swelling studies to determine their water content and diffusion experiments to assess their permeability to glucose. One of the PEG/PAA hydrogels prepared in this study had a glucose diffusion coefficient nearly identical to that of the human cornea (approximately 2.5 x 10(-6) cm(2)/sec). When implanted intrastromally in rabbit corneas, this hydrogel was retained and well-tolerated in 9 out of 10 cases for a period of 14 days. The retained hydrogels stayed optically clear and the epithelium remained intact and multilayered, indicating that the material facilitated glucose transport from the aqueous humor to the anterior part of the eye. The results from these experiments indicate that PEG/PAA hydrogels are promising candidates for corneal implant applications such as keratoprostheses and intracorneal lenses, and that the PEG/PAA IPN system in general is useful for creating permeable substrates for ophthalmic and other biomedical applications.

  View details for DOI 10.1080/02713680701793930

  View details for PubMedID 18214741

• Design and fabrication of an artificial cornea based on a photolithographically patterned hydrogel construct BIOMEDICAL MICRODEVICES Myung, D., Koh, W., Bakri, A., Zhang, F., Marshall, A., Ko, J., Noolandi, J., Carrasco, M., Cochran, J. R., Frank, C. W., Ta, C. N. 2007; 9 (6): 911-922

  Abstract

  We describe the design and fabrication of an artificial cornea based on a photolithographically patterned hydrogel construct, and demonstrate the adhesion of corneal epithelial and fibroblast cells to its central and peripheral components, respectively. The design consists of a central "core" optical component and a peripheral tissue-integrable "skirt." The core is composed of a poly(ethylene glycol)/poly(acrylic acid) (PEG/PAA) double-network with high strength, high water content, and collagen type I tethered to its surface. Interpenetrating the periphery of the core is a microperforated, but resilient poly(hydroxyethyl acrylate) (PHEA) hydrogel skirt that is also surface-modified with collagen type I. The well-defined microperforations in the peripheral component were created by photolithography using a mask with radially arranged chrome discs. Surface modification of both the core and skirt elements was accomplished through the use of a photoreactive, heterobifunctional crosslinker. Primary corneal epithelial cells were cultured onto modified and unmodified PEG/PAA hydrogels to evaluate whether the central optic material could support epithelialization. Primary corneal fibroblasts were seeded onto the PHEA hydrogels to evaluate whether the peripheral skirt material could support the adhesion of corneal stromal cells. Cell growth in both cases was shown to be contingent on the covalent tethering of collagen. Successful demonstration of cell growth on the two engineered components was followed by fabrication of core-skirt constructs in which the central optic and peripheral skirt were synthesized in sequence and joined by an interpenetrating diffusion zone.

  View details for DOI 10.1007/s10544-006-9040-4

  View details for PubMedID 17237989

• Histological processing of pH-sensitive hydrogels used in corneal implant applications JOURNAL OF HISTOTECHNOLOGY Farooqui, N., Myung, D., Koh, W., Masek, M., Dalal, R., Carrasco, M. R., Noolandi, J., Frank, C. W., Ta, C. N. 2007; 30 (3): 157-163

  View details for Web of Science ID 000258533600003

• Prospective randomized comparison of 1-day versus 3-day application of topical levofloxacin in eliminating conjunctival flora. European journal of ophthalmology Ta, C. N., Sinnar, S., He, L., Myung, D., Mino De Kaspar, H. 2007; 17 (1): 689-695

  Abstract

  To compare efficacy of a 1-day versus 3-ayapplication of topical levofloxacin in reducing ocular surface bacteria.In this prospective randomized controlled trial, 100 volunteer patients (50 per group) were assigned to receive topical 0.5% levofloxacin four times daily for 1 day or 3 days. Conjunctival cultures were obtained prior to (T0) and after the application of antibiotics (T1). Additionally, all patients received topical levofloxacin at 5-minute intervals for three applications (T2), followed by two drops of topical 5% povidone-iodine (T3). Conjunctival cultures were obtained at timepoints T2 and T3.A 1-day application of topical levofloxacin significantly reduced (p = 0.0004) the number of eyes with positive conjunctival cultures from 41 eyes (82%) to 23 eyes (46%). Similarly, a 3-day application significantly reduced (p = 0.0001) the positive culture rate from 37 eyes (74%) to 17 eyes (34%). Two drops of povidone-iodine further reduced the positive culture rate for both groups to 20% (10 eyes for each group). There was no significant difference in positive culture rate between the 1-day and 3-day groups at T0 (p = 0.4689), T1 (p = 0.3074), T2 (p = 0.6706), or T3 (p = 1.000).The application of topical 0.5% levofloxacin for 1 or 3 days significantly reduced the number of eyes with positive conjunctival cultures. The addition of 5% povidone-iodine further eliminated bacteria from the conjunctiva. The application of levofloxacin for 1 day appears to be as effective as a 3-day application.

  View details for DOI 10.5301/EJO.2008.3555

  View details for PubMedID 28221506

• Biomimetic strain hardening in interpenetrating polymer network hydrogels POLYMER Myung, D., Koh, W., Ko, J., Hu, Y., Carrasco, M., Noolandi, J., Ta, C. N., Frank, C. W. 2007; 48 (18): 5376-5387

  View details for DOI 10.1016/j.polymer.2007.06.070

  View details for Web of Science ID 000249712800021

• BIOT 66-A novel, biomimetic hydrogel construct to repair the cornea: Molecular design and biological response Myung, D., Cochran, J. R., Noolandi, J., Ta, C. N., Frank, C. W. AMER CHEMICAL SOC. 2007

  View details for Web of Science ID 000207593903359

• POLY 270-Structure-property relationships for hydrogels with applications to biomedical devices Frank, C., Harmon, M. E., Kucklung, D., Knoll, W., Myung, D. AMER CHEMICAL SOC. 2006

  View details for Web of Science ID 000207781701505

• Development of interpenetrating hydrogel networks for applications in ophthamology 231st National Meeting of the American-Chemical-Society Frank, C. W., Myung, D. J., Koh, W., Ko, J., Farooqui, N., Carrasco, M. R., Ta, C., Noolandi, J. AMER CHEMICAL SOC. 2006

  View details for Web of Science ID 000238125903034

• Glucose permeability of human, bovine, and porcine corneas in vitro OPHTHALMIC RESEARCH Myung, D., Derr, K., Huie, P., Noolandi, J., Ta, K. P., Ta, C. N. 2006; 38 (3): 158-163

  Abstract

  To measure glucose flux across human, bovine, and porcine corneas and to determine the diffusion coefficient of each type of cornea.Diffusion of glucose across human (n = 8), bovine (n = 7), and pig corneas (n = 8) was measured using a modified blind well chamber apparatus (Boyden chamber). Dialysis membranes (n = 7) and nonporous Mylar membranes (n = 7) were used as positive and negative controls, respectively. Glucose concentrations were measured at 30-min intervals with a commercially available glucose meter.The diffusion of glucose through corneas in vitro was calculated by a simple Fickian diffusion model. The diffusion coefficient of glucose is highest for the human cornea (D(HC) = 3.0 +/- 0.2 x 10(-6) cm(2)/s) followed by porcine corneas (D(PC) = 1.8 +/- 0.6 x 10(-6) cm(2)/s) and bovine corneas (D(BC) = 1.6 +/- 0.1 x 10(-6) cm(2)/s) (p < 0.05). The diffusion coefficients of all tested corneas were significantly higher (p < 0.05) than that of dialysis membrane (D(DM) = 3.4 +/- 0.2 x 10(-7) cm(2)/s).The glucose diffusion coefficients of human, bovine, and porcine corneas are on the order of 10(-6). Human corneas have higher permeability to glucose than either porcine or bovine corneas.

  View details for DOI 10.1159/000090726

  View details for PubMedID 16401912

• Utility and Feasibility of Teleophthalmology Using a Smartphone-Based Ophthalmic Camera in Screening Camps in Nepal. Asia-Pacific journal of ophthalmology (Philadelphia, Pa.) Collon, S. n., Chang, D. n., Tabin, G. n., Hong, K. n., Myung, D. n., Thapa, S. n. ; 9 (1): 54–58

  Abstract

  To determine whether use of a mobile device-based ophthalmic camera by ophthalmic technicians (OTs) in village screening camps in Nepal followed by remote image interpretation by an ophthalmologist can improve detection of ocular pathology and medical decision-making.Evaluation of mobile device-based ophthalmic camera through study of before and after clinical decision-making.One hundred forty patients over 18 years of age presenting to remote screening camps with best-corrected visual acuity ≤20/60 in one or both eyes were enrolled. Participants were examined by an OT with direct ophthalmoscopy. The technician recorded a diagnosis for each eye and a disposition for each patient. Patients then had anterior segment and fundus photos and/or videos taken using a smartphone-based ophthalmic camera system. Photos and videos were uploaded to a secure, HIPAA-compliant, cloud-based server, and interpreted by masked ophthalmologists from XXX, who independently recorded diagnoses and a disposition for each patient.The diagnoses given by OTs and ophthalmologists differed in 42.4% of eyes. Diagnosis agreement was highest for cataract [k = 0.732, 95% confidence interval (CI) 0.65-0.81], but much lower for posterior segment (retina/optic nerve) pathology (k = 0.057, 95% CI -0.03-0.14). Ophthalmologists and OTs suggested different dispositions for 68.6% of patients. Agreement was highest for cataract extraction (k = 0.623, 95% CI 0.49-0.75), whereas agreement for referral to XXX was lower (k = 0.12, 95% CI 0.00-0.24).Remote ophthalmologist consultation utilizing a mobile device ophthalmic camera system is logistically feasible, easily scalable, and capable of capturing high-quality images in the setting of rural eye screening camps. Although OTs are well equipped to identify and triage anterior segment pathology, this technology may be helpful in the detection of and referral for posterior segment pathology.

  View details for DOI 10.1097/01.APO.0000617936.16124.ba

  View details for PubMedID 31990747