Ophthalmology Trends and Health Challenges

FGAI4H-F-012-A01 Zanzibar, 3-5 September 2019 Source: TG-Ophthalmo topic driver Title: TDD update: TG-Ophthalmo (Ophthalmology) Purpose: Discussion Contact: Arun Shroff E-mail: arun@xtend.ai Abstract: This PPT summarizes the content of F-012 with the TDD for the TG on ophthalmology, for presentation and discussion during the meeting.

Meeting F Topic Group Update Ophthalmology (TG-Ophthalmo ) Zanzibar, Sep 3 5, 2019 Arun Shroff, Topic Driver, TG-Ophthalmology

Topic Group Ophthalmology Topics in this group: Diabetic Retinopathy (DR) Age Related Macular Degeneration (AMD) Glaucoma (GC) Pathological Myopia (PM) Topic Group Description Document (FGAI4H-E-014) Topic Group Members : Arun Shroff, Xtend.ai (USA and India) Yanwu(Frank) Xu, Baidu (China) Jingyu Wang, Baidu Xingxing Cao, Baidu Ash Krasley, M.D. M. S., Ophthalmologist, Bioinformatician

The Health Challenge Diabetic Retinopathy (DR) Caused by Diabetes damages retina, leads to vision loss At risk population - 422M people with diabetes worldwide (2014) 35%, 148M have DR (225M by 2040) 11%, 48M have Vision Threatening DR (64M by 2040) Leading cause of blindness among adults worldwide Age Related Macular Degeneration (AMD) Damages macula and impairs central vision 196M by 2020 Third leading cause of vision loss overall, leading cause for those over 50

The Health Challenge Glaucoma (GC) Damages optic nerve & leads to vision loss 80M by 2020 Pathological Myopia (PM) 35% of people with myopia have High Myopia, which can develop into PM Global Prevalence is 0.9% 3.1% In all cases, detection and diagnosis requires retinal imaging and examination by an ophthalmologist or eye care specialist

Benchmarking: DR Classifications Multi-class Classification: [0 (Nongradable Image) ] 1(No DR) 2 (Mild) 3 (Moderate NPDR) 4 (Severe NPDR) 5 (PDR) Binary : [0 (Nogradable Image)] 1 (Nonreferable Retinopathy = No DR or Mild) 2 (Referable Retinopathy = Moderate, Severe, PDR)

Benchmarking: AMD, GC, PM Classifications AMD: [0 (Image Nongradable)] 1 (No/early stage AMD 2 (Intermediate/advanced stage AMD) GC: [0 (Image Nongradable.] 1 (No GC) 2 (GC) PM: [0 (Image Nongradable)] 1 (No PM/HM) 2 (HM: high myopia) 3 (PM)

Available Public Datasets - DR EyePACS dataset: Approx 90,000 fundus images, 5 levels of severity Kaggle: (derived from EyePACS) Approx 35,000 images : 5 levels of severity MESSIDOR dataset: 1,200 images, 4 levels of severity DiaRetDB dataset: ~ 200 images marked with lesions etc

Available Public Datasets - AMD, GC AMD: AREDS dataset: (AgeRelated Eye Disease Study ) Images from ~4700 patients : (Cooperative Health Research in the Region of Augsburg (KORA) KORA dataset: dataset,) Approx 2840 patient records GC: ORIGA, 650 fundus images Retinal fundus images for glaucoma analysis (RIGA, 760 images) ACHIKO-K (258 images) DRISHTI-GS (100 images)

Benchmarking Metrics Sensitivity: % of positive (disease) cases correctly classified True Positive/(True Positive + False Negative) Specificity: % of negative (normal) cases correctly classified True Negative/(True Negative + False Positive) AUC (Area Under ROC); Sensitivity Vs (1-Specificity) plotted at different points of the model Other Metrics: Precision/Accuracy, F1 Score, Confusion Matrix

Use-Case & Topic Group History Meeting B - New York, 15-16 November 2018 AI for Ophthalmology Use case submitted in response to the Call for Proposals Using AI for Early Detection of DR to Prevent Vision Loss accepted as a use case Meeting C - Lausanne, Switzerland, 22-25 January 2019 Status report on the use case Using AI for Early Detection of DR Topic Group Ophthalmology established 2 Members : Medindia.net / Xtend.ai Baidu, China.

Use-Case & Topic Group History Meeting D- Shanghai, April 2-5, 2019 Topic Description Document (TDD) Version 1 completed Topic Group Status Update Meeting E - Geveva, May 30 June 1, 2019 Topic Description Document (TDD) Updated Edits / Corrections made Pathological Myopia (PM) added (by Xingxing Cao, Baidu) Reviewed and validated by topic group members New topic group members: Ashley Kras, M.D. M. S., Ophthalmologist & Bioinformatician

Progress Since Meeting E Call For Participation: Outreach via email / social media Several inbound emails with interest in joining/contributing to group New Topic group members: Dr Covadonga Bascaran, PHEC MSc Programme Director, International Centre for Eye Health (ICEH), London School of Hygiene & Tropical Medicine In s Sousa , Head of Intelligent Systems, Fraunhofer Portugal Online Meetings/Calls: Prof Leo Celi, Clinical Research Director, Harvard MIT Division of Health Science and Technology and Ash Krasley: (June 22, 2019) Details about MIT Open Access Project Potential collaboration with FGAI4H / Contribution of Data Dr. Jorge Cuadros, EyePACS (July 22, 2019) Database of over 5 million images Discussion about contributing datasets (ongoing)

Progress Since Meeting E Online Meetings/Calls: Topic Group Meeting, (Jul 31, 2019): Participants: Dr. Covadonga Bascaran & In s Sousa Discussion about DR-Net Possibility of getting undisclosed data sets for testing Contribution of data from different countries to make data representative Images are not currently annotated/labeled this would need to be done Other meetings/projects: Meeting in Geneva with ITU/WHO, Sanofi, Aivision.health(France), Minister of Health, Senegal Discussion about pilot project in Senegal - AI for DR detection, target start date Nov 2019

Next Steps Topic Description Document Continue to improve TDD for accuracy and completeness TDD validation from experts Call For Participation Continue outreach to increase members and get more experts involved Datasets: Follow-up with DR-Net, EyePACs, Moorefields, Open Eye & others for collaboration and procurement of undisclosed, labeled datasets for benchmarking.

Thank you!