Julián García Feijoo

Neuro-Fuzzy Nets in Medical Diagnosis: The DIAGEN Case Study of Glaucoma

This work presents an approach to the automatic interpretation of the visual field to enable ophthalmology patients to be classified as glaucomatous and normal. The approach is based on a neuro-fuzzy system (NEFCLASS) that enables a set of rules to be learnt, with no a priori knowledge, and the fuzzy sets that form the rule antecedents to be tuned, on the basis of a set of training data. Another alternative is to insert knowledge (fuzzy rules) and let the system tune its antecedents, as in the previous case. Three trials are shown which demonstrate the useful application of this approach in this medical discipline, enabling a set of rule bases to be obtained which produce high sensitivity and specificity values in the classification process.

Ocular Redness Measured with the Keratograph 5M in Patients Using Anti-Glaucoma Eye Drops

ABSTRACT Purpose: To examine correlations between ocular redness measured with the new topographer Keratograph 5M and the use of topical anti-glaucoma medication. Methods: A total of 211 eyes of 211 patients with open-angle glaucoma or ocular hypertension on topical medication and 51 eyes of 51 healthy volunteers were recruited over 10 months. Outcome variables were keratograph redness scores (RS): overall, bulbar temporal (BT), bulbar nasal (BN), limbar temporal (LT), and limbar nasal (LN). In each subject, we also recorded the intraocular pressure-lowering eye drops used, daily doses and daily and cumulative preservative concentrations, fluorescein corneal staining score (OXFORD), lower tear meniscus height (Fourier-domain OCT), non-invasive tear film breakup time (Keratograph 5M), and ocular surface disease questionnaire index (OSDI). Results: Higher RS were recorded in the medication than control group (P < 0.01 all scores). Within the medication group, older patients returned greater RS (P < 0.05 all scores). Prostaglandin was a strong predictor of higher scores, except LN RS. A higher OSDI was associated with a higher LN RS (β = 0.007; P < 0.05), while the use of β-blockers was linked to a lower LN RS (β = −0.225; P < 0.05). The use of ≥3 daily eye drops with preservative gave rise to a higher BN RS and ≥3 daily eye drops to a higher LN RS (β = 0.366, P < 0.01; β = 0.296, P < 0.05, respectively). Conclusion: Keratograph 5M can objectively detect the hyperaemia induced by glaucoma medication. The factors contributing to ocular redness were advanced age, more daily eye drops (nasal sectors), a higher OSDI, and prostaglandin as the medication used.

Minimally Invasive Glaucoma Surgery

Minimally invasive glaucoma surgery techniques have been developed with the aim of safely controlling intraocular pressure. We now review the available evidence for current devices, and discuss their indications and complications.