Abstract Details

Title A Quantitative Approach to Telemedicine Assessment of Ptosis and Ocular Motility for Patients with Myasthenia Gravis

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P7 - Poster Session 7 (8:00 AM-9:00 AM)

Poster/Presentation
Number 10-011

Objective The study assessed the capability to quantify eye movements and lid position in
patients with MG.

Background Ptosis and diplopia are nearly uniformly present in patients with myasthenia gravis
(MG). In the telemedicine setting, the unique presence of video capture lends use of emerging implementation of image-processing techniques that could provide precise, standardized assessment of ocular motility abnormalities.

Design/Methods We utilized video recordings of the ADAPT teleMG study performed. Six subjects
underwent standardized video examinations on two occasions 2-3 days apart. We performed a hybrid algorithm combining deep learning with computer vision to give quantitative metrics of ptosis and ocular motility.

Results All videos and still images could be used for analysis despite limitations of low
resolution dictated by internet bandwidth and cameras of the examiner and subject. The hybrid algorithm detected the distance between pupil and upper eyelid for ptosis and misalignment of the left and right pupil for diplopia assessment. The algorithm automatically detected the pupillary and lid margins with error of 2 pixels in average. Lid, pupil, and iris detection did not differ based on skin or iris color. We were able to detect ocular misalignment in subjects complaining of diplopia. The method worked both on a fixed image and video in real-time allowing capture of the dynamic changes during the examination.

Conclusions We were able to use standard Zoom recordings of lid and eye movements and
quantitate them using a hybrid deep learning computer vision algorithm. The system introduces modern image processing technique that are quick and robust to recover quantitative metrics that are independent of the examiner and would work on most video resolutions. The approach has the potential to quantitate ocular motility abnormalities and could be used to monitor patients.

Authors/Disclosures
Sienna McNett PRESENTER	Ms. McNett has nothing to disclose.
	No disclosure on file
	No disclosure on file
Henry J. Kaminski, MD, FAAN (George Washington University)	Dr. Kaminski has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Dr. Kaminski has received personal compensation in the range of $0-$499 for serving as a Consultant for Cabaletta Bio. The institution of Dr. Kaminski has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Kaminski has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Canopy Immunotherapeutics. Dr. Kaminski has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Curie.bio. Dr. Kaminski has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Samsung. Dr. Kaminski has received personal compensation in the range of $0-$499 for serving as a Consultant for Care Constitution. Dr. Kaminski has stock in mimivax. The institution of Dr. Kaminski has received research support from National Institutes of Health. Dr. Kaminski has received publishing royalties from a publication relating to health care.
	No disclosure on file
Mohammad Abu-Rub, MD	Dr. Abu-Rub has nothing to disclose.
	No disclosure on file

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