Pebble beach artifact: An apparent multicolor imaging maculopathy due to corneal desiccation
Bibliographic record
Abstract
Multimodal imaging[1] is increasingly used for clinical diagnosis and an increased pathophysiological understanding of retinal disease.[1] Recently, MultiColor scanning laser ophthalmoscopy has been incorporated into the Spectralis platform (Heidelberg Engineering, Heidelberg, Germany). This system uses the wavelengths of blue, green, and infrared laser simultaneously to provide information of the superficial, middle, and deeper retinal structures, respectively, of a single image.[2] We continue to learn of new artifacts associated with these imaging systems such as variation in the thickness measured to the appearance of a hyper-reflective spot on near-infrared and multicolor imaging.[34] Cyst-like changes not corresponding to anything seen on the clinical examination were noted inferiorly in several patients. Fundus examinations and the cross-sectional optical coherence tomography (OCT) of these eyes revealed no abnormalities in the same areas and raised the concern of image artifact. A normal participant had multicolor examinations performed at baseline [Fig. 1] followed by repeat imaging [Fig. 2] after administration of proparacaine and placement of a lid speculum 1-min later causing the ocular surface to desiccate. Cyst-like changes were seen in the images, predominantly inferiorly. The finding was more prevalent in the shorter wavelength image. The subsequently acquired OCT images confirmed that there was no retinal pathology.Figure 1: Multicolor image (a) along with its components of red (b), green (c), and blue (d) reflectance showing an unremarkable fundus seen aboveFigure 2: Multicolor image (a) along with its components of red (b), green (c), and blue (d) showing cyst-like changes, predominantly inferior, which represent a corneal dryness artifact seen aboveOcular surface dryness can result in punctate epithelial erosions or tear film irregularities, and we hypothesize that these are the cause of this finding. We believe that there is more scattering of the shorter blue wavelength light which resulted in more shadowing of the punctate erosions on the images, compared to the longer wavelength light images.[5] Ensuring sufficient blinking and/or the application of artificial tears before procuring images could ensure avoiding this artifact. Conclusion This is a previously unreported artifact seen on MultiColor scanning laser photography that is caused by corneal irregularity but simulates retinal disease. Since these changes resembled small pebbles on the beach, we have termed this finding the Pebble Beach artifact. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".