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Indian Journal of Ophthalmology May 2023Advent of pediatric handheld fundus cameras like RetCam, 3netra Forus, and Phoenix ICON pediatric retinal camera has aided in effective screening of retinopathy of... (Review)
Review
Advent of pediatric handheld fundus cameras like RetCam, 3netra Forus, and Phoenix ICON pediatric retinal camera has aided in effective screening of retinopathy of prematurity (ROP), especially in countries with limited number of trained specialists. Recent advent of various smartphone-based cameras has made pediatric fundus photography furthermore affordable and portable. Future advances like ultra-wide field fundus cameras, trans-pars-planar illumination pediatric fundus camera, artificial intelligence, deep learning algorithm, and handheld SS-OCTA can help in more accurate imaging and documentation. This article summarizes the features of existing and upcoming imaging modalities in detail, including their features, advantages, challenges, and effectiveness, which can help in implementation of telescreening as a standard screening protocol for ROP across developing as well as developed countries.
Topics: Infant, Newborn; Humans; Child; Retinopathy of Prematurity; Artificial Intelligence; Fundus Oculi; Diagnostic Techniques, Ophthalmological; Fluorescein Angiography; Photography; Ophthalmoscopy
PubMed: 37203030
DOI: 10.4103/IJO.IJO_2913_22 -
Klinische Monatsblatter Fur... Sep 2016For decades there was a general consensus about diagnostic investigations and surgical treatment of symptomatic pathological changes in the vitreomacular interface... (Review)
Review
For decades there was a general consensus about diagnostic investigations and surgical treatment of symptomatic pathological changes in the vitreomacular interface (VMI). The introduction of SD-OCT imaging helped in the understanding of the pathogenetic processes at this interface and risk factors were defined for the macular traction syndrome, epiretinal membrane (ERM) and macular hole. After approval of ocriplasmin for non-surgical treatment, a new classification based on treatment outcome and new imaging techniques was established. Precise separation of physiological, age-related changes in the VMI and pathological changes was then possible. Clinically relevant aspects in the diagnostic testing and treatment of diseases of the VMI are reported in this literature review.
Topics: Diagnosis, Differential; Evidence-Based Medicine; Humans; Ophthalmoscopy; Outcome Assessment, Health Care; Patient Selection; Severity of Illness Index; Tomography, Optical Coherence; Vitreoretinal Surgery; Vitreoretinopathy, Proliferative
PubMed: 27055492
DOI: 10.1055/s-0042-101553 -
Journal of Biomedical Optics Sep 2018Autofluorescence-based imaging techniques have become very important in the ophthalmological field. Being noninvasive and very sensitive, they are broadly used in... (Review)
Review
Autofluorescence-based imaging techniques have become very important in the ophthalmological field. Being noninvasive and very sensitive, they are broadly used in clinical routines. Conventional autofluorescence intensity imaging is largely influenced by the strong fluorescence of lipofuscin, a fluorophore that can be found at the level of the retinal pigment epithelium. However, different endogenous retinal fluorophores can be altered in various diseases. Fluorescence lifetime imaging ophthalmoscopy (FLIO) is an imaging modality to investigate the autofluorescence of the human fundus in vivo. It expands the level of information, as an addition to investigating the fluorescence intensity, and autofluorescence lifetimes are captured. The Heidelberg Engineering Spectralis-based fluorescence lifetime imaging ophthalmoscope is used to investigate a 30-deg retinal field centered at the fovea. It detects FAF decays in short [498 to 560 nm, short spectral channel (SSC) and long (560 to 720 nm, long spectral channel (LSC)] spectral channels, the mean fluorescence lifetimes (τm) are calculated using bi- or triexponential approaches. These are meant to be relatively independent of the fluorophore's intensity; therefore, fluorophores with less intense fluorescence can be detected. As an example, FLIO detects the fluorescence of macular pigment, retinal carotenoids that help protect the human fundus from light damages. Furthermore, FLIO is able to detect changes related to various retinal diseases, such as age-related macular degeneration, albinism, Alzheimer's disease, diabetic retinopathy, macular telangiectasia type 2, retinitis pigmentosa, and Stargardt disease. Some of these changes can already be found in healthy eyes and may indicate a risk to developing such diseases. Other changes in already affected eyes seem to indicate disease progression. This review article focuses on providing detailed information on the clinical findings of FLIO. This technique detects not only structural changes at very early stages but also metabolic and disease-related alterations. Therefore, it is a very promising tool that might soon be used for early diagnostics.
Topics: Humans; Ophthalmoscopy; Optical Imaging; Retina; Retinal Diseases
PubMed: 30182580
DOI: 10.1117/1.JBO.23.9.091415 -
Journal of Biomedical Optics Sep 2015Intrinsic optical signal (IOS) imaging promises to be a noninvasive method for high-resolution examination of retinal physiology, which can advance the study and... (Review)
Review
Intrinsic optical signal (IOS) imaging promises to be a noninvasive method for high-resolution examination of retinal physiology, which can advance the study and diagnosis of eye diseases. While specialized optical instruments are desirable for functional IOS imaging of retinal physiology, in depth understanding of multiple IOS sources in the complex retinal neural network is essential for optimizing instrument designs. We provide a brief overview of IOS studies and relationships in rod outer segment suspensions, isolated retinas, and intact eyes. Recent developments of line-scan confocal and functional optical coherence tomography (OCT) instruments have allowed in vivo IOS mapping of photoreceptor physiology. Further improvements of the line-scan confocal and functional OCT systems may provide a feasible solution to pursue functional IOS mapping of human photoreceptors. Some interesting IOSs have already been detected in inner retinal layers, but better development of the IOS instruments and software algorithms is required to achieve optimal physiological assessment of inner retinal neurons.
Topics: Animals; Cats; Electrophysiology; Evoked Potentials, Visual; Haplorhini; Microscopy, Confocal; Models, Neurological; Ophthalmoscopy; Retina; Tomography, Optical Coherence; Vision, Ocular
PubMed: 26405819
DOI: 10.1117/1.JBO.20.9.090901 -
Ophthalmic & Physiological Optics : the... May 2016Over the past 25 years, optical coherence tomography (OCT) and adaptive optics (AO) ophthalmoscopy have revolutionised our ability to non-invasively observe the living... (Review)
Review
PURPOSE
Over the past 25 years, optical coherence tomography (OCT) and adaptive optics (AO) ophthalmoscopy have revolutionised our ability to non-invasively observe the living retina. The purpose of this review is to highlight the techniques and human clinical applications of recent advances in OCT and adaptive optics scanning laser/light ophthalmoscopy (AOSLO) ophthalmic imaging.
RECENT FINDINGS
Optical coherence tomography retinal and optic nerve head (ONH) imaging technology allows high resolution in the axial direction resulting in cross-sectional visualisation of retinal and ONH lamination. Complementary AO ophthalmoscopy gives high resolution in the transverse direction resulting in en face visualisation of retinal cell mosaics. Innovative detection schemes applied to OCT and AOSLO technologies (such as spectral domain OCT, OCT angiography, confocal and non-confocal AOSLO, fluorescence, and AO-OCT) have enabled high contrast between retinal and ONH structures in three dimensions and have allowed in vivo retinal imaging to approach that of histological quality. In addition, both OCT and AOSLO have shown the capability to detect retinal reflectance changes in response to visual stimuli, paving the way for future studies to investigate objective biomarkers of visual function at the cellular level. Increasingly, these imaging techniques are being applied to clinical studies of the normal and diseased visual system.
SUMMARY
Optical coherence tomography and AOSLO technologies are capable of elucidating the structure and function of the retina and ONH noninvasively with unprecedented resolution and contrast. The techniques have proven their worth in both basic science and clinical applications and each will continue to be utilised in future studies for many years to come.
Topics: Fundus Oculi; Humans; Ophthalmoscopy; Optics and Photonics; Retina; Tomography, Optical Coherence
PubMed: 27112222
DOI: 10.1111/opo.12289 -
Journal of Medical Systems Dec 2019It can take several years to become proficient at direct ophthalmoscopy; the instrument's single eyepiece allows only one individual to view the image at a time, which...
It can take several years to become proficient at direct ophthalmoscopy; the instrument's single eyepiece allows only one individual to view the image at a time, which is considered disadvantageous during teaching. The introduction of smartphone ophthalmoscopes enables groups of teachers and students to view images together which could encourage peer-to-peer learning. In addition, the technology is significantly cheaper than the direct ophthalmoscope. User acceptability and engagement is essential to the success of any (medical) technological innovation. We sought to understand student opinions of a new commercially-available smartphone device for fundus examination, and compare usability to the traditional ophthalmoscope, from the perspective of both student practitioners and patients. Fifty-four undergraduate optometry students with prior experience of the traditional direct ophthalmoscope were asked to examine at least one eye with the D-EYE smartphone ophthalmoscope and also given an opportunity to experience the D-EYE from a patient's perspective. Minimal instructions were provided and all examinations conducted through undilated pupils. Participants completed an opinion survey to feedback on aspects such as the ease of handling and working distance. Compared to the direct ophthalmoscope, 92% of students preferred the (longer) working distance of the D-EYE; 77% felt it was easier to handle; and 92% preferred the patient experience with the D-EYE. Despite the positive feedback, only 43% of students preferred the D-EYE when assuming the role of the practitioner. Free text responses indicated that students felt the D-EYE may be most useful as a teaching tool. Student opinions indicated that smartphone ophthalmoscopes are an effective training tool for students as an accompaniment to learning the traditional ophthalmoscope method.
Topics: Adult; Clinical Competence; Education, Medical, Undergraduate; Female; Humans; Male; Ophthalmology; Ophthalmoscopy; Optic Disk; Smartphone; Students, Medical; Young Adult
PubMed: 31797206
DOI: 10.1007/s10916-019-1477-0 -
Der Ophthalmologe : Zeitschrift Der... May 2017Lacrimation of the eye is a relatively common problem, the cause of which must be clarified by differential diagnostics. The most important symptom of a dysfunction of... (Review)
Review
BACKGROUND
Lacrimation of the eye is a relatively common problem, the cause of which must be clarified by differential diagnostics. The most important symptom of a dysfunction of lacrimal drainage is epiphora.
METHODS
Due to the enhancement and miniaturization of endoscopes, which were originally used in gastroduodenoscopy in the 1990s, it is possible to check the anatomical structure and visualize pathological changes of the lacrimal drainage system, which is only approximately 1 mm in diameter. As shown by the results, mechanical stenoses are often caused by recurrent chronic inflammation. A complete stenosis usually occurs only slowly due to dysregulation of the lacrimal unit.
CONCLUSION
In contrast to the assumptions that were valid before the implementation of microendoscopy, complete stenoses are often only punctate and do not stretch over long distances. Shortly after the introduction of microendoscopic diagnostics minimally invasive therapy techniques, such as laser dacryoplasty (LDP) and microdrill dacryoplasty (MDP) were established. These procedures have enabled for the first time preservation of the entire physiology of the lacrimal drainage pump system despite surgical intervention after recanalization.
Topics: Dacryocystorhinostomy; Diagnosis, Differential; Endoscopy; Evidence-Based Medicine; Humans; Lacrimal Duct Obstruction; Microsurgery; Minimally Invasive Surgical Procedures; Ophthalmoscopy; Treatment Outcome
PubMed: 28378046
DOI: 10.1007/s00347-017-0481-3 -
Progress in Retinal and Eye Research Jan 2015Recent advances in clinical ophthalmic imaging have enhanced patient care. However, the ability to differentiate retinal neurons, such as retinal ganglion cells (RGCs),... (Review)
Review
Recent advances in clinical ophthalmic imaging have enhanced patient care. However, the ability to differentiate retinal neurons, such as retinal ganglion cells (RGCs), would advance many areas within ophthalmology, including the screening and monitoring of glaucoma and other optic neuropathies. Imaging at the single cell level would take diagnostics to the next level. Experimental methods have provided techniques and insight into imaging RGCs, however no method has yet to be translated to clinical application. This review provides an overview of the importance of non-invasive imaging of RGCs and the clinically relevant capabilities. In addition, we report on experimental data from wild-type mice that received an in vivo intravitreal injection of a neuronal tracer that labelled RGCs, which in turn were monitored for up to 100 days post-injection with confocal scanning laser ophthalmoscopy. We were able to demonstrate efficient and consistent RGC labelling with this delivery method and discuss the issue of cell specificity. This type of experimental work is important in progressing towards clinically applicable methods for monitoring loss of RGCs in glaucoma and other optic neuropathies. We discuss the challenges to translating these findings to clinical application and how this method of tracking RGCs in vivo could provide valuable structural and functional information to clinicians.
Topics: Animals; Eye Diseases; Humans; Mice; Neurodegenerative Diseases; Ophthalmoscopy; Retinal Ganglion Cells
PubMed: 25448921
DOI: 10.1016/j.preteyeres.2014.10.003 -
Canadian Journal of Ophthalmology.... Feb 2019Fundus autofluorescence (FAF) and widefield angiography (WFA) are relatively new imaging modalities becoming ubiquitous in many clinical practices. FAF uses the... (Review)
Review
Fundus autofluorescence (FAF) and widefield angiography (WFA) are relatively new imaging modalities becoming ubiquitous in many clinical practices. FAF uses the properties and distribution of retinal pigment to improve understanding of the pathophysiology of retinal diseases. Clinical applications of FAF continue to expand. It is noninvasive, and available on multiple platforms for clinicians. From monitoring progression of common diseases such as macular degeneration to evaluating drug toxicities, it has become a clinically important imaging modality in evaluating retinal disease. Similarly, fluorescein angiography has been useful in elucidating retinal vascular diseases not clearly evident by funduscopic examination alone. However, visualization of the peripheral retina with WFA has drastically improved ophthalmic providers' abilities to screen, diagnose, monitor, and treat various retinal vascular diseases. The aim of this review is to provide an overview of the role of FAF and WFA in common clinical practice, as well as limitations providers should be aware.
Topics: Fluorescein Angiography; Fundus Oculi; Humans; Ophthalmoscopy; Reproducibility of Results; Retinal Diseases; Retinal Pigment Epithelium; Tomography, Optical Coherence
PubMed: 30851762
DOI: 10.1016/j.jcjo.2018.10.003 -
Archives of Disease in Childhood.... Apr 2018Ophthalmoscopy and red reflex examination are core medical skills required to identify sight-threatening and life-threatening disease. We discuss the predictive utility...
Ophthalmoscopy and red reflex examination are core medical skills required to identify sight-threatening and life-threatening disease. We discuss the predictive utility and limitations of findings with an ophthalmoscope and tips as to how to optimise these. We outline important considerations in three clinical scenarios: an abnormal red reflex, an abnormal optic disc and retinal haemorrhages in the context of child protection concerns.
Topics: Adolescent; Child; Child, Preschool; Eye Diseases; Female; Humans; Infant; Male; Mass Screening; Ophthalmoscopes; Ophthalmoscopy; Pediatrics
PubMed: 28935833
DOI: 10.1136/archdischild-2016-312378