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Annual Review of Vision Science Sep 2020High-resolution retinal imaging is revolutionizing how scientists and clinicians study the retina on the cellular scale. Its exquisite sensitivity enables time-lapse... (Review)
Review
High-resolution retinal imaging is revolutionizing how scientists and clinicians study the retina on the cellular scale. Its exquisite sensitivity enables time-lapse optical biopsies that capture minute changes in the structure and physiological processes of cells in the living eye. This information is increasingly used to detect disease onset and monitor disease progression during early stages, raising the possibility of personalized eye care. Powerful high-resolution imaging tools have been in development for more than two decades; one that has garnered considerable interest in recent years is optical coherence tomography enhanced with adaptive optics. State-of-the-art adaptive optics optical coherence tomography (AO-OCT) makes it possible to visualize even highly transparent cells and measure some of their internal processes at all depths within the retina, permitting reconstruction of a 3D view of the living microscopic retina. In this review, we report current AO-OCT performance and its success in visualizing and quantifying these once-invisible cells in human eyes.
Topics: Humans; Ophthalmoscopy; Retina; Tomography, Optical Coherence
PubMed: 32609578
DOI: 10.1146/annurev-vision-030320-041255 -
Asia-Pacific Journal of Ophthalmology... 2015This systematic review was performed to estimate the diagnostic accuracy of the confocal scanning laser ophthalmoscopy in diagnosing glaucoma. We did a sensitive... (Meta-Analysis)
Meta-Analysis Review
This systematic review was performed to estimate the diagnostic accuracy of the confocal scanning laser ophthalmoscopy in diagnosing glaucoma. We did a sensitive electronic search to find relevant studies. Two reviewers independently screened relevant articles and extracted required data about study methods and reported results of sensitivity and specificity. A meta-analysis was conducted for pooling data to compare different editions of the Heidelberg Retina Tomograph (HRT) with one of its alternatives, scanning laser polarimetry (GDx) with the criteria of "visual field defect" and "changes of nerve fiber layer" as the reference standard. We identified 37 evaluations from 28 relevant primary studies. In these studies, 9573 eyes (4883 glaucomatous and 4689 non-glaucomatous) were assessed with regards to the reference standard using one of the HRT editions with or without GDx. Diagnostic odds ratios were 9.35 [95% confidence interval (CI): 7.58-11.53] for HRT, 11.84 (95% CI: 9.97-14.06) for HRT II, 11.86 (95% CI: 9.16-15.35) for HRT III, and 21.33 (95% CI, 13.56-33.55) for GDx. Although GDx was more accurate than HRT, all editions of HRT had acceptable performance in diagnosing glaucomatous eyes with an ophthalmologist's clinical examination as the reference standard.
Topics: Diagnostic Techniques, Ophthalmological; Glaucoma; Humans; Microscopy, Confocal; Ophthalmoscopy; Scanning Laser Polarimetry; Sensitivity and Specificity; Visual Field Tests; Visual Fields
PubMed: 26068611
DOI: 10.1097/APO.0000000000000085 -
Practical Neurology Oct 2020
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Humans; Ophthalmoscopy; Pandemics; Personal Protective Equipment; Pneumonia, Viral; Risk Factors; SARS-CoV-2
PubMed: 32830119
DOI: 10.1136/practneurol-2020-002650 -
Journal of Medical Engineering &... Apr 2017With the advancement in mobile technology, smartphone retinal photography is becoming a popular practice. However, there is limited information about the safety of the...
BACKGROUND
With the advancement in mobile technology, smartphone retinal photography is becoming a popular practice. However, there is limited information about the safety of the latest smartphones used for retinal photography.
AIMS
This study aims to determine the photobiological risk of iPhone 6 and iPhone 6 plus when used in conjunction with a 20Diopter condensing lens for retinal photography.
METHOD
iPhone 6 and iPhone 6 plus (Apple, Cupertino, CA) were used in this study. The geometrical setup of the study was similar to the indirect ophthalmoscopy technique. The phone was set up at one end of the bench with its flash turned on at maximal brightness; a 20 Dioptre lens was placed 15 cm away from the phone. The light that passes through the lens was measured with a spectroradiometer and an illuminance probe at the other end to determine the spectral profile, spatial irradiance, radiant power emitted by the phone's flash. Trigonometric and lens formula were applied to determine the field of view and retinal surface in order to determine the weighted retinal irradiance and weighted retinal radiant exposure.
RESULT
Taking ocular transmission and the distribution of the beam's spatial irradiance into account, the weighted retinal irradiance is 1.40 mW/cm and the weighted retinal radiant exposure is 56.25 mJ/cm. The peak weighted foveal irradiance is 1.61 mW/cm.
CONCLUSION
Our study concluded that the photobiological risk posed by iPhone 6 indirect ophthalmoscopy was at least 1 order of magnitude below the safety limits set by the ISO15004-2.2.
Topics: Humans; Ophthalmoscopy; Photography; Retina; Smartphone
PubMed: 27924670
DOI: 10.1080/03091902.2016.1264491 -
PloS One 2017The purpose of this study was to determine among patients with candidemia the real rate of ophthalmoscopy and the impact of performing ocular assessment on the outcome...
The purpose of this study was to determine among patients with candidemia the real rate of ophthalmoscopy and the impact of performing ocular assessment on the outcome of the disease. We performed a post hoc analysis of a prospective, multicenter, population-based candidemia surveillance program implemented in Spain during 2010-2011 (CANDIPOP). Ophthalmoscopy was performed in only 168 of the 365 patients with candidemia (46%). Ocular lesions related to candidemia were found in only 13/168 patients (7.7%), of whom 1 reported ocular symptoms (incidence of symptomatic disease in the whole population, 0.27% [1/365]). Ophthalmological findings led to a change in antifungal therapy in only 5.9% of cases (10/168), and performance of the test was not related to a better outcome. Ocular candidiasis was not associated with a worse outcome and progressed favorably in all but 1 evaluable patient, who did not experience vision loss. The low frequency of ophthalmoscopy and ocular involvement and the asymptomatic nature of ocular candidiasis, with a favorable outcome in almost all cases, lead us to reconsider the need for systematic ophthalmoscopy in all candidemic patients.
Topics: Aged; Antifungal Agents; Candidemia; Female; Humans; Male; Middle Aged; Ophthalmoscopy; Prospective Studies; Spain
PubMed: 29065121
DOI: 10.1371/journal.pone.0183485 -
Der Ophthalmologe : Zeitschrift Der... May 2017One of the most frequent issues in pediatric ophthalmology concerns congenital nasolacrimal duct obstruction (CNLDO). Typically, irritation of the medial eyelid angle... (Review)
Review
BACKGROUND
One of the most frequent issues in pediatric ophthalmology concerns congenital nasolacrimal duct obstruction (CNLDO). Typically, irritation of the medial eyelid angle occurs during the first days of life and later increased epiphora appears as tear production is still reduced in young infants. In the case of intrasaccal or postsaccal nasolacrimal duct stenosis, a chronic dacryocystitis develops.
METHODS
Modern minimally invasive diagnostics and therapy of CNLDO are reviewed by means of a search of the recent literature and reflection of own experiences.
RESULTS
An early diagnosis of CNLDO is desirable. If conservative therapeutic approaches fail, invasive procedures have to be considered. Probing and high pressure syringing of the nasolacrimal ducts remains the therapy of choice. Further therapy options, such as balloon dacryoplasty and dacryoendoscopy are also available. Additionally, due to improvement of the surgical techniques a minimally invasive approach is possible even for dacryocystorhinostomy; nevertheless, this procedure should be considered only as a last resort.
CONCLUSION
Precise classification of CNLDO and knowledge about the possible treatment options are important. Lacrimal surgery in childhood is dominated by transcanalicular procedures. Advanced minimally invasive techniques, such as dacryoendoscopy or modern autostable intubation sets have to be emphasized. All therapeutic interventions can be summarized using a staged therapeutic concept, which should be used individually and patient-centered.
Topics: Combined Modality Therapy; Dacryocystorhinostomy; Diagnosis, Differential; Endoscopy; Evidence-Based Medicine; Humans; Intubation; Lacrimal Duct Obstruction; Minimally Invasive Surgical Procedures; Ophthalmoscopy; Therapeutic Irrigation; Treatment Outcome
PubMed: 28258301
DOI: 10.1007/s00347-017-0472-4 -
Journal of Neuro-ophthalmology : the... Jun 2020Assessment of spontaneous venous pulsation (SVP) is commonly undertaken to help determine whether intracranial pressure (ICP) is elevated. Previous studies using direct...
BACKGROUND
Assessment of spontaneous venous pulsation (SVP) is commonly undertaken to help determine whether intracranial pressure (ICP) is elevated. Previous studies using direct ophthalmoscopy or slit-lamp assessments have found that SVP is not observed in 67%-81% of subjects with normal ICP, and that interobserver agreement when grading SVP is poor.
METHODS
Patients (n = 105) undergoing clinically indicated retinal OCT scans, who were all believed to have normal ICP, had 10-second infrared video recordings performed with the Heidelberg Spectralis OCT system (Heidelberg Engineering GmbH, Heidelberg, Germany). The presence and amplitude of SVP in each video was independently graded by 2 neuro-ophthalmologists.
RESULTS
The 2 observers found SVP present in 97% and 98% of right eyes and in one or both eyes in 99% and 100% of subjects. Interobserver agreement was high (Cohen's kappa 0.82 for right eyes). Optic discs with a smaller cup had a significantly lower SVP amplitude (Spearman's rho = 0.22, P = 0.02).
CONCLUSIONS
Infrared video is widely available in eye clinics by the use of OCT imaging systems and is substantially more sensitive in detecting SVP than traditional assessments using ophthalmoscopy. SVP is absent in as few as 1% of people with presumed normal ICP.
Topics: Female; Humans; Intracranial Pressure; Intraocular Pressure; Male; Middle Aged; Ophthalmoscopy; Optic Disk; Retinal Vein; Tomography, Optical Coherence; Video Recording
PubMed: 31464805
DOI: 10.1097/WNO.0000000000000815 -
Indian Journal of Ophthalmology May 2022To determine and validate retinal vascular caliber measurements by using the confocal scanning laser ophthalmoscopy system. Retinal vasculature changes are often... (Observational Study)
Observational Study
Normative data of retinal arteriolar and venular calibre measurements determined using confocal scanning laser ophthalmoscopy system - Importance and implications for study of cardiometabolic disorders.
PURPOSE
To determine and validate retinal vascular caliber measurements by using the confocal scanning laser ophthalmoscopy system. Retinal vasculature changes are often regarded as clinical markers for systemic disease.
METHODS
It was a prospective observational study conducted on 600 eyes of 300 normal subjects with no systemic or ocular illness from January 1, 2016 to June 30, 2017 in a tertiary referral eye center. Non-mydriatic infrared reflectance, blue reflectance, and blue peak blue autofluorescence fundus imaging were done on the confocal scanning laser ophthalmoscopy system. The dimensions of the retinal vessels were measured using inbuilt calipers at 1800 μm from the center of the optic disc. Internal and external dimensions were measured. Observer variation and its comparison using Image J software were assessed.
RESULTS
The median age was 29 years (18-50 years). Mean internal and external diameters for arterioles were 85.1 ± 12.4 μm and 105.0 ± 12.0 μm, and for venules were 133.8 ± 16.6 μm and 145.4 ± 16.1 μm, respectively. The mean internal and external wall thicknesses were 19.7 ± 8.0 μm and 11.0 ± 5.6 μm, and wall thickness-to-lumen ratios were 0.3 ± 0.1 and 0.1 ± 0.1, respectively. Arteriolar-to-venular ratio for lumen and vessel was 0.66 ± 0.1 and 0.74 ± 0.1, respectively. There was no statistically significant difference between age groups. Both inter- and intra-observer reproducibility was >95%. The Bland-Altman plot showed that the difference between measurements using both confocal scanning laser ophthalmoscopy and Image J software lies within the limits of agreement approximately 95% of the time.
CONCLUSION
This is the first effort to develop a normative database by using a simple non-invasive confocal scanning laser ophthalmoscopy system with high observer reproducibility.
Topics: Adult; Arterioles; Cardiovascular Diseases; Humans; Lasers; Ophthalmoscopy; Optic Disk; Reproducibility of Results; Retinal Vessels; Venules
PubMed: 35502046
DOI: 10.4103/ijo.IJO_2162_21 -
PloS One 2023To investigate the influence of the lens status and to describe fundus autofluorescence lifetimes (FLT) in a large cohort of healthy eyes across a wide age range.
PURPOSE
To investigate the influence of the lens status and to describe fundus autofluorescence lifetimes (FLT) in a large cohort of healthy eyes across a wide age range.
MATERIALS AND METHODS
FLT data were acquired from healthy phakic and pseudophakic eyes using fluorescence lifetime imaging ophthalmoscopy (FLIO). Retinal autofluorescence was excited with a 473 nm laser and emitted autofluorescence was detected in a short and a long spectral channel (SSC: 498-560 nm; LSC: 560-720 nm).
RESULTS
141 healthy eyes from 141 participants (56 ± 18 years) were included. The shortest mean FLTs were measured within the macular center, followed by the temporal inner and outer ETDRS (Early Treatment Diabetic Retinopathy Study) grid segments, and the remaining areas of the inner and the outer ETDRS ring. In phakic participants (81%), mean, short and long FLTs correlated with the age (SSC: r2 = 0.54; LSC: r2 = 0.7; both p<0.0001) with an increase of about 33 ps in the SSC resp. 28 ps in the LSC per decade. In pseudophakic subjects (19%), mean FLTs only correlated with age in the long spectral channel (r2 = 0.44; p = 0.0002) but not in the short spectral channel (r2 = 0.066; p = 0.2).
CONCLUSIONS
Fundus autofluorescence lifetimes are age dependent. FLTs in the SSC are more susceptible to lens opacities but less dependent on age changes, whereas FLTs in the LSC are largely independent of the lens status but display a higher degree of age dependency.
STUDY REGISTRY
ClinicalTrials.gov NCT01981148.
Topics: Humans; Fluorescein Angiography; Retina; Fundus Oculi; Ophthalmoscopy; Optical Imaging; Tomography, Optical Coherence
PubMed: 36608033
DOI: 10.1371/journal.pone.0279158 -
Ophthalmology. Retina May 2021To evaluate the usefulness of a high-magnification module (HMM) lens to visualize retinal photoreceptors, retinal nerve fiber layer (RNFL), and superficial retinal... (Observational Study)
Observational Study
PURPOSE
To evaluate the usefulness of a high-magnification module (HMM) lens to visualize retinal photoreceptors, retinal nerve fiber layer (RNFL), and superficial retinal vasculature in physiologic and pathologic retinal conditions.
DESIGN
Observational descriptive study.
PARTICIPANTS
Thirty-two participants with normal and pathologic retina examination results.
METHODS
Normal and pathologic maculae were imaged in vivo using still and video HMM lens modes, with fixation and contrast adjustments to enhance visualization. The HMM images were classified qualitatively based on structures identified as either good (photoreceptors seen), average (photoreceptor mosaic cannot be visualized clearly, retinal vessels and other retinal changes can be seen), or poor (no identifiable structures). Selected eyes were imaged with fundus photography, OCT, OCT angiography, indocyanine green angiography, and fluorescein angiography for comparison with the pathologic maculae.
MAIN OUTCOMES MEASURES
Description of HMM module-obtained macula images.
RESULTS
From 32 eyes imaged (16 normal and 16 pathologic retinas), 12 of 16 normal and 11 of 16 pathologic retinas demonstrated at least average image quality, in which retinal vasculature and landmarks could be visualized. The mosaic pattern of hexagonal shapes representing photoreceptors could not be resolved in most pathologic retinas. For the retinas in which the photoreceptor mosaics were visualized (12 of 16 normal and 2 of 16 pathologic retinas), parafoveal mosaic patterns appeared denser with better image quality for all participants compared with foveal photoreceptors. Difficulty in resolving the photoreceptors in the umbo, fovea, and perifovea was encountered, similar to what has been reported with adaptive optics devices. The RNFL was seen as arcuate hyperreflective bundles. Flow was observed in the macular microvasculature. Poorly resolved photoreceptors and scattered hyperreflective foci were correlated with changes in the retinal pigment epithelium in eyes with age-related macular degeneration or central serous chorioretinopathy. Macular striae were seen in eyes with epiretinal membrane.
CONCLUSIONS
In most eyes, regardless of whether retinal pathologic features were present, it was challenging to obtain average quality (or better) images. In the few participants with good-quality imaging, the parafoveal photoreceptor mosaic, vascular flow, and various features of pathologic eyes could be visualized.
Topics: Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Ophthalmoscopy; Retina; Retinal Diseases; Retinal Vessels; Visual Acuity; Young Adult
PubMed: 32861857
DOI: 10.1016/j.oret.2020.08.014