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Translational Vision Science &... Jul 2023To investigate the agreement between a fundus camera and a scanning laser ophthalmoscope in retinal vessel caliber measurements and to identify whether the presence of...
PURPOSE
To investigate the agreement between a fundus camera and a scanning laser ophthalmoscope in retinal vessel caliber measurements and to identify whether the presence of the central light reflex (CLR) explains potential discrepancies.
METHODS
For this cross-sectional study, we obtained fundus camera and scanning laser ophthalmoscope images from 85 eyes of 85 healthy individuals (aged 50-65 years) with different blood pressure status. We measured the central retinal artery equivalent (CRAE) and central retinal artery vein equivalent (CRVE) with the Knudtson-Parr-Hubbard algorithm and assessed the CLR using a semiautomatic grading method. We used Bland-Altman plots, 95% limits of agreement, and the two-way mixed effects intraclass correlation coefficient for consistency [ICC(3,1)] to describe interdevice agreement. We used multivariable regression to identify factors associated with differences in between-device measurements.
RESULTS
The between-device difference in CRAE (9.5 µm; 95% confidence interval, 8.0-11.1 µm) was larger than the between-device difference in CRVE (2.9 µm; 95% confidence interval, 1.3-4.5 µm), with the fundus camera yielding higher measurements (both P < 0.001). The 95% fundus camera-scanning laser ophthalmoscope limits of agreement were -4.8 to 23.9 µm for CRAE and -12.0 to 17.8 µm for CRVE. The corresponding ICCs(3,1) were 0.89 (95% confidence interval, 0.83-0.92) and 0.91 (95% confidence interval, 0.86-0.94). The between-device CRAE difference was positively associated with the presence of a CLR (P = 0.002).
CONCLUSIONS
Fundus cameras and scanning laser ophthalmoscopes yield correlated but not interchangeable caliber measurements. The CLR induces bias in arteriolar caliber in fundus camera images, compared with scanning laser ophthalmoscope images.
TRANSLATIONAL RELEVANCE
Refined measurements could yield better estimates of the association between retinal vessel caliber and ophthalmic or systemic disease.
Topics: Humans; Cross-Sectional Studies; Retinal Vessels; Retinal Vein; Retinal Artery; Reflex
PubMed: 37450282
DOI: 10.1167/tvst.12.7.16 -
Journal of Academic Ophthalmology (2017) Jan 2020The aim of this study is to evaluate the effectiveness of an interactive, small-group ophthalmology clinical training session by assessing medical students'...
OBJECTIVE
The aim of this study is to evaluate the effectiveness of an interactive, small-group ophthalmology clinical training session by assessing medical students' self-confidence with eye examination skills and long-term retention of direct ophthalmoscopy skills.
METHODS
The second-year medical students participated in a one-time small-group clinical training session that taught essential components of the eye examination. Students reported their confidence with each component in pre- and postsession surveys. Eight months later, direct ophthalmoscopy skills were reassessed by having students visualize the optic nerves of standardized patients and identify the matching optic nerve photograph in a multiple-choice quiz.
RESULTS
Among 197 second-year medical students who participated in the training session, 172 students completed the presession survey (87.3% response rate) and 108 students completed the postsession survey (54.8% response rate). Following the training session, students reported increased self-confidence ( < 0.01) overall. A total of 107 (107/108; 99.1%) students reported that they visualized the optic nerve head, and 80 out of 85 (94.1%) students stated that they preferred the PanOptic ophthalmoscope over the traditional direct ophthalmoscope. Students reported greater self-confidence using the PanOptic ophthalmoscope ( < 0.01). In the 8-month follow-up assessment, 42 medical students (42/197; 21.3%) completed the exercise. A total of 41 (41/42; 97.6%) students stated that they saw the optic nerve with the PanOptic ophthalmoscope; 24 (24/42; 57.1%) students identified the correct optic nerve image using the PanOptic ophthalmoscope on a standardized patient; 14 (14/42; 33.3%) students stated that they saw the optic nerve with the traditional direct ophthalmoscope; and 4 (4/42; 9.1%) students from the same cohort identified the correct optic nerve image with the traditional direct ophthalmoscope on a standardized patient.
CONCLUSION
Our comprehensive, one-time eye examination skills training session seeks to prepare students to incorporate these skills in future patient care. Students' overall confidence improved in each aspect of the eye examination that was covered. A follow-up assessment on students' direct ophthalmoscopy skills suggests that the PanOptic ophthalmoscope allows for superior skills retention as compared with the traditional direct ophthalmoscope. We believe that the PanOptic ophthalmoscope should be further integrated into medical education and clinical practice.
PubMed: 32728655
DOI: 10.1055/s-0040-1712175 -
Acta Ophthalmologica Sep 2017To report the results and complications of scleral buckling for the treatment of rhegmatogenous retinal detachment (RRD) using 25-gauge chandelier endoillumination.
PURPOSE
To report the results and complications of scleral buckling for the treatment of rhegmatogenous retinal detachment (RRD) using 25-gauge chandelier endoillumination.
METHODS
A total of 61 patients (61 eyes) with RRD were treated with scleral buckling. For the sclera buckling procedure, a 25-gauge chandelier was inserted through the pars plana for intra-ocular illumination, and retinal tears were identified and treated with episcleral cryotherapy under surgical microscope. On postoperative days 1, 3 and 7, the intra-ocular pressure was measured by a non-contact tonometer. On postoperative months 1 and 3, ultrasound biomicroscopy was used to examine the pars plana incision.
RESULTS
In the surgical procedure, there was no lenticular or retinal damage due to the chandelier insertion. There was no conjunctival bleb formation at pars plana incision and no incidence of endophthalmitis after surgery. The mean intra-ocular pressure was 15.74 ± 2.98, 15.83 ± 2.76 and 16.14 ± 2.52 mmHg on postoperative days 1, 3 and 7, respectively. The one-time retinal reattachment rate was 93.4%. No visible vitreous incarceration was found in the incision of the pars plana.
CONCLUSION
There was no complication found due to the chandelier insertion in early postoperative period. Chandelier endoillumination is a feasible method for retinal visualization under surgical microscope during scleral buckling.
Topics: Adolescent; Adult; Aged; Child; Equipment Design; Female; Follow-Up Studies; Humans; Light; Male; Microscopy, Acoustic; Middle Aged; Ophthalmoscopes; Retina; Retinal Detachment; Retrospective Studies; Scleral Buckling; Surgery, Computer-Assisted; Time Factors; Treatment Outcome; Visual Acuity; Young Adult
PubMed: 27966834
DOI: 10.1111/aos.13326 -
International Journal of Pharmaceutics Sep 2021To address the need for noninvasive monitoring of injectable preformed drug delivery implants in the eye, we developed noninvasive methods to monitor such implants in...
Noninvasive monitoring of suprachoroidal, subretinal, and intravitreal implants using confocal scanning laser ophthalmoscope (cSLO) and optical coherence tomography (OCT).
To address the need for noninvasive monitoring of injectable preformed drug delivery implants in the eye, we developed noninvasive methods to monitor such implants in different locations within the eye. Cylindrical polymeric poly(lactide-co-glycolide) or metal implants were injected into isolated bovine eyes at suprachoroidal, subretinal, and intravitreal locations and imaged noninvasively using the cSLO and OCT modes of a Heidelberg Spectralis HRA + OCT instrument after adjusting for the corneal curvature. Length and diameter of implants were obtained using cSLO images for all three locations, and the volume was calculated. Additionally, implant volume for suprachoroidal and subretinal location was estimated by integrating the cross-sectional bleb area over the implant length in multiple OCT images or using the maximum thickness of the implant based on thickness map along with length in cSLO image. Simultaneous cSLO and OCT imaging identified implants in different regions of the eye. Image-based measurements of implant dimensions mostly correlated well with the values prior to injection using blade micrometer. The accuracy (82-112%) and precision (1-19%) for noninvasive measurement of length was better than the diameter (accuracy 69-130%; precision 3-38%) using cSLO image for both types of implants. The accuracy for the measurement of volume of both types of implants from all three intraocular locations was better with cSLO imaging (42-152%) compared to those obtained using OCT cross-sectional bleb area integration (117-556%) or cSLO and thickness map (32-279%) methods. Suprachoroidal, subretinal, and intravitreal implants can be monitored for length, diameter, and volume using cSLO and OCT imaging. Such measurements may be useful in noninvasively monitoring implant degradation and drug release in the eye.
Topics: Animals; Cattle; Cross-Sectional Studies; Lasers; Ophthalmoscopes; Tomography, Optical Coherence
PubMed: 34271155
DOI: 10.1016/j.ijpharm.2021.120887 -
Turkish Journal of Ophthalmology Feb 2019In Turkey, preventive medicine services are the responsibility of family physicians and vision screening is a key component of this responsibility. In this study, we...
OBJECTIVES
In Turkey, preventive medicine services are the responsibility of family physicians and vision screening is a key component of this responsibility. In this study, we aimed to investigate the approach of family physicians to vision screening in infants and children.
MATERIALS AND METHODS
Data were collected using a 16-item questionnaire administered to 100 family physicians working in the center and provinces of Diyarbakır.
RESULTS
The results indicated that 88 (88%) physicians declared knowing what the red reflex test was, while 12 physicians declared that they had never heard of it. Only 16 (16%) physicians performed the test routinely and 36 (36%) physicians performed it only in suspicious cases. Ten (10%) physicians indicated that they did not refer the patients to an ophthalmologist even though they did not perform the red reflex test. Moreover, 5 (5%) physicians did not have an ophthalmoscope and 12 (12%) physicians reported not knowing how to use an ophthalmoscope. Forty (40%) of the physicians measured preschool visual acuity at least once. Sixty-six (66%) physicians referred younger children who could not express their vision problems to an ophthalmologist. Four (4%) physicians declared that they would delay surgery in children with strabismus until they were old enough for surgery. Ninety-three (93%) physicians suggested that educational seminars about vision screening would be beneficial.
CONCLUSION
Educational seminars about vision screening may have favorable outcomes. The medical devices in family medicine centers should be improved. Vision screening can be added to the negative performance-based compensation system in order to increase physicians’ attention to vision screening. To implement detailed eye screening programs like those in developed countries, an infrastructure should be established for this screening program.
Topics: Child; Child, Preschool; Clinical Competence; Family Practice; Female; Health Knowledge, Attitudes, Practice; Humans; Infant; Infant, Newborn; Male; Practice Patterns, Physicians'; Turkey; Vision Disorders; Vision Screening; Visual Acuity
PubMed: 30829022
DOI: 10.4274/tjo.galenos.2018.10829 -
Sensors (Basel, Switzerland) May 2020This paper proposes a teleophthalmology support system in which we use algorithms of object detection and semantic segmentation, such as faster region-based CNN (FR-CNN)...
This paper proposes a teleophthalmology support system in which we use algorithms of object detection and semantic segmentation, such as faster region-based CNN (FR-CNN) and SegNet, based on several CNN architectures such as: Vgg16, MobileNet, AlexNet, etc. These are used to segment and analyze the principal anatomical elements, such as optic disc (OD), region of interest (ROI) composed by the macular region, real retinal region, and vessels. Unlike the conventional retinal image quality assessment system, the proposed system provides some possible reasons about the low-quality image to support the operator of an ophthalmoscope and patient to acquire and transmit a better-quality image to central eye hospital for its diagnosis. The proposed system consists of four steps: OD detection, OD quality analysis, obstruction detection of the region of interest (ROI), and vessel segmentation. For the OD detection, artefacts and vessel segmentation, the FR-CNN and SegNet are used, while for the OD quality analysis, we use transfer learning. The proposed system provides accuracies of 0.93 for the OD detection, 0.86 for OD image quality, 1.0 for artefact detection, and 0.98 for vessel segmentation. As the global performance metric, the kappa-based agreement score between ophthalmologist and the proposed system is calculated, which is higher than the score between ophthalmologist and general practitioner.
Topics: Algorithms; Humans; Ophthalmology; Optic Disk; Retina; Telemedicine
PubMed: 32429400
DOI: 10.3390/s20102838 -
Biomedical Optics Express Oct 2020Confocal reflectance microscopy has demonstrated the ability to produce images of corneal tissue with sufficient cellular resolution to diagnose a broad range of...
Confocal reflectance microscopy has demonstrated the ability to produce images of corneal tissue with sufficient cellular resolution to diagnose a broad range of corneal conditions. To investigate the spectral behavior of corneal reflectance imaging, a modified laser ophthalmoscope was used. Imaging was performed on a human cornea as well as on porcine and lamb corneae. Various corneal layers were imaged at the wavelengths 488 nm, 518 nm, and 815 nm and compared regarding image quality and differences in the depicted structures. Besides the wavelength- and depth-dependent scattering background, which impairs the image quality, a varying spectral reflectance of certain structures could be observed. Based on the obtained results, this paper emphasizes the importance of choosing the appropriate light source for corneal imaging. For the examination of the epithelial layers and the endothelium, shorter wavelengths should be preferred. In the remaining layers, longer wavelength light has the advantage of less scattering loss and a potentially higher subject compliance.
PubMed: 33149979
DOI: 10.1364/BOE.397615 -
Computational Intelligence and... 2022When it comes to diabetic retinopathy, exudates are the most common sign; alarms for early screening and diagnosis are suggested. The images taken by cameras and...
When it comes to diabetic retinopathy, exudates are the most common sign; alarms for early screening and diagnosis are suggested. The images taken by cameras and high-definition ophthalmoscopes are riddled with flaws and noise. Overcoming noise difficulties and pursuing automated/computer-aided diagnosis is always a challenge. The major objective of this approach is to obtain a better prediction rate of diabetic retinopathy analysis. The accuracy, sensitivity, specificity, and prediction rate improvement are focused on the objective view. The images are separated into relevant patches of various sizes and stacked for use as inputs to CNN, which is then trained, tested, and validated. The article presents a mathematical approach to determine the prevalence, shape in precise, color, and density in the populations among image patches to operate and discover the fact the image collection consists of symptoms of exudates and methods to comprehend the diagnosis and suggest risks of early hospital treatment. The experimental result analysis of malignant quality shows the accuracy, sensitivity, specificity, and predictive value. Here, 78% of accuracy, 78.8% of sensitivity, and 78.3% of specificity are obtained, and both positive and negative predictive values are obtained.
Topics: Algorithms; Diabetic Retinopathy; Diagnosis, Computer-Assisted; Exudates and Transudates; Humans; Sensitivity and Specificity
PubMed: 35676956
DOI: 10.1155/2022/7968200 -
Turkish Journal of Medical Sciences Jun 2020To investigate the effect of intravitreal golimumab on rabbit retina histopathology.
BACKGROUND/AIM
To investigate the effect of intravitreal golimumab on rabbit retina histopathology.
MATERIALS AND METHODS
Sixteen albino New Zealand rabbits were divided into three groups. The right eye of each rabbit in groups I, II, and III received a single intravitreal injection of 5 mg/0.05 mL (6 eyes), 10 mg/0.1 mL (6 eyes), or 20 mg/0.2 mL (4 eyes) golimumab, while left eyes served as controls with the same volume of a balanced salt solution injection. All animals were examined using slit-lamp biomicroscopy and indirect ophthalmoscopy before and after intravitreal injection and at days 1 and 7. Animals were euthanized on day 7 and the eyes were enucleated for immunohistochemistry evaluation and electron microscopic examination of the retinas.
RESULTS
For groups I, II, and III, the number of cells in the outer nuclear layer and the inner nuclear layer was decreased compared to those in the control groups. In group I, the percentage of caspase-3 staining of the outer nuclear layer was significantly higher than that in the control. For groups II and III, TUNEL and caspase-3 staining percentages in the outer and inner nuclear layers were found to be significantly higher than those for the control groups. In the ganglion cell layer, for groups I, II, and III, neither TUNEL nor caspase-3 staining percentages showed any significant difference between two groups. No significant dose-dependent relationship was found for increasing doses of golimumab in all layers. Myelin figures and karyorrhexis in the photoreceptor cells were prominent in electron microscopy of the golimumab-injected eyes.
CONCLUSION
Golimumab caused apoptosis in both photoreceptors and bipolar cells of the rabbit retina. Potential retinal toxicity of intravitreal golimumab should be considered if an intravitreal administration is planned.
Topics: Animals; Antibodies, Monoclonal; Apoptosis; Disease Models, Animal; Intravitreal Injections; Ophthalmoscopy; Rabbits; Slit Lamp; Toxic Optic Neuropathy
PubMed: 32151118
DOI: 10.3906/sag-1911-11 -
Acta Ophthalmologica Sep 2014Recently, the authors encountered an intriguing and largely incomplete ophthalmoscope. The quest to identify and restore it led to a re-evaluation of the evolution of...
Recently, the authors encountered an intriguing and largely incomplete ophthalmoscope. The quest to identify and restore it led to a re-evaluation of the evolution of the modern-day ophthalmoscope and a re-examination of the life and contributions of its inventor, the Norwegian ophthalmologist Hjalmar August Schiøtz.
Topics: History, 19th Century; Humans; Norway; Ophthalmology; Ophthalmoscopes; Tonometry, Ocular
PubMed: 25259396
DOI: 10.1111/aos.12274