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International Ophthalmology Dec 2022To evaluate fundus examination accuracy of medical students when using an unmodified iPhone X or a direct ophthalmoscope in comparison to a staff ophthalmologist's...
PURPOSE
To evaluate fundus examination accuracy of medical students when using an unmodified iPhone X or a direct ophthalmoscope in comparison to a staff ophthalmologist's retinal examination.
METHODS
In this prospective comparative analysis, patients underwent dilated fundus examination by novice medical trainees using either an unmodified iPhone X or standard direct ophthalmoscope. The primary outcome was the mean difference and degree of agreement in cup-to-disc ratio between student examination and the staff ophthalmologist's cup-to-disc observation.
RESULTS
A total of 18 medical students conducted 230 retinal examinations, 117 with the iPhone X and 113 with the direct ophthalmoscope. A greater proportion of students were unable to report cup-to-disc ratio using the iPhone X (81.2%) vs direct ophthalmoscope (30.1%). Student examination of cup-to-disc ratio led to a systematic bias (95% limits of agreement) of + 0.16 (-0.22 to + 0.54) and + 0.10 (-0.36 to + 0.56) with the iPhone X and direct ophthalmoscope, respectively. iPhone X and direct ophthalmoscope student observation concordance for optic disc colour (88.7 and 82.4%, respectively) and contour (68.3 and 74.2%, respectively) demonstrated low agreement with staff ophthalmologist findings. Student iPhone X observations demonstrated lower agreement with staff findings compared to direct ophthalmoscope observations for spontaneous venous pulsations (Cohen's Kappa = -0.044 vs 0.099).
CONCLUSION
Amongst medical trainees, optic disc visualization using an unmodified iPhone X was inferior to the direct ophthalmoscope. When able to visualize the optic nerve head, there was no significant difference in reported cup-to-disc ratio between modalities. However, both modalities demonstrated poor reliability in comparison to staff ophthalmologist findings.
Topics: Humans; Students, Medical; Reproducibility of Results; Ophthalmoscopy; Ophthalmoscopes; Optic Disk
PubMed: 35871237
DOI: 10.1007/s10792-022-02377-4 -
Clinical Ophthalmology (Auckland, N.Z.) 2021Smartphone technology is advancing at a rapid pace. Their role in day-to-day life is becoming more and more intricate and irreplaceable. Of late, they have gained... (Review)
Review
Smartphone technology is advancing at a rapid pace. Their role in day-to-day life is becoming more and more intricate and irreplaceable. Of late, they have gained immense importance in different medical specialities where they possess an active ability to guide the clinician. This is particularly evident in ophthalmology, where the constantly evolving camera-illumination systems and the artificial intelligence integrated technology have unravelled many novel observations for non-contact posterior segment imaging. The scope of this review is to highlight the role of smartphones as ophthalmoscopes (direct as well as indirect). Nevertheless, their limitations and future directions are also stated here with the intention of making progress in the field of smartphone fundus imaging.
PubMed: 34737548
DOI: 10.2147/OPTH.S243103 -
Ophthalmologica. Journal International... 2020In the last decades, significant changes have been taking place regarding the pathogenesis of diabetic retinopathy (DR) and the complex mechanisms that eventually lead... (Review)
Review
In the last decades, significant changes have been taking place regarding the pathogenesis of diabetic retinopathy (DR) and the complex mechanisms that eventually lead to the various manifestations of the disease, including diabetic macular edema (DME). DR was first considered a pure microvascular disease, due to the evident capillary structural changes (microaneurysms), fluid extravasation, and lipid exudation. With the advent of fundus fluorescein angiography, the concept of ischemia and the correlation between peripheral nonperfusion and neovascularization has been introduced, which was eventually followed by the advent of new therapeutic strategies, such as peripheral photocoagulation. Nowadays, thanks to more advanced imaging techniques, namely optical coherence tomography (OCT), OCT angiography, and wide-field imaging (imaging up to 200° of the retina in a single shot), it became clear that other elements participate in the occurrence of DR and DME, including inflammation and neurodegeneration. In the future, integration of standard investigations with new diagnostic devices would allow the prompt recognition of DR even before clinical signs of the disease are ophthalmoscopically evident, and the development of personalized treatment for both retinopathy and DME will be available.
Topics: Diabetic Retinopathy; Fluorescein Angiography; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Tomography, Optical Coherence
PubMed: 32015239
DOI: 10.1159/000506312 -
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 -
EBioMedicine Jan 2021Inherited retinal diseases (IRDs) were first classified clinically by history, ophthalmoscopic appearance, type of visual field defects, and electroretinography (ERG).... (Review)
Review
Inherited retinal diseases (IRDs) were first classified clinically by history, ophthalmoscopic appearance, type of visual field defects, and electroretinography (ERG). ERGs isolating the two major photoreceptor types (rods and cones) showed some IRDs with greater cone than rod retinal dysfunction; others were the opposite. Within the cone-rod diseases, there can be phenotypic variability, which can be attributed to genetic heterogeneity and the variety of visual function mechanisms that are disrupted. Most cause symptoms from childhood or adolescence, although others can manifest later in life. Among the causative genes for cone-rod dystrophy (CORD) are those encoding molecules in phototransduction cascade activation and recovery processes, photoreceptor outer segment structure, the visual cycle and photoreceptor development. We review 11 genes known to cause cone-rod disease in the context of their roles in normal visual function and retinal structure. Knowledge of the pathobiology of these genetic diseases is beginning to pave paths to therapy.
Topics: Age of Onset; Alleles; Genetic Association Studies; Genetic Diseases, Inborn; Genetic Predisposition to Disease; Genotype; Humans; Mutation; Phenotype; Retinal Diseases; Retinal Rod Photoreceptor Cells; Vision, Ocular; Visual Acuity
PubMed: 33421946
DOI: 10.1016/j.ebiom.2020.103200 -
Continuum (Minneapolis, Minn.) Aug 2014This article offers a pragmatic roadmap to the practicing neurologist on how to approach the patient with double vision. Strategies of history taking and examination... (Review)
Review
PURPOSE OF REVIEW
This article offers a pragmatic roadmap to the practicing neurologist on how to approach the patient with double vision. Strategies of history taking and examination techniques are reviewed, followed by a broad overview of the causes of diplopia organized by neuroanatomic localization. Diplopia may be the first symptom of serious vision or life-threatening neurologic disease, and its correct localization and diagnosis are therefore essential. The systems responsible for ocular movement and alignment in the vertical and horizontal plane include complex supranuclear circuitry, brainstem nuclei, cranial nerves III, IV, and VI, and their respective neuromuscular junctions and target muscles. Disruption at any point within this system or within the vestibular afferents that govern eye movement in response to head movements may therefore produce diplopia, leading to a broad differential diagnosis for the patient with diplopia. With a careful history and examination, the neurologist should be able to observe the patterns of diplopia that reveal the site of dysfunction, thus generating a shorter localization-specific list of possible etiologies. Examination of ocular motility including smooth pursuit and saccadic function, followed, if necessary, by testing designed to uncover misalignments of the eyes, including cover and Maddox rod testing, are primary components of the efferent neurologic examination. Further testing designed to detect myasthenia (eg, lid testing and fatigable upgaze) and orbital disease (eg, measuring proptosis, testing for resistance to retropulsion) may be necessary.
RECENT FINDINGS
Recent advances in the diagnosis of diplopia include the observation that vertical diplopia from skew deviation is more likely to improve with supine positioning than that caused by trochlear nerve palsies. Advances in the field of ocular myasthenia include the observation of decreased conversion to the generalized form with treatment with either steroids or thymectomy, although these conclusions need to be confirmed by prospective, randomized trials. Rarely, pure ocular myasthenia may be associated with the muscle-specific tyrosine kinase (MuSK) antibody.
SUMMARY
With proper skills, the neurologist can elucidate the localization of diplopia, even in cases of complex ocular misalignment, and generate a management plan that can address the underlying disease, and, in many cases, ameliorate or cure the diplopia.
Topics: Aged; Diagnosis, Differential; Diplopia; Female; Humans; Magnetic Resonance Imaging; Neurologic Examination; Ophthalmoscopes; Visual Pathways
PubMed: 25099102
DOI: 10.1212/01.CON.0000453310.52390.58 -
International Journal of Retina and... Nov 2020Retinal reattachment surgery requires clear visualization of the posterior segment for optimal outcomes. Select patients may benefit most from primary scleral buckling...
BACKGROUND
Retinal reattachment surgery requires clear visualization of the posterior segment for optimal outcomes. Select patients may benefit most from primary scleral buckling without vitrectomy, but lack adequate posterior segment ophthalmoscopic visualization to use standard techniques.
CASE PRESENTATION
The authors describe a retinal reattachment technique utilizing endoscope-assisted visualization to perform a primary scleral buckle procedure for a 34yo female with Peters' Anomaly and a macula-sparing retinal detachment. Retinal reattachment was achieved with a single procedure and she remained stable with preservation of baseline visual acuity at 30 months follow-up.
CONCLUSION
In cases where a primary scleral buckle procedure is the preferred retinal detachment repair technique but posterior segment visualization is limited, intraoperative fundus examination, cryotherapy administration, and scleral buckle positioning can be facilitated with intraocular endoscopy.
PubMed: 33292773
DOI: 10.1186/s40942-020-00260-x -
Continuum (Minneapolis, Minn.) Aug 2014This review focuses on aspects of retinal and optic nerve ischemia that may be encountered by neurologists. (Review)
Review
PURPOSE OF REVIEW
This review focuses on aspects of retinal and optic nerve ischemia that may be encountered by neurologists.
RECENT FINDINGS
Recent guidelines have emphasized the similarities between cerebral and retinal ischemia in terms of etiologic workup, acute management, and subsequent stroke risk. However, although ischemic optic neuropathies reflect optic nerve ischemia, they result from local small vessel disease and are not associated with a higher risk of cerebral infarction. Their management is therefore very different from acute cerebral ischemia. It is essential to rule out giant cell arteritis in all patients with acute retinal or optic nerve ischemia.
SUMMARY
Because the eye is vascularized by branches of the internal carotid artery, retinal ischemic symptoms are common in patients with anterior circulation ischemic strokes. Patients with central retinal artery occlusion, whether permanent or transient (responsible for transient visual loss), need to be evaluated and managed emergently similar to patients with cerebral ischemia, while anterior and posterior ischemic optic neuropathy are more concerning for giant cell arteritis.
Topics: Aged; Brain Ischemia; Diabetic Retinopathy; Female; Humans; Male; Middle Aged; Ophthalmoscopes; Optic Neuropathy, Ischemic; Retina; Retinal Vessels; Stroke
PubMed: 25099097
DOI: 10.1212/01.CON.0000453315.82884.a1 -
Biomedical Optics Express Feb 2018Multi-modal retinal image registration is often required to utilize the complementary information from different retinal imaging modalities. However, a robust and...
Multi-modal retinal image registration is often required to utilize the complementary information from different retinal imaging modalities. However, a robust and accurate registration is still a challenge due to the modality-varied resolution, contrast, and luminosity. In this paper, a two step registration method is proposed to address this problem. on mean phase images is used to register images in the first step. based on modality independent neighbourhood descriptor (MIND) method is followed to refine the registration result in the second step. The proposed method is extensively evaluated on color fundus images and scanning laser ophthalmoscope (SLO) images. Both qualitative and quantitative tests demonstrate improved registration using the proposed method compared to the state-of-the-art. The proposed method produces significantly and substantially larger mean Dice coefficients compared to other methods (p<0.001). It may facilitate the measurement of corresponding features from different retinal images, which can aid in assessing certain retinal diseases.
PubMed: 29552382
DOI: 10.1364/BOE.9.000410