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Translational Vision Science &... Apr 2024To assess the agreement of retinoscope-based peripheral refraction techniques with the criterion standard open-field autorefractor.
PURPOSE
To assess the agreement of retinoscope-based peripheral refraction techniques with the criterion standard open-field autorefractor.
METHODS
Fifty young adults (mean age, 24 ± 3 years) participated in this study. Two masked, experienced senior examiners carried out central refraction and peripheral refraction at the temporal 22° (T22°) and nasal 22° (N22°) eccentricities. Peripheral refraction techniques were (a) peripheral refraction using ancillary retinoscope component (P-ARC), (b) retinoscopy with eye rotation, and (c) open-field autorefractor. Peripheral refraction with retinoscopy values was compared with an open-field autorefractor (Shinn Nippon NVision-K) to assess the agreement. All measurements were taken from the right eye under noncycloplegic conditions.
RESULTS
The mean difference ±95% limits of agreement of peripheral refraction values obtained using P-ARC from T22° (+0.11 diopters [D] ± 1.20 D; P = 0.20) or N22° (+0.13 D ± 1.16 D; P = 0.13) were comparable with open-field autorefractor. The eye rotation technique compared to autorefractor showed a significant difference for T22° (+0.30 D ± 1.26 D; P = 0.002); however, there was an agreement for N22° (+0.14 D ± 1.16 D; P = 0.10). With respect to the identification of peripheral refraction patterns, examiners were able to identify relative peripheral hyperopia in most of the participants (77%).
CONCLUSIONS
Peripheral refraction with P-ARC was comparable with open-field autorefractor at T22° and N22° eccentricities. Peripheral retinoscopy techniques can be another approache for estimating and identifying peripheral refraction and its patterns in a regular clinical setting.
TRANSLATIONAL RELEVANCE
Retinoscope with P-ARC has high potential to guide and enable eye care practitioners to perform peripheral refraction and identify peripheral refraction patterns for effective myopia management.
Topics: Young Adult; Humans; Adult; Retinoscopes; Refraction, Ocular; Vision Tests; Eye; Hyperopia
PubMed: 38568607
DOI: 10.1167/tvst.13.4.7 -
Frontiers in Neurology 2018Glaucoma is one of the leading causes of irreversible blindness in the world. It is characterized by the progressive loss of retinal ganglion cells (RGCs), mainly... (Review)
Review
Glaucoma is one of the leading causes of irreversible blindness in the world. It is characterized by the progressive loss of retinal ganglion cells (RGCs), mainly through the process of apoptosis. Glaucoma patients often come to clinical attention when irreversible loss of visual function has been already established; therefore, early recognition of RGC apoptosis is inordinately important in disease prevention. The novel technology called Detection of Apoptosing Retinal Cells (DARC) allows real-time quantification of apoptosing cells through the use of a fluorescent biomarker and a confocal scanning ophthalmoscope. A recent Phase I clinical trial has evaluated the safety of DARC and its ability to detect retinal apoptosis in glaucoma patients and healthy volunteers. Results suggest that DARC may have potential in the early detection of glaucoma, which could help alleviate the medical, social, and economic burden associated with this blinding condition.
PubMed: 29867744
DOI: 10.3389/fneur.2018.00338 -
Indian Journal of Ophthalmology Aug 2022The authors describe a novel technique of performing retinoscopy assisted with a smartphone (gimbalscope). We found this technique of digital retinoscopy to be useful...
The authors describe a novel technique of performing retinoscopy assisted with a smartphone (gimbalscope). We found this technique of digital retinoscopy to be useful for demonstrating and documenting retinoscopic reflexes and in addition as an easy teaching tool. This technical report explains the assembly of our smartphone-assisted retinoscope and provides examples of the range of normal and abnormal reflexes that can be captured.
Topics: Humans; Refraction, Ocular; Retinoscopes; Retinoscopy; Smartphone
PubMed: 35918982
DOI: 10.4103/ijo.IJO_221_22 -
Optics Letters Sep 2020Non-confocal adaptive optics scanning laser ophthalmoscopy (AOSLO) has enhanced the study of human retinal photoreceptors by providing complementary information to...
Non-confocal adaptive optics scanning laser ophthalmoscopy (AOSLO) has enhanced the study of human retinal photoreceptors by providing complementary information to standard confocal AOSLO images. Previously we developed the first confocal handheld AOSLO (HAOSLO) capable of in vivo cone photoreceptor imaging in supine and non-cooperative patients. Here, we introduce the first multimodal (M-)HAOSLO for confocal and non-confocal split-detection (SD) imaging to allow for more comprehensive patient data collection. Aside from its unprecedented miniature size and weight, M-HAOSLO is also the first system to perform sensorless wavefront-corrected SD imaging of cone photoreceptors.
Topics: Adult; Equipment Design; Humans; Image Processing, Computer-Assisted; Lasers; Ophthalmoscopes
PubMed: 32870897
DOI: 10.1364/OL.402392 -
International Scholarly Research Notices 2017We aimed to investigate the incidence and the severity of retinopathy of extremely premature infants and to evaluate the risk factors and outcome of the cases.
OBJECTIVE
We aimed to investigate the incidence and the severity of retinopathy of extremely premature infants and to evaluate the risk factors and outcome of the cases.
MATERIALS AND METHODS
Out of 200 premature births, we retrospectively reviewed 9 cases that developed ROP. We excluded cases where ROP developed in newborns > 30 weeks of gestational age and cases where medical notes were unavailable or incomplete. Topical drops of cyclopentolate 1% and phenylephrine 5% were instilled and fundoscopy was performed using a direct ophthalmoscope.
RESULTS
The incidence of ROP was 4.5% in the 9-year period. The infants were divided into two groups. Group 1 included premature infants ≤27 weeks of age and Group 2 included those >27 weeks but ≤ 30 weeks of age. We found that the infants of Group 1 showed advanced stages of ROP in comparison to Group 2. Out of 18 eyes, 11 eyes had stage 3 ROP and they were all found in Group 1 (100% of cases).
CONCLUSION
The severity of ROP was associated with earlier gestational age, lower birth weight, and oxygen supplementation. Constant cooperation between physicians and nursing staff is necessary to avoid undetected cases and further prevent ROP related blindness.
PubMed: 29181441
DOI: 10.1155/2017/4781279 -
Scientific Reports Jun 2020The fovea undergoes significant developmental changes from birth into adolescence. However, there is limited data examining cone photoreceptor density, foveal pit shape,...
The fovea undergoes significant developmental changes from birth into adolescence. However, there is limited data examining cone photoreceptor density, foveal pit shape, and foveal avascular zone (FAZ) size in children. The purpose of this study was to determine whether overall foveal structure differs as a function of age and refractive status in children. Forty-eight healthy children (ages 5.8 to 15.8 years) underwent optical coherence tomography imaging to quantify foveal point thickness and foveal pit diameter, depth, and slope. Adaptive optics scanning laser ophthalmoscope (AOSLO) images of foveal capillaries and cone photoreceptors were acquired in a subset of children to quantify FAZ metrics and cone densities at 0.2, 0.3, and 0.5 mm eccentricities. Results show that foveal pit and FAZ metrics were not related to age, axial length, or refractive status. However, linear cone density was lower in myopic versus non-myopic children at eccentricities of 0.2 mm (mean ± SD = 50,022 ± 5,878 cones/mm vs 58,989 ± 4,822 cones/mm, P < 0.001) and 0.3 mm (43,944 ± 5,547 cones/mm vs 48,622 ± 3,538 cones/mm, P < 0.001). These results suggest FAZ and foveal pit metrics do not systematically differ with age in children, while myopic eyes have decreased linear cone density near the foveal center. Significance Statement: The development of the fovea begins prior to birth and continues through the early teenage years until it reaches adult-like properties. Although the majority of changes during childhood are related to the maturation and migration of cone photoreceptors, in vivo data describing cone packing in children is limited. We assessed overall foveal structure in children as young as 5.8 years old by quantifying cone density and spacing, foveal avascular zone size, and foveal pit morphometry to investigate potential structural differences as a function of age and refractive status. While foveal avascular zone and foveal pit metrics did not significantly differ with age, results indicate that myopic children have lower linear cone densities close to the foveal center compared to non-myopic children.
Topics: Adolescent; Capillaries; Child; Female; Fluorescein Angiography; Fovea Centralis; Humans; Macula Lutea; Male; Myopia; Ophthalmoscopes; Ophthalmoscopy; Retinal Cone Photoreceptor Cells; Retinal Vessels; Tomography, Optical Coherence
PubMed: 32487997
DOI: 10.1038/s41598-020-65645-2 -
BMC Neurology Feb 2022Proper evaluation of ocular fundi is an integral part of neurological examination. Unfortunately, neurology residents are increasingly uncomfortable performing...
BACKGROUND
Proper evaluation of ocular fundi is an integral part of neurological examination. Unfortunately, neurology residents are increasingly uncomfortable performing fundoscopy and interpreting findings because of diminishing skills and lack of experience. This became more prominent during the COVID-19 pandemic as fundoscopy requires proximity to the patient. With the recent dramatic improvement of smartphone cameras, fundus photography using the PanOptic Ophthalmoscope (Welch Allyn, Skaneateles Falls, NY) with a smartphone adapter offered an alternative to direct fundoscopic examination. We present the first experience with our own design of a universal smartphone adapter.
METHODS
This is a single-center case series, consecutive for a single user and certain presenting neurological symptoms, which is aimed to evaluate the feasibility and practicality of a new, universal PanOptic smartphone adapter. Presenting symptoms included headache, ocular symptoms, seizure, or encephalopathy. We used 3D modeling and printing techniques to create the adapter. We also developed a methodology of capturing stereoscopic images of the optic disc using a single smartphone camera, but the method was not systematically evaluated in this paper.
RESULTS
Here we present our initial experience of fundus video/photography in patients, who presented with encephalopathy, headache, seizure, vision loss, and other ocular symptoms. Fundoscopic abnormalities were discovered in 11 out of 100 patients. Some were incidental findings and were unrelated to the presentation. In one case, fundoscopy played a critical role in establishing the correct diagnosis.
CONCLUSIONS
Our custom-designed smartphone adapter allowed obtaining high-quality video and photo recordings using PanOptic Ophthalmoscope. The acquisition of high-quality photos enables a high-yield diagnostic tool and allows revisiting the image in the patient's chart. Improvement of smartphone cameras opens vast horizons for stereo-fundoscopy and 3D reconstruction of the ocular fundus without using sophisticated and costly equipment. Microscopic eye movements allow taking snapshots of two side-by-side photos for 3D reconstruction and stereoscopic image viewing, which is the next level of optic disc assessment.
Topics: COVID-19; Fundus Oculi; Humans; Ophthalmoscopy; Pandemics; Photography; SARS-CoV-2
PubMed: 35183131
DOI: 10.1186/s12883-022-02578-5 -
Investigative Ophthalmology & Visual... May 2017To measure the effect of nonproliferative diabetic retinopathy (NPDR) on retinal branching. To compare vascular branching in healthy and diabetic subjects with...
PURPOSE
To measure the effect of nonproliferative diabetic retinopathy (NPDR) on retinal branching. To compare vascular branching in healthy and diabetic subjects with established biophysical models.
METHODS
Vascular bifurcations in arteries and veins were imaged in 17 NPDR and 26 healthy subjects with the Indiana adaptive optics scanning laser ophthalmoscope (AOSLO). Vessel measurements were grouped according to parent vessel diameters into large (≤50 ∼ <100 μm) and small (≤20 ∼ <50 μm) sizes. Vessel diameters and bifurcation angles were measured manually. Vascular diameters were compared with predictions of Murray's law using curve fitting. For analysis of bifurcation angles, two models from Zamir were compared: one based on the power required for blood pumping, the other based on drag force between blood and vascular wall.
RESULTS
For normal larger vessels, the exponent relating the parent and daughter branching diameters was significantly less than the value of 3 predicted by Murray's law (arteries: 2.59; veins: 1.95). In NPDR, the best-fit exponent was close to 3 for arteries but close to 2 in healthy subjects in veins, (arteries: 3.09; veins: 2.16). For both small arteries and veins, diabetics' exponent differed from healthy subjects (P < 0.01). Bifurcation angles in the healthy subjects (78° ± with a standard error (SE) of 0.9°) were not much different than in NPDR (79° ± SE 1.3°). The model based on minimizing pumping power predicted the measurements better than the one minimizing the vascular drag and lumen surface area.
CONCLUSIONS
The relation between parent and daughter branch diameters changes in diabetes, but the branching angles do not.
Topics: Adult; Arterioles; Diabetic Retinopathy; Female; Healthy Volunteers; Humans; Male; Microscopy, Confocal; Middle Aged; Ophthalmoscopes; Retinal Artery; Retinal Neovascularization; Retinal Vein; Venules
PubMed: 28525557
DOI: 10.1167/iovs.17-21653 -
Photoacoustics Mar 2022Selective Retina Therapy (SRT) uses microbubble formation (MBF) to target retinal pigment epithelium (RPE) cells selectively while sparing the neural retina and the...
OBJECTIVES
Selective Retina Therapy (SRT) uses microbubble formation (MBF) to target retinal pigment epithelium (RPE) cells selectively while sparing the neural retina and the choroid. Intra- and inter-individual variations of RPE pigmentation makes frequent radiant exposure adaption necessary. Since selective RPE cell disintegration is ophthalmoscopically non-visible, MBF detection techniques are useful to control adequate radiant exposures. It was the purpose of this study to evaluate optoacoustically based MBF detection algorithms.
METHODS
Fifteen patients suffering from central serous chorioretinopathy and diabetic macula edema were treated with a SRT laser using a wavelength of 527 nm, a pulse duration of 1.7 µs and a pulse energy ramp (15 pulses, 100 Hz repetition rate). An ultrasonic transducer for MBF detection was embedded in a contact lens. RPE damage was verified with fluorescence angiography.
RESULTS
An algorithm to detect MBF as an indicator for RPE cell damage was evaluated. Overall, 4646 irradiations were used for algorithm optimization and testing. The tested algorithms were superior to a baseline model. A sensitivity/specificity pair of 0.96/1 was achieved. The few false algorithmic decisions were caused by unevaluable signals.
CONCLUSIONS
The algorithm can be used for guidance or automatization of microbubble related treatments like SRT or selective laser trabeculoplasty (SLT).
PubMed: 34926158
DOI: 10.1016/j.pacs.2021.100316 -
A neophyte gonioscopist's animative and videographic atlas with focal points for effective practice.Indian Journal of Ophthalmology Feb 2022Though various gonioscopy teaching platforms are available, they predominantly comprise of real time scenarios and videos. For a beginner, we suggest providing...
BACKGROUND
Though various gonioscopy teaching platforms are available, they predominantly comprise of real time scenarios and videos. For a beginner, we suggest providing animations of the real time scenario for cognitive training; and then putting them in real time scenarios for a better concept application and practice.
PURPOSE
This video highlights the basic tips and tricks needed to perform gonioscopy with metaphorical conceptual learning matching the 2D and 3D animations with real time scenarios.
SYNOPSIS
Simple and practical scenarios with technical details on how to perform gonioscopy and various challenges are shown. All the animations and videos are created by us, tailored to a neophyte. The following concepts are covered: normal angle (animation versus real-time), dynamicity of the gonioscopic dates of person, methods of gonioscopy - direct and Indirect, precautions and slit lamp adjustment, bubble trouble, patient examination, iris process versus peripheral anterior synechiae (animation versus real-time), patient examination (angle viewing order) for different lens, how to remove gonioscopy lens from the eye, static versus dynamic gonioscopy, situations where gonioscopy is contraindicated, grading of the angle (with animations), clinical scenarios (pseudoexfoliation, pigment dispersion, angle recession and aniridia), and surgical scenarios (patent ostium and blocked ostium).
HIGHLIGHTS
Multiple animations and real-time videos with focal points for effective practice are the highlights of this video.
VIDEO LINK
https://youtu.be/fFmPmqgdjyM.
Topics: Anterior Chamber; Glaucoma, Angle-Closure; Glaucoma, Open-Angle; Gonioscopy; Humans; Intraocular Pressure; Iris; Iris Diseases; Slit Lamp
PubMed: 35086290
DOI: 10.4103/ijo.IJO_151_22