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The British Journal of Ophthalmology Aug 2018Adaptive optics (AO) ophthalmoscopy allows for non-invasive retinal phenotyping on a microscopic scale, thereby helping to improve our understanding of retinal diseases.... (Review)
Review
Adaptive optics (AO) ophthalmoscopy allows for non-invasive retinal phenotyping on a microscopic scale, thereby helping to improve our understanding of retinal diseases. An increasing number of natural history studies and ongoing/planned interventional clinical trials exploit AO ophthalmoscopy both for participant selection, stratification and monitoring treatment safety and efficacy. In this review, we briefly discuss the evolution of AO ophthalmoscopy, recent developments and its application to a broad range of inherited retinal diseases, including Stargardt disease, retinitis pigmentosa and achromatopsia. Finally, we describe the impact of this microscopic imaging on our understanding of disease pathogenesis, clinical trial design and outcome metrics, while recognising the limitation of the small cohorts reported to date.
Topics: Eye Diseases, Hereditary; Humans; Ophthalmoscopy; Optics and Photonics; Retinal Diseases
PubMed: 29141905
DOI: 10.1136/bjophthalmol-2017-311328 -
Asia-Pacific Journal of Ophthalmology... 2020With the advent of smartphone-based fundus imaging (SBFI), a low-cost alternative to conventional digital fundus photography has become available. SBFI allows for a... (Review)
Review
With the advent of smartphone-based fundus imaging (SBFI), a low-cost alternative to conventional digital fundus photography has become available. SBFI allows for a mobile fundus examination, is applicable both with and without pupil dilation, comes with built-in connectivity and post-processing capabilities, and is relatively easy to master. Furthermore, it is delegable to paramedical staff/technicians and, hence, suitable for telemedicine. Against this background a variety of SBFI applications have become available including screening for diabetic retinopathy, glaucoma, and retinopathy of prematurity and its applications in emergency medicine and pediatrics. In addition, SBFI is convenient for teaching purposes and might serve as a surrogate for direct ophthalmoscopy. First wide-field montage techniques are available and the combination of SBFI with machine learning algorithms for image analyses is promising. In conclusion, SBFI has the potential to make fundus examinations and screenings for patients particularly in low- and middle-income settings more accessible and, therefore, aid tackling the burden of diabetic retinopathy, glaucoma, and retinopathy of prematurity screening. However, image quality for SBFI varies substantially and a reference standard for grading appears prudent. In addition, there is a strong need for comparison of different SBFI approaches in terms of applicability to disease screening and cost-effectiveness.
Topics: Diagnostic Imaging; Diagnostic Techniques, Ophthalmological; Eye Diseases; Fundus Oculi; Humans; Ophthalmoscopy; Photography; Smartphone; Telemedicine
PubMed: 32694345
DOI: 10.1097/APO.0000000000000303 -
Progress in Retinal and Eye Research Sep 2017Imaging techniques based on retinal autofluorescence have found broad applications in ophthalmology because they are extremely sensitive and noninvasive. Conventional... (Review)
Review
Imaging techniques based on retinal autofluorescence have found broad applications in ophthalmology because they are extremely sensitive and noninvasive. Conventional fundus autofluorescence imaging measures fluorescence intensity of endogenous retinal fluorophores. It mainly derives its signal from lipofuscin at the level of the retinal pigment epithelium. Fundus autofluorescence, however, can not only be characterized by the spatial distribution of the fluorescence intensity or emission spectrum, but also by a characteristic fluorescence lifetime function. The fluorescence lifetime is the average amount of time a fluorophore remains in the excited state following excitation. Fluorescence lifetime imaging ophthalmoscopy (FLIO) is an emerging imaging modality for in vivo measurement of lifetimes of endogenous retinal fluorophores. Recent reports in this field have contributed to our understanding of the pathophysiology of various macular and retinal diseases. Within this review, the basic concept of fluorescence lifetime imaging is provided. It includes technical background information and correlation with in vitro measurements of individual retinal metabolites. In a second part, clinical applications of fluorescence lifetime imaging and fluorescence lifetime features of selected retinal diseases such as Stargardt disease, age-related macular degeneration, choroideremia, central serous chorioretinopathy, macular holes, diabetic retinopathy, and retinal artery occlusion are discussed. Potential areas of use for fluorescence lifetime imaging ophthalmoscopy will be outlined at the end of this review.
Topics: Fluorescein Angiography; Humans; Ophthalmoscopy; Retina; Retinal Diseases
PubMed: 28673870
DOI: 10.1016/j.preteyeres.2017.06.005 -
Current Opinion in Neurology Feb 2019The funduscopic examination can be a technically difficult, and often omitted, portion of the neurologic examination, despite its great potential to influence patient... (Review)
Review
PURPOSE OF REVIEW
The funduscopic examination can be a technically difficult, and often omitted, portion of the neurologic examination, despite its great potential to influence patient care.
RECENT FINDINGS
Medical practitioners are often first taught to examine the ocular fundus using a direct ophthalmoscope, however, this skill requires frequent practice. Nonmydriatic tabletop and portable fundus photography and even smartphone-based photography offer alternative and practical means for approaching examination of the ocular fundus. These alternative tools have been shown to be practical in a variety of settings including ambulatory clinics and emergency departments. Decreased retinal microvascular density detected with fundus photography has been linked to accelerated rates of cognitive decline. Research has also found optic disc pallor and retinopathy detected via fundus photography to be more prevalent in patients with recent stroke or transient ischemic attack.
SUMMARY
Alternative methods of funduscopic examination based on fundus photography have the potential to improve the ease of use, portability, and availability of funduscopy. Recognition of changes in retinal microvasculature has the potential to noninvasively identify patients at the highest risk for cognitive impairment and cerebrovascular disease. However, further research is needed to determine the specific utility of measurements of retinal microvascular changes in clinical care. Innovative funduscopy techniques offer neurologists new approaches to this essential facet of the neurological examination.
Topics: Eye Diseases; Fundus Oculi; Humans; Neurologic Examination; Ophthalmoscopy; Photography
PubMed: 30516640
DOI: 10.1097/WCO.0000000000000637 -
Indian Journal of Ophthalmology Jul 2015The methods of fundus examination include direct and indirect ophthalmoscopy and imaging with a fundus camera are an essential part of ophthalmic practice. The usage of... (Review)
Review
The methods of fundus examination include direct and indirect ophthalmoscopy and imaging with a fundus camera are an essential part of ophthalmic practice. The usage of unconventional equipment such as a hand-held video camera, smartphone, and a nasal endoscope allows one to image the fundus with advantages and some disadvantages. The advantages of these instruments are the cost-effectiveness, ultra portability and ability to obtain images in a remote setting and share the same electronically. These instruments, however, are unlikely to replace the fundus camera but then would always be an additional arsenal in an ophthalmologist's armamentarium.
Topics: Fluorescein Angiography; Fundus Oculi; Humans; Ophthalmoscopy; Retinal Diseases; Smartphone
PubMed: 26458475
DOI: 10.4103/0301-4738.167123 -
Eye (London, England) Jan 2021This is a comprehensive review of the principles and applications of adaptive optics (AO) in ophthalmology. It has been combined with flood illumination ophthalmoscopy,... (Review)
Review
This is a comprehensive review of the principles and applications of adaptive optics (AO) in ophthalmology. It has been combined with flood illumination ophthalmoscopy, scanning laser ophthalmoscopy, as well as optical coherence tomography to image photoreceptors, retinal pigment epithelium (RPE), retinal ganglion cells, lamina cribrosa and the retinal vasculature. In this review, we highlight the clinical studies that have utilised AO to understand disease mechanisms. However, there are some limitations to using AO in a clinical setting including the cost of running an AO imaging service, the time needed to scan patients, the lack of normative databases and the very small size of area imaged. However, it is undoubtedly an exceptional research tool that enables visualisation of the retina at a cellular level.
Topics: Humans; Ophthalmology; Ophthalmoscopy; Optics and Photonics; Retina; Tomography, Optical Coherence
PubMed: 33257798
DOI: 10.1038/s41433-020-01286-z -
BioMed Research International 2015
Topics: Animals; Cross-Linking Reagents; Humans; Keratoconus; Ophthalmoscopy; Photochemotherapy; Riboflavin; Tomography, Optical Coherence; Treatment Outcome; Ultraviolet Therapy
PubMed: 25949993
DOI: 10.1155/2015/306439 -
JAMA Ophthalmology Apr 2022Artificial intelligence (AI)-based retinopathy of prematurity (ROP) screening may improve ROP care, but its cost-effectiveness is unknown.
IMPORTANCE
Artificial intelligence (AI)-based retinopathy of prematurity (ROP) screening may improve ROP care, but its cost-effectiveness is unknown.
OBJECTIVE
To evaluate the relative cost-effectiveness of autonomous and assistive AI-based ROP screening compared with telemedicine and ophthalmoscopic screening over a range of estimated probabilities, costs, and outcomes.
DESIGN, SETTING, AND PARTICIPANTS
A cost-effectiveness analysis of AI ROP screening compared with ophthalmoscopy and telemedicine via economic modeling was conducted. Decision trees created and analyzed modeled outcomes and costs of 4 possible ROP screening strategies: ophthalmoscopy, telemedicine, assistive AI with telemedicine review, and autonomous AI with only positive screen results reviewed. A theoretical cohort of infants requiring ROP screening in the United States each year was analyzed.
MAIN OUTCOMES AND MEASURES
Screening and treatment costs were based on Current Procedural Terminology codes and included estimated opportunity costs for physicians. Outcomes were based on the Early Treatment of ROP study, defined as timely treatment, late treatment, or correctly untreated. Incremental cost-effectiveness ratios were calculated at a willingness-to-pay threshold of $100 000. One-way and probabilistic sensitivity analyses were performed comparing AI strategies to telemedicine and ophthalmoscopy to evaluate the cost-effectiveness across a range of assumptions. In a secondary analysis, the modeling was repeated and assumed a higher sensitivity for detection of severe ROP using AI compared with ophthalmoscopy.
RESULTS
This theoretical cohort included 52 000 infants born 30 weeks' gestation or earlier or weighed 1500 g or less at birth. Autonomous AI was as effective and less costly than any other screening strategy. AI-based ROP screening was cost-effective up to $7 for assistive and $34 for autonomous screening compared with telemedicine and $64 and $91 compared with ophthalmoscopy in the primary analysis. In the probabilistic sensitivity analysis, autonomous AI screening was more than 60% likely to be cost-effective at all willingness-to-pay levels vs other modalities. In a second simulated cohort with 99% sensitivity for AI, the number of late treatments for ROP decreased from 265 when ROP screening was performed with ophthalmoscopy to 40 using autonomous AI.
CONCLUSIONS AND RELEVANCE
AI-based screening for ROP may be more cost-effective than telemedicine and ophthalmoscopy, depending on the added cost of AI and the relative performance of AI vs human examiners detecting severe ROP. As AI-based screening for ROP is commercialized, care must be given to appropriately price the technology to ensure its benefits are fully realized.
Topics: Artificial Intelligence; Cost-Benefit Analysis; Gestational Age; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Neonatal Screening; Ophthalmoscopy; Retinopathy of Prematurity; Telemedicine
PubMed: 35297945
DOI: 10.1001/jamaophthalmol.2022.0223 -
The Canadian Veterinary Journal = La... May 2016
Topics: Animals; Dogs; Female; Hyperlipidemias; Ophthalmoscopy; Retinal Diseases
PubMed: 27152048
DOI: No ID Found -
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