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Romanian Journal of Ophthalmology 2021This study analyzed and compared the results of adaptive optics (AO) and fundus autofluorescence (FAF) in various maculopathies. The study included four different...
This study analyzed and compared the results of adaptive optics (AO) and fundus autofluorescence (FAF) in various maculopathies. The study included four different types of maculopathy: central serous chorioretinopathy (CSC), retinitis pigmentosa (RP), Stargardt disease (STGD) and phototoxic retinopathy. In all four cases, cone mosaic and cone density were obtained using AO fundus camera. Further, the high-resolution images were compared with the FAF and optical coherence tomography (OCT) results. In CSC, FAF and AO, changes could be shown in the macula even two years after the subretinal fluid resorption, as opposed to a normal OCT. The improvement of FAF and cone mosaic appearance was concomitant with the visual acuity growth. Several cone mosaic phenotypes were observed in RP and STGD. In RP, the cone density was 24.240 cones /mm2 in the center, and decreased to 8.163 cones/ mm2 in the parafoveal area. In STGD, the cone density was lower in the center, 9.219 cones/ mm2, and higher at the periphery, 12.594 cones/ mm2. In the case of phototoxic retinopathy, AO and OCT were more effective than FAF in highlighting the photoreceptor and retinal pigment epithelium lesions. FAF and AO are very useful tools in macular pathologies examination. FAF can offer a true picture of the metabolic changes in the macula, while AO allows the view of changes up to the cellular level. STGD = Stargardt disease, CSC = central serous chorioretinopathy, RP = retinitis pigmentosa, AO = adaptive optics, FAF = fundus autofluorescence.
Topics: Central Serous Chorioretinopathy; Fluorescein Angiography; Humans; Ophthalmoscopy; Retinal Cone Photoreceptor Cells; Tomography, Optical Coherence
PubMed: 34179590
DOI: 10.22336/rjo.2021.41 -
Retina (Philadelphia, Pa.) Aug 2017We describe the use of Google Cardboard for indirect ophthalmoscopy without dedicated ophthalmic equipment and with minimal cost. A smartphone is loaded with the camera...
We describe the use of Google Cardboard for indirect ophthalmoscopy without dedicated ophthalmic equipment and with minimal cost. A smartphone is loaded with the camera and light extruding laterally, and the image centered on the examiner’s dominant eye. The second acrylic lens, measuring approximately 22D, serves as an indirect lens.
Topics: Eye Diseases; Humans; Ophthalmoscopy; Reproducibility of Results; Video Recording; Web Browser
PubMed: 28719487
DOI: 10.1097/IAE.0000000000001772 -
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 -
Investigative Ophthalmology & Visual... Feb 2022To characterize the association between foveal shape and cone and retinal pigment epithelium (RPE) cell topographies in healthy humans.
PURPOSE
To characterize the association between foveal shape and cone and retinal pigment epithelium (RPE) cell topographies in healthy humans.
METHODS
Multimodal adaptive scanning light ophthalmoscopy and optical coherence tomography (OCT) were used to acquire images of foveal cones, RPE cells, and retinal layers in eyes of 23 healthy participants with normal foveas. Distributions of cone and RPE cell densities were fitted with nonlinear mixed-effects models. A linear mixed-effects model was used to examine the relationship between cone and RPE inter-cell distances and foveal shape as obtained from the OCT scans of retinal thickness.
RESULTS
The best-fit model to the cone densities was a power function with a nasal-temporal asymmetry. There was a significant linear relationship among cone and RPE cell spacing, foveal shape, and foveal cell topography. The model predictions of the central 10° show that the contributions of both the cones and RPE cells are necessary to account for foveal shape.
CONCLUSIONS
The results indicate that there is a strong relationship between cone and RPE cell spacing and the shape of the human adolescent and adult fovea. This finding adds to the existing evidence of the critical role that the RPE serves in fetal foveal development and through adolescence, possibly via the imposition of constraints on the number and distribution of foveal cones.
Topics: Adolescent; Adult; Aged; Female; Fovea Centralis; Healthy Volunteers; Humans; Male; Middle Aged; Ophthalmoscopy; Retinal Cone Photoreceptor Cells; Tomography, Optical Coherence; Visual Acuity; Young Adult
PubMed: 35113142
DOI: 10.1167/iovs.63.2.8 -
JAMA Ophthalmology Jun 2023Retinopathy of prematurity (ROP) telemedicine screening programs have been found to be effective, but they rely on widefield digital fundus imaging (WDFI) cameras, which...
IMPORTANCE
Retinopathy of prematurity (ROP) telemedicine screening programs have been found to be effective, but they rely on widefield digital fundus imaging (WDFI) cameras, which are expensive, making them less accessible in low- to middle-income countries. Cheaper, smartphone-based fundus imaging (SBFI) systems have been described, but these have a narrower field of view (FOV) and have not been tested in a real-world, operational telemedicine setting.
OBJECTIVE
To assess the efficacy of SBFI systems compared with WDFI when used by technicians for ROP screening with both artificial intelligence (AI) and human graders.
DESIGN, SETTING, AND PARTICIPANTS
This prospective cross-sectional comparison study took place as a single-center ROP teleophthalmology program in India from January 2021 to April 2022. Premature infants who met normal ROP screening criteria and enrolled in the teleophthalmology screening program were included. Those who had already been treated for ROP were excluded.
EXPOSURES
All participants had WDFI images and from 1 of 2 SBFI devices, the Make-In-India (MII) Retcam or Keeler Monocular Indirect Ophthalmoscope (MIO) devices. Two masked readers evaluated zone, stage, plus, and vascular severity scores (VSS, from 1-9) in all images. Smartphone images were then stratified by patient into training (70%), validation (10%), and test (20%) data sets and used to train a ResNet18 deep learning architecture for binary classification of normal vs preplus or plus disease, which was then used for patient-level predictions of referral warranted (RW)- and treatment requiring (TR)-ROP.
MAIN OUTCOME AND MEASURES
Sensitivity and specificity of detection of RW-ROP, and TR-ROP by both human graders and an AI system and area under the receiver operating characteristic curve (AUC) of grader-assigned VSS. Sensitivity and specificity were compared between the 2 SBFI systems using Pearson χ2testing.
RESULTS
A total of 156 infants (312 eyes; mean [SD] gestational age, 33.0 [3.0] weeks; 75 [48%] female) were included with paired examinations. Sensitivity and specificity were not found to be statistically different between the 2 SBFI systems. Human graders were effective with SBFI at detecting TR-ROP with a sensitivity of 100% and specificity of 83.49%. The AUCs with grader-assigned VSS only were 0.95 (95% CI, 0.91-0.99) and 0.96 (95% CI, 0.93-0.99) for RW-ROP and TR-ROP, respectively. For the AI system, the sensitivity of detecting TR-ROP sensitivity was 100% with specificity of 58.6%, and RW-ROP sensitivity was 80.0% with specificity of 59.3%.
CONCLUSIONS AND RELEVANCE
In this cross-sectional study, 2 different SBFI systems used by technicians in an ROP screening program were highly sensitive for TR-ROP. SBFI systems with AI may be a cost-effective method to improve the global capacity for ROP screening.
Topics: Infant, Newborn; Infant; Humans; Female; Adult; Male; Cross-Sectional Studies; Retinopathy of Prematurity; Prospective Studies; Smartphone; Ophthalmology; Artificial Intelligence; Telemedicine; Infant, Premature; Gestational Age; Sensitivity and Specificity; Ophthalmoscopy
PubMed: 37166816
DOI: 10.1001/jamaophthalmol.2023.1466 -
Medical Science Monitor : International... Dec 2023Visualization of the retinal structure is crucial for understanding the pathophysiology of ophthalmic diseases, as well as for monitoring their course and treatment... (Review)
Review
Visualization of the retinal structure is crucial for understanding the pathophysiology of ophthalmic diseases, as well as for monitoring their course and treatment effects. Until recently, evaluation of the retina at the cellular level was only possible using histological methods, because the available retinal imaging technology had insufficient resolution due to aberrations caused by the optics of the eye. Adaptive optics (AO) technology improved the resolution of optical systems to 2 µm by correcting optical wave-front aberrations, thereby revolutionizing methods for studying eye structures in vivo. Within 25 years of its first application in ophthalmology, AO has been integrated into almost all existing retinal imaging devices, such as the fundus camera (FC), scanning laser ophthalmoscopy (SLO), and optical coherence tomography (OCT). Numerous studies have evaluated individual retinal structures, such as photoreceptors, blood vessels, nerve fibers, ganglion cells, lamina cribrosa, and trabeculum. AO technology has been applied in imaging structures in healthy eyes and in various ocular diseases. This article aims to review the roles of AO imaging in the diagnosis, management, and monitoring of age-related macular degeneration (AMD), diabetic retinopathy (DR), glaucoma, hypertensive retinopathy (HR), central serous chorioretinopathy (CSCR), and inherited retinal diseases (IRDs).
Topics: Humans; Retina; Ophthalmoscopy; Tomography, Optical Coherence; Diabetic Retinopathy; Central Serous Chorioretinopathy
PubMed: 38044597
DOI: 10.12659/MSM.941926 -
Tidsskrift For Den Norske Laegeforening... May 2017
Topics: Anti-Bacterial Agents; Humans; Male; Middle Aged; Ophthalmoscopy; Optic Neuritis; Syphilis
PubMed: 28551973
DOI: 10.4045/tidsskr.16.1063 -
Arquivos de Neuro-psiquiatria May 2023The observation of the human retina began in 1851 after the invention of the first ophthalmoscope by the German physicist Hermann von Helmholtz. In the following...
The observation of the human retina began in 1851 after the invention of the first ophthalmoscope by the German physicist Hermann von Helmholtz. In the following decades, direct and indirect ophthalmoscopy, with the use of ophthalmoscopes and condensing lenses, respectively, became part of the clinical examination, especially in ophthalmology and neurology. Today, over 170 years later, many ophthalmoscopes and condensing lenses exist on the market. Nevertheless, ophthalmoscopy is still not widely adopted as part of the physical exam of general practitioners, and the teaching of ophthalmoscopy in medical school remains challenging. Studies have shown that students prefer using newer ophthalmoscope models or condensing lenses during training, but most do not feel confident in performing ophthalmoscopy afterwards, regardless of the models used. Also, few students acquire ophthalmoscopes for their future practice, and clinical trials have not clearly demonstrated superiority of newer ophthalmoscope models over the conventional ones in diagnostic accuracy. The technological improvement of smartphone cameras in recent years has made it feasible to photograph the fundus of the eye using ophthalmoscopes or condensing lenses, reducing the need for retinographs and similar equipment. Smartphone assisted indirect fundoscopy is becoming increasingly popular. This approach allows adequate identification of the structures of the fundus, is cost-efficient, easy to implement, and permits easy recording and sharing of the images obtained, which is useful for case discussions and medical teaching. However, controlled clinical trials validating this method in the evaluation of optic nerve pathologies are needed.
Topics: Humans; Smartphone; Ophthalmoscopy; Ophthalmoscopes; Fundus Oculi; Neurology
PubMed: 37257471
DOI: 10.1055/s-0043-1763489 -
JAMA Ophthalmology May 2018Examinations for retinopathy of prematurity (ROP) are typically performed using binocular indirect ophthalmoscopy. Telemedicine studies have traditionally assessed the... (Comparative Study)
Comparative Study
IMPORTANCE
Examinations for retinopathy of prematurity (ROP) are typically performed using binocular indirect ophthalmoscopy. Telemedicine studies have traditionally assessed the accuracy of telemedicine compared with ophthalmoscopy as a criterion standard. However, it is not known whether ophthalmoscopy is truly more accurate than telemedicine.
OBJECTIVE
To directly compare the accuracy and sensitivity of ophthalmoscopy vs telemedicine in diagnosing ROP using a consensus reference standard.
DESIGN, SETTING, AND PARTICIPANTS
This multicenter prospective study conducted between July 1, 2011, and November 30, 2014, at 7 neonatal intensive care units and academic ophthalmology departments in the United States and Mexico included 281 premature infants who met the screening criteria for ROP.
EXPOSURES
Each examination consisted of 1 eye undergoing binocular indirect ophthalmoscopy by an experienced clinician followed by remote image review of wide-angle fundus photographs by 3 independent telemedicine graders.
MAIN OUTCOMES AND MEASURES
Results of both examination methods were combined into a consensus reference standard diagnosis. The agreement of both ophthalmoscopy and telemedicine was compared with this standard, using percentage agreement and weighted κ statistics.
RESULTS
Among the 281 infants in the study (127 girls and 154 boys; mean [SD] gestational age, 27.1 [2.4] weeks), a total of 1553 eye examinations were classified using both ophthalmoscopy and telemedicine. Ophthalmoscopy and telemedicine each had similar sensitivity for zone I disease (78% [95% CI, 71%-84%] vs 78% [95% CI, 73%-83%]; P > .99 [n = 165]), plus disease (74% [95% CI, 61%-87%] vs 79% [95% CI, 72%-86%]; P = .41 [n = 50]), and type 2 ROP (stage 3, zone I, or plus disease: 86% [95% CI, 80%-92%] vs 79% [95% CI, 75%-83%]; P = .10 [n = 251]), but ophthalmoscopy was slightly more sensitive in identifying stage 3 disease (85% [95% CI, 79%-91%] vs 73% [95% CI, 67%-78%]; P = .004 [n = 136]).
CONCLUSIONS AND RELEVANCE
No difference was found in overall accuracy between ophthalmoscopy and telemedicine for the detection of clinically significant ROP, although, on average, ophthalmoscopy had slightly higher accuracy for the diagnosis of zone III and stage 3 ROP. With the caveat that there was variable accuracy between examiners using both modalities, these results support the use of telemedicine for the diagnosis of clinically significant ROP.
Topics: Female; Gestational Age; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Intensive Care Units, Neonatal; Male; Observer Variation; Ophthalmoscopy; Photography; Physical Examination; Prospective Studies; Reproducibility of Results; Retinopathy of Prematurity; Sensitivity and Specificity; Telemedicine
PubMed: 29621387
DOI: 10.1001/jamaophthalmol.2018.0649 -
Retina (Philadelphia, Pa.) Nov 2021To investigate and quantify the influence of imaging artifacts on retinal fluorescence lifetime (FLIO) values and to provide helpful hints and tricks to avoid imaging...
PURPOSE
To investigate and quantify the influence of imaging artifacts on retinal fluorescence lifetime (FLIO) values and to provide helpful hints and tricks to avoid imaging artifacts and to improve FLIO image acquisition quality.
METHODS
A systematic analysis of potential parameters influencing FLIO quality and/or fluorescence lifetime values was performed in a prospective systematic experimental imaging study in five eyes of five healthy subjects. For image acquisition, a fluorescence lifetime imaging ophthalmoscope (Heidelberg Engineering) was used. Quantitative analysis of FLIO lifetime changes due to imaging artifacts was performed.
RESULTS
Imaging artifacts with significant influence on fluorescence lifetimes included too short image acquisition time, insufficient illumination, ocular surface problems, and image defocus. Prior use of systemic or topical fluorescein makes analysis of retinal fluorescence lifetimes impossible.
CONCLUSION
Awareness of possible sources of imaging artifacts is important for FLIO image acquisition and analysis. Therefore, standardized imaging and analysis procedure in FLIO is crucial for high-quality image acquisition and the possibility for systematic quantitative fluorescence lifetime analysis.
Topics: Adult; Artifacts; Female; Fluorescein Angiography; Fundus Oculi; Humans; Male; Middle Aged; Ophthalmoscopy; Prospective Studies; Retina; Retinal Diseases; Tomography, Optical Coherence
PubMed: 34111887
DOI: 10.1097/IAE.0000000000003235