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Indian Journal of Ophthalmology Nov 2021The burden of diabetes mellitus (DM) and diabetic retinopathy (DR) is at alarming proportions in India and around the globe. The number of people with DM in India is...
The burden of diabetes mellitus (DM) and diabetic retinopathy (DR) is at alarming proportions in India and around the globe. The number of people with DM in India is estimated to increase to over 134 million by 2045. Screening and early identification of sight-threatening DR are proven ways of reducing DR-related blindness. An ideal DR screening model should include personalized awareness, targeted screening, integrated follow-up reminders, and capacity building. The DR screening technology is slowly shifting from direct examination by an ophthalmologist to remote screening using retinal photographs, including telescreening and automated grading of retinal images using artificial intelligence. The ophthalmologist-to-patient ratio is poor in India, and there is an urban-rural divide. The possibility of screening all people with diabetes by ophthalmologists alone is a remote possibility. It is prudent to use the available nonophthalmologist workforce for DR screening in tandem with the technological advances. Capacity-building efforts are based on the principle of task sharing, which allows for the training of a variety of nonophthalmologists in DR screening techniques and technology. The nonophthalmologist human resources for health include physicians, optometrists, allied ophthalmic personnel, nurses, and pharmacists, among others. A concurrent augmentation of health infrastructure, conducive health policy, improved advocacy, and increased people's participation are necessary requirements for successful DR screening. This perspective looks at the characteristics of various nonophthalmologist DR screening models and their applicability in addressing DR-related blindness in India.
Topics: Artificial Intelligence; Diabetes Mellitus; Diabetic Retinopathy; Humans; Mass Screening; Ophthalmologists; Optometrists
PubMed: 34708745
DOI: 10.4103/ijo.IJO_1117_21 -
Journal of Diabetes Investigation Jul 2023Regular screening for diabetic retinopathy is essential. This study aimed to show the process and current situation of diabetic retinopathy screening prescribed by...
Patient referral flow between physician and ophthalmologist visits for diabetic retinopathy screening among Japanese patients with diabetes: A retrospective cross-sectional cohort study using the National Database.
AIMS/INTRODUCTION
Regular screening for diabetic retinopathy is essential. This study aimed to show the process and current situation of diabetic retinopathy screening prescribed by physicians (internists) and ophthalmologists for Japanese patients with diabetes.
MATERIALS AND METHODS
This retrospective cohort study used data from the Japanese National Database of Insurance Claims between April 2016 and March 2018. Ophthalmology visits and fundus examinations are defined using specific medical procedure codes. The proportion of ophthalmology visits for patients with diabetic medication and for fundus examination among those who visited ophthalmologists was calculated in the fiscal year 2017. A modified Poisson regression analysis was carried out to identify factors associated with retinopathy screening. Similarly, quality indicators by prefectures were also calculated.
RESULTS
Among 4,408,585 patients receiving diabetic medications (57.8% men, 14.1% insulin use), 47.4% visited the ophthalmology department and 96.9% of those underwent fundus examination. Regression analysis showed that female sex, older age, insulin use, medical facilities with Japan Diabetes Society certification and large medical facilities were predictors of fundus examination. By prefecture, the ophthalmology consultation rate and the fundus examination ranged 38.5-51.0% and 92.1-98.7%, respectively.
CONCLUSIONS
Less than half of the patients who were prescribed antidiabetic medication by their physicians visited an ophthalmologist. However, most of the patients who visited an ophthalmologist had a fundus examination carried out. A similar tendency was noted for each prefecture. It is essential to reaffirm the necessity of recommending ophthalmologic examinations to physicians and healthcare professionals who care for patients with diabetes.
Topics: Female; Humans; Male; Cross-Sectional Studies; Diabetes Mellitus; Diabetic Retinopathy; East Asian People; Insulins; Mass Screening; Ophthalmologists; Physicians; Referral and Consultation; Retrospective Studies
PubMed: 37132068
DOI: 10.1111/jdi.14018 -
International Journal of Ophthalmology 2023To evaluate the clinical application value of the artificial intelligence assisted pathologic myopia (PM-AI) diagnosis model based on deep learning.
AIM
To evaluate the clinical application value of the artificial intelligence assisted pathologic myopia (PM-AI) diagnosis model based on deep learning.
METHODS
A total of 1156 readable color fundus photographs were collected and annotated based on the diagnostic criteria of Meta-pathologic myopia (PM) (2015). The PM-AI system and four eye doctors (retinal specialists 1 and 2, and ophthalmologists 1 and 2) independently evaluated the color fundus photographs to determine whether they were indicative of PM or not and the presence of myopic choroidal neovascularization (mCNV). The performance of identification for PM and mCNV by the PM-AI system and the eye doctors was compared and evaluated the relevant statistical analysis.
RESULTS
For PM identification, the sensitivity of the PM-AI system was 98.17%, which was comparable to specialist 1 (=0.307), but was higher than specialist 2 and ophthalmologists 1 and 2 (<0.001). The specificity of the PM-AI system was 93.06%, which was lower than specialists 1 and 2, but was higher than ophthalmologists 1 and 2. The PM-AI system showed the value of 0.904, while the values of specialists 1, 2 and ophthalmologists 1, 2 were 0.968, 0.916, 0.772 and 0.730, respectively. For mCNV identification, the AI system showed the sensitivity of 84.06%, which was comparable to specialists 1, 2 and ophthalmologist 2 (>0.05), and was higher than ophthalmologist 1. The specificity of the PM-AI system was 95.31%, which was lower than specialists 1 and 2, but higher than ophthalmologists 1 and 2. The PM-AI system gave the value of 0.624, while the values of specialists 1, 2 and ophthalmologists 1 and 2 were 0.864, 0.732, 0.304 and 0.238, respectively.
CONCLUSION
In comparison to the senior ophthalmologists, the PM-AI system based on deep learning exhibits excellent performance in PM and mCNV identification. The effectiveness of PM-AI system is an auxiliary diagnosis tool for clinical screening of PM and mCNV.
PubMed: 37724265
DOI: 10.18240/ijo.2023.09.07 -
Indian Journal of Ophthalmology May 2020
Topics: Betacoronavirus; COVID-19; Conjunctivitis; Coronavirus; Coronavirus Infections; Humans; Ophthalmologists; Pandemics; Pneumonia, Viral; SARS-CoV-2
PubMed: 32317428
DOI: 10.4103/ijo.IJO_869_20 -
American Journal of Ophthalmology Dec 2020
Topics: COVID-19; Humans; Internship and Residency; Ophthalmologists; Ophthalmology; Pandemics; Physical Distancing; SARS-CoV-2; Stress, Psychological
PubMed: 32971023
DOI: 10.1016/j.ajo.2020.06.048 -
Clinics in Dermatology 2020
Topics: Betacoronavirus; COVID-19; Conjunctivitis, Viral; Coronavirus Infections; Humans; Ophthalmologists; Pandemics; Pneumonia, Viral; SARS-CoV-2
PubMed: 32972612
DOI: 10.1016/j.clindermatol.2020.03.013 -
Indian Journal of Ophthalmology Oct 2022To compare the glaucoma assessment skills among general ophthalmologists in their referral patients over 5 years.
PURPOSE
To compare the glaucoma assessment skills among general ophthalmologists in their referral patients over 5 years.
METHODS
This was a retrospective auditing of the electronic medical record database. Details of consecutive new glaucoma patients seen in the glaucoma services of a tertiary eye care institute in 2013 and 2018 were collected. Details of each patient included the clinical presentation, baseline intra-ocular pressure (IOP), type and severity of glaucoma, referral details, gonioscopy, HVF (Humphrey visual field) data, and the number of medications. Statistical tests used were the Chi-square test and T test using SPSS version 22.
RESULTS
Of 28,886 medical records screened, 211 and 568 new glaucoma patients were retrieved in 2013 and 2018, respectively. The patients presenting in 2018 were younger (58.1 ± 15.4 years) at presentation than in 2013 (65.6 ± 15.2 years), P < 0.01, and also had higher baseline IOP (IOP ≥40 mm Hg was found in 9.5% in 2018 versus 2.4% in 2013; P < 0.01). The percentage of eyes with presenting visual acuity worse than 20/400 or 20/600 was higher in the patients presenting in 2018 (22.2% vs. 15.1%; P = 0.03). Although primary glaucoma predominated in both periods, the number of eyes referred to as disc suspects showed an increase in 2018 (4.7% to 14.4%; P < 0.01). Among 195 and 517 referrals in 2013 and 2018, respectively, the documentation of clinical findings were dismally poor in both the groups in terms of absent gonioscopy (99% vs. 98.2%, P = 0.4), absent disc details (89.6% vs. 91%, P = 0.5), or absent visual field analysis (79.1% vs. 74.8%, P = 0.2). However, the missing IOP values were significantly better in the latter year (77.3% vs. 57.2%; P < 0.01).
CONCLUSION
The increase in the number of new glaucoma patients and referrals did not show a corresponding improvement in documentation of findings except for IOP recording among general ophthalmologists. Hence, we need to re-emphasize the training of general ophthalmologists on basic glaucoma evaluation to improve their referral ability.
Topics: Glaucoma; Humans; Intraocular Pressure; Ophthalmologists; Retrospective Studies; Tonometry, Ocular
PubMed: 36190042
DOI: 10.4103/ijo.IJO_672_22 -
American Journal of Ophthalmology Dec 2020
Topics: COVID-19; Humans; Ophthalmologists; Pandemics; Patient Advocacy; SARS-CoV-2
PubMed: 32961114
DOI: 10.1016/j.ajo.2020.07.016 -
Clinics (Sao Paulo, Brazil) 2020
Topics: Brazil; Humans; Ophthalmologists
PubMed: 33206765
DOI: 10.6061/clinics/2020/e2201 -
Journal of Optometry 2020The pandemic of the severe acute respiratory syndrome disease caused by the new coronavirus SARS-CoV-2 (COVID-19), had profound impact in many countries and their health... (Review)
Review
The pandemic of the severe acute respiratory syndrome disease caused by the new coronavirus SARS-CoV-2 (COVID-19), had profound impact in many countries and their health care systems. Regarding Portugal, a suppression strategy with social distancing was adopted, attempting to break the transmission chains, bending the epidemy curve and reducing mortality. These measures seek to prevent an eventual National Health Service over-running, enforcing the suspension of all elective and non-urgent health care. Despite the success in so far, there is a consensus on the need to recover the previous level of health care provision and further enhance it. The Portuguese National Health Service, as a public, universal access, health care system funded by the State proved, in this context, its importance and relevance to the Portuguese population. However, long standing issues, such as the pre pandemic over long waiting lists for hospital ophthalmology attendance, whose determinants are fully identified but still unmet, emerge amplified from this pandemic. The lack of primary eye care in the National Health Service is a significant bottleneck, placing a huge stress on hospital-based care. An exclusive ophthalmologist's center care was over-runned before pandemic and will be even more so. The optometrist's exclusion from differentiated, multisectoral and multidisciplinary eye care teams remains the main hurdle to overcome and insure universal eye care in Portugal. National Health Service highlights the consequences of an overcome model. Universal eye care more than ever demands an evidence-based, integrated approach with primary eye care, in the community, on time and of proximity.
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Delivery of Health Care; Eye Diseases; Humans; Infection Control; Infectious Disease Transmission, Patient-to-Professional; National Health Programs; Ophthalmologists; Optometrists; Pandemics; Personal Protective Equipment; Pneumonia, Viral; Portugal; SARS-CoV-2; State Medicine
PubMed: 32711965
DOI: 10.1016/j.optom.2020.05.001