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Vision Research Sep 2023High-density threshold perimetry has found that conventional static threshold perimetry misses defects due to undersampling. However, high-density testing can be both...
High-density threshold perimetry has found that conventional static threshold perimetry misses defects due to undersampling. However, high-density testing can be both slow and limited by normal fixational eye movements. We explored alternatives by studying displays of high-density perimetry results for angioscotomas in healthy eyes-areas of reduced sensitivity in the shadows of blood vessels. The right eyes of four healthy adults were tested with a Digital Light Ophthalmoscope that gathered retinal images while presenting visual stimuli. The images were used to infer stimulus location on each trial. Contrast thresholds for a Goldmann size III stimulus were measured at 247 locations of a 13°×19° rectangular grid, with separation 0.5°, extending from 11° to 17° horizontally and -3° to +6° vertically, covering a portion of the optic nerve head and several major blood vessels. Maps of perimetric sensitivity identified diffuse regions of reduced sensitivity near the blood vessels, but these showed moderate structure-function agreement that was only modestly improved when effects of eye position were accounted for. An innovative method termed slice display was used to locate regions of reduced sensitivity. Slice display demonstrated that many fewer trials could yield similar structure-function agreement. These results are an indication that test duration might be reduced dramatically by focusing on location of defects rather than maps of sensitivity. Such alternatives to conventional threshold perimetry have the potential to map the shape of defects without the extensive time demands of high-density threshold perimetry. Simulations illustrate how such an algorithm could operate.
Topics: Adult; Humans; Visual Field Tests; Visual Fields; Optic Disk; Vision Disorders; Algorithms
PubMed: 37285782
DOI: 10.1016/j.visres.2023.108259 -
Clinical Ophthalmology (Auckland, N.Z.) 2023Encircling (360 degree) retinal detachment prophylaxis using indirect ophthalmoscope laser delivery recently achieved strong proof of safety and effectiveness by...
Encircling (360 degree) retinal detachment prophylaxis using indirect ophthalmoscope laser delivery recently achieved strong proof of safety and effectiveness by preventing the development of peripheral retinal tears and detachments in the eyes of patients with Stickler syndrome (syndromic eyes). Untreated, Stickler syndrome patients have a 65% lifetime risk of retinal detachment (half by age 20, 80% bilateral). This report describes an optimal technique of encircling laser retinopexy to also prevent the more common retinal detachments seen in aging (non-syndromic) eyes that share with Stickler syndrome the common pathogenesis of peripheral retinal tears caused by vitreous traction.
PubMed: 37273500
DOI: 10.2147/OPTH.S406337 -
Cureus Apr 2023Background Consistently raised intracranial pressure (ICP) is a common final pathway to morbidity/mortality in many neurosurgical conditions. This underscores the need...
Background Consistently raised intracranial pressure (ICP) is a common final pathway to morbidity/mortality in many neurosurgical conditions. This underscores the need for early diagnosis and prompt management of raised ICP. This study aims to determine whether smartphone fundal photography features of raised ICP can accurately predict the computed tomography (CT) findings suggestive of elevated ICP in neurosurgery patients. Methods Dilated ocular fundal photography examinations using an ophthalmoscope adapter mounted on a smartphone were done on 82 patients with clinical suspicion of raised ICP. Fundal photography findings were recorded as pictures/videos for disc analysis. Patients subsequently had neuroimaging with results analyzed for radiological features of raised ICP. These were correlated with fundal photography findings. Results A total of 82 adult patients participated in this study. Chi-square analysis showed a relationship between radiological signs of raised ICP and the absence of spontaneous retinal venous pulsation (SRVP) (p=0.001). There was no relationship observed between papilledema and radiological signs of raised ICP. However, when the fundal photography signs were aggregated, there was a significant relationship between the fundal signs of raised ICP and radiological signs of raised ICP (p=0.004). The sensitivity and specificity of smartphone-fundoscopy-detected papilledema in predicting radiological signs of raised ICP were 43.2% and 100%, respectively, while those of absent SRVP were 100% and 92.6%, respectively. Conclusion Smartphone ophthalmoscopy is a reliable screening tool for evaluating ICP in neurosurgical patients. It should be introduced into the neurosurgeon's tools for prompt evaluation of raised ICP, especially in developing/resource-poor settings where CT or magnetic resonance imaging is not readily available.
PubMed: 37261138
DOI: 10.7759/cureus.38246 -
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 -
Pakistan Journal of Medical Sciences 2023To evaluate the feasibility of a novel and simple smart phone-based Retinopathy of Prematurity (ROP) screening approach in a resource-constrained setting.
OBJECTIVES
To evaluate the feasibility of a novel and simple smart phone-based Retinopathy of Prematurity (ROP) screening approach in a resource-constrained setting.
METHODS
This cross-sectional validation study was conducted at the Department of Ophthalmology and Neonatal Intensive Care Unit (NICU) of The Aga Khan University Hospital, Pakistan, from January 2022 to April 2022. A total of 63 images of eyes with active ROP (stage-1, 2, 3, 4 and/or plus or pre-plus disease) were included in this study. The stage of ROP was documented by the principal investigator using an indirect ophthalmoscope and retinal images were obtained using this novel technique. These images were shared with two masked ROP experts who rated the image quality and determined the stage of ROP and presence of plus disease. Their reports were compared with the initial findings reported by principal investigator using indirect ophthalmoscope.
RESULTS
We reviewed 63 images for image quality, stage of ROP and presence of plus disease. There was significant agreement between the gold standard and the Rater-1 and 2 for the presence of plus disease (Cohen's kappa was 0.84 and 1.0) and the stage of the disease (Cohen's kappa 0.65 and 1.0). There was significant agreement between the Rater for presence of plus disease and any stage of ROP (Cohen's κ: 0.84 and 0.65 for plus disease and any stage of the ROP, respectively). Rater-1 and 2 rated 96.83% and 98.41% images as excellent / acceptable respectively.
CONCLUSIONS
High quality retinal images can be captured with a smartphone and 28D lens without using any additional adapter equipment. This approach of ROP screening can form basis of telemedicine for ROP in resource constrained areas.
PubMed: 37250571
DOI: 10.12669/pjms.39.3.7053 -
Ophthalmology Science Sep 2023Multiple sclerosis (MS) is an inflammatory neurodegenerative disease of the central nervous system. Recent evidence suggests that degeneration of the inner layers of the...
PURPOSE
Multiple sclerosis (MS) is an inflammatory neurodegenerative disease of the central nervous system. Recent evidence suggests that degeneration of the inner layers of the retina occurs in MS. This study aimed to examine whether there are outer retinal changes in patients living with MS.
DESIGN
This was a single center, cross-sectional study.
PARTICIPANTS
Sixteen patients with MS and 25 controls (volunteers without diagnosed MS) were recruited for the study.
METHODS
We acquired volumetric spectral domain-OCT scans of the macula and a circular scan around the optic nerve head (ONH). We also captured adaptive optics (AO) images at 0° (centered on the foveola), 2°, 4°, and 6° temporal to the fovea.
MAIN OUTCOME MEASURES
We calculated the thickness of the different retinal layers in the macula and around the ONH using the inbuilt software of the OCT. We evaluated changes in cone photoreceptors by calculating cone density and spacing by the inbuilt AO automatic segmentation algorithm with manual correction. We compared patients with and without optic neuritis and controls.
RESULTS
We found significant thinning of the inner retina and a thickening of the outer retina in the eye with a history of optic neuritis (eyes of patients with MS with a history of optic neuritis; mean difference [MD]: -11.13 ± 3.61 μm, = 0.002 and MD: 2.86 ± 0.89 μm, = 0.001; respectively). We did not observe changes in retinal layers without optic neuritis in eyes of patients with MS without a history of optic neuritis. However, regional differences were detected in the peripapillary retinal nerve fiber layer. Analyzing AO images revealed a significantly lower cone outer-segment density at all eccentricities in all patients compared with control eyes ( < 0.05), independent of optic neuritis history.
CONCLUSIONS
Our results showed that all MS cases were associated with decreased cone densities. Future longitudinal studies will help to elucidate whether this is a specific and sensitive method to detect and monitor the development and progression of MS.
FINANCIAL DISCLOSURES
Proprietary or commercial disclosure may be found after the references.
PubMed: 37214765
DOI: 10.1016/j.xops.2023.100308 -
JNMA; Journal of the Nepal Medical... Apr 2023Diabetic retinopathy is a specific microvascular ocular complication associated with diabetes. However, retinopathy has also been reported in people with prediabetes....
Diabetic Retinopathy among Patients with Prediabetes Attending the Outpatient Department of Ophthalmology in a Tertiary Eye Care Centre: A Descriptive Cross-sectional Study.
INTRODUCTION
Diabetic retinopathy is a specific microvascular ocular complication associated with diabetes. However, retinopathy has also been reported in people with prediabetes. The study aimed to find out the prevalence of diabetic retinopathy among patients with prediabetes attending the outpatient Department of Ophthalmology in a tertiary eye care centre.
METHODS
A descriptive cross-sectional study was conducted among patients with prediabetes attending the outpatient Department of Ophthalmology in a tertiary eye care centre from 1 January 2022 and 30 April 2022. Ethical approval was obtained from the Ethical Review Board (Registration number: 594/2021 P). All patients had their eyes dilated and examined under the slit-lamp with a 90 D convex lens or indirect ophthalmoscopes with a 20 D lens to find retinopathy. All patients aged 40 to 79 years with intermediate hyperglycemia were included in the study. Convenience sampling was used. Point estimate and 95% Confidence Interval were calculated.
RESULTS
Among 141 patients with prediabetes, diabetic retinopathy was found in 8 (5.67%) (1.85-9.49, 95% Confidence Interval). Among which all patients 8 (5.67%) had mild non-proliferative diabetic retinopathy. Among patients with retinopathy, all 8 (5.67%) were obese, 3 (37.50%) were hypertensive, 5 (62.50%) patients had intermediate hyperglycemia for more than 6 months, and 2 (25%) had a family history of diabetes mellitus.
CONCLUSIONS
The prevalence of diabetic retinopathy in prediabetes patient was found to be higher than the other studies conducted in similar settings.
KEYWORDS
diabetic retinopathy; prediabetes; prevalence.
Topics: Humans; Diabetic Retinopathy; Cross-Sectional Studies; Prediabetic State; Outpatients; Hyperglycemia
PubMed: 37208881
DOI: 10.31729/jnma.8118 -
Indian Journal of Ophthalmology May 2023To assess the need for spectacles and low-vision aids (LVA) in students attending schools for the blind and study their compliance with use.
PURPOSE
To assess the need for spectacles and low-vision aids (LVA) in students attending schools for the blind and study their compliance with use.
METHODS
Comprehensive ocular evaluation was performed using a hand-held slit lamp and ophthalmoscope. Vision acuity was measured using a logarithm of the minimum angle of resolution (logMAR) chart for distance, as well as for near. Spectacles and LVAs were dispensed after refraction and LVA trial. Follow-up was performed to assess the vision using the LV Prasad Functional Vision Questionnaire (LVP-FVQ) along with compliance with use after 6 months.
RESULTS
Of the 456 students examined from six schools, 188 (41.2%) were female; 147 (32.2%) were <10 years of age. In all, 362 (79.4%) were blind since birth. The students dispensed only LVAs were 25 (5.5%), only spectacles were 55 (12.1%), and both spectacle and LVAs were 10 (2.2%). The vision improved using LVAs in 26 (5.7%) and using spectacles in 64 (9.6%). There was a significant improvement in LVP-FVQ scores (P < 0.001). Also, 68/90 students were available for follow-up, of whom 43 (63.2%) were compliant to use. Causes of not wearing spectacles or LVA in 25 were left somewhere or lost 13 (52%), broken 3 (12%), uncomfortable to use 6 (24%), not interested to use 2 (8%), and got operated 1 (4%).
CONCLUSION
Although the dispensing of LVA and spectacles improved the visual acuity and vision function of 90/456 (19.7%) students, nearly a third were not using them after 6 months. Efforts need to be taken to improve the compliance of use.
Topics: Humans; Female; Male; India; Refraction, Ocular; Visual Acuity; Students; Vision Disorders; Schools
PubMed: 37203089
DOI: 10.4103/ijo.IJO_1733_22 -
Indian Journal of Ophthalmology May 2023To retrospectively study impact of preoperative posterior segment evaluation on surgical intervention in camp patients recruited for cataract surgery in Gujarat India.
PURPOSE
To retrospectively study impact of preoperative posterior segment evaluation on surgical intervention in camp patients recruited for cataract surgery in Gujarat India.
METHODS
Retrospective analysis of six months data collected from hospital electronic medical record (EMR) system of 9820 admitted patients recruited from screening camp for cataract surgery from 1/10/2019 to 31/3/2020 in Tertiary Eye Hospital in Gujarat, India, has been done. Comprehensive clinical evaluation, of both anterior and posterior segment which included detailed history; best corrected visual acuity (BCVA); intraocular pressure measurement with non-contact tonometer (NCT) and when required with Goldman applanation tonometer; slit lamp examination; and fundus examination with + 90 diopter lens as well as indirect ophthalmoscope as and when indicated. In case there was no view of retina, a B-scan ultrasound was done to rule out any posterior segment pathology. Immediate surgical intervention done was assessed and results analyzed in percentage.
RESULTS
Cataract surgery was advised for 8390 patients (85.43%). Surgical intervention for management of glaucoma was done for 68 patients (0.692%). Retina intervention was done for 86 patients. Posterior segment evaluation changed immediate surgical plane of management for 154 (1.57%) patients.
CONCLUSION
Comprehensive clinical evaluation is economical and should be mandatory especially in community services as comorbid conditions like glaucoma, diabetic retinopathy, retinal vein occlusion, and other varied posterior segment diseases contribute significantly to visual disability in elderly age group. It is difficult to follow these patients later if manageable comorbidity is not informed about and if indicated dealt simultaneously for visual rehabilitation of patient.
Topics: Humans; Aged; Retrospective Studies; Visual Acuity; Cataract Extraction; Cataract; Glaucoma
PubMed: 37203057
DOI: 10.4103/IJO.IJO_2883_22 -
Indian Journal of Ophthalmology May 2023Fundus photography is an arduous task as it involves using 90 D in one hand and a smartphone attached on an eyepiece of a slit-lamp biomicroscope in the other hand....
Fundus photography is an arduous task as it involves using 90 D in one hand and a smartphone attached on an eyepiece of a slit-lamp biomicroscope in the other hand. Similarly, with a 20 D lens, the filming distance is adjusted by moving the lens or mobile forward or backward, which makes it difficult to adjust and focus the image in busy ophthalmology outpatient departments (OPDs). Moreover, fundus camera costs thousands of dollars. Authors describe a novel technique of performing fundus photography with a 20 D lens and a universal slit-lamp-mounted mobile adapter made from trash. By the use of this simple, yet frugal innovation, primary care physicians or ophthalmologists without a fundus camera can easily snap a fundus photo and subject it to digital analysis by retina specialists across the world. This will help in simultaneous ocular examination and fundus photos taken via mounted 20 D on a slit lamp itself and also reduce the need for unnecessary retina referrals to tertiary eye care centers.
Topics: Humans; Slit Lamp; Diagnostic Techniques, Ophthalmological; Eye Diseases; Fundus Oculi; Photography
PubMed: 37202954
DOI: 10.4103/IJO.IJO_3226_22