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Ophthalmology Science 2024To utilize ultrawidefield (UWF) imaging to evaluate retinal and choroidal vasculature and structure in individuals with mild cognitive impairment (MCI) compared with...
PURPOSE
To utilize ultrawidefield (UWF) imaging to evaluate retinal and choroidal vasculature and structure in individuals with mild cognitive impairment (MCI) compared with that of controls with normal cognition.
DESIGN
Prospective cross sectional study.
PARTICIPANTS
One hundred thirty-one eyes of 82 MCI patients and 230 eyes of 133 cognitively normal participants from the Eye Multimodal Imaging in Neurodegenerative Disease Study.
METHODS
A scanning laser ophthalmoscope (California, Optos Inc) was used to obtain UWF fundus color images. Images were analyzed with the Vasculature Assessment Platform for Images of the Retina UWF (VAMPIRE-UWF 2.0, Universities of Edinburgh and Dundee) software.
MAIN OUTCOME MEASURES
Imaging parameters included vessel width gradient, vessel width intercept, large vessel choroidal vascular density, vessel tortuosity, and vessel fractal dimension.
RESULTS
Both retinal artery and vein width gradients were less negative in MCI patients compared with controls, demonstrating decreased rates of vessel thinning at the periphery ( < 0.001; = 0.027). Retinal artery and vein width intercepts, a metric that extrapolates the width of the vessel at the center of the optic disc, were smaller in MCI patients compared with that of controls ( < 0.001; = 0.017). The large vessel choroidal vascular density, which quantifies the vascular area versus the total choroidal area, was greater in MCI patients compared with controls ( = 0.025).
CONCLUSIONS
When compared with controls with normal cognition, MCI patients had thinner retinal vasculature manifested in both the retinal arteries and the veins. In MCI, these thinner arteries and veins attenuated at a lower rate when traveling toward the periphery. MCI patients also had increased choroidal vascular density.
FINANCIAL DISCLOSURES
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
PubMed: 38827032
DOI: 10.1016/j.xops.2024.100480 -
Cureus May 2024This case report describes a complicated case of giant cell arteritis (GCA) with tongue necrosis and bilateral central retinal artery occlusion (CRAO). An 81-year-old...
This case report describes a complicated case of giant cell arteritis (GCA) with tongue necrosis and bilateral central retinal artery occlusion (CRAO). An 81-year-old male patient with a history of recent retinal artery occlusion, ischemic stroke, and hypertensive emergency was evaluated. Clinical examination, including a visual acuity assessment, fundus evaluation, and oral examination, was performed. Laboratory investigations, such as erythrocyte sedimentation rate (ESR), were conducted. A temporal artery biopsy was performed to confirm the diagnosis of GCA. The patient presented with sudden vision loss in the left eye following a prior episode of retinal artery occlusion in the right eye. Ophthalmoscopic examination revealed CRAO in the left eye. Additionally, tongue necrosis, a rare manifestation of GCA, was observed. The ESR was significantly elevated. A temporal artery biopsy supported the diagnosis of GCA. The patient was promptly referred for immunologist consultation and initiated on intravenous methylprednisolone therapy. This case highlights the diverse and potentially devastating nature of GCA, involving ocular and systemic manifestations. Bilateral CRAO and tongue necrosis are rare but significant complications of GCA. Prompt diagnosis and early initiation of corticosteroid therapy are crucial to prevent irreversible visual loss and further complications. A multidisciplinary approach involving ophthalmologists and other specialists is essential for the comprehensive management of GCA.
PubMed: 38826883
DOI: 10.7759/cureus.59554 -
The National Medical Journal of India 2023Background Fundus examination is an integral part of the clinical evaluation of patients with medical emergencies. It is done at the bedside using a portable direct...
Background Fundus examination is an integral part of the clinical evaluation of patients with medical emergencies. It is done at the bedside using a portable direct ophthalmoscope. Smartphone fundus photography (SFP) is a novel technique of retinal imaging. We evaluated the use of SFP by a physician in medical emergencies and compared it with direct ophthalmoscopy (DO) findings of the ophthalmologist. Methods We did a prospective study on patients admitted with medical emergencies with an indication for fundus examination. The SFP was done by the physician, and its findings were noted. These were compared with the DO findings of the ophthalmologist. Results Of the 182 patients studied, 111 (61%) had fundus findings by SFP and 95 (52.5%) by DO. Papilloedema (21.4%), haemorrhages (20%) and Roth spots (12.5%) were most common. DO missed early papilloedema and findings in the peripheral retina. Conclusions SFP is as effective as DO, in detecting retinal findings in patients with medical emergencies and can be performed at the bedside by the physician.
Topics: Humans; Smartphone; Photography; Cross-Sectional Studies; Male; Female; Prospective Studies; Adult; Emergencies; Ophthalmoscopy; Middle Aged; Fundus Oculi; Retinal Diseases; Aged; Young Adult; Adolescent; Papilledema
PubMed: 38759976
DOI: 10.25259/NMJI_208_21 -
Investigative Ophthalmology & Visual... May 2024To demonstrate the first near-infrared adaptive optics fluorescence lifetime imaging ophthalmoscopy (NIR-AOFLIO) measurements in vivo of the human retinal pigment...
PURPOSE
To demonstrate the first near-infrared adaptive optics fluorescence lifetime imaging ophthalmoscopy (NIR-AOFLIO) measurements in vivo of the human retinal pigment epithelial (RPE) cellular mosaic and to visualize lifetime changes at different retinal eccentricities.
METHODS
NIR reflectance and autofluorescence were captured using a custom adaptive optics scanning light ophthalmoscope in 10 healthy subjects (23-64 years old) at seven eccentricities and in two eyes with retinal abnormalities. Repeatability was assessed across two visits up to 8 weeks apart. Endogenous retinal fluorophores and hydrophobic whole retinal extracts of Abca4-/- pigmented and albino mice were imaged to probe the fluorescence origin of NIR-AOFLIO.
RESULTS
The RPE mosaic was resolved at all locations in five of seven younger subjects (<35 years old). The mean lifetime across near-peripheral regions (8° and 12°) was longer compared to near-foveal regions (0° and 2°). Repeatability across two visits showed moderate to excellent correlation (intraclass correlation: 0.88 [τm], 0.75 [τ1], 0.65 [τ2], 0.98 [a1]). The mean lifetime across drusen-containing eyes was longer than in age-matched healthy eyes. Fluorescence was observed in only the extracts from pigmented Abca4-/- mouse.
CONCLUSIONS
NIR-AOFLIO was repeatable and allowed visualization of the RPE cellular mosaic. An observed signal in only the pigmented mouse extract infers the fluorescence signal originates predominantly from melanin. Variations observed across the retina with intermediate age-related macular degeneration suggest NIR-AOFLIO may act as a functional measure of a biomarker for in vivo monitoring of early alterations in retinal health.
Topics: Humans; Retinal Pigment Epithelium; Ophthalmoscopy; Adult; Middle Aged; Animals; Female; Mice; Male; Young Adult; Optical Imaging; Reproducibility of Results; Infrared Rays; ATP-Binding Cassette Transporters; Fluorescein Angiography
PubMed: 38758638
DOI: 10.1167/iovs.65.5.27 -
Translational Vision Science &... May 2024
PubMed: 38709503
DOI: 10.1167/tvst.13.5.4 -
Eye (London, England) Apr 2024To evaluate the diagnostic performance of B-scan kinetic ultrasonography (USG), standard ultra-widefield (UWF) imaging, and indirect ophthalmoscopy (IDO) in retinal...
BACKGROUND/OBJECTIVES
To evaluate the diagnostic performance of B-scan kinetic ultrasonography (USG), standard ultra-widefield (UWF) imaging, and indirect ophthalmoscopy (IDO) in retinal break detection in cataractous eyes.
SUBJECTS/METHODS
We consecutively enrolled 126 cataract patients (including 246 eyes) with no comorbidities that could decrease best corrected visual acuity (BCVA). Three index tests (USG, nonmydriatic UWF, and mydriatic IDO) were performed preoperatively to screen for retinal breaks. One week after cataract extraction, a dilated IDO examination was repeated for the definitive diagnosis of retinal break as the reference standard. The sensitivity, specificity, Youden index (YI), and predictive values of each index test were calculated according to postoperative ophthalmoscopic findings. A deep-learning nomogram was developed to quantify the risk of retinal break presence using patients' baseline data and findings reported from preoperative ophthalmic tests.
RESULTS
Fifty-two eyes (21%) were excluded from appropriate preoperative UWF imaging because of massive lens opacity. The BCVA cutoff point with maximum YI indicating UWF applicability was 0.6 logMAR (YI = 0.3; area under curve [AUC] = 0.7). Among all 246 eyes, preoperative IDO, USG, and UWF showed fair interobserver agreement (all κ > 0.2). According to postoperative IDO findings, the index tests with the highest sensitivity and specificity were USG (100%) and preoperative IDO (99%), respectively.
CONCLUSIONS
For cataractous eyes without vision-impairing comorbidities, a BCVA better than 0.6 logMAR (Snellen acuity, 20/80) allows for appropriate nonmydriatic standard UWF imaging. In a high-volume clinic equipped with skilled ophthalmic examiners, screening with USG followed by directed IDO allows the efficient identification of retinal breaks in cataractous eyes.
PubMed: 38658680
DOI: 10.1038/s41433-024-03093-2 -
Indian Journal of Ophthalmology Jul 2024In the field of ophthalmology, slit-lamp gonioscopy has long been a cornerstone for examining anterior chamber angles and diagnosing conditions such as angle closure,...
In the field of ophthalmology, slit-lamp gonioscopy has long been a cornerstone for examining anterior chamber angles and diagnosing conditions such as angle closure, secondary causes of raised intraocular pressure, neovascularization of angle, angle recession, angle tumors, and foreign bodies. However, the conventional approach for goniophotography is a demanding procedure requiring juggling a gonioscopy lens in one hand and a smartphone in the other. Balancing a gonioscopy lens with one hand makes it difficult to adjust and focus the image in busy clinical settings. This article introduces a groundbreaking solution to this problem - a universal slit-lamp-mounted gonioscope ingeniously repurposed from discarded materials, that is, indirect goniophotography (IndiGo). This novel system simplifies the process of both gonioscopy and goniophotography, allowing ophthalmologists to easily assess anterior chamber angles and capture high-quality images. These images can be swiftly shared with glaucoma specialists worldwide for digital analysis. Not only does this approach enhance examination efficiency, but also it fosters sustainability in ophthalmic diagnostics.
Topics: Gonioscopy; Humans; Intraocular Pressure; Equipment Design; Glaucoma, Angle-Closure; Anterior Chamber; Slit Lamp; Slit Lamp Microscopy
PubMed: 38634755
DOI: 10.4103/IJO.IJO_3035_23 -
Zhongguo Yi Liao Qi Xie Za Zhi =... Mar 2024In order to realize the diagnosis of slit lamp in cross-regional patients and improve the real-time and convenience of diagnosis, a remote slit lamp diagnosis platform...
In order to realize the diagnosis of slit lamp in cross-regional patients and improve the real-time and convenience of diagnosis, a remote slit lamp diagnosis platform based on Internet of Things (IoT) technology is designed. Firstly, the feasibility of remote slit lamp is analyzed. Secondly, the IoT platform architecture of doctor/server/facility (D/S/F) is proposed and a remote slit lamp is designed. Finally, the performance of the remote slit lamp diagnostic platform is tested. The platform solves the communication problem of distributed slit lamps and realizes respectively numerical control of multi-area slit lamp by multi-eye experts. The test results show that the remote control delay of the platform is less than 20 ms, which supports multiple experts to diagnose multiple patients separately.
Topics: Humans; Slit Lamp; Internet of Things; Technology
PubMed: 38605628
DOI: 10.12455/j.issn.1671-7104.230404 -
Scientific Reports Apr 2024Choroideremia (CHM) is an X-linked retinal degeneration leading to loss of the photoreceptors, retinal pigment epithelium (RPE), and choroid. Adaptive optics...
Choroideremia (CHM) is an X-linked retinal degeneration leading to loss of the photoreceptors, retinal pigment epithelium (RPE), and choroid. Adaptive optics optoretinography is an emerging technique for noninvasive, objective assessment of photoreceptor function. Here, we investigate parafoveal cone function in CHM using adaptive optics optoretinography and compare with cone structure and clinical assessments of vision. Parafoveal cone mosaics of 10 CHM and four normal-sighted participants were imaged with an adaptive optics scanning light ophthalmoscope. While acquiring video sequences, a 2 s 550Δ10 nm, 450 nW/deg stimulus was presented. Videos were registered and the intensity of each cone in each frame was extracted, normalized, standardized, and aggregated to generate the population optoretinogram (ORG) over time. A gamma-pdf was fit to the ORG and the peak was extracted as ORG amplitude. CHM ORG amplitudes were compared to normal and were correlated with bound cone density, ellipsoid zone to RPE/Bruch's membrane (EZ-to-RPE/BrM) distance, and foveal sensitivity using Pearson correlation analysis. ORG amplitude was significantly reduced in CHM compared to normal (0.22 ± 0.15 vs. 1.34 ± 0.31). In addition, CHM ORG amplitude was positively correlated with cone density, EZ-to-RPE/BrM distance, and foveal sensitivity. Our results demonstrate promise for using ORG as a biomarker of photoreceptor function.
Topics: Humans; Choroideremia; Ophthalmoscopy; Retinal Cone Photoreceptor Cells; Choroid; Retinal Pigment Epithelium; Tomography, Optical Coherence
PubMed: 38594294
DOI: 10.1038/s41598-024-58059-x