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Deutsches Arzteblatt International Jan 2015Dry eye disease (DED) is common; its prevalence around the world varies from 5% to 34%. Its putative pathogenetic mechanisms include hyperosmolarity of the tear film and... (Review)
Review
BACKGROUND
Dry eye disease (DED) is common; its prevalence around the world varies from 5% to 34%. Its putative pathogenetic mechanisms include hyperosmolarity of the tear film and inflammation of the ocular surface and lacrimal gland. Dry eye is clinically subdivided into two subtypes: one with decreased tear secretion (aqueous-deficient DED), and one with increased tear evaporation (hyperevaporative DED).
METHODS
This review is based on pertinent publications retrieved by a selective PubMed search and on the authors' own clinical and scientific experience.
RESULTS
The diagnostic evaluation of dry eye disease should include a detailed patient history, thorough split-lamp examination, and additional tests as indicated. Few randomized controlled therapeutic trials for dry eye have been published to date. Artificial tears of various kinds are recommended if the symptoms are mild. Lid hygiene is helpful in the treatment of hyperevaporative dry eye, while collagen or silicon plugs can be used for partial occlusion of the efferent lacrimal ducts to treat severe hyposecretory dry eye. The benefit of long-term topical anti-inflammatory treatment of moderate or severe dry eye disease with corticosteroids or cyclosporine A eye drops has been documented in clinical trials on a high evidence level. Orally administered tetraycycline derivatives and omega-3 or omega-6 fatty acids are also used.
CONCLUSION
The treatment of dry eye has evolved from tear substitution alone to a rationally based therapeutic algorithm. Current research focuses on pathophysiology, new diagnostic techniques, and novel therapies including secretagogues, topical androgens, and new anti- inflammatory drugs.
Topics: Anti-Inflammatory Agents; Dry Eye Syndromes; Humans; Lubricant Eye Drops; Medical History Taking; Slit Lamp
PubMed: 25686388
DOI: 10.3238/arztebl.2015.0071 -
Hong Kong Medical Journal = Xianggang... Feb 2019Dry eye disease is one of the most common ophthalmic complaints; it results from the activity of various pathways and is considered a multifactorial disease. An... (Review)
Review
Dry eye disease is one of the most common ophthalmic complaints; it results from the activity of various pathways and is considered a multifactorial disease. An important factor that contributes to the onset of dry eye disease is meibomian gland dysfunction. Meibomian gland dysfunction causes a disruption in the tear film lipid layer which affects the rate of tear evaporation. This evaporation leads to tear hyperosmolarity, eventually triggering the onset of dry eye disease. Dry eye disease and meibomian gland dysfunction are strongly associated with each other, such that many of their risk factors, signs, and symptoms overlap. This review aimed to provide an update on the association between dry eye disease and meibomian gland dysfunction. A stepwise approach for diagnosis and management is summarised.
Topics: Diagnostic Imaging; Dry Eye Syndromes; Eyelid Diseases; Fluorescent Dyes; Humans; Meibomian Glands; Randomized Controlled Trials as Topic; Risk Factors; Slit Lamp; Staining and Labeling; Tears
PubMed: 30713149
DOI: 10.12809/hkmj187331 -
International Journal of Retina and... Sep 2022Scanning laser ophthalmoscopes (SLOs) are used widely for reflectance, fluorescence or autofluorescence photography and less commonly for retroillumination imaging. SLOs... (Review)
Review
Scanning laser ophthalmoscopes (SLOs) are used widely for reflectance, fluorescence or autofluorescence photography and less commonly for retroillumination imaging. SLOs scan a visible light or near-infrared radiation laser beam across the retina, collecting light from each retinal spot as it's illuminated. An SLO's clinical applications, image contrast and axial resolution are largely determined by an aperture overlying its photodetector. High contrast, reflectance images are produced using small diameter, centered apertures (confocal apertures) that collect retroreflections and reject side-scattered veiling light returned from the fundus. Retroillumination images are acquired with annular on-axis or laterally-displaced off-axis apertures that capture scattered light and reject the retroreflected light used for reflectance imaging. SLO axial resolution is roughly 300 μm, comparable to macular thickness, so SLOs cannot provide the depth-resolved chorioretinal information obtainable with optical coherence tomography's (OCT's) 3 μm axial resolution. Retroillumination highlights and shades the boundaries of chorioretinal tissues and abnormalities, facilitating detection of small drusen, subretinal drusenoid deposits and subthreshold laser lesions. It also facilitates screening for large-area chorioretinal irregularities not readily identified with other en face retinal imaging modalities. Shaded boundaries create the perception of lesion elevation or depression, a characteristic of retroillumination but not reflectance SLO images. These illusions are not reliable representations of three-dimensional chorioretinal anatomy and they differ from objective OCT en face topography. SLO retroillumination has been a useful but not indispensable retinal imaging modality for over 30 years. Continuing investigation is needed to determine its most appropriate clinical roles in multimodal retinal imaging.
PubMed: 36180893
DOI: 10.1186/s40942-022-00421-0 -
Progress in Retinal and Eye Research Jan 2019Adaptive Optics (AO) retinal imaging has provided revolutionary tools to scientists and clinicians for studying retinal structure and function in the living eye. From... (Review)
Review
Adaptive Optics (AO) retinal imaging has provided revolutionary tools to scientists and clinicians for studying retinal structure and function in the living eye. From animal models to clinical patients, AO imaging is changing the way scientists are approaching the study of the retina. By providing cellular and subcellular details without the need for histology, it is now possible to perform large scale studies as well as to understand how an individual retina changes over time. Because AO retinal imaging is non-invasive and when performed with near-IR wavelengths both safe and easily tolerated by patients, it holds promise for being incorporated into clinical trials providing cell specific approaches to monitoring diseases and therapeutic interventions. AO is being used to enhance the ability of OCT, fluorescence imaging, and reflectance imaging. By incorporating imaging that is sensitive to differences in the scattering properties of retinal tissue, it is especially sensitive to disease, which can drastically impact retinal tissue properties. This review examines human AO retinal imaging with a concentration on the use of the Adaptive Optics Scanning Laser Ophthalmoscope (AOSLO). It first covers the background and the overall approaches to human AO retinal imaging, and the technology involved, and then concentrates on using AO retinal imaging to study the structure and function of the retina.
Topics: Humans; Ophthalmoscopes; Ophthalmoscopy; Optics and Photonics; Peripheral Vascular Diseases; Retinal Diseases; Tomography, Optical Coherence
PubMed: 30165239
DOI: 10.1016/j.preteyeres.2018.08.002 -
Advances in Experimental Medicine and... 2010Stargardt disease (STGD1) is an autosomal-recessively inherited condition often associated with mutations in ABCA4 and characterized by accumulation of autofluorescent... (Review)
Review
Stargardt disease (STGD1) is an autosomal-recessively inherited condition often associated with mutations in ABCA4 and characterized by accumulation of autofluorescent lipofuscin deposits in the retinal pigment epithelium (RPE). Non-invasive imaging techniques including fundus autofluorescence (FAF), spectral domain optical coherence tomography (SD-OCT) and adaptive optics scanning laser ophthalmoscopy (AOSLO) have the potential to improve understanding of vision loss in patients with STGD. We describe a comprehensive approach to the study of patients with STGD. Measures of retinal structure and FAF were correlated with visual function including best-corrected visual acuity (BCVA), color vision, kinetic and static perimetry, fundus-guided microperimetry and full-field and multifocal electroretinography. Mutation analysis of the ABCA4 gene was carried out by sequencing the complete coding region. Preliminary data suggest that a combination of imaging modalities may provide a sensitive measure of disease progression and response to experimental therapies in patients with STGD.
Topics: Corneal Dystrophies, Hereditary; Diagnostic Imaging; Fluorescence; Fundus Oculi; Humans; Ophthalmoscopes; Tomography, Optical Coherence
PubMed: 20238033
DOI: 10.1007/978-1-4419-1399-9_38 -
Continuum (Minneapolis, Minn.) Aug 2014This article offers a pragmatic roadmap to the practicing neurologist on how to approach the patient with double vision. Strategies of history taking and examination... (Review)
Review
PURPOSE OF REVIEW
This article offers a pragmatic roadmap to the practicing neurologist on how to approach the patient with double vision. Strategies of history taking and examination techniques are reviewed, followed by a broad overview of the causes of diplopia organized by neuroanatomic localization. Diplopia may be the first symptom of serious vision or life-threatening neurologic disease, and its correct localization and diagnosis are therefore essential. The systems responsible for ocular movement and alignment in the vertical and horizontal plane include complex supranuclear circuitry, brainstem nuclei, cranial nerves III, IV, and VI, and their respective neuromuscular junctions and target muscles. Disruption at any point within this system or within the vestibular afferents that govern eye movement in response to head movements may therefore produce diplopia, leading to a broad differential diagnosis for the patient with diplopia. With a careful history and examination, the neurologist should be able to observe the patterns of diplopia that reveal the site of dysfunction, thus generating a shorter localization-specific list of possible etiologies. Examination of ocular motility including smooth pursuit and saccadic function, followed, if necessary, by testing designed to uncover misalignments of the eyes, including cover and Maddox rod testing, are primary components of the efferent neurologic examination. Further testing designed to detect myasthenia (eg, lid testing and fatigable upgaze) and orbital disease (eg, measuring proptosis, testing for resistance to retropulsion) may be necessary.
RECENT FINDINGS
Recent advances in the diagnosis of diplopia include the observation that vertical diplopia from skew deviation is more likely to improve with supine positioning than that caused by trochlear nerve palsies. Advances in the field of ocular myasthenia include the observation of decreased conversion to the generalized form with treatment with either steroids or thymectomy, although these conclusions need to be confirmed by prospective, randomized trials. Rarely, pure ocular myasthenia may be associated with the muscle-specific tyrosine kinase (MuSK) antibody.
SUMMARY
With proper skills, the neurologist can elucidate the localization of diplopia, even in cases of complex ocular misalignment, and generate a management plan that can address the underlying disease, and, in many cases, ameliorate or cure the diplopia.
Topics: Aged; Diagnosis, Differential; Diplopia; Female; Humans; Magnetic Resonance Imaging; Neurologic Examination; Ophthalmoscopes; Visual Pathways
PubMed: 25099102
DOI: 10.1212/01.CON.0000453310.52390.58 -
Journal of Biomedical Optics 2006Scanning laser ophthalmoscopy (SLO) is a powerful imaging tool with specialized applications limited to research and ophthalmology clinics due in part to instrument...
Scanning laser ophthalmoscopy (SLO) is a powerful imaging tool with specialized applications limited to research and ophthalmology clinics due in part to instrument size, cost, and complexity. Conversely, low-cost retinal imaging devices have limited capabilities in screening, detection, and diagnosis of diseases. To fill the niche between these two, a hand-held, nonmydriatic line-scanning laser ophthalmoscope (LSLO) is designed, constructed, and tested on normal human subjects. The LSLO has only one moving part and uses a novel optical approach to produce wide-field confocal fundus images. Imaging modes include multiwavelength illumination and live stereoscopic imaging with a split aperture. Image processing and display functions are controlled with two stacked prototype compact printed circuit boards. With near shot-noise limited performance, the digital LSLO camera requires low illumination power (<500 microW) at near-infrared wavelengths. The line-scanning principle of operation is examined in comparison to SLO and other imaging modes. The line-scanning approach produces high-contrast confocal images with nearly the same performance as a flying-spot SLO. The LSLO may significantly enhance SLO utility for routine use by ophthalmologists, optometrists, general practitioners, and also emergency medical personnel and technicians in the field for retinal disease detection and other diverse applications.
Topics: Computer-Aided Design; Equipment Design; Equipment Failure Analysis; Image Enhancement; Image Interpretation, Computer-Assisted; Information Storage and Retrieval; Microscopy, Confocal; Ophthalmoscopes; Reproducibility of Results; Sensitivity and Specificity; Signal Processing, Computer-Assisted
PubMed: 16965154
DOI: 10.1117/1.2335470 -
International Ophthalmology Dec 2022To evaluate fundus examination accuracy of medical students when using an unmodified iPhone X or a direct ophthalmoscope in comparison to a staff ophthalmologist's...
PURPOSE
To evaluate fundus examination accuracy of medical students when using an unmodified iPhone X or a direct ophthalmoscope in comparison to a staff ophthalmologist's retinal examination.
METHODS
In this prospective comparative analysis, patients underwent dilated fundus examination by novice medical trainees using either an unmodified iPhone X or standard direct ophthalmoscope. The primary outcome was the mean difference and degree of agreement in cup-to-disc ratio between student examination and the staff ophthalmologist's cup-to-disc observation.
RESULTS
A total of 18 medical students conducted 230 retinal examinations, 117 with the iPhone X and 113 with the direct ophthalmoscope. A greater proportion of students were unable to report cup-to-disc ratio using the iPhone X (81.2%) vs direct ophthalmoscope (30.1%). Student examination of cup-to-disc ratio led to a systematic bias (95% limits of agreement) of + 0.16 (-0.22 to + 0.54) and + 0.10 (-0.36 to + 0.56) with the iPhone X and direct ophthalmoscope, respectively. iPhone X and direct ophthalmoscope student observation concordance for optic disc colour (88.7 and 82.4%, respectively) and contour (68.3 and 74.2%, respectively) demonstrated low agreement with staff ophthalmologist findings. Student iPhone X observations demonstrated lower agreement with staff findings compared to direct ophthalmoscope observations for spontaneous venous pulsations (Cohen's Kappa = -0.044 vs 0.099).
CONCLUSION
Amongst medical trainees, optic disc visualization using an unmodified iPhone X was inferior to the direct ophthalmoscope. When able to visualize the optic nerve head, there was no significant difference in reported cup-to-disc ratio between modalities. However, both modalities demonstrated poor reliability in comparison to staff ophthalmologist findings.
Topics: Humans; Students, Medical; Reproducibility of Results; Ophthalmoscopy; Ophthalmoscopes; Optic Disk
PubMed: 35871237
DOI: 10.1007/s10792-022-02377-4 -
Clinical Ophthalmology (Auckland, N.Z.) 2023Recent advances in telemedicine have led to increased use of digital ophthalmoscopes (DO) in clinical settings. This review aims to assess commercially available DOs,... (Review)
Review
PURPOSE
Recent advances in telemedicine have led to increased use of digital ophthalmoscopes (DO) in clinical settings. This review aims to assess commercially available DOs, including smartphone (SP), desktop, and handheld ophthalmoscopes, and evaluate their applications.
METHODS
A literature review was performed by searching PubMed (pubmed.ncbi.nlm.nih.gov), Web of Science (webofknowledge.com), and Science Direct (sciencedirect.com). All English-language papers that resulted from the search terms "digital ophthalmoscope", "screening tool", "glaucoma screening", "diabetic retinopathy screening", "cataract screening", and "papilledema screening" were reviewed. Studies that contained randomized clinical trials with human participants between January 2010 and December 2020 were included. The Risk of Bias in Systematic Reviews (ROBIS) tool was used to assess the methodological quality of each included paper.
RESULTS
Of the 1307 studies identified, 35 met inclusion and exclusion criteria. The ROBIS tool determined that 29/35 studies (82.8%) had a low risk of bias, 3/35 (8.5%) had a moderate risk of bias, and 3/35 (8.5%) had a high risk of bias.
CONCLUSION
The continued adoption of DOs remains uncertain because of concerns about the image quality for non-mydriatic eyes and the confidence in data captured from the device. Likewise, there is a lack of guidelines for the use of DOs, which makes it difficult for providers to determine the best device for their practice and to ensure appropriate use. Even so, DOs continue to gain acceptance as technology and practice integration improve, especially in underserved areas with limited access to ophthalmologists.
PubMed: 37822326
DOI: 10.2147/OPTH.S423845