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Progress in Retinal and Eye Research Jan 2019Recent developments in imaging technologies now allow the documentation, qualitative and quantitative evaluation of peripheral retinal lesions. As wide field retinal... (Review)
Review
Recent developments in imaging technologies now allow the documentation, qualitative and quantitative evaluation of peripheral retinal lesions. As wide field retinal imaging, capturing both the central and peripheral retina up to 200° eccentricity, is becoming readily available the question is: what is it that we gain by imaging the periphery? Based on accumulating evidence it is clear that findings in the periphery do not always associate to those observed in the posterior pole. However, the newly acquired information may provide useful clues to previously unrecognised disease features and may facilitate more accurate disease prognostication. In this review, we explore the anatomy and physiology of the peripheral retina, focusing on how it differs from the posterior pole, recount the history of peripheral retinal imaging, describe various peripheral retinal lesions and evaluate the overall relevance of peripheral retinal findings to different diseases.
Topics: Humans; Ophthalmoscopy; Optical Imaging; Retina; Retinal Diseases
PubMed: 30316018
DOI: 10.1016/j.preteyeres.2018.10.001 -
Journal of Biomedical Optics Sep 2018Autofluorescence-based imaging techniques have become very important in the ophthalmological field. Being noninvasive and very sensitive, they are broadly used in... (Review)
Review
Autofluorescence-based imaging techniques have become very important in the ophthalmological field. Being noninvasive and very sensitive, they are broadly used in clinical routines. Conventional autofluorescence intensity imaging is largely influenced by the strong fluorescence of lipofuscin, a fluorophore that can be found at the level of the retinal pigment epithelium. However, different endogenous retinal fluorophores can be altered in various diseases. Fluorescence lifetime imaging ophthalmoscopy (FLIO) is an imaging modality to investigate the autofluorescence of the human fundus in vivo. It expands the level of information, as an addition to investigating the fluorescence intensity, and autofluorescence lifetimes are captured. The Heidelberg Engineering Spectralis-based fluorescence lifetime imaging ophthalmoscope is used to investigate a 30-deg retinal field centered at the fovea. It detects FAF decays in short [498 to 560 nm, short spectral channel (SSC) and long (560 to 720 nm, long spectral channel (LSC)] spectral channels, the mean fluorescence lifetimes (τm) are calculated using bi- or triexponential approaches. These are meant to be relatively independent of the fluorophore's intensity; therefore, fluorophores with less intense fluorescence can be detected. As an example, FLIO detects the fluorescence of macular pigment, retinal carotenoids that help protect the human fundus from light damages. Furthermore, FLIO is able to detect changes related to various retinal diseases, such as age-related macular degeneration, albinism, Alzheimer's disease, diabetic retinopathy, macular telangiectasia type 2, retinitis pigmentosa, and Stargardt disease. Some of these changes can already be found in healthy eyes and may indicate a risk to developing such diseases. Other changes in already affected eyes seem to indicate disease progression. This review article focuses on providing detailed information on the clinical findings of FLIO. This technique detects not only structural changes at very early stages but also metabolic and disease-related alterations. Therefore, it is a very promising tool that might soon be used for early diagnostics.
Topics: Humans; Ophthalmoscopy; Optical Imaging; Retina; Retinal Diseases
PubMed: 30182580
DOI: 10.1117/1.JBO.23.9.091415 -
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 -
Ophthalmic Surgery, Lasers & Imaging :... Jul 2011Photoacoustic ophthalmoscopy (PAOM) is a new retinal imaging technology that offers the unique capability to measure optical absorption in the retina. Because PAOM is... (Review)
Review
Photoacoustic ophthalmoscopy (PAOM) is a new retinal imaging technology that offers the unique capability to measure optical absorption in the retina. Because PAOM is compatible with optical coherence tomography, scanning laser ophthalmoscopy, and autofluorescence imaging, registered multimodal images can be acquired from a single device at comparable resolution for comprehensive anatomic and functional retinal characterizations. Therefore, PAOM is anticipated to have applications in both research and clinical diagnosis of many blinding diseases. The authors explain the basic principles of the photoacoustic effect and imaging. Then, different types of photoacoustic microscopy are introduced and compared. Finally, the current status of photoacoustic imaging in animal eyes is presented and the prospects of future development of PAOM are suggested.
Topics: Animals; Diagnostic Techniques, Ophthalmological; Humans; Ophthalmoscopy; Photoacoustic Techniques; Retina
PubMed: 21790106
DOI: 10.3928/15428877-20110627-10 -
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 -
Scientific Reports Nov 2022To analyze the performance of ultra-wide-field (UWF) fundus photography compared with ophthalmoscopy in identifying and classifying retinal diseases. Patients examined...
To analyze the performance of ultra-wide-field (UWF) fundus photography compared with ophthalmoscopy in identifying and classifying retinal diseases. Patients examined for presumed major retinal disorders were consecutively enrolled. Each patient underwent indirect ophthalmoscopic evaluation, with scleral depression and/or fundus biomicroscopy, when clinically indicated, and mydriatic UWF fundus imaging by means of CLARUS 500™ fundus camera. Each eye was classified by a clinical grader and two image graders in the following groups: normal retina, diabetic retinopathy, vascular abnormalities, macular degenerations and dystrophies, retinal and choroidal tumors, peripheral degenerative lesions and retinal detachment and myopic alterations. 7024 eyes of new patients were included. The inter-grader agreement for images classification was perfect (kappa = 0.998, 95% Confidence Interval (95%CI) = 0.997-0.999), as the two methods concordance for retinal diseases diagnosis (kappa = 0.997, 95%CI = 0.996-0.999) without statistically significant difference. UWF fundus imaging might be an alternative to ophthalmoscopy, since it allows to accurately classify major retinal diseases, widening the range of disorders possibly diagnosed with teleophthalmology. Although the clinician should be aware of the possibility that a minority of the most peripheral lesions may be not entirely visualized, it might be considered a first line diagnostic modality, in the context of a full ophthalmological examination.
Topics: Humans; Ophthalmology; Telemedicine; Ophthalmoscopy; Photography; Fundus Oculi; Retinal Diseases; Diabetic Retinopathy
PubMed: 36369463
DOI: 10.1038/s41598-022-23170-4 -
Vision Research Jul 2011A quarter century ago, we were limited to a macroscopic view of the retina inside the living eye. Since then, new imaging technologies, including confocal scanning laser... (Review)
Review
A quarter century ago, we were limited to a macroscopic view of the retina inside the living eye. Since then, new imaging technologies, including confocal scanning laser ophthalmoscopy, optical coherence tomography, and adaptive optics fundus imaging, transformed the eye into a microscope in which individual cells can now be resolved noninvasively. These technologies have enabled a wide range of studies of the retina that were previously impossible.
Topics: Humans; Microscopy, Confocal; Ophthalmoscopy; Retina; Retinal Cone Photoreceptor Cells; Retinal Vessels; Tomography, Optical Coherence
PubMed: 21596053
DOI: 10.1016/j.visres.2011.05.002 -
CMAJ : Canadian Medical Association... Mar 2012
Review
Topics: Acute Disease; Diagnosis, Differential; Humans; Ophthalmoscopy; Retinal Detachment; Vitreous Detachment
PubMed: 22125334
DOI: 10.1503/cmaj.110686 -
Eye (London, England) Mar 2011To review the ability of current imaging technologies to provide estimates of rates of structural change in glaucoma patients. (Review)
Review
PURPOSE
To review the ability of current imaging technologies to provide estimates of rates of structural change in glaucoma patients.
PATIENTS AND METHODS
Review of literature.
RESULTS
Imaging technologies, such as confocal scanning laser ophthalmoscopy (CSLO), scanning laser polarimetry (SLP), and optical coherence tomography (OCT), provide quantifiable and reproducible measurements of the optic disc and parapapillary retinal nerve fibre layer (RNFL). Rates of change as quantified by the rim area (RA) (for CSLO) and RNFL thickness (for SLP and OCT) are related to glaucoma progression as detected by conventional methods (eg, visual fields and optic disc photography). Evidence shows that rates of RNFL and RA loss are significantly faster in progressing compared with non-progressing glaucoma patients.
CONCLUSION
Measurements of rates of optic disc and RNFL change are becoming increasingly precise and individualized. Currently available imaging technologies have the ability to detect and quantify progression in glaucoma, and their measurements may be suitable end points in glaucoma clinical trials.
Topics: Diagnostic Imaging; Diagnostic Techniques, Ophthalmological; Disease Progression; Glaucoma; Humans; Ophthalmoscopy; Scanning Laser Polarimetry; Tomography, Optical Coherence
PubMed: 21212798
DOI: 10.1038/eye.2010.202 -
Journal of Biomedical Optics 2004Imaging the vitreous is an attempt to view what is by design invisible. The inability to adequately image vitreous hinders a more complete understanding of its normal... (Review)
Review
Imaging the vitreous is an attempt to view what is by design invisible. The inability to adequately image vitreous hinders a more complete understanding of its normal structure and function and how these change in aging and disease. The combined use of more than one technique could provide better imaging for investigational and clinical purposes. Past and present imaging methodologies are summarized and research and clinical techniques that are currently in development for future applications, are discussed. Dark-field slit microscopy has been used to characterize vitreous anatomy, both within the vitreous body as well as at the vitreo-retinal interface. In addition to this methodology, slit-lamp biomicroscopy; direct, indirect, and scanning laser ophthalmoscopies; ultrasonography; optical coherence tomography; magnetic resonance and Raman spectroscopies; and dynamic light-scattering methodologies for noninvasive evaluation are presented. Dark-field slit microscopy enables in vitro imaging without dehydration or tissue fixatives. Optical coherence tomography enables better in vivo visualization of the vitreo-retinal interface than scanning laser ophthalmoscopy and ultrasonography, but does not image the vitreous body. Dynamic light scattering can determine the average sizes of vitreous macromolecules within the vitreous body as well as possibly image the posterior vitreous cortex once detached, while Raman spectroscopy can detect altered vitreous molecules, such as glycated collagen and other proteins in diabetic vitreopathy.
Topics: Eye Diseases; Humans; Ophthalmoscopes; Ophthalmoscopy; Photometry; Scattering, Radiation; Spectrum Analysis; Tomography, Optical Coherence; Ultrasonography; Vitreous Body
PubMed: 14715056
DOI: 10.1117/1.1627339