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Indian Journal of Ophthalmology Feb 2022To compare multicolor imaging (MCI) with Optos color fundus photography (OCFP) for the evaluation of morphology and extent of preretinal membranes in diabetic tractional...
PURPOSE
To compare multicolor imaging (MCI) with Optos color fundus photography (OCFP) for the evaluation of morphology and extent of preretinal membranes in diabetic tractional retinal detachments (TRD).
METHODS
In this retrospective study, 30 eyes with diabetic TRDs were imaged using the MCI feature of the Heidelberg Spectralis Spectral-domain optical coherence tomography (SD-OCT) and color photo using the Optos Daytona ultra-widefield fundus camera. Two investigators independently graded and determined the agreeability between the two modalities with respect to the extent of the TRD and preretinal membranes on the SD-OCT B-scan images.
RESULTS
The MCI provided better visualization of the attachments and traction points of the posterior hyaloid face and preretinal membranes and is comparable to the SD-OCT B-scan images. The inter-rater agreeability rates for OCFP had a Kappa (κ) value of 0.37, while the MCI had a κ value of 0.46. When comparing between images of different wavelengths, grading using infrared reflectance (IR) had a poor agreement (-0.04 ± 0.04) while green reflectance (GR) (0.46 ± 0.32) and blue reflectance (BR) (0.53 ± 0.19) had a moderate agreement. The composite MCI and GR images also had comparatively higher intraclass coefficient when compared to the OCFP (0.25 [-0.09-0.55]) and IR (-0.03 [-0.39-0.34]) images.
CONCLUSION
MCI is more sensitive for determining the extent of TRDs and for the detection of secondary membranes when compared to OCFP, thus, aiding in better surgical planning.
Topics: Fluorescein Angiography; Fundus Oculi; Humans; Ophthalmoscopy; Retinal Detachment; Retrospective Studies; Tomography, Optical Coherence
PubMed: 35086217
DOI: 10.4103/ijo.IJO_1289_21 -
Retinal Cases & Brief Reports 2015To describe photoreceptor structure and recovery after macular hole (MH) closure with pars plana vitrectomy (PPV) using adaptive optics scanning light ophthalmoscopy and...
PURPOSE
To describe photoreceptor structure and recovery after macular hole (MH) closure with pars plana vitrectomy (PPV) using adaptive optics scanning light ophthalmoscopy and spectral domain optical coherence tomography.
METHODS
A pilot imaging study of four eyes from four subjects undergoing PPV for MH was conducted. Imaging with spectral domain optical coherence tomography and adaptive optics scanning light ophthalmoscopy was performed at varying time points after PPV.
RESULTS
Despite successful MH closure, disruption of the foveal inner segment ellipsoid zone was seen in all patients when imaged at a mean of 117 days after PPV. Disruption of the photoreceptor mosaic was seen using adaptive optics scanning light ophthalmoscopy at locations corresponding to regions of ellipsoid zone disruption on spectral domain optical coherence tomography. Cone density immediately surrounding these disruptions was normal, except for one patient. In 2 patients who were imaged serially up to 516 days after PPV, recovery of cone cells within regions of mosaic disruption could be detected over time.
CONCLUSION
Photoreceptor disruption exists even after apparent MH closure. Remodeling of the foveal cone mosaic continues for many months after surgery, perhaps accounting for the delayed postoperative improvements of visual acuity in some patients. Spectral domain optical coherence tomography and adaptive optics scanning light ophthalmoscopy are useful tools for monitoring photoreceptor recovery after surgical closure of MH.
Topics: Fovea Centralis; Humans; Middle Aged; Ophthalmoscopy; Pilot Projects; Retinal Cone Photoreceptor Cells; Retinal Perforations; Tomography, Optical Coherence; Vitrectomy
PubMed: 25525907
DOI: 10.1097/ICB.0000000000000117 -
Experimental Biology and Medicine... Feb 2021Quantitative retinal imaging is essential for advanced study and clinical management of eye diseases. However, spatial resolution of retinal imaging has been limited due... (Review)
Review
Quantitative retinal imaging is essential for advanced study and clinical management of eye diseases. However, spatial resolution of retinal imaging has been limited due to available numerical aperture and optical aberration of the ocular optics. Structured illumination microscopy has been established to break the diffraction-limit resolution in conventional light microscopy. However, practical implementation of structured illumination microscopy for ophthalmoscopy of the retina is challenging due to inevitable eye movements that can produce phase artifacts. Recently, we have demonstrated the feasibility of using virtually structured detection as one alternative to structured illumination microscopy for super-resolution imaging. By providing the flexibility of digital compensation of eye movements, the virtually structured detection provides a feasible, phase-artifact-free strategy to achieve super-resolution ophthalmoscopy. In this article, we summarize the technical rationale of virtually structured detection, and its implementations for super-resolution imaging of freshly isolated retinas, intact animals, and awake human subjects.
Topics: Animals; Eye Diseases; Humans; Microscopy; Ocular Physiological Phenomena; Ophthalmoscopy; Retina
PubMed: 33243006
DOI: 10.1177/1535370220970533 -
Ophthalmologica. Journal International... 2011Advances in retinal imaging technology have largely contributed to the understanding of the natural history, prognostic markers and disease mechanisms of geographic... (Review)
Review
Advances in retinal imaging technology have largely contributed to the understanding of the natural history, prognostic markers and disease mechanisms of geographic atrophy (GA) due to age-related macular degeneration. There is still no therapy available to halt or slow the disease process. In order to evaluate potential therapeutic effects in interventional trials, there is a need for precise quantification of the GA progression rate. Fundus autofluorescence imaging allows for accurate identification and segmentation of atrophic areas and currently represents the gold standard for evaluating progressive GA enlargement. By means of high-resolution spectral-domain optical coherence tomography, distinct microstructural alterations related to GA can be visualized.
Topics: Fluorescein Angiography; Geographic Atrophy; Humans; Lasers; Macular Degeneration; Ophthalmoscopy; Tomography, Optical Coherence
PubMed: 21865677
DOI: 10.1159/000330420 -
Indian Journal of Ophthalmology Aug 2022To compare image characteristics of retinal nerve fiber layer (RNFL) between glaucoma patients and healthy controls using adaptive optics scanning laser ophthalmoscopy...
PURPOSE
To compare image characteristics of retinal nerve fiber layer (RNFL) between glaucoma patients and healthy controls using adaptive optics scanning laser ophthalmoscopy (AOSLO).
METHODS
This was a cross-sectional pilot study with two groups: a glaucoma group with patients with moderate or severe glaucoma as per the Hodapp-Parrish-Anderson classification system and a control group with healthy individuals. The optic nerve damage in moderate glaucoma was predominantly located in only one hemisphere; the other hemisphere was un- or minimally affected on optical coherence tomography and automated perimetry and is referred to as early glaucoma. The structure of RNFL bundles and gain (%) in RNFL images with mean pixel values between 15 and 35 were analyzed. Imaging was performed one degree away from the optic disc margin at two and four cardinal clock positions in the glaucoma and control groups, respectively. The field of view was 1.3° at 2.3 μ resolution. We studied one eye per participant.
RESULTS
There were 11 glaucoma patients and 7 healthy controls. Imaging was successful at 88% of the locations in controls and early glaucoma; the reflectivity differed significantly (0.51 and 0.56, respectively, P < 0.001) but not the structure of RNFL bundles (Cohen's Kappa 0.11) between them. In patients with moderate and severe glaucoma, imaging was successful only at 46% of the locations; RNFL bundles were not discernible, and RNFL reflectivity did not differ from those with early glaucoma (P < 0.11).
CONCLUSION
The recorded gain (%) of RNFL images obtained using AOSLO could be an objective indicator of early glaucoma.
Topics: Cross-Sectional Studies; Early Diagnosis; Glaucoma; Humans; Lasers; Nerve Fibers; Ophthalmoscopy; Pilot Projects; Tomography, Optical Coherence
PubMed: 35918935
DOI: 10.4103/ijo.IJO_1044_21 -
Investigative Ophthalmology & Visual... Jan 2022To characterize the structure and function of patches of dysflective cones in the foveal region of subjects with normal vision and no known pathology. Dysflective cones...
PURPOSE
To characterize the structure and function of patches of dysflective cones in the foveal region of subjects with normal vision and no known pathology. Dysflective cones are cones that have little or no reflective properties in optical coherence tomography (OCT) or adaptive optics scanning laser ophthalmoscope (AOSLO) images yet exhibit measurable function.
METHODS
AOSLO images were surveyed for the presence of hyporeflective cone patches, and subjects were brought back for imaging to determine the changes in the hyporeflective region. Adaptive optics microperimetry (AOMP) was used to assess the function of hyporeflective patches in four subjects to determine that they did, in fact, contain dysflective cones. AOMP utilized a stimulus size of less than 1 arcmin to measure thresholds inside and outside the hyporeflective region.
RESULTS
Nineteen out of 47 individuals retrospectively reviewed had one or more regions with hyporeflective cone patches in one or both eyes. Ten subjects with hyporeflective cone patches were brought back for imaging. Seven of the 10 had resolved at follow up, and in three subjects new hyporeflective patches appeared in a different location. All AOMP-measured subjects had measurable function in the dysflective cone region. Three out of four subjects showed no difference in light sensitivity in the dysflective region compared to adjacent areas, and one subject showed a 3× reduction in sensitivity in the area.
CONCLUSIONS
Patches of dysflective cone have been identified in subjects with normal vision and no known pathology, and we have observed instances where dysflective cones in these subjects regain normal reflective properties.
Topics: Adult; Fovea Centralis; Humans; Male; Middle Aged; Ophthalmoscopy; Optics and Photonics; Retinal Cone Photoreceptor Cells; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity
PubMed: 35072690
DOI: 10.1167/iovs.63.1.29 -
MedEdPORTAL : the Journal of Teaching... 2022Ophthalmology education has been underemphasized in medical school curricula despite the fact that patient eye-related complaints are commonplace across primary care...
INTRODUCTION
Ophthalmology education has been underemphasized in medical school curricula despite the fact that patient eye-related complaints are commonplace across primary care specialties. Although previous curricula used direct ophthalmoscopy to teach medical students the fundamentals of ophthalmic examination, there has been a growing call to teach these fundamentals through reading fundus photos due to the increasing prevalence and decreased costs of fundus cameras in primary care settings. We developed a virtual workshop to teach ophthalmoscopy to medical students using fundus photography.
METHODS
First-year medical students were enrolled in a 2-hour, synchronous, virtual ophthalmoscopy workshop as part of an advanced physical exam curriculum at the University of Pittsburgh School of Medicine. Students participated in a pretest, introductory lecture, interactive small-group session, and posttest. Breakout groups were led by senior medical students or residents. We compared pre- and posttest results for improved understanding of concepts covered in the workshop.
RESULTS
Of 147 students, the average scores on the pretest and posttest were 39% and 75%, respectively ( < .01). Students were significantly more confident in their ability to identify various pathologies on fundus photography. After the workshop, the student preceptors indicated increased comfort in a teaching role and greater interest in medical education. The preceptors were also more confident in their own ability to interpret fundus photography and in their understanding of various ocular pathologies.
DISCUSSION
Our virtual, interactive workshop is effective in teaching medical students a systematic approach to the interpretation of fundus photographs.
Topics: Curriculum; Eye Diseases; Fundus Oculi; Humans; Ophthalmology; Ophthalmoscopy; Students, Medical
PubMed: 35692603
DOI: 10.15766/mep_2374-8265.11252 -
Ophthalmic Surgery, Lasers & Imaging... Oct 2019Ultra-widefield fundus imaging (UWFI) is a relatively new technology capable of capturing 200° images of the retina. Since vision changes can be irreversible in... (Review)
Review
Ultra-widefield fundus imaging (UWFI) is a relatively new technology capable of capturing 200° images of the retina. Since vision changes can be irreversible in diabetic retinopathy (DR), recognition of prognostic biomarkers in the peripheral retina may prove invaluable toward optimizing the management and reducing the societal burden of this blinding disease. Following a bibliographic review using Pubmed, OVID Medline, Embase, and the Cochrane Library, the current review systematically examined 13 studies that compared UWFI to conventional screening techniques such as seven standard field (7SF) Early Treatment In Diabetic Retinopathy Study (ETDRS) and non-mydriatic multifield fundus photography (NMFP), as well as their scientific level of evidence. Overall, UWFI had good agreement with 7SF ETDRS and NMFP, and moderate agreement with dilated fundus examination. Seven additional studies were examined that considered the significance of peripheral lesions found on UWFI. These studies demonstrated that UWFI captured additional DR pathology in the peripheral retina that may not be evident if evaluation is limited to the posterior pole and may be relevant to patient outcomes. Future directions include but are not limited to the potential of UWFI to track the progression of DR with treatment. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:639-648.].
Topics: Diabetic Retinopathy; Disease Progression; Early Diagnosis; Humans; Ophthalmoscopy; Photography
PubMed: 31671197
DOI: 10.3928/23258160-20191009-07 -
Journal of Biophotonics Jun 2013Photoacoustic ophthalmoscopy (PAOM) is a novel imaging technology that measures optical absorption in the retina. The capability of PAOM can be further enhanced if it...
Photoacoustic ophthalmoscopy (PAOM) is a novel imaging technology that measures optical absorption in the retina. The capability of PAOM can be further enhanced if it could image mouse eyes, because mouse models are widely used for various retinal diseases. The challenges in achieving high-quality imaging of mouse retina, however, come from the much smaller eyeball size. Here, we report an optimized imaging system, which integrates PAOM, spectral-domain optical coherence tomography (SD-OCT), and autofluorescence-scanning laser ophthalmoscopy (AF-SLO), for mouse eyes. Its multimodal capability was demonstrated by imaging transgenic Nrl-GFP mice that express green fluorescent protein (GFP) in photoreceptors. SD-OCT provided guidance of optical alignment for PAOM and AF-SLO, and complementary contrast with high depth-resolution retinal cross sections. PAOM visualized the retinal vasculature and retinal pigment epithelium melanin, and AF-SLO measured GFP-expressing in retinal photoreceptors. The in vivo imaging results were verified by histology and confocal microscopy.
Topics: Animals; Fundus Oculi; Mice; Mice, Transgenic; Multimodal Imaging; Ophthalmoscopy; Photoacoustic Techniques; Tomography, Optical Coherence
PubMed: 22649053
DOI: 10.1002/jbio.201200061 -
BMJ (Clinical Research Ed.) Jul 2005To evaluate the additional value of funduscopy in the routine management of patients with hypertension. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate the additional value of funduscopy in the routine management of patients with hypertension.
DESIGN
Systematic review.
PARTICIPANTS
Adults aged 19 or more with hypertensive retinopathy.
DATA SOURCES
Medline, Embase, and the Cochrane Library from 1990.
REVIEW METHODS
Studies were included that assessed hypertensive retinopathy with blinding for blood pressure and cardiovascular risk factors. Studies on observer agreement had to be assessed by two or more observers and expressed as a kappa statistic. Studies on the association between hypertensive retinopathy and hypertensive organ damage were carried out in patients with hypertension. The association between hypertensive retinopathy and cardiovascular risk was carried out in unselected normotensive and hypertensive people without diabetes mellitus.
RESULTS
The assessment of microvascular changes in the retina is limited by large variation between observers. The positive and negative predictive values for the association between hypertensive retinopathy and blood pressure were low (47% to 72% and 32% to 67%, respectively). Associations between retinal microvascular changes and cardiovascular risk were inconsistent, except for retinopathy and stroke. The increased risk of stroke, however, was also present in normotensive people with retinopathy. These studies did not adjust for other indicators of hypertensive organ damage.
CONCLUSION
Evidence is lacking that routine funduscopy is of additional value in the management of hypertensive patients.
Topics: Adult; Aged; Blood Pressure; Cardiovascular Diseases; Diagnostic Tests, Routine; Humans; Hypertension; Microcirculation; Middle Aged; Observer Variation; Ophthalmoscopy; Retinal Diseases; Retinal Vessels; Risk Factors
PubMed: 16002881
DOI: 10.1136/bmj.331.7508.73