Eyesi direct ophthalmoscope simulator: an effective training tool for medical undergraduates.

INTRODUCTION: Non-ophthalmologists often lack sufficient operational training to use a direct ophthalmoscope proficiently, resulting in a global deficit of basic ophthalmological skills among general practitioners. This deficiency hampers the timely diagnosis, referral, and intervention of patients. Consequently, the optimization of teaching tools and methods to enhance teaching efficiency is imperative. This study explores the effectiveness of the Eyesi Direct Ophthalmoscope Simulator (Eyesi) as an innovative tool for fundus examination training. METHODS: Medical undergraduates were randomly assigned to Group A or B (n = 168). All participants completed a pre-training questionnaire. Group A received Eyesi training, while Group B underwent traditional direct ophthalmoscope (TDO) training. Subsequently, participants answered questionnaires relevant to their respective training methods. Both groups exchanged training tools and completed a summary questionnaire. RESULTS: After training, 54.17% of participants believed that images presented by the Eyesi were consistent with the real fundus. Group A scored significantly higher than Group B in fundus structure recognition and self-confidence in examination. The degree of mastery over fundus theory score increased from 6.10 ± 0.13 to 7.74 ± 0.16 (P < 0.001) in Group A, but Group B did not demonstrate a significant difference. We also compared undergraduates' tendencies for different learning purposes, 75.59% of participants preferred the Eyesi to TDO as a training tool, and 88.41% of participants were receptive to introducing the Eyesi in training. CONCLUSION: According to subjective participant feedback, Eyesi outperformed TDO in fundus observation, operational practice, and theoretical learning. It effectively equips undergraduates with fundus examination skills, potentially promoting the use of direct ophthalmoscopes in primary medical institutions.

Sex Difference in the Association between Depression and Adherence to Recommended Dilated Eye Examinations among Patients with Diabetes: Findings from National Health and Nutrition Examination Survey.

INTRODUCTION: The relationship between depression and adherence to regular dilated fundus examination (DFE) in patients with diabetes remains unclear. This study aimed to assess the association between depression and adherence to annual or biennial DFE among individuals with diabetes. METHODS: In this cross-sectional study, we used the National Health and Nutrition Examination Survey database from 2005 to 2016 which contains information on demographics, clinical characteristics, health-related factors, and the time since last DFE. Participants were classified as having depression based on a score of >9 on the Patient Health Questionnaire-9. The main outcomes were the association between depression and the adherence of patients with diabetes to annual or biennial DFE. The second objective was to explore the potential influence of gender in this association. The independent association of depression with DFE compliance was explored by a series of multivariate logistic regression analyses (overall sample and then stratified by sex). RESULTS: In total, 3,656 eligible participants were identified. The adherence rates to annual or biennial DFE were all higher for participants without depression than those with depression (64.8% vs. 56.1% and 80.3% vs. 69.7%, respectively). In the multivariate analyses, depression was neither independently associated with the adherence to annual DFE nor biennial DFE in the overall sample. An interaction was observed between depression and gender for the adherence to annual or biennial DFE (p = 0.017 and p = 0.026, respectively). When analyses were stratified by sex, female patients with diabetes and depression had a significantly increased odds ratio (OR) of being nonadherent to annual and biennial DFE (OR = 1.52, 95% confidence interval [CI]: 1.02-2.25, p = 0.039; OR = 1.55, 95% CI: 1.02-2.35, p = 0.039, respectively). However, this relationship was not evident in men with diabetes. CONCLUSIONS: The independent association between depression and DFE compliance varied by sex, that is, only female patients with diabetes and depression were at a higher risk of nonadherence to annual or biennial DFE compared to those without depression.

Overview of the retina and imaging in patients with severe acute respiratory syndrome coronavirus 2.

INTRODUCTION: The role of the human eye in severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is still under investigation. The pathophysiology of the ocular findings is arduous when dealing with critically ill Covid-19 patients with comorbidities. Multiorgan involvement and the effects of inflammation, infection and systemic treatment on the retina are complex, and comparison of studies is difficult. Most studies in human patients have investigated the anterior segment, whereas few reports deal with the posterior segment of the eye. The present review aims to evaluate the retinal manifestations and imaging features in COVID-19 patients. METHODS: Studies on the retinal manifestations and retinal imaging in COVID-19 patients published through June 2021 were reviewed. We included cross-sectional and case-control studies, case series, case reports and correspondence in the analysis. RESULTS: Flame-shaped hemorrhages, cotton wool spots, augmented diameter and tortuosity of retinal vessels were found on funduscopic examination. Peripapillary, macular retinal nerve fiber layer and ganglion cell layer thickness alterations were reported on spectral domain optical coherence tomography. Reduced vessel density of the superficial and deep retinal capillary plexus on optical coherence tomography angiography was reported. CONCLUSIONS: Retinal complications may arise in COVID-19 patients. Although no consensus on presentation is currently available, retinal funduscopy and imaging has shown neuronal and vascular alterations. Systemic neurological complications and microangiopathy are associated with SARS-COV-2; thus, as the retina has a neuronal and vascular component, funduscopy and retinal imaging on COVID-19 patients can provide further insight to SARS-COV-2 disease and the follow-up of patients.

Comparison of conventional and wide field direct ophthalmoscopy on medical students' self-confidence for fundus examination: a 1-year follow-up.

BACKGROUND: Fundus examination is an easy, quick and effective way to diagnose sight- and life-threatening diseases. However, medical students and physicians report lack of proficiency and self-confidence in perform fundoscopy. The aim of this study was to compare students' self-confidence in fundus examination, using two different direct ophthalmoscopes, 1 month and 1 year after practical training. METHODS: In this prospective cohort, medical students (MS) of the same class were divided in small groups for PanOptic (PO) or conventional (CO) direct ophthalmoscope training. The intervention group encompassed MS of the 4th -year (class of 2019), and the control group encompassed MS of year behind (class of 2020). A questionnaire to measure self-confidence in fundoscopy technique assessing optic nerve, cup-to-disc ratio and macula was translated and validated to Portuguese, and applied 1-month and 1-year after practical training. RESULTS: One-hundred and sixty-seven MS were enrolled (35 PO group, 38 CO group, and 94 control group). PO group had a significantly higher overall self-confidence comparing either control or CO groups, respectively (3.57 ± 0.65 vs. 2.97 ± 1.03 vs. 2.46 ± 0.87, p < 0.01) as well as in evaluate cup-to-disc ratio (3.09 ± 0.75 vs. 2.32 ± 0.87 vs. 1.46 ± 0.81, p < 0.01), optic disc margins (3.26 ± 0.85 vs. 2.71 ± 0.96 vs. 2.01 ± 0.97, p < 0.01) and macula (3.43 ± 1.12 vs. 2.89 ± 1.08 vs. 2.02 ± 0.89, p < 0.01) 1-month after practical training. One-year after intervention, CO group showed a significantly higher score compared to PO group in overall self-confidence (3.31 ± 0.69 vs. 3.18 ± 0.73, p = 0.03) and in optic disc margins assessing (3.16 ± 0.85 vs. 2.95 ± 0.78, p = 0.03), but not significant in the evaluation of cup-to-disc ratio (2.78 ± 0.97 vs. 2.68 ± 0.94, p = 0.08), and macula (3.34 ± 0.79 vs. 3.27 ± 0.98, p = 0.07). CONCLUSIONS: Students were more confident in use PO as an instrument to perform direct ophthalmoscopy immediately after practical training, but confidence level of CO was higher compared to PO one year after practical training. These findings would help medical schools decide which ophthalmoscope to choose to teach fundus examination.

Resilience, anxiety and depression, coping style, social support and their correlation in parents of premature infants undergoing outpatient fundus examination for retinopathy of prematurity.

Retinopathy of prematurity (ROP) has become the main cause of blindness in children. To study resilience, anxiety and depression, coping style and social support and their correlation in parents of premature infants undergoing outpatient fundus examination for ROP, and thereby provide evidence for clinical intervention. Questionnaire surveys were conducted by using General Information Questionnaire, Connor-Davidson Resilience Scale, Self-rating Anxiety Scale, Self-rating Depression Scale, Social Support Scale, and the Simplified Coping Style Questionnaire. The resilience in the parents scored (63.24 ± 12.97) points, which was lower than that of Chinese norm (t = 2.309, P < 0.05). The scores of anxiety and depression were higher than those of Chinese norm (t = 12.592, t = 2.362, both P < 0.05). The score of social support was lower than that of Chinese norm (t = 3.793, p < 0.01). Resilience was negatively correlated with anxiety and depression (r = -0.287, -0.358, both P < 0.01), and positively correlated with coping tendency and social support (r = 0.299, 0.139, both P < 0.05). These findings suggested that the parents have low resilience, high levels of anxiety and depression, and low level of social support. Medical staff should assess and improve their psychological status.

Awareness of diabetic retinopathy among diabetic patients.

OBJECTIVE: To assess the awareness of diabetic patients about diabetic retinopathy. METHODS: The cross-sectional study was conducted at the Ophthalmology Department, Fauji Foundation Hospital, Rawalpindi, Pakistan, from April 2018 to April 2019, and comprised diabetic patients of either gender aged 21-80 years. A pre-tested semi-structured questionnaire was used to collect data on socio-demographic, diabetes and diabetic retinopathy characteristics. Fundoscopic examination was done, and the presence and stage of diabetic retinopathy were documented. Data was analysed using SPSS 20. RESULTS: Of the 132 subjects, 9(6.8%) were male and 123(93.2%) were females. The majority 64(48.5%) was aged 61-80 years. Overall, 74(56.1%) patients were aware that diabetes could affect their eyes, 57(43.2%) were never diagnosed with diabetic retinopathy, 76(57.6%) had gained information about diabetic retinopathy from ophthalmologists, 61(46.2%) and 29(22%) respondents reported that eyes should be examined 'only when vision is affected' and 'every 6 months' respectively, 98(74.2%) said the biggest barrier in getting eyes examined earlier was 'lack of knowledge', 23(17.4%) believed surgery was done for diabetic retinopathy treatment and 33(25%) believed that surgery, laser and injections all can be used. Significant relationship of diabetic retinopathy was found with duration of diabetes and the general health status (p<0.05). CONCLUSIONS: Though more than half the patients were aware that diabetes could affect the eyes, awareness of diabetic retinopathy and its consequences was low.

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OBJECTIVES: Idiopathic intracranial hypertension (IIH) is a syndrome that excludes secondary causes such as intracranial space-occupying lesion, hydrocephalus, cerebrovascular disease, and hypoxic ischemic encephalopathy. If not be treated promptly and effectively, IIH can cause severe, permanent vision disability and intractable, disabling headache. This study aims to explore the clinical and image features for IIH, to help clinicians to understand this disease, increase the diagnose rate, and improve the outcomes of patients. METHODS: We retrospectively analyzed 15 cases of IIH that were admitted to Xiangya Hospital, Central South University, during January 2015 to September 2020. The diagnosis of IIH was based on the updated modified Dandy criteria. We analyzed clinical data of patients and did statistical analysis, including age, gender, height, weight, medical history, physical examination, auxiliary examination, treatment and outcome. RESULTS: There were 10 females and 5 males. Female patients were 22 to 42 years old with median age of 39.5. Male patients were 27 to 52 years old with the median age of 44.0. The BMI was 24.14-34.17 (28.71±2.97) kg/m2. All patients had a BMI above the normal range (≥24 kg/m2), among them 10 cases (66.7%) were obese, and 5 cases (33.3%) were overweight. Eleven cases (73.3%) had headache, and 8 cases (53.3%) had persistent visual loss of different severity. Other symptoms included paroxysmal amaurosis (2 cases), tinnitus (3 cases), horizontal diplopia (2 cases), unilateral peripheral facial paralysis (2 cases), and unilateral blepharoptosis (1 case). Iron-deficiency anemia was found in 3 patients. One of them fully recovered from IIH after the correction of anemia. Other comorbidities included hypertension (8 cases) and polycystic ovarian syndrome (1 case). Fourteen patients assessed blood lipid profile, and all of them had abnormity. Nervous system signs included cervical rigidity (2 cases), limited abduction of eyeball (6 cases), peripheral facial paralysis (2 cases), and blepharoptosis (1 case). Cerebral spinal fluids of all patients had normal cell count, chemical component, Gram's stain, acid-fast stain, and India ink stain. Typical image signs suggesting that IIH could be seen in some patients, including empty sella (5 cases, 33.3%) or partially empty sella (4 cases, 26.7%), distension of perioptic subarachnoid space (3 cases, 20%), flattening of the posterior sclera (5 cases, 33.3%), intraocular protrusion of the optic papilla (7 cases, 46.7%), and enhancement of the optic papilla (2 cases, 13.3%). Ophthalmic exam showed all patients had bilateral papilledema. After diagnosed as IIH, all patients received individualized dehydration treatment to reduce the intracranial hypertension. Three patients received the ventriculo-peritoneal shunt operation. Most patients had good outcome after treatment. For 2 patients, visual impairment was poorly recovered. CONCLUSIONS: IIH primarily affects women of childbearing age who are overweight. The major hazard of IIH is the severe and permanent visual loss. Typical image signs have high specificity in IIH diagnosis. Prompt diagnosis and effective treatment are significantly important to improve the outcomes of patients.

Retinopathy Analysis Based on Deep Convolution Neural Network.

At medical checkups or mass screenings, the fundus examination is effective for early detection of systemic hypertension, arteriosclerosis, diabetic retinopathy, etc. In most cases, ophthalmologists and physicians grade retinal images by the condition of the blood vessels, lesions. However, human observation does not provide quantitative results, thus blood vessel analysis is an important process in determining hypertension and arteriosclerosis, quantitatively. This chapter describes the latest automated blood vessel extraction using the deep convolution neural network (DCNN). Diabetic retinopathy is a common cardiovascular disease and a major factor in blindness. Therefore, early detection of diabetic retinopathy is very important to preventing blindness. A microaneurysm is an initial sign of diabetic retinopathy, and much research has been conducted for microaneurysm detection. This chapter also describes diabetic retinopathy detection and automated microaneurysm detection using the DCNN.

Algorithm for predicting threshold retinopathy of prematurity is insufficient and fundus examinations are still needed before 31 weeks.

AIM: We evaluated the weight, insulin-like growth factor-1, neonatal, retinopathy of prematurity (WINROP) algorithm for very premature infants. METHOD: Infants born before 32 weeks who had undergone fundus examinations in the neonatal intensive care unit at the University Hospital of Nancy were included in this French retrospective cohort study from July 2012 to July 2016. We evaluated how well the WINROP software predicted threshold retinopathy of prematurity (ROP). RESULTS: We studied 570 infants with a mean gestational age of 28.7 ± 1.8 weeks and a mean birth weight of 1110 ± 297 g: 28.1% had ROP and 1.2% had threshold ROP. The overall WINROP sensitivity was 57.1%, specificity was 46.0%, predictive positive value was 1.3% and predictive negative value was 98.9%. At more than 30 weeks of gestation or 1250 g, these figures rose to a respective specificity of 100% and 95.7% and respective predictive negative value of 100% and 100%. There were independent associations between the severity of ROP and the Apgar score at five minutes, the duration of oxygen therapy and non-invasive ventilation. CONCLUSION: WINROP worked better on preterm infants born from 31 weeks onwards or weighing over 1250 g. Fundus examinations remain necessary for infants born earlier or lighter.

The efficacy and safety of Retcam in detecting neonatal retinal hemorrhages.

BACKGROUND: To investigate the ability of characterizing neonatal retinal hemorrhage (RH) using RetCam in healthy newborns and the systemic effects during the procedure. METHODS: This prospective study enrolled 68 healthy newborns aged 2 to 4 days old. The RH was imaged and classified according to the location and numbers of hemorrhages. The heart rate (HR), respiration rate (RR), and oxygen saturation (OS) were recorded at 4 time points before (Phase 1, P1), during (P2 and P3) and after the examination (P4). RESULTS: The median exam time was 151 s. RH was present in 15 infants and 23 eyes. All 23 eyes had hemorrhage in Zone II. Grade II and III hemorrhages were present in 5 and 18 eyes, respectively. The HR increased to 168 beats per minute (bpm) in P3 and recovered to 122.5 bpm in P4. The RR increased to 38 bpm in P3 and recovered to 25 bpm in P4. The OS was reduced to 83% in P2 and recovered to 96% in P4. CONCLUSIONS: RH in healthy newborns, mostly present in Zone II with grade II and III, can be characterized in detail by RetCam. Systemic effects during the process are mild and can be revolved spontaneously.

Examination strategies of experienced and novice clinicians viewing the retina.

PURPOSE: Expertise in viewing medical images is thought to be due to the ability to process holistic image information. Eye care clinicians can inspect photographs of the retina to search for signs of disease. However, they commonly also view the eye in vivo using the restricted view of a slit lamp, which removes the potential benefits of holistic processing. We investigated how expert and novice clinicians inspect the fundus using these two methods. METHODS: Twenty clinicians (10 experienced, 10 novices) examined 64 photographs of human retinae. Each participant viewed half of the images as fundus photographs while having their eye position recorded. The other half were viewed via a simple slit lamp simulation, whereby a computer mouse was used to control the position of a viewing window that revealed the underlying fundus photograph. RESULTS: Experienced clinicians made decisions significantly faster than novices, with faster decision-making when viewing the fundus photograph compared to via the slit lamp simulation. The distribution of inspection was similar, although novices spent longer examining the optic nerve head than other regions. Experienced clinicians showed significantly earlier inspection of the optic nerve head when it was judged to be unhealthy. CONCLUSIONS: Our results support the idea that experienced eyecare clinicians use holistic image information, if available, when inspecting the fundus. This was particularly prominent for the optic nerve head region, which was the region that novices spent most of their time examining. Holistic processing benefits were only present in experts' free-viewing fundus photographs; the limited field of view from the slit lamp disrupts such global image benefits.

Papillary Traction Due to the Posterior Form of a Bilateral Persistent Fetal Vasculature Mimicking Papilledema.

Persistent fetal vasculature (PFV), or persistent hyperplastic primary vitreous (PHPV), is a congenital developmental disorder characterized by a failure of resorption of the hyaloid system. It typically presents unilaterally and has three forms: anterior, posterior, and mixed. In this case report, a seven-year-old patient, without specific personal or family medical history, was referred from the pediatric department for bilateral papilledema. The patient had a best-corrected visual acuity of 20/20 (Logarithmic Measure of Angle of Resolution (LogMAR): 0) in both eyes. Fundus examination of both eyes revealed congested pseudopapilledema with a short, mobile, brownish band extending from the optic disc towards the vitreous cavity. Ocular ultrasound of both eyes showed a fine hyperechoic line pulling on the optic nerve head, and papillary optical coherence tomography (OCT) showed a papillary traction syndrome. The diagnosis of a posterior and bilateral form of persistent fetal vasculature with papillary traction was established.

Patients with Type 2 Diabetes, Higher Blood Pressure, and Infrequent Fundus Examinations Have a Higher Risk of Sight-Threatening Retinopathy.

Background: Diabetic retinopathy (DR) is the most common cause of preventable blindness among working-age adults. This study aimed to evaluate the impact of the regularity of fundus examinations and risk factor control in patients with type 2 diabetes (T2DM) on the prevalence and severity of DR. Methods: One hundred and fifty-six T2DM patients were included in this cross-sectional study. Results: In this sample, the prevalence of DR was 46.2%. Patients with no DR mainly did not examine the fundus regularly, while most patients with mild/moderate nonproliferative DR (NPDR) underwent a fundus examination regularly. In 39.7% of patients, this was the first fundus examination due to diabetes, and 67% of them had sight-threatening DR (STDR). Diabetes duration (p = 0.007), poor glycemic control (HbA1c) (p = 0.006), higher systolic blood pressure (SBP) (p < 0.001), and diastolic blood pressure (DBP) (p = 0.002) were the main predictors of DR. However, the impact of SBP (AOR 1.07, p = 0.003) and DBP (AOR 1.13, p = 0.005) on DR development remained significant even after adjustment for diabetes duration and HbA1c. The DR prevalence was higher in patients with higher blood pressure (≥130/80 mmHg) than in those with target blood pressure (<130/80 mmHg) (p = 0.043). None of the patients with target blood pressure had STDR. The peaks in SBP and DBP were observed in T2DM with DR and the first fundus examination due to diabetes. Conclusions: In this T2DM sample, DR prevalence was very high and strongly related to blood pressure and a lack of regular fundus examinations. These results indicate the necessity of establishing systematic DR screening in routine diabetes care and targeting blood pressure levels according to T2DM guidelines.

Fundus examination using a wide-angle viewing system and intraocular illumination through the corneal incision during cataract surgery: a case series.

PURPOSE: To report a new technique for fundus examination using a wide-angle viewing system combined with intraocular illumination without accessing the vitreous cavity. STUDY DESIGN: Retrospective case series METHODS: Consecutive patients with atopic dermatitis-related cataracts who underwent standard cataract surgery and the novel fundus examination technique were included. After phacoemulsification, the anterior and posterior chambers were filled with ocular viscoelastic devices. A 27-gauge endo-illumination probe was inserted into the anterior chamber through a corneal incision made for cataract surgery. The fundus examination was performed with a wide-angle viewing system and scleral indentation. If any retinal breaks/detachments were detected, they were treated simultaneously. Finally, an intraocular lens was implanted. RESULTS: Ten patients (13 eyes) were included (mean age 26.8 years; 9 men). Retinal breaks were detected in 5 eyes (38%); 2 of the 5 had rhegmatogenous retinal detachment (RRD) (15%). Intraoperative cryopexy was performed for 3 eyes with retinal breaks, while 2 eyes with RRD underwent a scleral buckling procedure (SBP) during the same surgery. There were no intra- or postoperative complications, including posterior capsule damage. The average surgical time was 22 minutes for cases requiring only fundus examination and about 28 and for eyes with cryopexy and 80 minutes for SBP. CONCLUSION: The described technique may reduce the disadvantages of creating scleral incisions and provide comparable visibility to inserting the illuminator into the vitreous cavity.

A survey on the willingness of outpatients to participate in fundus examination procedures conducted by ophthalmology training residents in China: A cross-sectional study.

Background and Aims: The National Standardized Training for Resident Doctors (STRD) in mainland China encounters many challenges in its implementation. To investigate whether outpatients are willing to undergo indirect ophthalmoscopy examination conducted by ophthalmology residents in the ophthalmology STRD program in China. Methods: This study conducted a cross-sectional survey at the Eye Hospital of Wenzhou Medical University between September 2021 and September 2023. A cohort of 300 initial outpatients requiring indirect ophthalmoscopy examinations were enlisted from the outpatient department. Based on whether the patients are willing to undergo an indirect ophthalmoscopy examination by resident doctors, patients were divided into two groups: Group 1 (willing) and Group 2 (unwilling), and their questionnaire responses were comparatively analyzed. Results: A total of 261/300 (87%) valid questionnaires were returned in the survey, which included 149 males and 112 females. No notable gender difference (p = 0.400) or disparity in medical expense categories (p = 0.786) was observed between the two groups. However, variables such as outpatient marital status (p = 0.002), the presence of training faculty during fundus examinations with residents and outpatients (p < 0.001), the demeanor of training residents toward patients (p < 0.001), and the quality of doctor-patient communication (p < 0.001) significantly varied between the groups. Conclusion: The level of outpatients' cooperation with ophthalmology residents during fundus examinations in the Chinese ophthalmology STRD program was observed to be low. Enhancing the presence of training faculty during examinations and enhancing the communication skills of training residents could significantly improve this situation.

Retinal nerve fiber layer defects and chronic kidney disease: the Kailuan Eye Study.

AIM: To investigate whether retinal nerve fiber layer defects (RNFLDs) is a potential risk factor for chronic kidney disease (CKD) in Chinese adults. METHODS: The Kailuan Eye Study was a population-based study that included 14 440 participants. All participants underwent detailed assessments, RNFLDs were diagnosed using color fundus photographs. RESULTS: Overall, 12 507 participants [8533 males (68.23%)] had complete systemic examination data and at least one evaluable fundus photograph. RNFLDs were found in 621 participants [5.0%; 95% confidence interval (CI): 4.6%-5.34%], and 70 cases of multiple RNFLDs were found (11.27%). After adjusting multiple factors, RNFLDs was significantly associated with CKD severity, the ORs of CKD stage 3, stage 4 and stage 5 were 1.698, 4.167, and 9.512, respectively. Multiple RNFLDs were also associated with CKD severity after adjusting multiple factors, the ORs of CKD stage 3 and stage 5 were 4.465 and 11.833 respectively. Furthermore, 2294 participants had CKD (18.34%, 95%CI: 17.68%-18.99%). After adjusting for other factors, CKD presence was significantly correlated with the presence of RNFLDs. CONCLUSION: The strongest risk factors for RNFLDs are CKD and hypertension. Conversely, RNFLDs can be an ocular feature in patients with CKD. Fundoscopy can help detect systemic diseases, and assessment for RNFLDs should be considered in CKD patients.

Purtscher-Like Retinopathy in a Patient of Atopic Dermatitis Associated with Dupilumab Use: A Case Report.

PURPOSE: Purtscher-like retinopathy is a rare and vision-threatening eye disease, which is usually associated with acute pancreatitis, autoimmune diseases, and renal failure. We here reported a case of Purtscher-like retinopathy after dupilumab treatment in atopic dermatitis. CASE REPORT: A 48-year-old woman with a history of severe atopic dermatitis developed ocular manifestations after second exposure to dupilumab. Best-corrected visual acuity (BCVA) was count fingers at 2 feet in the right eye and 20/133 in the left eye when she referred to our hospital. Fundus examination demonstrated bilateral serous macular off, thickening of papillomacular bundle, intraretinal hemorrhage, cotton-wool spots and Purtscher flecken surrounding the optic disc. Optical coherence tomography (OCT) angiography showed flow void in the superficial and deep capillary plexuses. And early hypofluorescence corresponding to grayish-white retinal thickening was observed in fundus fluorescein angiography. Laboratory tests revealed hypereosinophilia after symptoms appeared. A diagnosis of Purtscher-like retinopathy was made, which may associate with dupilumab. The patient accepted the treatment with glucocorticoids. At six months follow up, BCVA was 20/40 in the right eye and 20/25 in the left eye. CONCLUSION: The Purtscher-like retinopathy we report may be the adverse event of dupilumab. Rare adverse reactions to biologics deserve the attention of ophthalmologists.

From Bedside to Diagnosis: The Role of Ocular Fundus in Systemic Infections.

In this comprehensive review, we delve into the significance of the ocular fundus examination in diagnosing and managing systemic infections at the bedside. While the utilization of advanced ophthalmological diagnostic technologies can present challenges in bedside care, especially for hospitalized patients confined to their beds or during infection outbreaks, the ocular fundus examination often emerges as an essential, and sometimes the only practical, diagnostic tool. Recent discussions have highlighted that the role of an ocular fundus examination might not always be advocated as a routine diagnostic procedure. With this context, we introduce a decision tree tailored for assessing the ocular fundus in inpatients with systemic infections. We also present an overview of systemic infections that impact the eye and elucidate key signs detectable through a bedside ocular fundus examination. Targeted primarily at non-ophthalmology clinicians, this review seeks to offer a comprehensive insight into a multifaceted approach and the enhancement of patient clinical outcomes.

Retinitis Pigmentosa: Pathogenesis, Diagnostic Findings, and Treatment.

Retinitis Pigmentosa (RP) is an inherited retinal dystrophy (IRD) that causes progressive visual loss. Patients suffering from RP have a substantial influence on their everyday activities, social contacts, and jobs, lowering their quality of life. Frequent referral delays, as well as the lack of a standard therapy for the majority of patients, contribute to the significant unmet demand for RP. Any retinal injury has the potential to result in total blindness and visual impairment. Despite the fact that there is no cure for RP, people can manage it using rehabilitation programs and low-vision gadgets. The purpose of this research is to characterize the expanding treatment landscape for RP, as well as the justification for advanced therapy medicinal products (ATMPs). Vitamin A supplements can help prevent the sluggish visual loss caused by a prevalent kind of RP. The presence of visual purple in the rods and the underlying vascular choroid causes the retina to look purplish red. The major portion of the retina damaged is the rod photoreceptor electric cell; the development of diverse diseases is progressive. Because of the retina's accessibility, immunological privilege, and compartmentalization, hereditary retinal diseases are amenable to cell and gene therapy. Therapeutic techniques that attempt to rescue photoreceptors (gene therapies) require the existence of non-functional target cells, but other therapies (cell therapies) do not require the presence of live photoreceptors. To provide successful therapy choices for RP patients at all disease phases, the development pipeline must be continually diversified and advanced, as well as ongoing efforts to encourage early patient identification and quick diagnosis. Future research will focus on avoiding vision loss in genetic eye illnesses and assisting patients in regaining their eyesight. Retinal implants, cell therapies, supplementary medications, and gene therapies may become common treatments for reducing vision loss in the future.

An All-Digital, Binocular, Indirect Virtual Video Ophthalmoscope: A Novel Approach to Retinal Examination and Photography.

Purpose: We describe a novel method of digital, virtual-reality based binocular indirect ophthalmoscopy which allows for simultaneous stereoscopic recording of the examination with the potential of real-time anatomic correction of the retinal view. Materials and Methods: A provisional prototype of the all-digital, binocular, indirect virtual stereo video ophthalmoscope was designed consisting of a generic LED light source and two synchronized closely spaced side-by-side minicameras which are connected to a processor, storage media (a Samsung note-9 android smartphone in the current provisional prototype), and a virtual reality set (VISIONHMD Bigeyes H1 3D Video Glasses, in the current prototype). A custom designed android application was developed to capture the examination media and allow optional real-time anatomical correction of the examination view. Binocular stereoscopic indirect ophthalmoscopy was attempted on 15 eyes of 15 patients without and with digital real-time anatomic correction of the examination view. Results: Binocular, video, stereo ophthalmoscopic media could be successfully obtained in all 15 patients. Anatomic correction of the examination view as well as a collateral observer's view could be achieved in all 15 patients. Conclusion: An all-digital, binocular, stereo, video indirect ophthalmoscopy is a feasible alternative for conventional binocular indirect ophthalmoscopy and provides stereoscopic video documentation identical to what the examiner sees. The examination video can be streamed in the real-time of the examination for educational or telemedicine purposes.