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1.
Klin Monbl Augenheilkd ; 241(4): 533-537, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38653305

RESUMEN

Electroretinography (ERG) provides crucial insights into retinal function and the integrity of the visual pathways. However, ERG assessments classically require a complicated technical background with costly equipment. In addition, the placement of corneal or conjunctival electrodes is not always tolerated by the patients, which restricts the measurement for pediatric evaluations. In this short review, we give an overview of the use of the RETeval portable ERG device (LKC Technologies, Inc., Gaithersburg, MD, USA), a modern portable ERG device that can facilitate screening for diseases involving the retina and the optic nerve. We also review its potential to provide ocular biomarkers in systemic pathologies, such as Alzheimer's disease and central nervous system alterations, within the framework of oculomics.


Asunto(s)
Electrorretinografía , Diseño de Equipo , Enfermedades de la Retina , Humanos , Electrorretinografía/instrumentación , Electrorretinografía/economía , Enfermedades de la Retina/diagnóstico , Análisis de Falla de Equipo , Miniaturización , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Tamizaje Masivo/instrumentación , Tamizaje Masivo/economía , Selección Visual/instrumentación , Selección Visual/economía , Costos de la Atención en Salud
2.
Nutr Hosp ; 37(1): 155-159, 2020 Feb 17.
Artículo en Inglés | MEDLINE | ID: mdl-31746623

RESUMEN

INTRODUCTION: Objective: To compare the diagnosis of NB through the use of the standardized interview of the World Health Organization/Pan American Health Organization (WHO/PAHO) with electroretinography, and also to evaluate the association of these diagnoses with serum concentrations of retinol in class III obesity individuals. Methods: Adult patients of both genders, in the 20-60 age group, with BMI ≥ 40 kg/m² were studied. NB was diagnosed through electroretinography and the standardized interview validated by the WHO/PAHO. Serum level of retinol was quantified by the HPLC-UV method, and VAD was diagnosed when levels were <1.05 µmol /L, and severity was also evaluated. Statistical analysis was carried out through the Statistical Package for the Social Sciences, version 21.0 (p < 0.05). Results: Mean BMI was 44.9  11.8 kg/m², and a negative correlation was found in serum levels of retinol (p= 0.01). The prevalence of VAD, according to the serum concentrations of retinol, was 14%, and of this percentage 23.3% had NB according to the standardized interview, and 22.0% according to electroretinography. NB diagnosed by both methods showed an association with VAD according to the serum concentrations of retinol. Of these individuals with NB, according to the standardized interview, 6.9% showed severe VAD, 10.3% moderate VAD and 82.8% marginal VAD. Conclusion: The standardized interview for the diagnosis of NB can be a good strategy to evaluate the nutritional status of vitamin A, and it is a simple, non-invasive and low-cost method.


INTRODUCCIÓN: Objetivo: Comparar el diagnóstico de NB mediante el uso de la entrevista estandarizada de la Organización Mundial de la Salud/Organización Panamericana de la Salud (OMS/OPS) con electrorretinografía, y también evaluar la asociación de estos diagnósticos con las concentraciones séricas de retinol en la clase III personas obesas. Métodos: se estudiaron pacientes adultos de ambos sexos, en el grupo de 20 a 60 años de edad, con un IMC ≥ 40 kg/m². La NB se diagnosticó mediante electrorretinografía y la entrevista estandarizada validada por la OMS/OPS. El nivel sérico de retinol se cuantificó mediante el método HPLC-UV, y el DVA se diagnosticó cuando los niveles eran <1.05 µmol / L, y también se evaluó la gravedad. El análisis estadístico se realizó a través del Paquete Estadístico para las Ciencias Sociales, versión 21.0 (p <0.05). Resultados: IMC promedio fue de 44.9 ± 11.8 kg / m², y se encontró una correlación negativa en los niveles séricos de retinol (p = 0.01). La prevalencia de DVA, según las concentraciones séricas de retinol, fue del 14%, y de este porcentaje, el 23,3% tenía NB de acuerdo con la entrevista estandarizada y el 22,0% según la electrorretinografía. La NB diagnosticada por ambos métodos mostró una asociación con VAD según las concentraciones séricas de retinol. De estos individuos con NB, según la entrevista estandarizada, el 6,9% mostró VAD grave, el 10,3% de VAD moderado y el 82,8% de VAD marginal. Conclusión: la entrevista estandarizada para el diagnóstico de NB puede ser una buena estrategia para evaluar el estado nutricional de la vitamina A, y es un método simple, no invasivo y de bajo costo.


Asunto(s)
Electrorretinografía , Entrevistas como Asunto , Ceguera Nocturna/diagnóstico , Adulto , Índice de Masa Corporal , Brasil/epidemiología , Estudios Transversales , Electrorretinografía/economía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ceguera Nocturna/sangre , Ceguera Nocturna/complicaciones , Ceguera Nocturna/diagnóstico por imagen , Obesidad/sangre , Obesidad/complicaciones , Vitamina A/sangre , Deficiencia de Vitamina A/sangre , Deficiencia de Vitamina A/complicaciones , Adulto Joven
3.
Ann Ist Super Sanita ; 52(4): 598-602, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27999234

RESUMEN

INTRODUCTION: Integrated care, by allowing information exchange among health professionals, improves outcomes and favours a reduction in hospital admission in diabetes. Retinal complications can be sight-threatening, and diabetic patients often miss the suggested yearly clinical examination. METHODS: Teleretinography can be easily performed in patients attending Diabetes Clinics: images are sent to a remote ophthalmologist, grading and instructions are received and forwarded to General Practitioners by a dedicated software. RESULTS: We here report the results of teleretinography performed in our Diabetes Clinic in 362 patients missing the yearly fundus examination: 253 patients showed no diabetic retinopathy, 86 a mild form, and 23 needed referral to hospital settings. CONCLUSIONS: Teleretinography is a user-friendly, time-saving and cost-effective technique, easily integrable into integrated care, allowing a better adherence to guidelines.


Asunto(s)
Prestación Integrada de Atención de Salud/métodos , Retinopatía Diabética/terapia , Electrorretinografía/métodos , Telemedicina/métodos , Adulto , Anciano , Anciano de 80 o más Años , Análisis Costo-Beneficio , Retinopatía Diabética/patología , Electrorretinografía/economía , Femenino , Fondo de Ojo , Médicos Generales , Humanos , Italia , Masculino , Persona de Mediana Edad , Telemedicina/economía , Adulto Joven
4.
Retina ; 36(10): 1958-63, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27465574

RESUMEN

BACKGROUND: Throughout medicine, the cost of various treatments has been increasingly studied with the result that certain management guidelines might be reevaluated in their context. Cost-utility is a term referring to the expense of preventing the loss of quality of life, quantified in dollars per quality-adjusted life year. In 2002, the American Academy of Ophthalmology published hydroxychloroquine screening recommendations which were revised in 2011. The purpose of this report is to estimate the cost-utility of these recommendations. METHODS: A hypothetical care model of screening for hydroxychloroquine retinopathy was formulated. The costs of screening components were calculated using 2016 Medicare fee schedules from the Centers for Medicare and Medicaid Services. RESULTS: The cost-utility of screening for hydroxychloroquine retinopathy with the 2011 American Academy of Ophthalmology guidelines was found to vary from 33,155 to 344,172 dollars per quality-adjusted life year depending on the type and number of objective screening tests chosen, practice setting, and the duration of hydroxychloroquine use. Screening had a more favorable cost-utility when the more sensitive and specific diagnostics were used, and for patients with an increased risk of toxicity. CONCLUSION: American Academy of Ophthalmology guidelines have a wide-ranging cost-utility. Prudent clinical judgment of risk stratification and tests chosen is necessary to optimize cost-utility without compromising the efficacy of screening.


Asunto(s)
Antimaláricos/efectos adversos , Antirreumáticos/efectos adversos , Análisis Costo-Beneficio , Técnicas de Diagnóstico Oftalmológico/economía , Hidroxicloroquina/efectos adversos , Enfermedades de la Retina/diagnóstico , Enfermedades de la Retina/economía , Academias e Institutos/normas , Electrorretinografía/economía , Femenino , Angiografía con Fluoresceína/economía , Humanos , Masculino , Persona de Mediana Edad , Modelos Teóricos , Oftalmología/normas , Guías de Práctica Clínica como Asunto/normas , Pautas de la Práctica en Medicina , Años de Vida Ajustados por Calidad de Vida , Enfermedades de la Retina/inducido químicamente , Sensibilidad y Especificidad , Tomografía de Coherencia Óptica/economía , Estados Unidos
5.
Am J Ophthalmol ; 155(3): 418-428.e1, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-23218706

RESUMEN

PURPOSE: To determine the impact of the revised academy guidelines on screening for hydroxychloroquine retinopathy. DESIGN: Retrospective, observational cohort study. METHODS: setting: Private practice of 29 doctors. study population: Total of 183 patients for follow-up and 36 patients for baseline screening. observation procedure: Review of charts, 10-2 visual fields (VFs), multifocal electroretinograms (mfERG), and spectral-domain optical coherence tomography (SD-OCT) images before and after the revised guidelines. main outcome measure: Rates of use of ancillary tests and clinical intervention, costs of screening, follow-up schedules, and comparative sensitivity of tests. RESULTS: New hydroxychloroquine toxicity was found in 2 of 183 returning patients (1.1%). Dosing above 6.5 mg/kg/d was found in 28 of 219 patients (12.8%), an underestimate because patient height, weight, and daily dose were not determined in 77 (35.1%), 84 (38.4%), and 59 (26.9%), respectively. In 10 of the 28 (35.7%), the dose was reduced, in 2 (7.1%) hydroxychloroquine was stopped, but in 16 (57.1%) no action was taken. The cost of screening rose 40%/patient after the revised guidelines. Fundus autofluorescence imaging was not used. No toxicity was detected by adding mfERG or SD-OCT. In no case was a 5-year period free of follow-up recommended after baseline screening in a low-risk patient. CONCLUSIONS: Detection of toxic daily dosing is a cost-effective way to reduce hydroxychloroquine toxicity, but height, weight, and daily dose were commonly not checked. The revised guidelines, emphasizing mfERG, SD-OCT, or FAF, raised screening cost without improving case detection. The recommended 5-year screening-free interval for low-risk patients after baseline examination was ignored.


Asunto(s)
Antirreumáticos/efectos adversos , Técnicas de Diagnóstico Oftalmológico/normas , Hidroxicloroquina/efectos adversos , Guías de Práctica Clínica como Asunto/normas , Pautas de la Práctica en Medicina/normas , Retina/patología , Enfermedades de la Retina/diagnóstico , Academias e Institutos/normas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Artritis Reumatoide/tratamiento farmacológico , Constitución Corporal , Análisis Costo-Beneficio , Técnicas de Diagnóstico Oftalmológico/economía , Monitoreo de Drogas , Electrorretinografía/economía , Electrorretinografía/normas , Femenino , Costos de la Atención en Salud , Humanos , Lupus Eritematoso Sistémico/tratamiento farmacológico , Masculino , Tamizaje Masivo/economía , Tamizaje Masivo/normas , Persona de Mediana Edad , Oftalmología/economía , Oftalmología/normas , Retina/efectos de los fármacos , Enfermedades de la Retina/inducido químicamente , Enfermedades de la Retina/economía , Estudios Retrospectivos , Tomografía de Coherencia Óptica/economía , Tomografía de Coherencia Óptica/normas , Estados Unidos , Campos Visuales , Adulto Joven
6.
Physiol Meas ; 33(6): 1053-2, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-22561091

RESUMEN

Electroretinography (ERG) is widely used in clinical work and research to assess the retinal function. We evaluated an easy to build ERG setup adapted for small animals comprising two contact lens electrodes with a built-in light-emitting diode and a custom-made amplification system. The system's sensitivity was tested by monitoring ERG in albino rat eyes subjected to mild ischemia. Flash ERG was recorded by two contact lens electrodes positioned on the rat's corneas and used alternately as test or reference. The a- and b-wave amplitudes, a-wave latency, b-wave implicit time and oscillatory potentials (OPs) were analyzed. Ischemia was achieved by elevating the intraocular pressure in the eye's anterior chamber. ERG was recorded on post-ischemia (PI) days -1, 1, 3 and 7. Morphological changes were analyzed on hematoxylin/eosin stained 5 µm sections of control 7d PI retinas. In control eyes, ERG exhibited a pattern similar to a standard recording. Retinas subjected to mild ischemia preserved ordered layered morphology, exhibiting approximately 30% loss of ganglion cells and no changes in gross morphology. By day 3 PI, ischemia caused an increase in the a-wave amplitude (from 34.9 ± 2.7 to 45.4 ± 4.3 µV), a decrease in the b-wave amplitude (from 248 ± 13 to 162 ± 8 µV), an increase in a-wave latency (from 11.1 ± 0.3 to 17.3 ± 1.4 ms) and b-wave implicit time (from 81.0 ± 1.6 to 90.0 ± 2.5 ms), and attenuation of OPs. The described setup proved sensitive and reliable for evaluating subtle changes in the retinal function in small animals.


Asunto(s)
Lentes de Contacto , Electrorretinografía/economía , Electrorretinografía/instrumentación , Isquemia/diagnóstico , Monitoreo Fisiológico/instrumentación , Óptica y Fotónica/instrumentación , Retina/patología , Potenciales de Acción , Animales , Lentes de Contacto/economía , Análisis Costo-Beneficio , Relación Dosis-Respuesta en la Radiación , Electrodos , Isquemia/fisiopatología , Luz , Masculino , Monitoreo Fisiológico/economía , Óptica y Fotónica/economía , Ratas , Ratas Sprague-Dawley , Retina/fisiopatología
7.
J Neurosci Methods ; 146(1): 13-21, 2005 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-15935218

RESUMEN

Investigating the properties of light responsive neurons and their networks requires appropriate control of stimulus parameters, such as intensity, spectral composition, spatial and temporal profile. In the present paper, we describe how to build a simple, versatile and low-cost light source for use in visual neuroscience. The light source is a InGaN-based ultrabright light-emitting diode (LED), which may generate conventional light flashes as well as a variety of time varying stimuli to be used in quantitative studies of the visual system. In particular, with this instrument one may generate light stimuli sinusoidally modulated in time at frequencies ranging from 0.05 to 50 Hz, with less than 1% harmonic distortion at a contrast exceeding 85%. The relationship between applied voltage and energy emitted by the source is linear over an intensity range that exceeds 4.5 log-units, up to the full suppression of the light-sensitive currents in mammalian rods. The light source has minimal space requirement and does not generate appreciable radiating heat and hum, allowing its use for single cell work "in vitro" as well as for "in vivo" recording of the electroretinogram (ERG).


Asunto(s)
Electrorretinografía/instrumentación , Iluminación/instrumentación , Neurofisiología/instrumentación , Estimulación Luminosa/instrumentación , Retina/fisiología , Animales , Células Cultivadas , Electrónica/instrumentación , Electrónica/métodos , Electrorretinografía/economía , Electrorretinografía/métodos , Análisis de Fourier , Cobayas , Iluminación/métodos , Masculino , Potenciales de la Membrana/fisiología , Potenciales de la Membrana/efectos de la radiación , Neurofisiología/economía , Neurofisiología/métodos , Estimulación Luminosa/métodos , Células Fotorreceptoras Retinianas Bastones/fisiología , Células Fotorreceptoras Retinianas Bastones/efectos de la radiación , Visión Ocular/fisiología , Visión Ocular/efectos de la radiación
8.
Int J Technol Assess Health Care ; 19(2): 373-83, 2003.
Artículo en Inglés | MEDLINE | ID: mdl-12862194

RESUMEN

OBJECTIVES: To conduct a systematic review of the evidence for the effectiveness of five visual electrodiagnostic tests to inform the Medical Services Advisory Committee (MSAC) of the Department of Health and Ageing (Australia) in its decision in allocating public funding for new technologies. METHODS: We searched the biomedical literature to identify English-language articles published from 1966 to September 2000. We assessed validity of methodology of included studies against the following criteria: investigators (i) compared test with an appropriate reference test; (ii) tested an appropriate spectrum of patients; (iii) masked assessment of study and reference tests; (iv) measured the study test independently of clinical information; and (v) measured the reference test before any interventions. RESULTS: Sixty-one articles met inclusion criteria for critical appraisal: nineteen were cross-sectional studies that compared a study test with another test, thirty-four were case-control studies that compared a test in a group of patients with an eye disease to a group of subjects without eye disease, and eight studies were case series. None of the included studies met all of the validity criteria. Only four studies provided enough information to calculate diagnostic characteristics but were flawed due to inclusion of patients already diagnosed with disease or lack of an appropriate reference test and, thus, overestimated test accuracy. CONCLUSIONS: Identified studies did not provide sufficient valid evidence of the clinical value of the five visual tests in diagnosing diseases of the retina or optic nerve. Thus, MSAC recommended that the tests not be supported by public funding.


Asunto(s)
Electrorretinografía , Oftalmopatías/diagnóstico , Política de Salud , Evaluación de la Tecnología Biomédica , Australia , Electrorretinografía/economía , Estudios de Evaluación como Asunto , Financiación Gubernamental , Humanos , Administración en Salud Pública , Reproducibilidad de los Resultados , Evaluación de la Tecnología Biomédica/economía
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