EVALUATION OF A TELEMEDICINE MODEL TO FOLLOW UP PATIENTS WITH EXUDATIVE AGE-RELATED MACULAR DEGENERATION.

PURPOSE: To evaluate a telemedicine model to follow up patients with exudative age-related macular degeneration and compare the time spent using this model with the time spent conducting office examinations. METHODS: Results of office and telemedicine evaluations were compared to determine whether patients with exudative age-related macular degeneration previously treated with intravitreal injections needed additional treatment. The office examinations included visual acuity measurement, fundus examination, and optical coherence tomography. The telemedicine evaluation included evaluation of retinography images, optical coherence tomography images, and visual acuity data obtained in the office. We also measured the time spent on telemedicine evaluations and compared it with the time spent on office examinations. RESULTS: Twenty-one patients were included. A comparison of office and remote diagnostic decisions showed the same results in 181 cases. Among the 20 remaining patients and considering office diagnostic decisions as the gold standard, 17 (8%) patients had false-positive diagnoses and 3 (1%) had false-negative diagnoses. The sensitivity and specificity of the telemedicine evaluations were 96% and 85%, respectively. The average time spent on remote evaluations was 1 minute 21 seconds compared with 10 minutes spent on office examination (P < 0.001). CONCLUSION: The telemedicine model can be a useful alternative for following up patients with age-related macular degeneration.

Formalize clinical processes into electronic health information systems: Modelling a screening service for diabetic retinopathy.

Most healthcare services use information and communication technologies to reduce and redistribute the workload associated with follow-up of chronic conditions. However, the lack of normalization of the information handled in and exchanged between such services hinders the scalability and extendibility. The use of medical standards for modelling and exchanging information, especially dual-model based approaches, can enhance the features of screening services. Hence, the approach of this paper is twofold. First, this article presents a generic methodology to model patient-centered clinical processes. Second, a proof of concept of the proposed methodology was conducted within the diabetic retinopathy (DR) screening service of the Health Service of Navarre (Spain) in compliance with a specific dual-model norm (openEHR). As a result, a set of elements required for deploying a model-driven DR screening service has been established, namely: clinical concepts, archetypes, termsets, templates, guideline definition rules, and user interface definitions. This model fosters reusability, because those elements are available to be downloaded and integrated in any healthcare service, and interoperability, since from then on such services can share information seamlessly.

Changes in the Epidemiology of Diabetic Retinopathy in Spain: A Systematic Review and Meta-Analysis.

BACKGROUND: The aim of the present study was to determine the prevalence and incidence of diabetic retinopathy (DR) and its changes in the last 20 years in type 2 diabetes mellitus (T2DM) patients in Spain. METHODS: A systematic review with a meta-analysis was carried out on the studies published between 2001-2020 on the prevalence and incidence of DR and sight-threatening diabetic retinopathy (STDR) in Spain. The articles included were selected from four databases and publications of the Spanish Ministry of Health and Regional Health Care System (RHCS). The meta-analysis to determine heterogeneity and bias between studies was carried out with the MetaXL 4.0. RESULTS: Since 2001, we have observed an increase in the detection of patients with DM, and at the same time, screening programs for RD have been launched; thus, we can deduce that the increase in the detection of patients with DM, many of them in the initial phases, far exceeds the increased detection of patients with DR. The prevalence of DR was higher between 2001 and 2008 with values of 28.85%. These values decreased over the following period between 2009 and 2020 with a mean of 15.28%. Similarly the STDR prevalence decrease from 3.67% to 1.92% after 2008. The analysis of the longitudinal studies determined that the annual DR incidence was 3.83%, and the STDR annual incidence was 0.41%. CONCLUSION: In Spain, for T2DM, the current prevalence of DR is 15.28% and 1.92% forSTDR. The annual incidence of DR is 3.83% and is 0.41% for STDR.

Traumatic expulsive iridodialysis with vitreous prolapse.

Traumatic expulsive iridodialysis is a rare complication after trauma by a blunt object in eyes with previous small-incision cataract surgery. The presence of an intact lens capsule with an intraocular lens was thought to protect against damage beyond the posterior capsule. We report a case of dehiscence of the cataract wound and traumatic expulsive iridodialysis that also exhibited vitreous prolapse.

Randomised controlled trial on vitreoretinal surgery with and without oral anticoagulants: surgical complications, visual results and perioperative thromboembolic events.

BACKGROUND: Vitreoretinal surgery in anticoagulated patients is a challenging situation for vitreoretinal surgeons, who have to choose between being faced with the systemic thromboembolic risks that the interruption of anticoagulation involves, or the intra- and postoperative haemorrhagic risks associated with maintenance of this therapy. So far, no trial has compared, in a prospective and randomized manner, perioperative complications and the visual results associated with continuation or interruption of oral anticoagulant therapy before pars plana vitrectomy (PPV) under retrobulbar anaesthesia. The main objective of this trial is to compare haemostasis-related perioperative complications of PPV in patients maintaining anticoagulant therapy before surgery compared to patients with an interruption in this therapy before surgery. METHODS: Ninety-six patients will be randomly assigned to either the control group, in whom oral anticoagulant therapy will be interrupted and substituted with subcutaneous heparin according to local clinical practice, or the intervention group in whom oral anticoagulant therapy will not be interrupted before surgery. Patients will be stratified according to the oral anticoagulant they were taking (direct or indirect anticoagulation). They will be followed up for 12 weeks, and the primary outcome, and haemorrhagic complications until 15 days after surgery, will be evaluated. DISCUSSION: This trial will provide novel information on the possibility of continuing anticoagulant therapy during PPV. The benefits expected from the change in the current surgical management paradigm for anticoagulated patients would be a decreased risk in the incidence of perioperative thromboembolic events and the possibility of performing surgery without delay and without the need for patients to change their usual anticoagulation protocol to the more complex and less safe substitutive therapy. TRIAL REGISTRATION: Clinical Trials Register EudraCT, 2018-000753-45. Registered on 11 November 2018.

Vitrectomy for bilateral macular schisis without apparent optic disc anomalies.

A 78-year-old man complained of bilateral visual acuity loss. Optical coherence tomography examination showed bilateral macular schisis with fluid accumulation in the external retinal layers without vitreous traction. Fundus examination and fluorescein angiography were normal in both eyes. Both eyes were treated by phacoemulsification, intraocular lens implantation, and vitrectomy without laser, gas exchange, or retinal fenestration. Slow and progressive fluid resorption and improvement in VA were observed in both eyes. Macular schisis similar to the one associated with optic disc anomalies is a possibility in patients without apparent disc anomalies. Vitrectomy without laser, gas, or retinal fenestration may be a good therapeutic option even in patients with a PVD preoperatively.

Diabetic retinopathy screening by general practitioners using non-mydriatic retinography.

Diabetic retinopathy (DR) is the leading cause of visual loss in people aged 30 to 69 years. Most authorities recommend screening of the ocular fundus to prevent severe visual loss. The increasing incidence of diabetes mellitus and fewer ophthalmologists in many countries is leading to inadequate screening. Establishing an adequate system for DR screening is a complex issue and represents a challenge for most health authorities. To alleviate the burden of DR screening for most health systems, some investigators have suggested that general practitioners (GPs) perform the initial screenings. The aim of this article was to review the current status of DR screening performed by GPs using non-mydriatic retinography. The five studies analyzed in this review indicated that after adequate training GPs can be effective and reliable screeners of DR using non-mydriatic retinography. Including GPs in the screening model would be a useful way to alleviate the increasing demands of ophthalmic care resulting from the increased prevalence of diabetes mellitus. In addition, GPs would have full control of the diabetic process, which could bolster their motivation and confidence in other areas of diabetes care and medical practice.

Diabetic retinopathy screening with non-mydriatic retinography by general practitioners: 2-year results.

AIMS: To ascertain in real practice the diagnosis rate of diabetic retinopathy (DR) in patients considered to have positive screening test by general practitioners (GPs) and what are the reasons for the false positive diagnosis. METHODS: Four GPs previously instructed in the interpretation of retinal photographs evaluated the digital retinography images of patients with diabetes obtained during a 2-year period. When the images were considered normal, a new appointment was scheduled for 1 year later and a report was emailed to the referring physician. Patients with any sign of DR or other suspicious retinal alterations and those whose images were considered difficult or impossible to assess were referred to an ophthalmologist. RESULTS: A total of 2750 patients were referred for screening. The images of 2036 (74%) patients were considered normal, and the images of 714 (26%) patients were sent to ophthalmologists. Among the referred patients, 392 (55%) did not have DR, 244 (34%) had DR, and 78 (11%) had unreadable images. The retinal images of 240 patients whose fundi were considered normal were read again by ophthalmologists to evaluate false negatives. Of them, 16 patients (7%) had DR but only two patients (1%) had treatable DR. CONCLUSIONS: After adequate training, GPs can screen for DR with a high level of accuracy using non-mydriatic retinography. There is a need to strengthen the training of GPs in order to recognize non-visual threatening abnormalities.

Diabetic retinopathy screening using tele-ophthalmology in a primary care setting.

We evaluated tele-ophthalmology for diabetic retinopathy screening in a primary care setting. Four general practitioners (GPs) were taught to assess non-mydriatic retinography images of patients with diabetes. After training, a total of 1223 patients were screened using this method: 926 (76%) did not have diabetic retinopathy and 297 (24%) were referred for an ophthalmologic assessment. Of the 297 patients, 186 (15%) did not have diabetic retinopathy and were considered to be false positives, 85 (7%) had diabetic retinopathy and in 26 cases (2%) the retinography images were unreadable. The specificity of GPs for detecting diabetic retinopathy by non-mydriatic retinography was 83%. Ophthalmologists also assessed 120 patients who had been diagnosed as normal to detect false negatives. Ten patients (8.3%) had mild non-proliferative diabetic retinopathy with small isolated retinal hemorrhages. Only one patient (0.8%) had treatable diabetic retinopathy with hard exudates and microaneurysms. The sensitivity of GPs for detecting diabetic retinopathy was 90.9%; the sensitivity for detecting treatable lesions was 99.2%. We concluded that adequately trained GPs can screen for treatable lesions of diabetic retinopathy with a very high level of reliability using non-mydriatic retinography.