RESUMO
Despite the fact that cosmetic products undergo rigorous testing to ensure they are safe for human use, some users report mild discomfort following their application. The cutaneous changes, such as allergic dermatitis, are well reported, but the ocular changes associated with eye cosmetic use are less so. Some pigmented cosmetic products may accumulate within the lacrimal system and conjunctivae over many years of use, but immediate reports of eye discomfort after application are most common. Changes to the tear film and its stability may occur shortly after application, and contact lens wearers can also be affected by lens spoliation from cosmetic products. Additionally, creams used in the prevention of skin aging are often applied around the eyes, and retinoids present in these formulations can have negative effects on meibomian gland function and may be a contributing factor to dry eye disease. The aim of this review is to summarize current knowledge regarding the impact of cosmetic products on the eye, ocular surface, and tear film.
Assuntos
Cosméticos/efeitos adversos , Olho/efeitos dos fármacos , Olho/microbiologia , Olho/patologia , Olho/fisiopatologia , Alérgenos/efeitos adversos , Animais , Antioxidantes/efeitos adversos , Bimatoprost/efeitos adversos , Blefarite/etiologia , Blefarite/patologia , Blefarite/fisiopatologia , Túnica Conjuntiva/microbiologia , Túnica Conjuntiva/patologia , Túnica Conjuntiva/fisiopatologia , Doenças da Túnica Conjuntiva/etiologia , Lentes de Contato , Contraindicações , Cosméticos/farmacologia , Cosméticos/toxicidade , Síndromes do Olho Seco/etiologia , Síndromes do Olho Seco/fisiopatologia , Infecções Oculares/etiologia , Infecções Oculares/microbiologia , Humanos , Aparelho Lacrimal/patologia , Aparelho Lacrimal/fisiopatologia , Glândulas Tarsais/efeitos dos fármacos , Glândulas Tarsais/fisiopatologia , Ácaros/microbiologia , Retinoides/efeitos adversos , Pele/microbiologia , Pele/fisiopatologia , Tensoativos/efeitos adversos , Lágrimas/fisiologiaRESUMO
PURPOSE: To examine, record, and quantify the migration of a conventional eye cosmetic pencil when applied to periocular skin in two different locations: behind the lash line (ELI) and along the periocular skin (ELO). METHODS: This was a pilot study (prospective, randomized crossover design) involving two visits on separate days. Three female subjects were randomly assigned one of two eyeliner application conditions: ELI (inside the lash line) or ELO (anterior to the lash line). Pencil eyeliner ("Glimmerstick" in Graphite; Avon, Northampton, United Kingdom) was applied to the subject's upper and lower right eyelid by the examiner. Slitlamp video recording of glitter particles suspended within the tear film was conducted for 30 sec on 10 occasions up to 2 hr post-eyeliner application. The number of glitter particles suspended in the tear film, analyzed using ImageJ software, is reported. RESULTS: The migration of the glitter particles occurred more readily in ELI application, with maximum contamination of the tear film achieved 5 to 10 min post-application. The migration of eyeliner following ELO application was comparatively slower and reduced compared with ELI application. The quantity of glitter particles suspended in the tear film varied between subjects; however, 2 hr post-application, contamination of the tear film from pencil eyeliner was negligible. CONCLUSIONS: Pencil eyeliner migrates most readily and maximally contaminates the tear film when applied posterior to the lash line. This has implications for contact lens wearers and patients with dry eye syndrome or sensitive eyes. Eye cosmetic usage for participants involved in anterior eye and contact lens research should be carefully considered in the design of studies.
Assuntos
Cosméticos/análise , Lágrimas/química , Adulto , Cosméticos/farmacocinética , Estudos Cross-Over , Síndromes do Olho Seco/etiologia , Feminino , Humanos , Projetos Piloto , Estudos Prospectivos , Distribuição Aleatória , Fatores de TempoRESUMO
PURPOSE: This article aims to describe a case of asymptomatic branch retinal vein occlusion (BRVO) in a patient with cystic fibrosis (CF) and discuss the possible link between the two. CASE REPORT: A young adult (aged 35 years) with CF who presented for routine ocular examination was found to have a superior temporal BRVO in the left eye. Visual acuity was unaffected, measuring -0.06 LogMAR, and intraocular pressure was 10 mm Hg. Optical coherence tomography showed no macular involvement. Regarding the patient's general health, blood pressure was within the normal range, and there was no diabetes. Exploratory blood tests revealed elevated fibrinogen levels. CONCLUSIONS: It is hypothesized that BRVO occurred secondary to raised fibrinogen levels, a common feature in CF resulting from chronic pulmonary infection and inflammation. Practitioners should be aware of the possible link between BRVO and CF.
Assuntos
Fibrose Cística/complicações , Oclusão da Veia Retiniana/etiologia , Adulto , Pressão Sanguínea , Fibrose Cística/diagnóstico , Fibrinogênio/metabolismo , Humanos , Pressão Intraocular , Masculino , Oclusão da Veia Retiniana/diagnóstico , Trombose/etiologia , Acuidade Visual/fisiologiaRESUMO
PURPOSE: To determine the accuracy with which the optic disc can be diagnosed as normal or glaucomatous according to the ISNT rule, whereby, in the normal eye, the neuroretinal rim area follows the order inferior (I) > superior (S) > nasal (N) > temporal (T). DESIGN: Prospective, cross-sectional, observational, case series. PARTICIPANTS: Fifty-one normal individuals and 78 individuals with open-angle glaucoma exhibiting field loss (median mean deviation, -4.37 dB; interquartile range [IQR], -2.10 to -7.96 dB; median pattern standard deviation, 5.65 dB; IQR, 2.94 to 8.56 dB). The reference diagnosis was made by 2 experts on the basis of the appearance of the optic disc and of the corresponding visual field. METHODS: Stereoscopic optic disc photographs, acquired for each individual, were digitized at high resolution and analyzed using a digital, quad-buffered, stereoscopic viewing system in which a Z screen was used to dissociate the images to the 2 eyes of the observer. Three expert observers, trained to fellowship standard in glaucoma, independently undertook planimetry of the neuroretinal rim and of the disc margin from 1 eye of each individual, using a cursor moving in stereoscopic space to minimize parallax errors. Software automatically calculated the neuroretinal rim area in 10°, 30°, 40°, and 90° segments. For the ISNT rule to be obeyed, the 3 Boolean comparisons of the neuroretinal rim area, I>S, S>N, and N>T, had to be true. If any of the comparisons returned false, the rule was considered not to have been obeyed. Values were compared at a precision of 0.0001 mm(2). MAIN OUTCOME MEASURES: The outcome of the ISNT rule in terms of the 3 Boolean comparisons of the neuroretinal rim area was specified in terms of the sensitivity, specificity, and hence, the positive and negative likelihood ratios. RESULTS: Based on the ISNT rule being obeyed for 10° segments, the positive likelihood ratio among the 3 observers was 1.11 (95% confidence interval [CI], 0.99-1.25), 1.07 (95% CI, 0.94-1.21), and 1.06 (95% CI, 0.96-1.18), respectively. It was similar for the other segment sizes. Variants of the rule were not appreciably better. CONCLUSIONS: The ISNT rule has limited utility in the diagnosis of open-angle glaucoma.
Assuntos
Técnicas de Diagnóstico Oftalmológico , Glaucoma de Ângulo Aberto/diagnóstico , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Idoso , Estudos Transversais , Reações Falso-Positivas , Feminino , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Acuidade Visual , Campos VisuaisRESUMO
The photopic negative response (PhNR) has attracted interest as a flash ERG component reflecting inner retinal activity, with investigators adopting various approaches to analysing the response. This study has two principal aims: first to determine the most reliable technique for assessing the PhNR amplitude; secondly to compare the repeatability characteristics of the PhNR recorded using DTL and skin active electrodes. Electroretinograms were recorded in 31 subjects, using both electrode types, in response to a Ganzfeld red stimulus (Lee filter "bright red"; 1.76 log phot td.s; 4 Hz) presented over a steady blue background (Schott glass filter BG28; 3.9 log scot td). Sixteen subjects returned to assess repeatability. PhNR amplitude was measured from b-wave peak-to-PhNR trough, pre-stimulus baseline to trough, and from peak and baseline to a fixed time-point; a ratio of b-wave/PhNR amplitude was also calculated. Coefficients of variation (CoV), and inter-ocular and inter-session limits of agreement (LoA) were calculated for all measures. The ratio of b-wave/PhNR amplitude showed the lowest CoV (14.3% DTL; 23.2% skin), inter-ocular LoA (22.2% DTL; 25.0% skin), and inter-session LoA (22.8% DTL; 20.3% skin). The peak-to-trough and peak-to-fixed-time measurements were also consistently reliable. Least reliable measures were those measured from baseline. While skin electrode responses were significantly smaller than DTL responses (P < 0.0001), the variability was only slightly increased. This study suggests that peak-to-trough measurements are the most reliable means of measuring the PhNR and ratio calculation further improves repeatability. Skin electrodes provided a viable alternative to DTL electrodes for recording the PhNR.
Assuntos
Eletrorretinografia , Estimulação Luminosa , Retina/fisiologia , Células Ganglionares da Retina/fisiologia , Adulto , Humanos , Microeletrodos , Reprodutibilidade dos Testes , Adulto JovemRESUMO
OBJECTIVES: This paper sets out to establish the numbers and titles of regulated healthcare professionals in the UK and uses a review of how continuing professional development (CPD) for health professionals is described internationally to characterise the postqualification training required of UK professions by their regulators. It compares these standards across the professions and considers them against the best practice evidence and current definitions of CPD. DESIGN: A scoping review. SEARCH STRATEGY: We conducted a search of UK health and social care regulators' websites to establish a list of regulated professional titles, obtain numbers of registrants and identify documents detailing CPD policy. We searched Applied Social Sciences Index and Abstracs (ASSIA), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, EMCare and Scopus Life Sciences, Health Sciences, Physical Sciences and Social Sciences & Humanities databases to identify a list of common features used to describe CPD systems internationally and these were used to organise the review of CPD requirements for each profession. RESULTS: CPD is now mandatory for the approximately 1.5 million individuals registered to work under 32 regulated titles in the UK. Eight of the nine regulators do not mandate modes of CPD and there is little requirement to conduct interprofessional CPD. Overall 81% of those registered are required to engage in some form of reflection on their learning but only 35% are required to use a personal development plan while 26% have no requirement to engage in peer-to-peer learning. CONCLUSIONS: Our review highlights the wide variation in the required characteristics of CPD being undertaken by UK health professionals and raises the possibility that CPD schemes are not fully incorporating the best practice.
Assuntos
Educação Continuada , Pessoal de Saúde , Educação Continuada/normas , Educação Continuada/estatística & dados numéricos , Pessoal de Saúde/educação , Pessoal de Saúde/organização & administração , Pessoal de Saúde/normas , Humanos , Reino UnidoRESUMO
Tear ferning (TF) has shown good sensitivity and specificity in the diagnosis of dry eye, but is a relatively uncommon test, especially in contact lens wearers. The aim of this study was to investigate the relationship between TF, ocular comfort and tear film stability amongst contact lens (CL) wearers and non-contact lens (NCL) wearers. Subjects (36 NCL, 24 CL; mean age 23.2 +/- 4.8 years) underwent assessment of non-invasive tear break up time (NIBUT), fluorescein tear break up time (FBUT) and completed the Ocular Comfort Index (OCI) questionnaire. Non-stimulated tears were collected from the inferior tear meniscus with a glass capillary. Samples of 1.5 microL were air dried, observed by light microscopy and the TF pattern quantified according to Rolando's grading scale. Significantly higher grades of TF pattern and discomfort (higher OCI scores) were observed in CL wearers compared to NCL wearers (Mann-Whitney U-test; p < 0.005 and p < 0.05 respectively). Differences in tear film stability were not significant between groups. Even when asymptomatic (low OCI scores) CL and NCL subjects were compared, TF remained significantly different (p < 0.005). In both CL and NCL subjects, TF displayed poor correlation with tear film stability tests and OCI scores. Higher TF grades in CL wearers, even if asymptomatic, indicate an unfavourable ratio of salt to macromolecule concentration within the tear film of such subjects. The lack of significant difference in TF between symptomatic CL and NCL wearers could suggest similar aetiology (tear film hyperosmolarity) in each cohort. The TF technique demonstrates limited sensitivity and specificity for the prediction of ocular surface comfort in both CL and NCL wearers.
Assuntos
Lentes de Contato/efeitos adversos , Síndromes do Olho Seco/metabolismo , Lágrimas/metabolismo , Adolescente , Adulto , Técnicas de Diagnóstico Oftalmológico , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Estatística como Assunto , Adulto JovemRESUMO
PURPOSE: To describe two methods of neural damage quantification from perimetric data, and to discuss their theoretical implications. METHODS: A recently published model of retinal ganglion cell (GC) receptive field density is used to obtain best estimates of the receptive fields per solid degree at each stimulus point in the 24-2 test pattern array. A method of age related change compensation is proposed and a functional relationship between perimetric sensitivity and GC survival is used for loss quantification. RESULTS: Data for the 24-2 test pattern array for the right eye are presented. These can be adjusted for age related loss, but are also expressed as percentages which are considered to be age invariant. Simple models relating receptive field density to sensitivity are proposed for quantification. CONCLUSIONS: Equations relating GC receptive field densities at points in the visual field to normative data on sensitivity are proposed to estimate GC loss in glaucoma. If 1/Lambert sensitivity is <800, (29 dB), a linear relationship applies and a loss factor of 1-10, where TD is the signed total deviation in decibels, may be applied to values in a percentage chart which are provided to give the percentage loss for each stimulus. Higher sensitivities are non-linearly related. Two equations are proposed to cover the range corresponding to thresholds from 0 dB to 33 dB. Hypothetical examples are given and the relationship between visual field defects and pattern electroretinograms is discussed in quantitative terms.
Assuntos
Glaucoma/fisiopatologia , Modelos Biológicos , Células Ganglionares da Retina , Testes de Campo Visual , Campos Visuais , Adulto , Envelhecimento , Morte Celular , Sobrevivência Celular , Humanos , Modelos Lineares , Dinâmica não Linear , Sensibilidade e EspecificidadeRESUMO
PURPOSE: Our aim was to determine if pulsatile ocular blood flow (POBF) measurements could distinguish between type 2 diabetes mellitus (DM) subjects with and without diabetic retinopathy (DR). METHODS: Ninety-eight DM subjects were recruited. POBF was measured using an Ocular Blood Flow tonometer and retinopathy was assessed using retinal digital photography. The duration of diabetes, blood pressure, glycosylated haemoglobin and plasma glucose level were also recorded. RESULTS: Seventy-two subjects had no DR and 26 subjects exhibited mild to moderate non-proliferative DR. POBF was higher in those subjects with non-proliferative DR but did not reach significance. Those subjects receiving insulin treatment had a significantly longer duration of DM, higher HbA1c and plasma glucose levels and greater incidence of non-proliferative DR compared to subjects receiving oral hypoglycaemic agents, who in turn demonstrated higher levels of these parameters than those who were controlled by diet alone (ANOVA p < 0.05 in all cases). POBF was found to increase with level of management but not significantly so. CONCLUSIONS: A single measurement of POBF does not distinguish between subjects with and without mild/moderate non-proliferative DR.
Assuntos
Retinopatia Diabética/fisiopatologia , Fluxo Pulsátil/fisiologia , Vasos Retinianos/fisiopatologia , Idoso , Retinopatia Diabética/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: The aim of this study was to analyse the changes in new certifications for both sight impairment (SI) and severe sight impairment (SSI, blindness) in Wales due to diabetic retinopathy (DR)/maculopathy between 2007 and 2015. RESEARCH DESIGN AND METHODS: This is a retrospective analysis of annual data of new certifications for visual impairment and blindness (Certificate of Vision Impairment) for England and Wales derived from the national database provided by the Certifications Office, Moorfields Eye Hospital, over a period of 8 years from 2007. RESULTS: In Wales there were 339 less new certifications for both SI and severe SSI from any cause combined from 2007-2008 to 2014-2015. The number SI and SSI combined specifically due to DR was reduced by 22 in people with known diabetes. This was a reduction in new certifications over the observation period from 82.4 to 46.9 per 100 000 (-43.1%) with a fall in SSI from 31.3 to 15.8 per 100 000 (-49.4%), respectively. During this observation period however, there was a parallel increase in 52 229 (39.8%) persons with diabetes in Wales. CONCLUSIONS: While acknowledging the limitations of the certification process and the increasing numbers of persons with diabetes, the incidence of SI and SSI per 100 000 population of persons with diabetes in Wales has almost halved over an 8-year period up to 2015. This may reflect the earlier diagnosis of DR and sight-threatening DR since the introduction of screening and/or improved diabetes management with timely onward referral and newer treatments.
Assuntos
Complicações do Diabetes/epidemiologia , Retinopatia Diabética/epidemiologia , Avaliação da Deficiência , Baixa Visão/epidemiologia , Adolescente , Adulto , Idoso , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , País de Gales/epidemiologia , Adulto JovemRESUMO
PURPOSE: To determine the accuracy of automated alignment algorithms for the registration of optic disc images obtained by 2 different modalities: fundus photography and scanning laser tomography. MATERIALS AND METHODS: Images obtained with the Heidelberg Retina Tomograph II and paired photographic optic disc images of 135 eyes were analyzed. Three state-of-the-art automated registration techniques Regional Mutual Information, rigid Feature Neighbourhood Mutual Information (FNMI), and nonrigid FNMI (NRFNMI) were used to align these image pairs. Alignment of each composite picture was assessed on a 5-point grading scale: "Fail" (no alignment of vessels with no vessel contact), "Weak" (vessels have slight contact), "Good" (vessels with <50% contact), "Very Good" (vessels with >50% contact), and "Excellent" (complete alignment). Custom software generated an image mosaic in which the modalities were interleaved as a series of alternate 5×5-pixel blocks. These were graded independently by 3 clinically experienced observers. RESULTS: A total of 810 image pairs were assessed. All 3 registration techniques achieved a score of "Good" or better in >95% of the image sets. NRFNMI had the highest percentage of "Excellent" (mean: 99.6%; range, 95.2% to 99.6%), followed by Regional Mutual Information (mean: 81.6%; range, 86.3% to 78.5%) and FNMI (mean: 73.1%; range, 85.2% to 54.4%). CONCLUSIONS: Automated registration of optic disc images by different modalities is a feasible option for clinical application. All 3 methods provided useful levels of alignment, but the NRFNMI technique consistently outperformed the others and is recommended as a practical approach to the automated registration of multimodal disc images.
Assuntos
Algoritmos , Glaucoma/diagnóstico , Interpretação de Imagem Assistida por Computador , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Diagnóstico por Imagem/métodos , Humanos , Aumento da Imagem/métodos , Pressão Intraocular , Fotografação , Reprodutibilidade dos TestesRESUMO
PURPOSE: The association of hyperglycemia and diabetic retinopathy (DR) in established type 2 diabetes mellitus (T2DM) subjects is well accepted. However, the association between ß-cell responsiveness and insulin sensitivity leading to fasting and postprandial hyperglycemia with DR in newly diagnosed treatment-naïve T2DM subjects remain unreported. METHODS: A total of 544 newly diagnosed treatment-naïve T2DM subjects were screened for DR (digital photography) and underwent a standardized meal tolerance test. Serial plasma glucose and insulin levels were measured, and fasting (M0) and postprandial ß-cell responsiveness calculated Calculating Pancreatic Response Program along with homeostasis model assessment-ß cell function (HOMA-B) and HOMA-Insulin Sensitivity. A subgroup of 201 subjects also underwent a frequently sampled IV glucose tolerance test and the acute insulin response to glucose, insulin sensitivity, and glucose effectiveness (SG) estimated (MINMOD model). RESULTS: A total of 16.5% (90) subjects had DR at diagnosis. Subjects with DR had significantly reduced M0, HOMA-B and SG leading to higher fasting and postprandial (2 hour) glucose and significantly lower fasting and postprandial (2 hour) insulin. Factors independently associated with DR in multivariate logistic regression analysis were M0, HOMA-B, and SG with fasting and postprandial (2 hour) glucose and insulin. There was no statistical difference in glycated hemoglobin, systolic blood pressure, acute insulin response to glucose, and insulin sensitivity between those with or without DR. PRINCIPAL CONCLUSIONS: In this cohort of newly diagnosed T2DM subjects, DR is associated with reduced ß-cell responsiveness, resulting from ß-cell failure rather than insulin resistance, leading to fasting and postprandial hyperglycemia and hypoinsulinemia.
Assuntos
Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/patologia , Retinopatia Diabética/patologia , Células Secretoras de Insulina/patologia , Idoso , Glicemia/análise , Estudos de Coortes , Feminino , Glucose/farmacologia , Teste de Tolerância a Glucose , Homeostase , Humanos , Hiperglicemia/sangue , Insulina/sangue , Resistência à Insulina , Masculino , Pessoa de Meia-Idade , Retina/patologiaRESUMO
Retinal and intra-retinal layer thicknesses are routinely generated from optical coherence tomography (OCT) images, but on-board software capabilities and image scaling assumptions are not consistent across devices. This study evaluates the device-independent Iowa Reference Algorithms (Iowa Institute for Biomedical Imaging) for automated intra-retinal layer segmentation and image scaling for three OCT systems. Healthy participants (n = 25) underwent macular volume scans using a Cirrus HD-OCT (Zeiss), 3D-OCT 1000 (Topcon), and a non-commercial long-wavelength (1040nm) OCT on two occasions. Mean thickness of 10 intra-retinal layers was measured in three ETDRS subfields (fovea, inner ring and outer ring) using the Iowa Reference Algorithms. Where available, total retinal thicknesses were measured using on-board software. Measured axial eye length (AEL)-dependent scaling was used throughout, with a comparison made to the system-specific fixed-AEL scaling. Inter-session repeatability and agreement between OCT systems and segmentation methods was assessed. Inter-session coefficient of repeatability (CoR) for the foveal subfield total retinal thickness was 3.43µm, 4.76µm, and 5.98µm for the Zeiss, Topcon, and long-wavelength images respectively. For the commercial software, CoR was 4.63µm (Zeiss) and 7.63µm (Topcon). The Iowa Reference Algorithms demonstrated higher repeatability than the on-board software and, in addition, reliably segmented all 10 intra-retinal layers. With fixed-AEL scaling, the algorithm produced significantly different thickness values for the three OCT devices (P<0.05), with these discrepancies generally characterized by an overall offset (bias) and correlations with axial eye length for the foveal subfield and outer ring (P<0.05). This correlation was reduced to an insignificant level in all cases when AEL-dependent scaling was used. Overall, the Iowa Reference Algorithms are viable for clinical and research use in healthy eyes imaged with these devices, however ocular biometry is required for accurate quantification of OCT images.
Assuntos
Retina/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Adulto , Algoritmos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Retina/anatomia & histologia , Software , Adulto JovemRESUMO
AIMS: Determine the prevalence and severity of diabetic retinopathy (DR) and risk factors in a large community based screening programme, in order to accurately estimate the future burden of this specific and debilitating complication of diabetes. METHODS: A cross-sectional analysis of 91,393 persons with diabetes, 5003 type 1 diabetes and 86,390 type 2 diabetes, at their first screening by the community based National Diabetic Retinopathy Screening Service for Wales from 2005 to 2009. Image capture used 2×45° digital images per eye following mydriasis, classified by qualified retinal graders with final grading based on the worst eye. RESULTS: The prevalence of any DR and sight-threatening DR in those with type 1 diabetes was 56.0% and 11.2%, respectively, and in type 2 diabetes was 30.3% and 2.9%, respectively. The presence of DR, non-sight-threatening and sight-threatening, was strongly associated with increasing duration of diabetes for either type 1 or type 2 diabetes and also associated with insulin therapy in those with type 2 diabetes. CONCLUSIONS: Prevalence of DR within the largest reported community-based, quality assured, DR screening programme, was higher in persons with type 1 diabetes; however, the major burden is represented by type 2 diabetes which is 94% of the screened population.
Assuntos
Retinopatia Diabética/epidemiologia , Programas de Rastreamento , Adolescente , Adulto , Idoso , Criança , Estudos Transversais , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/classificação , Retinopatia Diabética/diagnóstico , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Programas Nacionais de Saúde/estatística & dados numéricos , Razão de Chances , Fotografação , Prevalência , Fatores de Risco , Índice de Gravidade de Doença , País de Gales/epidemiologia , Adulto JovemRESUMO
PURPOSE: To determine if a computer-based stereoscopic teaching program could improve optic cup/disc ratio (CDR) agreement between student observers and an expert. DESIGN: Experimental study. PARTICIPANTS: Six student observers (A-F) assessed at least 30 digital stereoscopic optic disc images using a digital stereoscopic analysis program. All observers made 36 CDR measurements (every 10 degrees ) for each disc image that they assessed. METHODS: Disc images were divided into 3 sets of 10 images (image sets 1, 2, and 3). Observers A, B, and C determined CDRs for all 3 image sets. Set 1 was examined without access to a teaching program, set 2 using a teaching program that allowed the observer to view an expert assessment of the optic disc, and set 3 after using the teaching program. Observers D, E, and F evaluated image sets 1 and 3 only and did not have access to the teaching program. Ten months later, these same observers (D-F) viewed image set 2 using the teaching program and then reassessed image set 3. MAIN OUTCOME MEASURES: Standard deviation (SD) of CDR differences between observers and an expert, the percentage of CDR observations differing > or =0.20 from those of the expert, and intraclass correlation coefficients (ICCs) between observers. RESULTS: Before teaching, the average SD of differences between all observers and the expert was 0.10. After teaching, the average SD of differences between all observers and the expert was 0.057. For observers D, E, and F, the average SD of differences for image set 3 without teaching was 0.074. The percentage of all observer measurements that differed > or =0.20 from those of the expert for image set 1 was 16.7%; for set 3 after teaching, 1.7%; and for set 3 for observers D, E, and F without teaching, 10%. Interobserver ICC values for all observers were 0.37 before teaching and 0.76 after. For observers D, E, and F, the ICC value for set 3 without access to teaching was 0.69. CONCLUSIONS: This study suggests that an interactive digital stereoscopic teaching program improves agreement between observers and an expert when assessing CDRs.
Assuntos
Técnicas de Diagnóstico Oftalmológico , Glaucoma/diagnóstico , Disco Óptico/patologia , Doenças do Nervo Óptico/diagnóstico , Ensino/métodos , Humanos , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Processamento de Sinais Assistido por ComputadorRESUMO
Silent substitution and selective adaptation techniques were used to obtain full field S-cone and L + M-cone electroretinograms from 18 patients with ocular hypertension (OHT), 9 with normotensive glaucoma (NTG), 18 with early primary open angle glaucoma (POAG) and 19 normal controls. Pattern electroretinograms were also recorded, using a reduced check size to increase the contribution of retinal ganglion cells. In the OHT and POAG groups, statistically significant reductions (P = 0.05-0.001) were observed in the amplitudes, most notably in the late negative waves of all three types of ERG compared to the controls. These are thought to reflect ganglion cell activity. The results imply a diffusely distributed loss of activity (20-35%) affecting many retinal pathways to a similar extent in OHT and early POAG, with an additional amount (<5%) in POAG corresponding approximately to the loss associated with local field defects. The electrophysiology indicated that virtually all cases of untreated OHT have greater retinal dysfunction than the least affected cases of POAG. The NTG group showed a different pattern of loss in that the PERG was markedly affected but the S-cone ERG was not significantly reduced.
Assuntos
Hipertensão Ocular/fisiopatologia , Células Fotorreceptoras Retinianas Cones/fisiopatologia , Idoso , Eletrorretinografia/métodos , Glaucoma/fisiopatologia , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Pressão Intraocular , Pessoa de Meia-Idade , Campos VisuaisRESUMO
We used background adaptation and silent substitution techniques to record full-field ON and OFF-visually evoked cortical potentials (VECPs) selectively from the S-cone and L- and M-cone pathways in 15 patients with primary open angle glaucoma (POAG), and 15 normal controls. The most statistically significant (P=0.01) VECP test for POAG was a voltage change in the S-cone pathway cortical OFF-response. A sensitivity of 93% was achieved, with 60% specificity at minimum error rate. This is presumed to reflect reduced activity in the S-cone and magnocellular visual pathways, and may provide an effective method for research and monitoring change in early glaucoma.
Assuntos
Potenciais Evocados Visuais , Glaucoma de Ângulo Aberto/fisiopatologia , Células Fotorreceptoras Retinianas Cones/fisiopatologia , Córtex Visual/fisiopatologia , Idoso , Estudos de Casos e Controles , Glaucoma de Ângulo Aberto/diagnóstico , Humanos , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Vias VisuaisRESUMO
This paper presents novel pre-processing image enhancement algorithms for retinal optical coherence tomography (OCT). These images contain a large amount of speckle causing them to be grainy and of very low contrast. To make these images valuable for clinical interpretation, we propose a novel method to remove speckle, while preserving useful information contained in each retinal layer. The process starts with multi-scale despeckling based on a dual-tree complex wavelet transform (DT-CWT). We further enhance the OCT image through a smoothing process that uses a novel adaptive-weighted bilateral filter (AWBF). This offers the desirable property of preserving texture within the OCT image layers. The enhanced OCT image is then segmented to extract inner retinal layers that contain useful information for eye research. Our layer segmentation technique is also performed in the DT-CWT domain. Finally we describe an OCT/fundus image registration algorithm which is helpful when two modalities are used together for diagnosis and for information fusion.
Assuntos
Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador , Nervo Óptico/anatomia & histologia , Tomografia de Coerência Óptica , Algoritmos , Fundo de Olho , Humanos , Análise de OndaletasRESUMO
PURPOSE: To assess the effect of a combination of proparacaine 0.50%-sodium fluorescein 0.25% and ultrasound (US) pachymetry on central and midperipheral corneal thickness. SETTING: School of Optometry and Vision Sciences, Cardiff University, Cardiff, Wales, United Kingdom. DESIGN: Case series. METHOD: Topographic measurements of corneal thickness in healthy right eyes were obtained using a scanning-slit device (Orbscan IIz) and a Scheimpflug device (Pentacam) before and after application of proparacaine 0.50%-sodium fluorescein 0.25% and US pachymetry. Changes in corneal thickness in the center and 2.5 mm from the center in the temporal, nasal, inferior, and superior locations were assessed. RESULTS: The study evaluated 35 eyes. The scanning-slit and Scheimpflug devices recorded a small but statistically significant increase in corneal thickness at all locations (mean 4.9 ± 14.3 [SD] to 9.1 ± 11.7 µm; P<.05, paired t test). The cornea swelled uniformly across its diameter (scanning slit, P=.934; Scheimpflug, P=.654; analysis of variance); there was no statistically significant difference in the amount of swelling between the 2 devices (P>.05, t test). The 95% limits of agreement were broad (-10 to +30 µm), suggesting a large degree of interindividual variability. CONCLUSIONS: Ultrasound pachymetry combined with proparacaine 0.50%-sodium fluorescein 0.25% caused a small (<10 µm) but significant amount of corneal swelling on average. Because the effect on corneal thickness may be greater than -10 to +30 µm in individual cases, clinicians should avoid contact procedures before obtaining topographic maps of corneal thickness using scanning-slit and Scheimpflug devices.
Assuntos
Anestésicos Locais/efeitos adversos , Córnea/efeitos dos fármacos , Edema da Córnea/induzido quimicamente , Técnicas de Diagnóstico Oftalmológico/instrumentação , Fluoresceína/efeitos adversos , Corantes Fluorescentes/efeitos adversos , Propoxicaína/efeitos adversos , Adulto , Córnea/diagnóstico por imagem , Edema da Córnea/diagnóstico por imagem , Topografia da Córnea , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Refração Ocular/fisiologia , Ultrassonografia , Acuidade Visual/fisiologia , Adulto JovemRESUMO
PURPOSE: To map choroidal (ChT) and retinal thickness (RT) in healthy subjects and patients with diabetes with and without maculopathy using three dimensional 1060-nm optical coherence tomography (3D-1060nm-OCT). METHODS: Sixty-three eyes from 42 diabetic subjects (41-82 years of age; 11 females) grouped according to a custom scheme using Early Treatment Diabetic Retinopathy Study definitions for pathology within 1 disc-diameter of fovea (without pathology [NDR], microaneurysms [M1], exudates [M2], clinically significant macular edema [CSME]) and 16 eyes from 16 healthy age matched subjects (38-79 years of age; 11 females) were imaged by 3D-1060nm-OCT performed over a 36° × 36° field of view. Axial length, 45° fundus photographs, body mass index, plasma glucose, and blood pressure measurements were recorded. The ChT at the subfoveal location and ChT maps between RPE and the choroidal-scleral interface were generated and statistically analyzed. RESULTS: RT maps show thinning in the NDR group but an increase in thickness with increasing maculopathy in the temporal and central regions (unpaired t-test; P < 0.05). ChT mapping of all diabetic patients revealed central and inferior thinning compared to healthy eyes (unpaired t-test; P < 0.001). Subfoveal ChT (mean ± SD) for healthy eyes was 327 ± 74 µm, which was significantly thicker than all diabetic groups (214 ± 55 µm for NDR, 208 ± 49 µm for M1, 205 ± 54 µm for M2, and 211 ± 76 µm for CSME (ANOVA P < 0.001; Tukey P < 0.001). CONCLUSIONS: 3D-1060nm-OCT has shown that the central choroid is thinner in all type 2 diabetic eyes regardless of disease stage. The choroidal thinning may exceed the magnitude of possible choriocapillaris atrophy. In contrast to the conventional assessment of pathologic thickness change in several locations, thickness maps allow investigation of the choroid over the extent of affected areas.