Home Monitoring for Glaucoma: Current Applications and Future Directions.

Technological advances provide a number of options for glaucoma monitoring outside the office setting, including home-based tonometry and perimetry. This has the potential to revolutionize management of this chronic disease, improve access to care, and enhance patient engagement. Here, we provide an overview of existing technologies for home-based glaucoma monitoring. We also discuss areas for future research and the potential applications of these technologies to telemedicine, which has been brought to the forefront during the ongoing COVID-19 pandemic.

Modern neuro-ophthalmological evaluation of patients with pituitary disorders.

Pituitary adenomas can manifest as ophthalmological symptoms, such as decreased vision, impaired visual field or diplopia. It is important to recognize these neuro-ophthalmological syndromes to achieve early diagnosis and treatment and to improve prognosis. Currently, ophthalmological examination includes precise measuring instruments, such as optical coherence tomography (OCT), which allows the evaluation of optic atrophy related to compression of the anterior optic tract. These measurements are reproducible and are useful for diagnostic and prognostic evaluation. In this review, we describe the ophthalmological syndromes associated with pituitary tumours: anterior optic pathway compression, followed by oculomotor disorders and pituitary apoplexy.

New imaging systems in diabetic retinopathy.

Various imaging modalities are of significant utility in the screening, grading, treatment, and follow-up of the different stages of diabetic retinopathy (DR) and diabetic macular edema. Color stereographic photography, fluorescein angiography, and optical coherence tomography (OCT) have been the gold standard for DR imaging for years. Besides these tools, newer technologies are gaining validation and popularity, such as fundus autofluorescence and OCT angiography. Furthermore, widefield retinography and ultra-widefield retinography have been introduced for a more comprehensive evaluation of the medium-far and very-far retinal peripheries, which is crucial for the assessment of the diverse manifestations of the disease. The aim of this review is to illustrate the recent advancements of the imaging systems for diagnosing DR, with a focus on the newest and noninvasive diagnostic tools.

Caracterización de indicadores de detección de glaucoma con los equipos OCT Spectralis y campímetro Humphrey II en pacientes altos miopes y altos miopes glaucomatosos del Hospital Clínico Universidad de Chile / Characterization of glaucoma detection indicators with OCT Spectralis equipment and Humphrey II campimeter in patients with high myopia and high myopia glaucomatous at the Hospital Clínico Universidad de Chile

Purpose: Characterize and describe glaucoma index parameters of the results of visual exams, Optical Coherence Tomography and Visual Field, in high myopic subjects with and without the pathology. Method: Cross sectional and observational study of 39 eyes, 15 high myopic with glaucoma y 24 high myopic without it. Visual Field (VF) were performed, where the global index between both groups were analyzed; Mean Deviation (MD), Model Standard Deviation (MSD) and Visual Field Index (VFI), beside Optical Coherence Tomography (OCT), in which the thickness of the ganglion cells layer (GCL) inside 3 central mm was compared. Results: The results were satisfactory, demonstrating different characteristics between the high myopic group with glaucoma and without it, both in VF and OCT exams. It was obtained in the VF analysis difference in average MD of -4,92 dB + 3,71 (p<0,05); difference in average DSM of 2,01 dB + 2,85 (p>0,05) and VFI with Friedman Test 10,29 (p>0,05). The statistical OCT analysis, when comparing GCL, observed that the Temporary sector (T) had a statistically significant decrease (p<0,05). Conclusions: To continue studies in this investigative line, can expand the knowledge in this area, mainly in the study of the GCL. (AU)

Imagining eye care in India (2018 Lalit Prakash Agarwal lecture).

India has done well in eye care delivery by recognizing visual impairment and blindness as a major medical challenge. Major contributions have come from ophthalmologists (mass cataract surgery in the early 1900s; major participation of non-government organizations), policy makers (National Program for Control of Blindness and Visual Impairment 1976; systematic development under the World Bank assisted India Cataract Project, 1995-2002), and the industry (manufacturing of affordable surgical instruments and medicines). Although the country could boast of higher cataract surgical coverage and near-total elimination of trachoma, there is increasing prevalence of diabetic retinopathy and undetected glaucoma. India is in the crossroad of adherence to old successful models of service delivery and adoption of new innovative methods of teaching and training, manpower development and skill-based training, relevant medical research and product development. In the absence of these new approaches, the initial gains in eye care could not be furthered in India. A new approach, that will combine the best of the "old" tradition of empathy and the "new" technology of analytics, is required to imagine the future of eye care in India.

Vision and the Nobel Prize.

The Nobel Prize is the world's foremost honor for scientific advances in medicine and other areas. Founded by Alfred Nobel, the prizes have been awarded annually since 1901. We reviewed the literature on persons who have won or competed for this prize in subjects related to vision and ophthalmology. The topics were divided into vision physiology, diagnostic and therapeutic methods, disease mechanism, and miscellaneous categories. Allvar Gullstrand is the only ophthalmologist to win a Nobel Prize; he is also the only one to receive it for work in ophthalmology. Other ophthalmologists that have been nominated were Hjalmar Schiötz (tonometer), Karl Koller (topical anesthesia), and Jules Gonin (retinal detachment). Other scientists have won the prize for eye-related research: Ragnar Granit, Haldan Hartline and George Wald (chemistry and physiology of vision), and David Hubel and Torsten Wiesel (processing in the visual system). Peter Medawar is the only person born in Brazil to have won the Nobel Prize.

Vision and the Nobel Prize / A visão e Prêmio Nobel

ABSTRACT The Nobel Prize is the world's foremost honor for scientific advances in medicine and other areas. Founded by Alfred Nobel, the prizes have been awarded annually since 1901. We reviewed the literature on persons who have won or competed for this prize in subjects related to vision and ophthalmology. The topics were divided into vision physiology, diagnostic and therapeutic methods, disease mechanism, and miscellaneous categories. Allvar Gullstrand is the only ophthalmologist to win a Nobel Prize; he is also the only one to receive it for work in ophthalmology. Other ophthalmologists that have been nominated were Hjalmar Schiötz (tonometer), Karl Koller (topical anesthesia), and Jules Gonin (retinal detachment). Other scientists have won the prize for eye-related research: Ragnar Granit, Haldan Hartline and George Wald (chemistry and physiology of vision), and David Hubel and Torsten Wiesel (processing in the visual system). Peter Medawar is the only person born in Brazil to have won the Nobel Prize.

RESUMO O Prêmio Nobel é a principal honraria do mundo para avanços científicos em medicina e outras áreas. Fundada por Alfred Nobel, os prêmios são concedidos anualmente desde 1901. Revisamos a literatura sobre pessoas que ganharam ou competiram por esse prêmio em assuntos relacionados à visão e oftalmologia. Os tópicos foram divididos em fisiologia da visão, métodos diagnósticos e terapêuticos, mecanismo de doenças e variados. Allvar Gullstrand não é o único oftalmologista a ganhar um Nobel, porém é o único a recebê-lo por contribuições na oftalmologia. Outros oftalmologistas foram nomeados: Hjalmar Schiötz (tonometro), Karl Koller (anestesia tópica) e Jules Gonin (descolamento da retina). Outros cientistas ganharam o prêmio com pesquisas relacionadas à visão: Ragnar Granit, Haldan Hartline e George Wald (química e fisiologia da visão); David Hubel e Torsten Wiesel (processamento no sistema visual). Peter Medawar é a única pessoa que nasceu no Brasil a ganhar o prêmio.

Orbital exenteration: Institutional review of evolving trends in indications and rehabilitation techniques.

PURPOSE: To determine the changes in indications for orbital exenteration over 20 years and to assess its impact on patient survival. Evolving techniques of rehabilitation of the orbit in our institution were also evaluated. METHODS: This was a retrospective review of hospital records of patients who underwent orbital exenteration from 1995 to 2015 in a tertiary care center. Data extracted included primary location of the tumor, preoperative treatments, interval between initial diagnosis and exenteration, status of surgical margins, presence of metastatic disease, and postoperative survival. The types of prosthesis utilized over the years were also reviewed. Cox regression analysis was performed for categorical variables. Kaplan-Meier analysis was used to estimate post-exenteration survival. RESULTS: Over a 20-year period, orbital exenteration was performed on 100 orbits of 100 patients. The mean age was 39.4 years (range: 2 months to 90 years). The most common indications among 98 malignant causes were retinoblastoma, squamous cell carcinoma, basal cell carcinoma, extraocular extension of uveal melanoma, and conjunctival melanoma. Postoperative survival was significantly related to age and tumor location but independent from gender, surgical margin, histopathological diagnosis, previous treatment modality, and preoperative interval. In the whole cohort, 1-year and 5-year survival rates were 97% and 84%, respectively. CONCLUSIONS: Exenteration appears to be life-saving in children with orbital extension of retinoblastoma. While patients exenterated for malignant eyelid tumors have the best chance of survival, those with orbital extension of uveal melanoma and adenoid cystic carcinoma of the lacrimal gland have the worst prognosis.

Routine colonoscopy, diabetic eye care, mammogram and pap smear screening in vascular surgery patients.

Objective An increasing emphasis on preventive medicine has been supported by the recent reforms in United States health care system. Majority of the patients seen in vascular surgery clinics are elderly with more extensive medical comorbidities compared to the general population. Thus, these patients would be expected at higher risk for common malignant pathologies such as colon, breast and cervical cancer, and nonmalignant diseases such as diabetic retinopathy. This study looked at the screening compliance of vascular patients compared to data provided by Centers for Disease Control on the national and state levels. Methods The office records of 851 consecutive patients seen in Brooklyn and Staten Island vascular clinics were examined. We queried patients regarding their last colonoscopy, diabetic eye exams, recent mammograms, and Pap smears. Our patient screening compliance was compared between the two clinics as well as to the national and New York state data provided by Centers for Disease Control. Compliance with regard to patient's age was also examined. Results Patients referred to the Staten Island office have a better colonoscopy compliance compared to the Brooklyn office ( P = .0001) and the national Centers for Disease Control average ( P = .026). Compliance for mammography and cervical cancer screening was higher in Staten Island office compared to the Brooklyn office ( P = .0001, P < .0001), respectively. Compliance was lower for Pap smear ( P = .0273) in Brooklyn when compared to the national average. Compliance for colonoscopy increased with age for both clinics ( P = .001, P < .001), while Pap smear decreased ( P < .001, P = .004). Conclusion Patients in vascular clinics in an urban setting had better adherence to screening protocol than the national and state average, with the exception of female patients for colonoscopy in our Brooklyn vascular office. There exists variability in both patient populations based on sub-specific locality and demographics including socioeconomic status. Overall, however patients in Staten Island had better compliance and adherence to the screening protocol than Brooklyn vascular clinic.

[Update on recommendations for screening for hydroxychloroquine retinopathy]. / Mise à jour des recommandations sur la toxicité rétinienne des antipaludéens de synthèse.

INTRODUCTION: Recommendations for screening for chloroquine (CQ) and hydroxychloroquine (HCQ) retinopathy have recently been changed by the American Academy of Ophthalmology, taking into account new published data on toxicity prevalence, risk factors, location of onset in the retina and the efficacy of screening tests. METHODS: Literature review. RESULTS AND DISCUSSION: The risk of developing CQ or HCQ retinopathy depends on the daily dose and duration of treatment. At recommended doses, the risk is<1 % at 5 years, <2 % at 10years but increases to about 20 % after 20years of treatment. The maximum recommended daily dose is 5.0mg/kg for HCQ and 2.3mg/kg for CQ. The two main risk factors are the daily dose and duration of treatment. The presence of kidney failure and treatment with tamoxifen are also significant risk factors. A baseline examination should be performed at the initiation of treatment to rule out pre-existing maculopathy. The screening is then annual and starts from the 5th year of treatment. The two tests recommended for screening are the automated visual field and spectral domain OCT. Multifocal ERG and autofluorescence fundus imaging are only carried out secondarily to confirm the pathology.

Decade-Long Profile of Imaging Biomarker Use in Ophthalmic Clinical Trials.

Purpose: The purpose of this study was to investigate the use of imaging biomarkers in published clinical trials (CTs) in ophthalmology and its eventual changes during the past 10 years. Methods: We sampled from published CTs in the fields of cornea, retina, and glaucoma between 2005-2006 and 2015-2016. Data collected included year of publication, phase, subspecialty, location, compliance with Consolidated Standards for Reporting Trials, impact factor, presence and use of imaging biomarkers (diagnostic, prognostic and predictive; primary and secondary surrogate endpoints), and use of centralized reading centers. Results: We included 652 articles for analysis, equally distributed in three timeframes (2005-2006, 2010-2011, and 2015-2016), mainly reporting phase IV CTs and trials on procedures (42.2% and 35.4%, respectively). Imaging biomarkers were included in 46.3% of the analyzed CTs and their use significantly increased over time (P < 0.05). Optical coherence tomography was the most frequently used device (27.7%), whereas diagnostic biomarkers and secondary surrogate endpoints were the most frequent biomarker types (19.5% and 22.5%, respectively). Early-phase CTs showed an increase in the use of biomarkers for patient selection and stratification over time (P < 0.05), but not in the use of imaging surrogate endpoints (P = 0.90). Only 3 of 59 (5.1%) of phase III CTs included primary surrogate imaging endpoints, whereas secondary surrogate imaging endpoints were present in 50.8% of these trials (P < 0.001). Retinal CTs had the highest prevalence for each type of imaging biomarker (P < 0.001). Reading centers were used in 52 of 302 CTs (17.2%), with no significant time-related increase. Conclusions: Imaging biomarkers are increasingly used in published CTs in ophthalmology. Additional efforts, including centralized reading centers, are needed to improve their validation and use, allowing a wider use of these tools as primary surrogate endpoints in phase III CTs.

[Modern approach to early diagnosis and pathogenetic treatment of diabetic retinopathy]. / Sovremennye podkhody k rannei diagnostike, patogeneticheskomu lecheniyu diabeticheskoi retinopatii.

AIM: To improve the approach to pathogenetic treatment of diabetic retinopathy (DR) through early diagnosis and a new method for predicting disease progression. MATERIAL AND METHODS: The study enrolled 330 type 2 diabetes patients with DR (660 eyes), of whom women constituted 64.6%, men - 35.4%. The mean patient age was 62.3±2.3 years. Three groups were formed: the controls - 30 healthy volunteers (60 eyes) and 30 type 2 diabetes patients without ocular involvement (DR 0, 60 eyes); group 1 - 30 type 2 diabetes patients with DR I but no diabetic macular edema (DR I without DME, 60 eyes) that were treated with calcium dobesilate; group 2 - 240 type 2 diabetes patients, who had diabetic retinopathy of different stages (DR I, II, or III with DME, 480 eyes) and received laser retinal photocoagulation (LRP). The groups were all alike in terms of sex and age distribution. All patients underwent ophthalmic examination, including best corrected visual acuity (BCVA) and critical flicker fusion frequency (CFFF) testing, tonometry, biomicroscopy, MAIA fundus microperimetry, optical coherence tomography (OCT), and fluorescein angiography (FAG) of the retina. Traditionally we also determined blood sugar and glycated hemoglobin levels as well as vascular endothelial growth factor (VEGF-A) and monocyte chemoattractant protein (MCP-1) in tear fluid by ELISA. RESULTS: In group 1, which was under conservative therapy with calcium dobesilate, there was an increase in BCVA by the average of 0.95±0.02 and CFFF by 42.5±0.2 Hz (p<0,05). The mean central retinal thickness decreased reliably down to 265.1±12.1 µm (p<0.05). Light sensitivity of the macula improved and scored 24.13±12.3 dB (p<0.05). In group 2, the mean central retinal thickness appeared to be 383.1±221 µm, which was reliably higher than that in healthy individuals (p<0.05) and in type 2 diabetes patients without diabetic retinopathy (DR 0) (p<0.05). Tear assessment 12 months after the treatment revealed a significant decrease in VEGF-A and MCP-1 concentrations - down to 655.1±86.1 pg/ml and 1133 pg/ml, respectively (p<0.05). CONCLUSION: Conservative treatment with calcium dobesilate has proved effective in patients with DR I without DME as it ensures improvement and stabilization of the state of the retina (clinical and morphological) in one month already (judging from FAG and OCT findings). Laser treatment is rational in DR I, DR II, and DR III patients, whose condition is complicated with DME. Improvement and stabilization take, however, longer to be achieved - up to 1 year (according to FAG and OCT). Tear fluid assessment for particular participants in disease pathogenesis, such as VEGF-A and MCP-1, is a unique method for disease control and patient follow-up with account to different treatments. A new method for predicting the progression of diabetic retinopathy and diabetic macular edema has been suggested (RF patent for invention №2520826).