Gender Representation Among Ophthalmology Fellowship Directors in 2022.

PURPOSE: Women are underrepresented in several medical specialties, including ophthalmology. Reducing disparities is critical in diversifying perspectives and increasing equity within ophthalmology, both of which can ultimately improve care delivery. We examined ophthalmic fellowship programs directors in the United States to investigate gender disparities by subspecialty. DESIGN: Cross-sectional study. METHODS: This was a retrospective cross-sectional study of ophthalmology fellowship program directors in academic medical centers. The primary outcome measure was a descriptive analysis of current fellowship directors in 2022 when stratified by subspecialty and demographic features. RESULTS: Analysis was conducted on 358 fellowship directors in the United States. Twenty-nine percent of directors were women. Female directors had significantly fewer years since residency graduation compared with male peers (17 vs 24; P < .001); however, no differences were observed by program type (P = .896) or location (P = 0.104). Differences in female director representation were observed by subspecialty (P < .001), with the greatest percentage of women in pediatric ophthalmology (54%), other (oncology and pathology) fellowships (50%), and medical retina (40%). The subspecialties with the lowest percentage of female directors were oculoplastic and reconstructive surgery (13%) surgical retina and vitreous (16%). CONCLUSION: There are disparities in female representation in academic leadership positions across ophthalmic subspecialties. Addressing this difference may have critical impacts on career advancement and opportunities available for marginalized groups in medicine.

Future direction for the deployment of deep learning artificial intelligence: Vision threatening disease detection in underserved communities during COVID-19.

PURPOSE: Vision-threatening diseases (VTDs) are the leading causes of vision loss and blindness. Use of deep learning artificial intelligence (DLAI) in early detection and subspecialty referral is critical to saving vision years and maintaining quality of life. To address this, we propose a comprehensive community-based screening retinal approach that incorporates DLAI to mitigate disparities and address need in an underserved urban community. METHODS: We evaluated two DLAI software designed for 45° retinal image analysis. DLAI was deployed in clinical settings to triage cases for ophthalmic referrals. Functionality was evaluated to propose implementation in a community screening. RESULTS: Our community screenings have incorporated various imaging modalities to improve VTD pick up rate: nonmydriatic color retinal imaging (18%), fundus autofluorescence (AF) (23%), and ocular coherence tomography B and angiography scans (35%). Robotic teleconsultation increased follow-up reached 100%. In clinical settings, DLAI reduced image analysis time (EyeArt™ = under 38 s, SELENA+™ =10.6 s) and highlighted multiple VTDs. High concordance was observed between human graders and DLAI (k = 0.68 in the department of endocrinology and k = 1 in the emergency department). CONCLUSION: Integration of DLAI in our ocular screening protocol can be used to reach underserved communities, especially when traditional health-care access is limited.

EyeArt artificial intelligence analysis of diabetic retinopathy in retinal screening events.

PURPOSE: Early detection and treatment of diabetic retinopathy (DR) are critical for decreasing the risk of vision loss and preventing blindness. Community vision screenings may play an important role, especially in communities at higher risk for diabetes. To address the need for increased DR detection and referrals, we evaluated the use of artificial intelligence (AI) for screening DR. METHODS: Patient images of 124 eyes were obtained using a 45° Canon Non-Mydriatic CR-2 Plus AF retinal camera in the Department of Endocrinology Clinic (Newark, NJ) and in a community screening event (Newark, NJ). Images were initially classified by an onsite grader and uploaded for analysis by EyeArt, a cloud-based AI software developed by Eyenuk (California, USA). The images were also graded by an off-site retina specialist. Using Fleiss kappa analysis, a correlation was investigated between the three grading systems, the AI, onsite grader, and a US board-certified retina specialist, for a diagnosis of DR and referral pattern. RESULTS: The EyeArt results, onsite grader, and the retina specialist had a 79% overall agreement on the diagnosis of DR: 86 eyes with full agreement, 37 eyes with agreement between two graders, 1 eye with full disagreement. The kappa value for concordance on a diagnosis was 0.69 (95% CI 0.61-0.77), indicating substantial agreement. Referral patterns by EyeArt, the onsite grader, and the ophthalmologist had an 85% overall agreement: 96 eyes with full agreement, 28 eyes with disagreement. The kappa value for concordance on "whether to refer" was 0.70 (95% CI 0.60-0.80), indicating substantial agreement. Using the board-certified retina specialist as the gold standard, EyeArt had an 81% accuracy (101/124 eyes) for diagnosis and 83% accuracy (103/124 eyes) in referrals. For referrals, the sensitivity of EyeArt was 74%, specificity was 87%, positive predictive value was 72%, and negative predictive value was 88%. CONCLUSIONS: This retrospective cross-sectional analysis offers insights into use of AI in diabetic screenings and the significant role it will play in automated detection of DR. The EyeArt readings were beneficial with some limitations in a community screening environment. These limitations included a decreased accuracy in the presence of cataracts and the functional cost of EyeArt uploads in a community setting.

Implementation of deep learning artificial intelligence in vision-threatening disease screenings for an underserved community during COVID-19.

INTRODUCTION: Age-related macular degeneration, diabetic retinopathy, and glaucoma are vision-threatening diseases that are leading causes of vision loss. Many studies have validated deep learning artificial intelligence for image-based diagnosis of vision-threatening diseases. Our study prospectively investigated deep learning artificial intelligence applications in student-run non-mydriatic screenings for an underserved, primarily Hispanic community during COVID-19. METHODS: Five supervised student-run community screenings were held in West New York, New Jersey. Participants underwent non-mydriatic 45-degree retinal imaging by medical students. Images were uploaded to a cloud-based deep learning artificial intelligence for vision-threatening disease referral. An on-site tele-ophthalmology grader and remote clinical ophthalmologist graded images, with adjudication by a senior ophthalmologist to establish the gold standard diagnosis, which was used to assess the performance of deep learning artificial intelligence. RESULTS: A total of 385 eyes from 195 screening participants were included (mean age 52.43 ± 14.5 years, 40.0% female). A total of 48 participants were referred for at least one vision-threatening disease. Deep learning artificial intelligence marked 150/385 (38.9%) eyes as ungradable, compared to 10/385 (2.6%) ungradable as per the human gold standard (p < 0.001). Deep learning artificial intelligence had 63.2% sensitivity, 94.5% specificity, 32.0% positive predictive value, and 98.4% negative predictive value in vision-threatening disease referrals. Deep learning artificial intelligence successfully referred all 4 eyes with multiple vision-threatening diseases. Deep learning artificial intelligence graded images (35.6 ± 13.3 s) faster than the tele-ophthalmology grader (129 ± 41.0) and clinical ophthalmologist (68 ± 21.9, p < 0.001). DISCUSSION: Deep learning artificial intelligence can increase the efficiency and accessibility of vision-threatening disease screenings, particularly in underserved communities. Deep learning artificial intelligence should be adaptable to different environments. Consideration should be given to how deep learning artificial intelligence can best be utilized in a real-world application, whether in computer-aided or autonomous diagnosis.

EARLY RETINAL MICROVASCULAR ABNORMALITIES IN YOUNG ADULTS WITH TYPE 1 DIABETES MELLITUS WITHOUT CLINICALLY EVIDENT DIABETIC RETINOPATHY.

PURPOSE: To characterize the early retinal microvascular changes in young adults (age: 22.69 ± 3.50 years) with Type 1 diabetes mellitus without clinically detectable diabetic retinopathy using optical coherence tomography angiography and investigate the associated factors. METHODS: A total of 36 participants with Type 1 diabetes mellitus (70 eyes) and 34 healthy controls (57 eyes) were retrospectively reviewed. The analyzed optical coherence tomography angiography indices included capillary vessel density, foveal avascular zone area/perimeter/acircularity index, and foveal vascular density, acquired in the 6 × 6-mm2 area centered on the fovea. The generalized estimation equations model was applied to compare the mean values and to study the associated factors. RESULTS: In subjects with diabetes, statistically significant decreases were observed in parafoveal vessel density in both superficial and deep capillary plexuses, foveal avascular zone area/perimeter, and foveal vascular density when compared with controls (all P < 0.05). Higher glycated hemoglobin level was independently associated with the decrease of parafoveal vessel density as well as the increase of foveal avascular zone area/perimeter (all P < 0.05). Prepubescent onset of diabetes mellitus was also independently associated with the decrease of superficial parafoveal vessel density, foveal avascular zone area/perimeter, and foveal vascular density (P = 0.015, 0.011, 0.015, and 0.001, respectively). CONCLUSION: In young adults with Type 1 diabetes mellitus lacking clinical signs of diabetic retinopathy, optical coherence tomography angiography revealed alterations in retinal microvasculature that were associated with glycated hemoglobin level and onset of diabetes mellitus related to puberty.

Use of Telepresence Robots in Glaucoma Patient Education.

PRCIS: Telepresence robots (TR) present the versatility to effectively provide remote educational sessions for patients affected by glaucoma to improve disease knowledge. Given COVID-19's effect on clinical practice, TR can maintain social distancing when educating patients. PURPOSE: TR are devices that allow remote users to have a mobile presence anywhere. We compared the effect of an education session given by an in-person educator versus a TR on glaucoma knowledge and identified factors that impact patient education. METHODS: Eighty-five glaucoma patients were split into control, human, and TR groups. We measured glaucoma knowledge scores (KS) using the National Eye Institute's Eye-Q Test. Human and TR groups had the education session with a human or TR followed by the questionnaire. The control group was administered the questionnaire without an education session. Treatment regimen recall (RR) >90% was considered a success. We used linear regression and binary logistic regression to determine variables that affect KS and RR, respectively. RESULTS: Mean age was 58.3±2.8 years. 49% were female. Mean KS were 5.8±0.7 in the control group (n=31), 7.9±0.5 in the TR group (n=26), and 8.4±0.5 in the human group (n=28). Control participants had a lower mean KS than the human or TR groups (P<0.001). Having the education session (2.5, P<0.001), education greater than high school (0.8, P=0.016), and diabetes (-0.7, P=0.037) affected KS. Having diabetes (odds ratio=0.14, P=0.014) negatively affected RR. Having the education session may affect RR (odds ratio=5.47, P=0.07), warranting additional studies. CONCLUSIONS: Education sessions with a human and TR improved patients' glaucoma KS. TRs may serve as an alternative to in-person education sessions and allow educators to safely and effectively educate patients remotely to adhere to COVID-19 social distancing guidelines.

Tele-glaucoma versus clinical evaluation: The New Jersey Health Foundation Prospective Clinical Study.

INTRODUCTION: Glaucoma, the second most common cause of blindness, is normally detected in clinic. With technological improvements, tele-glaucoma exams can identify these changes off-site. The quality of tele-glaucoma exams needs to be compared with that of traditional exams. This study's purpose was to validate the tele-glaucoma programme, which allows a physician comprehensive access to patients' data, by comparing results to clinical examinations. METHODS: A prospective study of 107 subjects evaluated in clinic and then tele-glaucoma stations, which consisted of non-mydriatic fundus photography, puff-tonometry, auto-refraction and Optical Coherence Tomography (OCT). The OCT captured central corneal thickness, angle anatomy, cup-to-disc ratio (CDR), retinal nerve fibre layer distribution and posterior-pole ganglion cell complex data. RESULTS: Intraocular pressure (IOP) comparisons between clinical and tele-glaucoma exams had strong positive Pearson correlation coefficients (0.8248 OD, 0.8672 OS). Strong positive correlations were seen for CDR (0.7835 OD, 0.8082 OS) as well as diagnosis (glaucoma, no glaucoma or glaucoma suspect). A moderate positive correlation was seen for return to clinic time (RTC). Tele-glaucoma had an average lower RTC (2.7 vs 3.9 months). Tele-glaucoma was more likely to elicit a non-glaucomatous diagnosis not found in clinic vs a diagnosis found only in clinic (18% vs 5% of subjects). DISCUSSION: Tele-glaucoma allows for detecting glaucoma remotely. These advancements alleviate patient difficulties with obtaining adequate glaucoma screenings and helps ophthalmologists triage patients with more severe pathology. Our study indicates that our tele-glaucoma protocol is comparable to a clinical exam in its ability to detect glaucoma. Further studies will be needed for off-site testing and transferring data separately for analysis.

Ganglion cell complex loss in patients with type 1 diabetes: A 36-month retrospective study.

BACKGROUND: To analyze changes over a 3-year period in ganglion cell complex (GCC) thickness in individuals with type 1 diabetes mellitus (T1DM) using spectral-domain optical coherence tomography (Optovue, Fremont, CA, USA). METHODS: Thirty-seven individuals from "Friends for Life Conference" with T1DM and a 3-year history of GCC thickness measurements were included in the study. Data analysis using SPSS 22 and Excel StatPlus was completed to note the subgroups that had a significant change. RESULTS: Significant decreases were noted in the following subgroups with slope in parenthesis. Overall: GCC superior thickness OD (-0.48)Male: GCC thickness OD (-0.86), GCC superior thickness OD (-0.735)Body mass index (BMI) 25.0-29.9: GCC thickness OD (-0.48), GCC superior thickness OS (-0.915), GCC inferior thickness OD (-0.43)Ages 10-20 years: GCC superior thickness OD (-0.635)Duration of diabetes 10-20 years: GCC thickness OD (-1.055), GCC superior thickness OD (-0.99). CONCLUSION: GCC loss was noted in individuals who were males, those with BMIs of 25.0-29.9, and those who had diabetes for 10-20 years. Ganglion cell loss was also noted before the presence of any diabetic retinopathy, suggesting onset of neuronal loss before any vasculature changes.

Are Disposable and Standard Gonioscopy Lenses Comparable?

PURPOSE: Gonioscopy is important in the evaluation and treatment of glaucoma. With increased scrutiny of acceptable sterilization processes for health care instruments, disposable gonioscopy lenses have recently been introduced. Single-time use lenses are theorized to decrease infection risk and eliminate the issue of wear and tear seen on standard, reusable lenses. However, patient care would be compromised if the quality of images produced by the disposable lens were inferior to those produced by the reusable lens. The purpose of this study was to compare the quality of images produced by disposable versus standard gonioscopy lenses. MATERIALS AND METHODS: A disposable single mirror lens (Sensor Medical Technology) and a standard Volk G-1 gonioscopy lens were used to image 21 volunteers who were prospectively recruited for the study. Images of the inferior and temporal angles of each subject's left eye were acquired using a slit-lamp camera through the disposable and standard gonioscopy lens. In total, 74 images were graded using the Spaeth gonioscopic system and for clarity and quality. Clarity was scored as 1 or 2 and defined as either (1) all structures perceived or (2) all structures not perceived. Quality was scored as 1, 2, or 3, and defined as (1) all angle landmarks clear and well focused, (2) some angle landmarks clear, others blurred, or (3) angle landmarks could not be ascertained. The 74 images were divided into images taken with the disposable single mirror lens and images taken with the standard Volk G-1 gonioscopy lens. The clarity and quality scores for each of these 2 image groups were averaged and P-values were calculated. RESULTS: Average quality of images produced with the standard lens was 1.46±0.56 compared with 1.54±0.61 for those produced with the disposable lens (P=0.55). Average clarity of images produced with the standard lens was 1.47±0.51 compared with 1.49±0.51 (P=0.90) with the disposable lens. CONCLUSIONS: We conclude that there is no significant difference in quality of images produced with standard versus disposable gonioscopy lenses. Disposable gonioscopy lenses may be an acceptable alternative to standard reusable lenses, especially in conditions where sterilization is difficult.

Fundus Autofluorescence Captured With a Nonmydriatic Retinal Camera in Vegetarians Versus Nonvegetarians.

BACKGROUND: A baseline level of lipofuscin in the retinal pigment epithelium (RPE) is inevitable with age, but increased levels due to increased oxidative stress can result in deleterious vision loss at older ages. As earlier detection of differences in levels can lead to superior preventative management, we studied the relationship between lipofuscin accumulation and dietary lifestyle (vegetarian vs. nonvegetarian) in the younger, healthy South Asian population using retinal fundus autofluorescence (FAF) imaging. METHODS: In this pilot study, we examined 37 healthy subjects (average age 23 years ± 1) all undergoing similar stress levels as medical students at Rutgers New Jersey Medical School. Levels of lipofuscin concentrations were imaged using a FAF retinal camera (Canon CX-1). Two images (color and FAF) were captured of the left eye and included in the analysis. FAF quantitative scoring was measured in 2 regions of the captured image, the papillo-macular region (P) and the macula (M), by determining the grayscale score of a 35.5 mm(2) rectangle in the respective regions. Standardized scores (corrected to remove baseline fluorescence) were then obtained. Means, standard deviations, and t tests were performed for comparisons. RESULTS: Fundus autofluorescence scores of regions P and M were significantly different (P < .05) between groups. Region P was further standardized and results remained significant. CONCLUSIONS: Our preliminary results show that in this cohort, vegetarians had statistically significant lower levels of autofluorescence. These findings can have potential implications regarding long-term retinal health and risk for developing certain diseases over decades in subjects at risk for vision-threatening diseases.

Structural Changes by Spectral Domain Optical Coherence Tomography in Patients With Type 1 Diabetes Mellitus.

BACKGROUND: With a possible increase in the prevalence of type 1 diabetes mellitus (DM1), the pediatric patient population is expected to be at risk for other health care complications. Current imaging modalities, such as the spectral domain optical coherence tomography (SD-OCT), that allow micron resolution imaging of the retina have become a standard of care for showing morphological changes seen in the retina in adults with diabetes. Such pathologies can be associated with known risk factors such as poor glycemic control (HbA1C) and body mass index (BMI). METHODS: A comprehensive screening was performed in subjects with DM1 including nonmydriatic fundus imaging (Canon, CR2 Plus-AF with EOS-60D, Tokyo, Japan) and SD-OCT imaging (Optovue, iVue, Fremont, CA). SD-OCT scans were acquired showing macular thickness (MT) and thickness of the parafoveal regions and the perifoveal regions. Associations of macular, paramacular, and perimacular thickness were analyzed as a function of HbA1C and BMI by simple linear regressions. RESULTS: SD-OCT changes were analyzed in eyes of subjects with DM1 and normal fundus appearance by color imaging. Linear regression analysis of thickness of macula right eye (RT), paramacula RT, paramacula left eye (LT), perimacula LT with BMI were statistically significant (P < .05). HbA1C >7.5% was also found statistically significant in the macula RT, paramacula RT, paramacula LT, perimacula RT, and perimacula LT. A general trend of thickening of the macula, paramacula, and perimacula was observed with increasing HbA1C (>7.5%) and increasing BMI; however, no statistical significance was found. CONCLUSIONS: SD-OCT with retinal imaging was feasible in young individuals with DM1 and revealed ultrastructural macular and perimacular changes prior to manifest clinical disease.

Feasibility of retinal screening in a pediatric population with type 1 diabetes mellitus.

PURPOSE: To study the feasibility of using a nonmydriatic camera to screen children with type 1 diabetes mellitus (DM1) as young as 2 years for diabetic retinopathy. METHODS: Prospective pilot imaging study involving children with DM1 aged 2 to 17 years. The screening consisted of: (1) intake form; (2) measurement of blood pressure, pulse, and oximetry; (3) assessment of visual acuity (SIMAV, Padova, Italy); and (4) nonmydriatic color imaging (Canon CX-1 45° 15.1 megapixel camera; Canon Corp., Tokyo, Japan). Images were assessed for signs of diabetic retinopathy and graded for quality on a scale of 1 to 5 by two clinicians. Kappa coefficient was calculated to determine inter-observer agreement. RESULTS: One hundred four of 106 (98%) children underwent imaging (mean age: 11.1 years, 51% male, 88% white). One (1%) child had nonproliferative diabetic retinopathy and 2 (1.9%) had incidental findings. Only 62% of children had an eye examination within the past year, with children with DM1 for more than 5 years significantly more likely to have done so (P = .03). Children who had an eye examination within the past year were significantly older than their counterparts (P = .01). Images of high quality (grades 4 and 5) were acquired in 178 (86%) eyes, and images of some clinical value (grades ≥ 2) were obtained in 207 (99.5%) eyes. Inter-observer agreement for image quality was 0.896. CONCLUSIONS: The feasibility of using a nonmydriatic camera to screen children as young as 2 years for changes related to diabetic eye disease was demonstrated. Nonmydriatic imaging may supplement standard dilated clinical ophthalmology examinations for select patient populations.

Complimentary imaging technologies in blunt ocular trauma.

We describe complimentary imaging technologies in traumatic chorioretinal injury. Color and fundus autofluorescence (FAF) images were obtained with a non-mydriatic retinal camera. Optical coherence tomography (OCT) helped obtain detailed images of retinal structure. Microperimetry was used to evaluate the visual function. A 40-year-old man sustained blunt ocular trauma with a stone. Color fundus image showed a large chorioretinal scar in the macula. Software filters allowed detailed illustration of extensive macular fibrosis. A 58-year-old man presented with blunt force trauma with a tennis ball. Color fundus imaging showed a crescentric area of macular choroidal rupture with fibrosis. FAF imaging delineated an area of hypofluorescence greater on fundus imaging. OCT showed chorioretinal atrophy in the macula. Microperimetry delineated an absolute scotoma with no response to maximal stimuli. Fundus imaging with digital filters and FAF illustrated the full extent of chorioretinal injury, while OCT and microperimetry corroborated the structure and function correlations.

Fundus autofluorescence and colour fundus imaging compared during telemedicine screening in patients with diabetes.

We investigated the use of fundus autofluorescence (FAF) imaging in screening the eyes of patients with diabetes. Images were obtained from 50 patients with type 2 diabetes undergoing telemedicine screening with colour fundus imaging. The colour and FAF images were obtained with a 15.1 megapixel non-mydriatic retinal camera. Colour and FAF images were compared for pathology seen in nonproliferative and proliferative diabetic retinopathy (NPDR and PDR, respectively). A qualitative assessment was made of the ease of detecting early retinopathy changes and the extent of existing retinopathy. The mean age of the patients was 47 years, most were male (82%) and most were African American (68%). Their mean visual acuity was 20/45 and their mean intraocular pressure was 14.3 mm Hg. Thirty-eight eyes (76%) did not show any diabetic retinopathy changes on colour or FAF imaging. Seven patients (14%) met the criteria for NPDR and five (10%) for severe NPDR or PDR. The most common findings were microaneurysms, hard exudates and intra-retinal haemorrhages (IRH) (n = 6 for each). IRH, microaneurysms and chorioretinal scars were more easily visible on FAF images. Hard exudates, pre-retinal haemorrhage and fibrosis, macular oedema and Hollenhorst plaque were easier to identify on colour photographs. The value of FAF imaging as a complementary technique to colour fundus imaging in detecting diabetic retinopathy during ocular screening warrants further investigation.

Optic disc drusen in a child: diagnosis using noninvasive imaging tools.

PURPOSE: To describe a case of bilateral optic nerve head drusen (ONHD) in a pediatric patient and the complementary use of advanced noninvasive imaging techniques to confirm this diagnosis. CASE REPORT: A 15-year-old female adolescent with type 1 diabetes and no ocular history was seen at a routine screening without complaints. Visual acuity was 20/20 bilaterally, and visual fields using frequency doubling technology (Zeiss Humphrey Systems, Dublin, CA) were within normal limits. Fundus photography (CX-1 Mydriatic/Non-Mydriatic Hybrid Digital Retinal Camera, Canon, Toyko, Japan) showed slight elevation of the left disc margin, with lack of physiologic cup, elevation of the inferior neuroretinal rim, and no swelling of the nerve fiber layer. Fundus autofluorescence image of the left eye showed hyperfluorescence in the inferior optic disc. Red/green/blue channel separation analysis using the blue channel (Eye-Q software, Canon, Irvine, CA) showed elevation of the nerve fiber layer without obscuration of small vessels surrounding the left optic disc. Embossed technique highlighted the drusen in the left disc. B-scan ultrasound (Eye Cubed, Ellex, Adelaide, Australia) showed a hyperechoic focus on the optic disc with posterior shadowing and corresponding spike on A-scan in both eyes, indicative of bilateral drusen. Optical coherence tomography (RTVue, Optovue, Fremont, CA) showed an elevation in the ONH corresponding to the drusen. CONCLUSIONS: The complementary use of noninvasive imaging modalities such as fundus autofluorescence, red/green/blue separation, B-scan, and optical coherence tomography is important in confirming the diagnosis of ONHD in pediatric patients. They allow us to rule out more serious conditions and avoid unnecessary, costly, and invasive investigative procedures, relieving young patients and their families of potential financial and emotional burdens.

Software-assisted analysis during ocular health screening.

OBJECTIVE: To describe the use of software-assisted analysis of non-mydriatic 45° color fundus images during comprehensive ocular screening. MATERIALS AND METHODS: Software-driven filters (blue [490 nm; nerve fiber layer], green [550 nm; neural retina], and red [610 nm; pigmented retina/choroid]) and an "emboss" (topographic changes) digital filter were used to enhance image analysis during ocular health screening performed using a Canon (Tokyo, Japan) 8.2-megapixel non-mydriatic retinal camera. Intraocular pressure (model TX-f full auto non-contact tonometer; Canon) and visual acuity (SIMAV, Padova, Italy) were also determined. An on-site medical director analyzed the collected data, provided immediate subject feedback, and made recommendations and referrals for general or specialty ophthalmology clinics. RESULTS: Software-assisted analysis was performed on color images from 128 veterans (mean age, 37.5 years; 66% male; 43% white). Software filters allowed efficient image analysis at a rate of 26 eyes/h. Thirteen (10.2%) persons had a finding consistent with a vision-threatening disease and were referred for a dilated fundus examination. CONCLUSIONS: Software-assisted screening permits thorough and efficient evaluation of ocular health during an ocular screening event.

Effects of prone and reverse trendelenburg positioning on ocular parameters.

BACKGROUND: : In a pilot study of awake volunteers, intraocular pressure (IOP), choroid layer thickness, and optic nerve diameter were shown to increase in the prone position over 5 h with a nonsignificant trend of attenuation using a 4-degree increase of table inclination. These effects have previously not been isolated from anesthetic and fluid administration over a prolonged period, using an adequate sample size. METHODS: : After institutional review board approval, 10 healthy volunteers underwent IOP measurement (Tono-Pen XL, Medtronic Solan, Jacksonville, FL) as well as choroidal thickness and optic nerve diameter assessment (Sonomed B-1000, Sonomed, Inc., Lake Success, NY, or the I System-ABD, Innovative Imaging, Inc., Sacramento, CA) on a Jackson table (Orthopedic Systems, Inc., Union City, CA), during 5 h horizontal prone and 5 h 4-degree reverse Trendelenburg positioning. Measurements were assessed as initial supine, initial prone, and hourly thereafter. Vital signs were recorded at each position and time point. RESULTS: : IOP, choroidal thickness, and optic nerve diameter were observed to increase with time in the prone position. A small degree of reverse Trendelenburg attenuated the increase in choroidal thickness but not IOP or optic nerve diameter. CONCLUSIONS: : Prolonged prone positioning increases IOP, choroid layer thickness, and optic nerve diameter independent of anesthetics and intravenous fluid infusion and 4 degrees of table inclination (15 cm of head to foot vertical disparity) may not attenuate these effects.

Software-assisted optic nerve assessment for glaucoma tele-screening.

Increased optic nerve head (ONH) cup-to-disc ratio (CDR) may indicate glaucoma but evaluation needs to be performed by a trained examiner. This research assessed new software to calculate CDR from ONH images. Digital stereoscopic ONH images from 28 subjects acquired during screening using a nonmydriatic 45-degree camera with 8.2-Megapixel resolution (Canon, Tokyo, Japan) were analyzed by 3 individuals with different levels of ophthalmic training: glaucoma specialist (GS), an optometrist (OD), and trainees. Images were logged and accessed by raters masked to each other's evaluations. Images from two groups were included: normal-appearing ONH (Group 1) and confirmed glaucoma (Group 2). All images were captured in DICOM format. Images were evaluated on a 32-bit, 1,600 x 1,200-pixel resolution monitor. EyeScape software (v. 7.4, Synemed, Inc., Benicia, CA) was used for CDR analysis. Software CDR determination requires an operator to place ONH disc and cup contour lines. Once lines were placed, the software provided CDR calculations (range 0.00-1.00). A total of 84 ONH evaluations were analyzed. Overall CDR mean, standard deviation, standard error of the mean, and mean difference from GS CDR evaluations were determined. Reproducibility was similar for all operators. The trainee had a small, statistically significant greater CDR in group 1 and 2 evaluations. Evaluation of ONH images for CDR can be performed using EyeScape software, by individuals with different levels of ophthalmic training. Accurate determination of CDR is important in tele-screening for vision-threatening diseases, and can aid in identifying subjects with suspicious ONH in need of specialty eye care.