Cross-Camera External Validation for Artificial Intelligence Software in Diagnosis of Diabetic Retinopathy.

Aims: To investigate the applicability of deep learning image assessment software VeriSee DR to different color fundus cameras for the screening of diabetic retinopathy (DR). Methods: Color fundus images of diabetes patients taken with three different nonmydriatic fundus cameras, including 477 Topcon TRC-NW400, 459 Topcon TRC-NW8 series, and 471 Kowa nonmyd 8 series that were judged as "gradable" by one ophthalmologist were enrolled for validation. VeriSee DR was then used for the diagnosis of referable DR according to the International Clinical Diabetic Retinopathy Disease Severity Scale. Gradability, sensitivity, and specificity were calculated for each camera model. Results: All images (100%) from the three camera models were gradable for VeriSee DR. The sensitivity for diagnosing referable DR in the TRC-NW400, TRC-NW8, and non-myd 8 series was 89.3%, 94.6%, and 95.7%, respectively, while the specificity was 94.2%, 90.4%, and 89.3%, respectively. Neither the sensitivity nor the specificity differed significantly between these camera models and the original camera model used for VeriSee DR development (p = 0.40, p = 0.065, respectively). Conclusions: VeriSee DR was applicable to a variety of color fundus cameras with 100% agreement with ophthalmologists in terms of gradability and good sensitivity and specificity for the diagnosis of referable DR.

Funduscopy in Cerebral Malaria Diagnosis: An International Survey of Practice Patterns.

Cerebral malaria (CM) is a significant cause of mortality and morbidity in sub-Saharan Africa, particularly among young children. Malarial retinopathy is the most specific clinical finding in CM, and fundus examination could help clinicians distinguish CM from other causes of encephalopathy in resource-poor areas. To assess clinician knowledge, practice patterns, and barriers to the use of funduscopy in the diagnosis of CM, we designed a descriptive multinational survey of clinicians in malaria endemic areas. Results of this survey showed that 19% of respondents were not aware of the utility of eye examinations for malarial retinopathy, and almost half (49%) never or almost never examine the eyes in cases of suspected CM. Educating clinicians about malarial retinopathy could be important in improving diagnostic specificity for CM.

Uso clínico del tomógrafo de coherencia óptica Spectralis en la evaluación del glaucoma / Use of the Spectralis optical coherence tomography scanner to evaluate glaucoma

La evolución reciente de las herramientas de imagen ha mejorado notablemente la determinación objetiva y cuantitativa de los cambios estructurales en el glaucoma. El tomógrafo de coherencia óptica de dominio espectral, disponible comercialmente, y su módulo Glaucoma Premium Edition recientemente incorporado, ofrece beneficios en la evaluación del glaucoma, por presentar una mayor resolución axial, velocidades de exploración más rápidas, reproducibilidad mejorada, compensación de movimientos oculares, supresión de interferencia y algoritmos avanzados de segmentación. La presente revisión describe las características técnicas, los parámetros de fiabilidad, los protocolos de estudio, la interpretación de los resultados y los principales artefactos que afectan sus medidas. Esta información permite a la comunidad médica realizar un uso y una evaluación adecuada de esta tecnología, y en consecuencia ajustar la gestión clínica según sea necesario(AU)

The recent evolution of imaging tools has notably improved the objective, quantitative determination of structural changes in the glaucoma. The spectral domain optical coherence tomography scanner, commercially available, and its recently incorporated Glaucoma Module Premium Edition, facilitate evaluation of the glaucoma, due to their greater axial resolution, faster exploration speeds, improved reproducibility, eye movement compensation, interference suppression, and advanced segmentation algorithms. The present review describes the technical features, reliability parameters, study protocols, interpretation of results and main artifacts affecting its measurements. Such information will make it possible for the medical community to adequately use and evaluate this technology, adjusting clinical management as required(AU)

Rotura ocular posterior traumática / Traumatic posterior ocular rupture

El trauma ocular es una causa importante de morbilidad oftalmológica en el mundo con implicaciones socioeconómicas importantes para el paciente y sus familiares. Ocurre generalmente en adultos jóvenes, con una buena agudeza visual al inicio del evento traumático, la cual se verá comprometida según la severidad del trauma, las estructuras oculares que afecte y las complicaciones que puedan aparecer. Presentamos dos pacientes con rotura escleral posterior secundario a trauma ocular a globo abierto contuso. Se describe el manejo personalizado el seguimiento en cada caso y sus resultados visuales(AU)

The ocular trauma is an important cause of ophthalmological morbidity in the world with significant socio-economic implications for the patient and its relatives. It generally occurs in young adults, with good visual acuity at the beginning of the traumatic event, which may be affected by the trauma severity, the ocular structures that it affects and the possible complications. This is the report on two patients with posterior scleral rupture secondary to blunt open-globe ocular trauma. The customized management, the follow-up of each case and the visual results achieved were all described(AU)

Multimedia interactiva para el desarrollo de habilidades en el uso del oftalmoscopio indirecto / Interactive Multimedia development skills in the use of indirect ophthalmoscope

El oftalmoscopio indirecto es un medio diagnóstico y terapéutico muy necesario y con una amplia utilidad para todos los oftalmólogos, pues este contribuye al desarrollo del proceso de enseñanza-aprendizaje de la asignatura Oftalmología y en especial del segmento posterior del ojo. El objetivo es presentar una multimedia interactiva "Oftalmoscopio indirecto" para el desarrollo de las habilidades profesionales en el uso correcto de este medio diagnóstico en los residentes del Servicio Oftalmológico del Hospital Militar Central "Dr. Carlos J. Finlay". La multimedia contiene diferentes acápites relacionados con el examen oftalmológico, historia, videos, simuladores, posturas y ventajas del oftalmoscopio indirecto. La implementación de esta herramienta de trabajo, a partir del cumplimiento de las acciones que se establecen en la guía elaborada al efecto, permitirá a los residentes que se encuentran en ejercicio o en formación autoprepararse y contribuir a resolver los problemas que detecten a través del oftalmoscopio indirecto en el diagnóstico y tratamiento oportuno de afecciones oftalmológicas que constituyen un problema de salud en Cuba.

The indirect ophthalmoscope is a very necessary diagnostic and therapeutic tool, widely used by all ophthalmologists, as this contributes to the development of teaching and learning Ophthalmology in general and particularly the posterior segment of the eye. Our purpose was to present the interactive multimedia "Indirect Ophthalmoscope" for the development of professional skills in residents of the ophthalmology Service at the Central Military Hospital concerning the proper use of this diagnostic tool. The multimedia contains different headings related to eye exam, history, videos, simulators, positions and advantages of indirect ophthalmoscope. From the fulfillment of the actions set out in the guide produced for this purpose, the implementation of this tool will allow residents to prepare themselves and help to solve problems detected through the indirect ophthalmoscope when diagnosing and treating eye conditions that constitute a health problem in Cuba.

[Value of different measurements of the preoperative visual acuity and perception of Purkinje's vessel shadows for prediction of the postoperative visual acuity after vitrectomy in diabetic vitreous hemorrhage]. / Wertigkeit unterschiedlicher Verfahren der präoperativen Sehschärfeerfassung und der Aderfigurwahrnehmung zur Vorhersage des postoperativen Visus nach Vitrektomien bei diabetischer Glaskörperblutung.

BACKGROUND: In cases of strong vitreous hemorrhage due to diabetic vitreo-retinopathy there is an uncertainty for the prediction of postoperative visual acuity after vitrectomy. This study compares the value of different preoperative measurements for the prognosis of postoperative visual acuity. METHOD AND PATIENTS: We evaluated retrospectively the reports of all patients who have been operated by vitrectomy due to diabetic vitreous hemorrhage at our hospital in 2004 (first vitreoretinal surgery). The following measurements were evaluated: preoperative distance and reading VA, last known VA before hemorrhage, laser interference VA, Purkinje's vessel shadow and postoperative distance VA. RESULTS: 42 patients had entire documentation of all evaluated parameters. The preoperative distance VA was 20/1000 (light perception to 20/60), only 3 patients had a reading VA. Laser interference VA was better than red light perception in 13 patients (7 without red light perception). Purkinje's vessel shadows were positive in 22 patients, negative in 17 patients, but 3 patients did not understand the procedure. Prehemorrhage VA was known in 19 patients. Laser interference VA and last known VA prior to hemorrhage (in mean 20 months old) had the best correlation to postoperative VA (p > 0.05). Purkinje's vessel shadow predicts -- if positive -- a postoperative VA of 20/300 or better. CONCLUSIONS: Postoperative VA after vitrectomy due to diabetic vitreous hemorrhage is best predicted by prehemorrhage VA or laser interference VA, especially if no prehemorrhage VA is known. Positive Purkinje's vessel shadow predicts a postoperative VA of 20/300 or better.

Panoptic versus conventional ophthalmoscope.

BACKGROUND: The 'ease of use' and accuracy in measurement of the vertical optic cup/disc ratio (VCDR) was compared between the conventional direct ophthalmoscope (CO) and Panoptic direct ophthalmoscope (PO) in a group of 'naïve' first year medical students to determine which would be more suitable for non-ophthalmologists. METHODS: In this quasi-randomized method comparison study, eight students received an introductory session on ophthalmoscopy then examined 18 eyes (9 left, 9 right) with each ophthalmoscope in a private practice. The subjects were the eight students themselves plus two other subjects. Each subject (n = 10) had one eye dilated. Students determined a VCDR and a subjective score of 'ease of use' on a scale of 1 (difficult) to 10 (easy). A consultant ophthalmologist (GAG) determined the benchmark VCDR for each eye with each ophthalmoscope. RESULTS: Of 288 eye examinations, there were 111 measurements of VCDR using the CO (47 undilated, 64 dilated), and 140 measurements using the PO (75 undilated, 65 dilated). Differences in the students' estimated VCDR and the benchmark were similar for the CO and PO (P = 0.67). 'Ease of use' was scored in 288 eyes and the median score was higher in the PO overall (CO: median 8, IQR 6-9; PO median 9, IQR 8-10; P < 0.0001), and within each session (P < 0.0001 for each session). CONCLUSIONS: Medical students found the PO much easier to use, with accuracy of rating the VCDR similar to the CO. This comparison would support the wider use of the PO amongst medical students, general practitioners and other primary care providers.

Extraction of fluorescent dot traces from a scanning laser ophthalmoscope image sequence by spatio-temporal image analysis: Gabor filter and radon transform filtering.

The scanning laser ophthalmoscope (SLO) allows the tracking of fluorescent dot motion, thereby enabling the flow velocities in perimacular capillaries to be directly measured. These can serve as an important index of local retinal soundness or reflect the whole body circulation status in disorders such as diabetes. Although it is possible to perceive moving fluorescent dots with the human eye, they are so faint and unstable that it is difficult to detect them by conventional digital still-image processing methods. To solve this problem, we generated spatio-temporal images of the fluorescent dots in a capillary and applied Gabor filters tuned to the direction of the traces in order to detect them. Finally, by discriminating and integrating the output using two levels of threshold, we were able to extract their traces. Because the medium-size Gabor filter requires a considerable amount of time for two-dimensional convolution calculation, we prove that there is a certain equivalence between the Gabor filter, the radon transform, and the Hough transform. In the light of this, we propose a form of radon transform filtering that includes a radon transform Gabor filter as a very long Gabor filter. This allows a whole trace to be detected in a single step with a one-dimensional convolution, thereby shortening the processing time. In an experiment, 60% of the traces could be detected without error, which is sufficient to allow the mean flow velocity in a capillary to be measured.

El oftalmoscopio directo en la consulta pediátrica

Con la llegada del nuevo milenio el oftalmoscopio directo habrá cumplido 150 años de su creación. A pesar de ser una herramienta importante para el exámen de pacientes de cualquier edad, sigue siendo subutilizado por médicos generales y especialistas. Nuestro objetivo es dar a pediatras y médicos no oftalmólogos argumentos y claves para incluir rutinariamente la oftalmoscopia directa en el exámen inicial de sus pacientes

Telangiectasias retinianas justafoveolares idiopáticas: padräo clínico e fundoscópico em 19 casos / Idiopathic juxtafoveal retinal telangiectasis: clinic and fundoscopic pattern in 19 cases

A telangiectasia justafoveolar idiopática (TJI) é uma vasculopatia retiniana da idade adulta, pode causar baixa acuidade visual e ser de difícil diagnóstico. Estudou-se os prontuários de 19 pacientes com TJI usando-se a classificaçäo de GASS & BLODI. Observou-se 8 pacientes no grupo 1 (42 p/c), 11 no grupo 2 (58 p/c) e nenhum no grupo 3. Todos os do grupo 1 apresentaram doença unilateral, com as telangiectasias facilmente visíveis, depósitos lipídicos e edema cistóide de mácula. A idade média foi de 55,8 anos, com cinco pacientes do sexo masculino (63 p/c) e três do feminino (37 p/c). Todos os do grupo 2 tinham doença bilateral com telangiectasias evidenciadas apenas à angiofluoresceinografia. A idade média foi de 54,5 anos, com dois