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1.
Curr Opin Ophthalmol ; 31(6): 521-531, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33009085

RESUMO

PURPOSE OF REVIEW: Ocular sarcoidosis is one of the most common causes of uveitis worldwide. The diagnosis and treatment of patients with ocular sarcoidosis remains challenging in some cases. It is important for clinicians to keep up to date with new diagnostic and treatment tools for this disease. RECENT FINDINGS: The International Workshop on Ocular Sarcoidosis diagnostic criteria were first proposed in 2009 and revised in 2017. The new criteria contained two parts: ocular presentation and systemic investigation. The diagnostic value of liver enzymes was reduced in the new criteria, whereas the value placed of lymphopenia and the CD4/CD8 ratio in bronchoalveolar lavage fluid were increased. Despite not being included in the criteria, recent studies have also highlighted the diagnostic value of serum soluble interleukin-2 receptors. Recent ophthalmologic imaging also provides useful insights for the differential diagnosis.Many new treatments for ocular sarcoidosis have been developed in recent years. The introduction of biological immunomodulatory agents for uveitis treatment represents a big improvement. Antitumor necrosis factor-alpha antibodies, including adalimumab, have been proven to be effective for treating ocular sarcoidosis. Many studies have also suggested that other biological agents could be effective and well tolerated. Newer intravitreal dexamethasone and fluocinolone implants have been developed. Patients treated with these implants have experienced good and sustained control of their intraocular inflammation. SUMMARY: Diagnosis and treatment options for ocular sarcoidosis have changed over time. However, challenges still exist in some difficult patients. Future studies should focus on finding more sensitive biomarkers and developing more effective immunomodulatory treatments with longer efficacy and less side effects.


Assuntos
Oftalmopatias/diagnóstico , Oftalmopatias/tratamento farmacológico , Sarcoidose/diagnóstico , Sarcoidose/tratamento farmacológico , Biomarcadores/análise , Diagnóstico Diferencial , Endoftalmite/diagnóstico , Humanos
2.
Discov Med ; 29(158): 145-157, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33007190

RESUMO

Coronavirus disease 2019 (COVID-19), a newly identified acute respiratory disease caused by a strain of novel coronavirus (SARS-CoV-2), has become a worldwide pandemic. From December 2019 to present, millions of cases have been reported, bringing unprecedented pressure on both health and epidemic prevention services in every country. As frontline healthcare workers, ophthalmologists face an increased threat of viral infection, not only because of close contact with patients during examinations or operations, but also due to evidence showing that ocular fluids such as tears or conjunctival secretions may carry the virus. The risk that healthcare workers face is emphasized by the loss of our colleagues who have sacrificed themselves in combating the virus. As a result, it is necessary to have a comprehensive understanding of the threats that we face. In the first part of this review, we start by explaining the structure of SARS-CoV-2 and examining its transmission and means of infection. Next, we summarize the latest scientific advancements of epidemiology, clinical presentations, and current treatments of COVID-19. In the second half of the review, we emphasize the ocular transmission, symptomatic manifestations, and the essential knowledge in an ophthalmology clinic setting. As the pandemic of COVID-19 continues to pose a threat to global health, we hope that this review makes a contribution to combating COVID-19.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Oftalmopatias/virologia , Pneumonia Viral/complicações , Antivirais/uso terapêutico , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/imunologia , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/transmissão , Reposicionamento de Medicamentos , Oftalmopatias/diagnóstico , Oftalmopatias/imunologia , Oftalmopatias/terapia , Humanos , Imunização Passiva/métodos , Fatores Imunológicos/uso terapêutico , Medicina Tradicional Chinesa/métodos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Pneumonia Viral/transmissão
3.
Curr Opin Ophthalmol ; 31(5): 303-311, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32740061

RESUMO

PURPOSE OF REVIEW: As artificial intelligence continues to develop new applications in ophthalmic image recognition, we provide here an introduction for ophthalmologists and a primer on the mechanisms of deep learning systems. RECENT FINDINGS: Deep learning has lent itself to the automated interpretation of various retinal imaging modalities, including fundus photography and optical coherence tomography. Convolutional neural networks (CNN) represent the primary class of deep neural networks applied to these image analyses. These have been configured to aid in the detection of diabetes retinopathy, AMD, retinal detachment, glaucoma, and ROP, among other ocular disorders. Predictive models for retinal disease prognosis and treatment are also being validated. SUMMARY: Deep learning systems have begun to demonstrate a reliable level of diagnostic accuracy equal or better to human graders for narrow image recognition tasks. However, challenges regarding the use of deep learning systems in ophthalmology remain. These include trust of unsupervised learning systems and the limited ability to recognize broad ranges of disorders.


Assuntos
Aprendizado Profundo , Diagnóstico por Imagem/métodos , Oftalmopatias/diagnóstico , Interpretação de Imagem Assistida por Computador/métodos , Oftalmologistas , Humanos , Redes Neurais de Computação
4.
Curr Opin Ophthalmol ; 31(5): 324-328, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32769696

RESUMO

PURPOSE OF REVIEW: To review four recent controversial topics arising from deep learning applications in ophthalmology. RECENT FINDINGS: The controversies of four recent topics surrounding deep learning applications in ophthalmology are discussed, including the following: lack of explainability, limited generalizability, potential biases and protection of patient confidentiality in large-scale data transfer. SUMMARY: These controversial issues spanning the domains of clinical medicine, public health, computer science, ethics and legal issues, are complex and likely will benefit from an interdisciplinary approach if artificial intelligence in ophthalmology is to succeed over the next decade.


Assuntos
Inteligência Artificial , Oftalmopatias/diagnóstico , Interpretação de Imagem Assistida por Computador/métodos , Oftalmologia , Big Data , Humanos
5.
BMJ Health Care Inform ; 27(3)2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32796085

RESUMO

BACKGROUND: The COVID-19 crisis forced hospitals in the UK dramatically to reduce outpatient activity. To provide continuity of care and to assist patients reluctant or unable to leave their homes, video consultations were rapidly implemented across routine and emergency ophthalmology services. OBJECTIVE: To describe the deployment and scaling to a large volume of teleophthalmology using a video consultation platform 'Attend Anywhere' in Moorfields Eye Hospital's accident and emergency (A&E) department (London, UK). METHOD: Patient satisfaction, waiting time, consultation duration, outcome and management were audited following the launch of the new virtual A&E service. RESULTS: In the 12 days following the service launch, 331 patients were seen by video consultation. 78.6% of patients (n=260) were determined not to need hospital A&E review and were managed with advice (n=126), remote prescription (n=57), general practitioner referral (n=27), direct referral to hospital subspecialty services (n=26) or diversion to a local eye unit (n=24). Mean patient satisfaction was 4.9 of 5.0 (n=62). The mean consultation duration was 12 min (range 5-31 min) and the wait time was 6 min (range 0-37 min). CONCLUSION: Video consultations showed greater than expected usefulness in the remote management of eye disease and supported a substantial reduction in the number of people visiting the hospital.


Assuntos
Serviços Médicos de Emergência , Serviço Hospitalar de Emergência/organização & administração , Oftalmopatias , Oftalmologia , Encaminhamento e Consulta/estatística & dados numéricos , Telemedicina/organização & administração , Infecções por Coronavirus , Serviços Médicos de Emergência/estatística & dados numéricos , Serviços Médicos de Emergência/tendências , Oftalmopatias/diagnóstico , Oftalmopatias/terapia , Feminino , Humanos , Londres , Masculino , Pandemias , Satisfação do Paciente , Pneumonia Viral
6.
Curr Opin Ophthalmol ; 31(5): 366-373, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32694270

RESUMO

PURPOSE OF REVIEW: The aim of this article is to assess the current state of teleophthalmology given the sudden surge in telemedicine demand in response to the novel coronavirus 2019 (COVID-19). RECENT FINDINGS: Recommendations and policies from government and national health organizations, combined with social distancing, have led to exponential increases in telemedicine use. Teleophthalmology can be integrated into ophthalmic care delivery. In the emergency room, teleophthalmology can be utilized to triage patients and diagnose common ophthalmic eye diseases. Ophthalmology practices can utilize real-time medicine to conduct many parts of an in-person exam. In cases where more complex diagnostic tools are warranted, a model incorporating telemedicine and focused in-person visits may still be beneficial. Innovative technologies emerging in the market allow for increased remote monitoring, screening, and management of adult and pediatric patients for common eye diseases. SUMMARY: COVID-19 created a demand for healthcare delivery that limits in-person examination and potential viral exposure. Teleophthalmology allows ophthalmologists to continue caring for patients while keeping physicians and patients safe. Although challenges still exist, the pandemic has accelerated the adoption of teleophthalmology. As a result, teleophthalmology will play an integral role in providing high-quality efficient care in the near future.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Assistência à Saúde , Oftalmologia/métodos , Pneumonia Viral/epidemiologia , Telemedicina/métodos , Oftalmopatias/diagnóstico , Humanos , Oftalmologia/organização & administração , Pandemias , Telemedicina/organização & administração
7.
Semin Ophthalmol ; 35(4): 210-215, 2020 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-32644878

RESUMO

Telemedicine is the provision of healthcare-related services from a distance and is poised to move healthcare from the physician's office back into the patient's home. The field of ophthalmology is often at the forefront of technological advances in medicine including telemedicine and the use of artificial intelligence. Multiple studies have demonstrated the reliability of tele-ophthalmology for use in screening and diagnostics and have demonstrated benefits to patients, physicians, as well as payors. There remain obstacles to widespread implementation, but recent legislation and regulation passed due to the devastating COVID-19 pandemic have helped to reduce some of these barriers. This review describes the current status of tele-ophthalmology in the United States including benefits, hurdles, current programs, technology, and developments in artificial intelligence. With ongoing advances patients may benefit from improved detection and earlier treatment of eye diseases, resulting in better care and improved visual outcomes.


Assuntos
Inteligência Artificial , Betacoronavirus , Infecções por Coronavirus/complicações , Oftalmopatias/diagnóstico , Oftalmologia/métodos , Pandemias , Pneumonia Viral/complicações , Telemedicina/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa/prevenção & controle , Oftalmopatias/complicações , Humanos , Programas de Rastreamento/métodos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão
8.
West Afr J Med ; 37(3): 221-224, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32476114

RESUMO

BACKGROUND: Ophthalmology consultations are more thorough on outpatient basis, but inpatient evaluation cannot be over looked especially in terms of care of patients admitted in other specialties. OBJECTIVES: This is to assess the profile of inpatient consultation and eye problems evaluated and managed by the ophthalmology department of the University of Benin Teaching Hospital, Benin City, Nigeria. METHODS: All consecutive inpatients who had ophthalmic consultations requested for by various departments in the hospital between July 2018 and June 2019. RESULTS: A total of 227 inpatient consultations with 217 diagnoses were seen. Most of the patients were between the ages of 20-39 years. The highest number of consults (50.7%) were received from the medical wards. The most common reasons for ophthalmic inpatient consultations were reduction in vision (26.7%), eye pain (19.9%) and ocular screening which was ocular examination for patients with raised intracranial pressure, hypertension, diabetes and glaucoma (15.4%). Based on subspecialties, anterior segment and cornea unit received the highest number of consults (41.9%) while retina/ uveitis received the highest (58.7%) number of screening consultation. CONCLUSION: Inpatient consultations is very useful to the patient and managing physician. Although a better knowledge in the identification of common ophthalmic conditions can help to reduce the number of inpatient consults from other medical specialties.


Assuntos
Pacientes Internados/estatística & dados numéricos , Oftalmologia/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Oftalmopatias/diagnóstico , Oftalmopatias/epidemiologia , Humanos , Nigéria , Estudos Retrospectivos , Adulto Jovem
9.
Indian J Ophthalmol ; 68(7): 1316-1327, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32587157

RESUMO

While telemedicine has been around for a few decades, it has taken great importance and prominence in recent times. With the fear of the virus being transmitted, patients and physicians across specialties are using consultation via a telephone call or video from the safety of their homes. Though tele-ophthalmology has been popular for screening, there are no clear guidelines on how to comprehensively manage patients seeking advice and treatment for a particular eye condition. Some major barriers to diagnosis and management are compromised detailed examination, no measurement of the visual acuity or intraocular pressure and a retinal evaluation not being feasible. Despite these limitations, we do need to help those patients who need immediate care or attention. Hence, this article has put together some guidelines to follow during such consultations. They are important and timely due to the medicolegal and financial implications.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Oftalmopatias/terapia , Programas de Rastreamento/normas , Oftalmologia/normas , Pneumonia Viral/epidemiologia , Consulta Remota/normas , Infecções por Coronavirus/transmissão , Oftalmopatias/diagnóstico , Humanos , Pandemias , Pneumonia Viral/transmissão
10.
Indian J Ophthalmol ; 68(7): 1328-1338, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32587158

RESUMO

Telemedicine and tele-ophthalmology have been in existence since many years, but have recently gained more importance in the present scenario of pandemic COVID-19. The attitude and perception of the doctors and patients has been changing gradually. Telemedicine has many advantages including providing care in inaccesible areas.In the present scenario, tele-ophthalmology gives an oppurtunity to patient for seeking consultation while also protecting against the contagion. There are many barriers faced by the patients and doctors that have restricted use of this technology in the past. However, with a systematic approach to designing the best suited technology, these barriers can be overcome and user friendly platforms can be created. Furthermore, the demand and use of teleconsulation had increased presently in this area of pandemic. Recent survey conducted by the All India Ophthalmological Society also reveals that many ophthalmologists who have not used tele-ophthalmology in the past are more keen to use it presently. In this article, we have reviewed telemedicine and tele-ophthalmology literature on Google and PubMed to get a holistic idea towards teleconsultation, its advantages, increased importance and prefrence during COVID-19 pandemic and various barriers faced so that the known challenges can be understood, which can pave way for better understanding and future incorporation into practice.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Oftalmopatias/diagnóstico , Oftalmologia/métodos , Pandemias , Pneumonia Viral/epidemiologia , Telemedicina , Infecções por Coronavirus/transmissão , Humanos , Índia , Pneumonia Viral/transmissão
11.
Indian J Ophthalmol ; 68(7): 1381-1384, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32587169

RESUMO

Purpose: COVID-19 related pan- India lockdown brought teleophthalmology to the forefront. The study ventures to understand the relevance of this modality in a government setup. The objective is to understand the feasibility, clinical profile and addressability of patients using teleconsultation in ophthalmology at a tertiary care government medical university during the COVID-19 Lockdown in India. Methods: An online survey targeting faculty members and resident doctors in a tertiary eye center in a government medical university in north India was conducted. Various aspects of teleconsultation were analyzed including the number and preferential mode of consultations, commonest complaints and diagnoses made. Frequency and factors mandating physical examination of patients was also analyzed. Results: The questionnaire was sent to 40 ophthalmologists of whom 38 responded. A total of 4880 teleconsultations were given. The commonest mode of communication was by WhatsApp messages (65.6%) and E-mail was the least preferred medium. More than 80% consultations were from previously seen patients. Red eye was the commonest presenting complaint (22.8%), followed by watering (18.7%) and foreign body sensation (14.5%). Computer vision syndrome was the commonest diagnosis (25.9%) followed by conjunctivitis (17.7%) and refractive error (17.7%). About 40% required physical examination, mostly due to uncertain diagnosis (22%) or inadequate response to prescribed treatment (19%). Conclusion: Teleconsultation was feasible in a government medical university for providing ophthalmic services during lockdown. WhatsApp was the preferred communication modality, computer vision syndrome was the most frequent tentative diagnosis and approximately 60% did not require in-person physical examination.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Oftalmopatias/diagnóstico , Oftalmologia/métodos , Pneumonia Viral/epidemiologia , Consulta Remota/métodos , Atenção Terciária à Saúde/métodos , Universidades , Infecções por Coronavirus/complicações , Estudos Transversais , Oftalmopatias/complicações , Governo , Humanos , Índia/epidemiologia , Pandemias , Projetos Piloto , Pneumonia Viral/complicações , Inquéritos e Questionários
12.
Indian J Ophthalmol ; 68(7): 1393-1399, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32587174

RESUMO

Purpose: The aim of this study is to describe the demographics and clinical profile of patients with ocular disorders presenting during the novel coronavirus (COVID-19) lockdown in India. Methods: This cross-sectional hospital-based study included patients presenting between March 23, 2020 and April 19, 2020. All patients who presented to the emergency department were included as cases. The data were collected using an electronic medical record system. Results: Overall, 1,192 patients (mean 42.57 per day) presented to the ocular emergency department and were included for analysis. The median age of the patients was 35 (Interquartile range, IQR: 20-52) years and they were mostly adults (77.85%). The majority of patients were male (62.16%) and presented from the local metropolitan region (56.21%). On triaging based on the ocular disorders at presentation, the majority of the patients were emergency related (65.02%), followed by urgent (8.14%) and routine (26.85%) in nature. The most common emergencies were microbial keratitis (23.74%), followed by corneal trauma (16.39%). There was an increasing trend seen in emergency patients (46.11%; week 1 to 71.78%; week 4) and a decreasing trend seen in routine patients (45%; week1 to 21.20%; week 4). A subset of patients (23.49%) underwent surgery where indicated and the most commonly performed procedures were vitreo-retinal procedures (32.86%) followed by trauma related (31.43%). Conclusion: The enforcement of the nationwide lockdown due to COVID-19 resulted in a fewer patients presenting to the hospital. The majority of them presented from the local metropolitan region and the common emergencies were microbial keratitis and corneal trauma. About one fourth required a surgical intervention which was most commonly a vitreo-retinal procedure.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Gerenciamento Clínico , Oftalmopatias/epidemiologia , Pneumonia Viral/epidemiologia , Adulto , Distribuição por Idade , Infecções por Coronavirus/complicações , Estudos Transversais , Oftalmopatias/complicações , Oftalmopatias/diagnóstico , Feminino , Humanos , Incidência , Índia/epidemiologia , Masculino , Pandemias , Pneumonia Viral/complicações , Distribuição por Sexo , Fatores Socioeconômicos
20.
Arch Soc Esp Oftalmol ; 95(6): 300-310, 2020 Jun.
Artigo em Inglês, Espanhol | MEDLINE | ID: covidwho-271052

RESUMO

OBJECTIVE: Minimize exposure to the SARS-CoV-2, reduce the chances of cross-transmission between patients and healthcare personnel, and prevent the development of postoperative complications from the management of patients with eye diseases during the 2019 coronavirus disease pandemic (COVID-19). METHODS: COVID-19 literature review and consensus establishment between different Spanish ophthalmology societies in order to provide guidelines and recommendations of maximum resources primarily conditioned by the state of alert, confinement and social distancing that occurs in Spain since March 16, 2020. RESULTS: The recommendations will promote the adoption of action and protection measures for eye care in outpatient clinics, surgical areas and hospitalization, for unconfirmed (asymptomatic and symptomatic) and confirmed COVID-19 patients. Measures must be adapted to the circumstances and availability of personal protective equipment in each of the centers and Autonomous Communities, which will be updated according to the pandemic phases and the measures adopted by the Spanish Government. CONCLUSIONS: During the COVID-19 pandemic, attention to the potential health risks to the population caused by coronavirus should prevail over the possible progression of the common eye diseases. Ophthalmologists and other eye care professionals must assume a possible progression of these diseases due to the impossibility of adequate patient follow-up.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Oftalmopatias/diagnóstico , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Complicações Pós-Operatórias/prevenção & controle , Antimaláricos/uso terapêutico , Doenças Assintomáticas , Segurança do Sangue , Cloroquina/uso terapêutico , Lentes de Contato , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Progressão da Doença , Oftalmopatias/terapia , Humanos , Hidroxicloroquina/uso terapêutico , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Procedimentos Cirúrgicos Oftalmológicos/métodos , Oftalmologia , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Fatores de Risco , Sociedades Médicas , Espanha , Avaliação de Sintomas/métodos , Suspensão de Tratamento
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