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1.
Curr Opin Ophthalmol ; 31(2): 91-100, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31904596

RESUMO

PURPOSE OF REVIEW: Current recommendations for glaucoma screening are decidedly neutral. No studies have yet documented improved long-term outcomes for individuals who undergo glaucoma screening versus those who do not. Given the long duration that would be required to detect a benefit, future studies that may answer this question definitively are unlikely. Nevertheless, advances in artificial intelligence and telemedicine will lead to more effective screening at lower cost. With these new technologies, additional research is needed to determine the costs and benefits of screening for glaucoma. RECENT FINDINGS: Using optic disc photographs and/or optical coherence tomography, deep learning systems appear capable of diagnosing glaucoma more accurately than human graders. Eliminating the need for expert graders along with better technologies for remote imaging of the ocular fundus will allow for less expensive screening, which could enable screening of individuals with otherwise limited healthcare access. In India and China, where most glaucoma remains undiagnosed, glaucoma screening was recently found to be cost-effective. SUMMARY: Recent advances in artificial intelligence and telemedicine have the potential to increase the accuracy, reduce the costs, and extend the reach of screening. Further research into implementing these technologies in glaucoma screening is required.


Assuntos
Inteligência Artificial , Aprendizado Profundo , Técnicas de Diagnóstico Oftalmológico , Economia Médica , Glaucoma/diagnóstico , Telemedicina , Análise Custo-Benefício , Humanos , Tomografia de Coerência Óptica/métodos
2.
Einstein (Sao Paulo) ; 18: eGS4913, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31531556

RESUMO

OBJECTIVE: To evaluate indications, results and strategy of retinal exams requested at Primary Care Units. METHODS: A retrospective study that analyzed the indications and results of retinal exams, in the modalities clinical dilated fundus exams and color fundus photographs. In the following situations, patients were considered eligible for color fundus photographs if visual acuity was normal and ocular symptoms were absent: diabetes mellitus and/or hypertension, in use of drugs with potential retinal toxicity, diagnosis or suspicion of glaucoma, stable and asymptomatic retinopathies, except myopia greater than -3.00 diopters. RESULTS: A total of 1,729 patients were evaluated (66% female, age 63.5±15.5 years), and 1,190 underwent clinical dilated fundus exam and 539 underwent color fundus photographs. Diabetes was present in 32.2%. The main indications were diabetes (23.7%) and glaucoma evaluation (23.5%). In 3.4% of patients there was no apparent indication. The main results were a large cup/disc ratio (30.7%) and diabetic retinopathy (13.2%). Exam was normal in 9.6%, detected peripheral changes in 7% and could not be performed in 1%. Considering patients eligible for fundus photographs (22.4%), more than half underwent clinical dilated fundus exams. CONCLUSION: Regarding exam modality, there were no important differences in the distribution of indications or diagnosis. Color fundus photograph is compatible with telemedicine and more cost-effective, and could be considered the strategy of choice in some scenarios. Since there are no clear guidelines for retinal exams indications or the modality of choice, this study may contribute to such standardization, in order to optimize public health resources.


Assuntos
Técnicas de Diagnóstico Oftalmológico , Atenção Primária à Saúde/estatística & dados numéricos , Retina , Doenças Retinianas/diagnóstico , Idoso , Retinopatia Diabética/diagnóstico , Técnicas de Diagnóstico Oftalmológico/economia , Feminino , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Fotografação , Exame Físico , Estudos Retrospectivos , Telemedicina , Acuidade Visual
3.
Klin Monbl Augenheilkd ; 236(12): 1423-1427, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31805593

RESUMO

Machine learning and artificial intelligence are mostly important if data analysis by knowledge-based analytical methods is difficult and complex. In such cases, combined analytical and empirical approaches based on AI are also meaningful. The development and validation of several clinical parameters for the Corvis ST are a concrete example of this approach. In this article, the development of three screening parameters is described. It is shown how these developments lead to clinical solutions that can be beneficial for detecting clinical and subclinical keratoconus as well as for glaucoma screening.


Assuntos
Inteligência Artificial , Córnea , Ceratocone , Técnicas de Diagnóstico Oftalmológico , Humanos , Ceratocone/diagnóstico por imagem , Programas de Rastreamento
4.
Parasit Vectors ; 12(1): 505, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666101

RESUMO

BACKGROUND: Countries of eastern Europe are considered, due to several risk factors, more vulnerable to infections with newly (re)emerging pathogens. During the last decade, in several European countries, reports of autochthonous cases of ocular thelaziosis due to Thelazia callipaeda have been published, posing a great concern from both veterinary and public health perspective. However, in the Republic of Moldova only limited epidemiological data are available regarding zoonotic vector-borne pathogens and, until now, no data exist on the zoonotic nematode T. callipaeda. METHODS: In September 2018, an 11-year-old dog, mixed-breed, intact male was referred to a private veterinary clinic from Chișinau, Republic of Moldova, with a history of 2 weeks of an ocular condition affecting the right eye. The ophthalmological exam revealed the presence of nematode parasites in the conjunctival sac and under the third eyelid. The collected parasites were identified by morphological techniques and molecular analysis. RESULTS: A total of 7 nematodes were collected, and 5 females and 2 males of T. callipaeda were identified morphologically. The BLAST analysis confirmed the low genetic variability of this parasite in Europe. The travel history of the patient allowed us to confirm the autochthonous character of the case. CONCLUSIONS: To the best of our knowledge, this is the first report of thelaziosis in dogs from the Republic of Moldova, which confirms the spreading trend of T. callipaeda and the existence of an autochthonous transmission cycle of this zoonotic parasite in the country.


Assuntos
Doenças do Cão/parasitologia , Infecções Oculares Parasitárias/veterinária , Infecções por Spirurida/veterinária , Thelazioidea/isolamento & purificação , Animais , Diagnóstico Diferencial , Técnicas de Diagnóstico Oftalmológico/veterinária , Cães , Infecções Oculares Parasitárias/parasitologia , Feminino , Aparelho Lacrimal/parasitologia , Masculino , Moldávia , Membrana Nictitante/parasitologia , Exame Físico/veterinária , Infecções por Spirurida/parasitologia , Thelazioidea/classificação , Thelazioidea/genética
5.
Ophthalmic Surg Lasers Imaging Retina ; 50(10): 608-612, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31671192

RESUMO

BACKGROUND AND OBJECTIVE: To analyze the examination practices and referral of patients with diabetic retinopathy (DR) by optometrists in routine clinical care. PATIENTS AND METHODS: Diabetic patient records from 2012 to 2018 were retrospectively reviewed for documentation of dilated fundus exam (DFE), imaging, follow-up appointments, and referrals. Concordance between clinical exam and coding was also analyzed. RESULTS: For 97.8% of encounters, DFE was performed, the patient was referred for DFE, or DFE was scheduled for follow-up. When DFE was performed at the initial visit, this resulted in referral of 19.8% of patients to an ophthalmologist. Imaging was obtained occasionally, with fundus photos in 2.6% and optical coherence tomography in 14.5% of encounters. Concordance of DR grading between exam and coding was 78.8%. Recommended follow-up times were incorrect based on DR severity level in 13.8% of encounters. CONCLUSION: Although DFE was performed reliably by optometrists, utilization of imaging, DR grading and coding, and appropriate follow-up periods could be improved. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:608-612.].


Assuntos
Retinopatia Diabética/diagnóstico , Técnicas de Diagnóstico Oftalmológico/estatística & dados numéricos , Optometria/métodos , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Idoso , Técnicas de Diagnóstico Oftalmológico/normas , Feminino , Fundo de Olho , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Optometria/normas , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos
6.
Medicine (Baltimore) ; 98(47): e17993, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764812

RESUMO

This study aims to establish the range of exophthalmometry values (EV) in the adult Hong Kong (HK) Chinese population, its relationship with various anthropometric parameters, and to compare it with the EV in different ethnic groups.About 1485 adult HK Chinese were drawn from a random sample from the community-based FAMILY Cohort. Participants were interviewed, and comprehensive ophthalmological assessments were conducted. EV was measured using the Hertel's exophthalmometer.EV of both eyes from 630 male (42.4%) and 855 female (57.6%) participants, mean age 54 ±â€Š17.2 and 52 ±â€Š16 respectively were analyzed. The mean EV were found to be 15.3 ±â€Š2.8 mm in the right eye, 15.2 ±â€Š2.9 mm in the left eye for men and 14.4 ±â€Š2.7 mm in the right eye, 14.3 ±â€Š2.7 mm in the left eye for women. There were no differences in the EV between right and left eyes (P > .05). Men had significantly higher EV than women (P < .05) and age was found to be negatively correlated to EV (P < .05). Body height (r = 0.20), weight (r = 0.25), waist (r = 0.11), hip circumference (r = 0.15), body mass index (r = 0.17), interpupillary distance (r = 0.54), and axial length (AL) (r = 0.20) were all found to have statistically significant positive correlations with EV (P < .01). Spherical equivalent was found to have statistically significant negative correlation with EV (P < .01).Our study provides normative data on EV in the HK Chinese population. Height, weight, interpupillary distance, waist, hip circumference, and AL had positive correlations with EV. Spherical equivalent had negative correlation with EV. There was no significant difference in EV between the right and left eye. Age and gender had significant effect on EV.


Assuntos
Exoftalmia/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Técnicas de Diagnóstico Oftalmológico , Grupos Étnicos , Feminino , Hong Kong , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
7.
Ophthalmic Surg Lasers Imaging Retina ; 50(11): e274-e277, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31755978

RESUMO

BACKGROUND AND OBJECTIVE: This study examines the rate of adherence to recommended ophthalmology follow-up after primary care-based telemedicine diabetic retinopathy (DR) screening. PATIENTS AND METHODS: Retrospective observational study of 5,764 insured diabetic patients undergoing telemedicine DR screening between May 2015 and April 2017 in an urban primary care setting. Patients underwent non-mydriatic fundus photography for telemedicine DR screening. The main outcome measure was the "capture rate." RESULTS: Of the patients studied, 31.7% were found to have any retinal pathology, and 20% were found to have DR. In the 11.8% percent of patients with sight-threatening retinopathy who were recommended to have a retinal examination, the capture rate was 81.9%. CONCLUSION: The authors' study demonstrated higher capture rate than has been previously reported, indicating that telemedicine DR screening in an urban, insured population may be a useful method for triaging high-risk patients without losing patients to follow-up. [Ophthalmic Surg Lasers Imaging Retina. 2019;50: e274-e277.].


Assuntos
Retinopatia Diabética/diagnóstico , Técnicas de Diagnóstico Oftalmológico , Programas de Rastreamento/organização & administração , Telemedicina/métodos , Serviços Urbanos de Saúde/organização & administração , Adulto , Feminino , Fundo de Olho , Fidelidade a Diretrizes/normas , Humanos , Masculino , Pessoa de Meia-Idade , Fotografação/métodos , Estudos Retrospectivos
8.
Ophthalmic Surg Lasers Imaging Retina ; 50(11): e294-e299, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31755981

RESUMO

BACKGROUND AND OBJECTIVE: The posterior segment of the eye has been investigated in the pathogenesis of amblyopia, but no abnormalities have yet been reported consistently. PATIENTS AND METHODS: In this prospective study, treatment-naïve amblyopes aged 6 years to 12 years with best-corrected visual acuity in the amblyopic eye between logMAR 0.3 and logMAR 0.7 and logMAR 0.1 or better in the contralateral eye were recruited. All patients underwent optical coherence tomography angiography (OCTA) imaging of the retina and choriocapillaris. RESULTS: The mean age of the 14 recruited patients was 10.26 years ± 1.31 years. The choriocapillaris vessel density was found to be attenuated in the amblyopic eye as compared to the fellow eye. There was a significant difference in the choriocapillaris vessel density between the amblyopic (39.61% ± 0.45%), and the fellow eye (44.10% ± 0.37%; P = .005). The choriocapillaris vessel density correlated positively with the visual acuity (r = 0.41; P = .03). CONCLUSION: The pathogenesis of amblyopia may involve the choriocapillaris, which is the primary source of blood supply for the photoreceptors. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e294-e299.].


Assuntos
Ambliopia/patologia , Angiografia/métodos , Corioide/patologia , Vasos Retinianos/patologia , Tomografia de Coerência Óptica/métodos , Ambliopia/diagnóstico por imagem , Criança , Técnicas de Diagnóstico Oftalmológico , Feminino , Humanos , Masculino , Estudos Prospectivos , Retina/patologia , Acuidade Visual
9.
Ophthalmic Surg Lasers Imaging Retina ; 50(11): e311-e319, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31755983

RESUMO

BACKGROUND AND OBJECTIVE: To evaluate the relationship between spherical equivalent (SE) refractive error and myopia-related peripheral retinal changes (MPRCs) and to find the optimal cutoff for screening myopic teenagers. PATIENTS AND METHODS: The study included 2,286 myopic subjects who had a dilated fundus examination between 1998 and 2011 and SE of -4.0 diopters (D) or higher in both eyes. RESULTS: Ninety-five subjects (4.16%) had MPRCs. Two subjects (0.09%) had moderate-to-severe MPRCs. A significant correlation (P < .0001) between SE and MPRC was found. The highest sum of sensitivity (72.63%) and specificity (73.44%) was achieved when a SE of -6.25 D in the more myopic eye was utilized as the cutoff. CONCLUSIONS: SE and MPRCs are highly associated. The optimal cutoff to detect MPRC in teenagers is -6.25 D. However, using a SE of -4.0 D as the cutoff may be the practical choice for screening due to the noninvasiveness nature and low cost of the examination. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e311-e319.].


Assuntos
Miopia/patologia , Miopia/fisiopatologia , Erros de Refração/fisiopatologia , Retina/patologia , Adolescente , Técnicas de Diagnóstico Oftalmológico/normas , Feminino , Humanos , Modelos Logísticos , Masculino , Programas de Rastreamento/métodos , Sensibilidade e Especificidade
10.
Medicine (Baltimore) ; 98(40): e17255, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577717

RESUMO

BACKGROUND: The aim of the study was to evaluate the dynamic changes of tear film optical quality in a short tear break-up time (TBUT) dry eye by using a double-pass system. METHODS: Thirty-five short TBUT dry eye participants and 43 control subjects without dry eye were included in this study. One eye for each subject was analyzed. The Objective Scatter Index (OSI), modulation transfer function (MTF), and strehl ratio (SR) were recorded within a 20-second period with the participants asked to blink freely, and 10 successive seconds of nonblinking immediately after a blink was recorded to analyze the tear film OSI. The mean tear film OSI in 10 successive seconds, ΔOSI, and ΔOSI/time were evaluated. The correlation between tear film OSI and MTF, and the correlation between tear film OSI and MIT were also analysed. RESULTS: Short TBUT dry eye participants showed significant deterioration of MTF and SR compared to control subjects. The mean tear film OSI in 10 successive seconds was significantly higher in dry eye participants than in control subjects. The mean OSI of the tear film (0-5 seconds) and the mean OSI of the tear film (6-10 seconds) were significantly higher in dry eye participants than in control participants. Moreover, the ΔOSI was significantly higher in dry eye participants than in control participants. The tear film OSI was significantly correlated with the MTF and the SR. CONCLUSIONS: The tear film OSI of short TBUT dry eye participants is significantly increased in the early stage. Tear film instability in short TBUT dry eye participants has a significant effect on optical quality.


Assuntos
Técnicas de Diagnóstico Oftalmológico/normas , Síndromes do Olho Seco/diagnóstico , Lágrimas , Adulto , Piscadela/fisiologia , Estudos de Casos e Controles , Síndromes do Olho Seco/diagnóstico por imagem , Feminino , Humanos , Masculino , Índice de Gravidade de Doença
11.
Middle East Afr J Ophthalmol ; 26(3): 178-180, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31619909

RESUMO

A 40-year-old woman presented with vitellieruptive stage of Best's vitelliform macular dystrophy (BVMD) in the right eye and pseudohypopyon stage in the left eye. She underwent comprehensive ophthalmic examination and fundus imaging using multicolor (MC) imaging technology of Spectralis (Heidelberg Engineering, Heidelberg, Germany) spectral-domain-optical coherence tomography system. Composite MC imaging revealed larger area of retinal pigment epithelium atrophy in vitellierruptive stage of the disease in the right eye compared to color fundus photograph. Retinal elevation in the pseudohypopyon stage was better delineated on composite MC and blue reflectance images in the left eye. Subretinal lipofuscin was best seen in green reflectance and short-wave autofluorescence images. The present case reports the MC imaging features of BVMD.


Assuntos
Retina/diagnóstico por imagem , Distrofia Macular Viteliforme/diagnóstico por imagem , Adulto , Técnicas de Diagnóstico Oftalmológico , Feminino , Angiofluoresceinografia , Humanos , Lipofuscina/metabolismo , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Distrofia Macular Viteliforme/metabolismo
12.
Graefes Arch Clin Exp Ophthalmol ; 257(11): 2579-2585, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31501929

RESUMO

BACKGROUND: Inadequate screening of treatment-warranted retinopathy of prematurity (ROP) can lead to devastating visual outcomes. Especially in resource-poor communities, the use of an affordable, portable, and easy to use smartphone-based non-contact fundus photography device may prove useful for screening for high-risk ROP. This study evaluates the feasibility of screening for high-risk ROP using a novel smartphone-based fundus photography device, RetinaScope. METHODS: Retinal images were obtained using RetinaScope on a cohort of prematurely born infants during routine examinations for ROP. Images were reviewed by two masked graders who determined the image quality, the presence or absence of plus disease, and whether there was retinopathy that met predefined criteria for referral. The agreement between image-based assessments was compared to the gold standard indirect ophthalmoscopic assessment. RESULTS: Fifty-four eyes of 27 infants were included. A wide-field fundus photograph was obtained using RetinaScope. Image quality was acceptable or excellent in 98% and 95% of cases. There was substantial agreement between the gold standard and photographic assessment of presence or absence of plus disease (Cohen's κ = 0.85). Intergrader agreement on the presence of any retinopathy in photographs was also high (κ = 0.92). CONCLUSIONS: RetinaScope can capture digital retinal photographs of prematurely born infants with good image quality for grading of plus disease.


Assuntos
Técnicas de Diagnóstico Oftalmológico , Triagem Neonatal/métodos , Fotografação/métodos , Retinopatia da Prematuridade/diagnóstico , Smartphone , Telemedicina/métodos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes
13.
Arch. Soc. Esp. Oftalmol ; 94(9): 436-440, sept. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-186222

RESUMO

Objetivo: Proponer una guía para el diagnóstico y el manejo de pacientes con distonías faciales por parte de un grupo de expertos en órbita y oculoplástica miembros de la Sociedad Iberoamericana de Oculoplástica. Material y métodos: Se realizó una discusión dirigida interactiva entre el panel de expertos y los asistentes al VI Congreso de la Sociedad Iberoamericana de Oculoplástica realizado en las instalaciones del Hospital Nuestra Señora de la Luz en la Ciudad de México el 22 de octubre de 2018, presentando la experiencia basada en la evidencia y la experiencia personal para el diagnóstico y el tratamiento de distonías faciales. Al encuentro asistieron alrededor de 200 médicos oftalmólogos especialistas en oculoplástica originarios de Norte, Centro y Sudamérica, así como de España y Portugal. La discusión se centró en los siguientes sub-temas: fisiopatología, diagnóstico, manejo médico y manejo quirúrgico. Conclusiones: El diagnostico de las distonías faciales es clínico y rara vez requiere estudios complementarios de imagen. El oftalmólogo es generalmente el médico de primer contacto y está capacitado para ser el médico tratante salvo casos muy específicos de espasmo hemifacial, donde el manejo en conjunto con neurocirugía puede resultar beneficioso. El tratamiento de primera elección es la toxina botulínica. La terapia con neurolépticos orales y la miectomía del músculo orbicular se reservan para casos refractarios, ya que no presentan buena respuesta clínica como terapias de primera elección. El uso crónico de toxina botulínica no modifica el curso natural de la enfermedad


Objective: To propose guidelines for the diagnosis and treatment of facial dystonia prepared by a group of experts in orbit and oculoplastics from the Iberoamerican Oculoplastic Society. Material and methods: An interactive discussion between the expert panel and those attending the 6th Iberoamerican Society of Oculoplastics Congress, which took place at the Hospital Nuestra Señora de la Luz in Mexico City on 22 October 2018, providing their personal experience based on evidence for diagnosis and treatment of facial dystonia. Around 200 ophthalmologists specialised in oculoplastics from North, Central and South America, Spain, and Portugal were involved. Discussion was focused on the following themes: pathophysiology, diagnosis, medical management, and surgical management. Conclusions: Facial dystonia diagnosis is clinical; therefore, image studies are rarely needed. The ophthalmologist is generally the first physician to be consulted, and is able to be the treating physician, with the exception of specific cases of hemifacial spasm where management with neurosurgery may be beneficial. Botulinum toxin is the treatment of choice. Treatment with oral neuroleptics and myectomy of the orbicularis oculi muscle are reserved for refractory cases, since these do not have an adequate clinical response as first choice treatments. Persistent use of botulinum toxin does not modify the natural course of the disease


Assuntos
Humanos , Distúrbios Distônicos/diagnóstico , Distúrbios Distônicos/tratamento farmacológico , Face , Antipsicóticos/uso terapêutico , Blefarospasmo/diagnóstico , Blefarospasmo/tratamento farmacológico , Toxinas Botulínicas/uso terapêutico , Técnicas de Diagnóstico Oftalmológico , Gerenciamento Clínico , Distúrbios Distônicos/fisiopatologia , Distúrbios Distônicos/cirurgia , Espasmo Hemifacial/diagnóstico , Espasmo Hemifacial/tratamento farmacológico , Espasmo Hemifacial/cirurgia , Cirurgia de Descompressão Microvascular , Músculo Esquelético/cirurgia , Prognóstico
14.
Cornea ; 38(9): 1137-1141, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31394553

RESUMO

PURPOSE: The prospective case series aimed to examine the agreement between the use of a slit-scanning contact specular microscope and a noncontact specular microscope in corneal endothelial cell (CEC) analysis and to evaluate the differences between the central and peripheral regions in normal corneas. METHODS: After confirming normal corneal endothelium with slit-lamp microscopy, CEC images of 56 eyes of 56 cataractous patients were analyzed in the central and 4 peripheral regions using a slit-scanning contact specular microscope. A noncontact specular microscope was used for the analysis in the central region. The endothelial cell density (ECD), the percentage of hexagonal shape cells (HEX), and the coefficient of variation (CV) in the central region were compared. Differences between central and peripheral CECs were also evaluated. RESULTS: The mean ECD was 2778 cell/mm and was not different from the results using the noncontact specular microscope (2736 cell/mm, P = 0.051). There was a significant correlation (P < 0.001, R = 0.72). The analysis of HEX resulted in larger values with the slit-scanning contact microscope (53.13% vs. 48.89%, P < 0.001), whereas there was no difference in the CV (38.48 vs. 38.04, P = 0.56). On comparing the central and peripheral regions, there was no significant difference in the ECD, whereas significant differences were found in the superior region in the HEX and CV (P < 0.001) and in the nasal region in CV (P = 0.023). CONCLUSIONS: The analysis of ECD with the use of the slit-scanning contact specular microscope did not differ from the noncontact specular microscope, and the results demonstrated no difference between the central and peripheral ECD.


Assuntos
Catarata/diagnóstico por imagem , Técnicas de Diagnóstico Oftalmológico , Células Endoteliais/citologia , Epitélio Posterior/diagnóstico por imagem , Microscopia/métodos , Adulto , Idoso , Contagem de Células , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Microscopia com Lâmpada de Fenda
15.
Trials ; 20(1): 502, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412937

RESUMO

BACKGROUND: Globally, eye care provision is currently insufficient to meet the requirement for eye care services. Lack of access and awareness are key barriers to specialist services; in addition, specialist services are over-utilised by people with conditions that could be managed in the community or primary care. In combination, these lead to a large unmet need for eye health provision. We have developed a validated smartphone-based screening algorithm (Peek Community Screening App). The application (App) is part of the Peek Community Eye Health system (Peek CEH) that enables Community Volunteers (CV) to make referral decisions about patients with eye problems. It generates referrals, automated short messages service (SMS) notifications to patients or guardians and has a program dashboard for visualising service delivery. We hypothesise that a greater proportion of people with eye problems will be identified using the Peek CEH system and that there will be increased uptake of referrals, compared to those identified and referred using the current community screening approaches. STUDY DESIGN: A single masked, cluster randomised controlled trial design will be used. The unit of randomisation will be the 'community unit', defined as a dispensary or health centre with its catchment population. The community units will be allocated to receive either the intervention (Peek CEH system) or the current care (periodic health centre-based outreach clinics with onward referral for further treatment). In both arms, a triage clinic will be held at the link health facility four weeks from sensitisation, where attendance will be ascertained. During triage, participants will be assessed and treated and, if necessary, referred onwards to Kitale Eye Unit. DISCUSSION: We aim to evaluate a M-health system (Peek CEH) geared towards reducing avoidable blindness through early identification and improved adherence to referral for those with eye problems and reducing demand at secondary care for conditions that can be managed effectively at primary care level. TRIAL REGISTRATION: The Pan African Clinical Trials Registry (PACTR), 201807329096632 . Registered on 8 June 2018.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Agentes Comunitários de Saúde/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Técnicas de Diagnóstico Oftalmológico , Oftalmopatias/terapia , Aplicativos Móveis , Oftalmologia/organização & administração , Telemedicina/organização & administração , Oftalmopatias/diagnóstico , Feminino , Humanos , Quênia , Masculino , Valor Preditivo dos Testes , Ensaios Clínicos Controlados Aleatórios como Assunto , Encaminhamento e Consulta/organização & administração , Mensagem de Texto
16.
J Sci Med Sport ; 22(12): 1287-1291, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31445952

RESUMO

OBJECTIVES: To assess the reliability and effect of exercise on sideline dynamic visual performance measures of ocular-motor function using a portable visual assessment system (EYE-SYNC®). DESIGN: Prospective cohort study. METHODS: Healthy student athletes, ages 18-25 years, performed eye-tracking six times-three times consecutively prior to and after practice-using EYE-SYNC® goggles. Ocular-motor performance was assessed by calculating five gaze error outcomes between target position and actual gaze position to inform dynamic visual synchronization. We assessed reliability by calculating the intraclass correlation coefficient (ICC) for each outcome (we defined the standard deviation of tangential error (SDTE) as our primary outcome) and calculated differences in mean pre- and post-practice scores. RESULTS: ICCs for the SDTE score were 0.86 (95% confidence interval, CI: 0.82-0.9) and 0.88 (0.84-0.91) at pre- and post-practice, respectively. 133 (89%) and 135 (90%) of 150 athletes had at least one measurement at pre- and post-practice, respectively. 117 (78%) and 122 (81%) athletes had more than one SDTE score at pre- and post-practice, respectively. The absolute mean (SD) differences between pre- and post-practice mean scores ranged from 0.02 (0.05) for horizontal gain to 0.1 (0.5) for SDTE. CONCLUSIONS: We observed high ICC scores indicating excellent reliability of visual synchronization measurements, suggesting that one measurement would be sufficient. Most athletes had similar scores before and after practice, indicating little change in visual performance following exercise. EYE-SYNC® goggles have the potential for use in obtaining objective visual performance measures of ocular-motor function for sideline assessment of concussion and return to play decisions.


Assuntos
Técnicas de Diagnóstico Oftalmológico/instrumentação , Exercício , Fixação Ocular , Adolescente , Adulto , Algoritmos , Atletas , Óculos , Feminino , Humanos , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes , Software , Estudantes , Adulto Jovem
17.
Radiol Med ; 124(12): 1296-1303, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31435862

RESUMO

AIM: Our aim was to assess MRI findings in the acute phase of ON and their correlation with visual acuity at presentation, visual outcome (VO) and MS development, to analyze a possible correlation between lesions number and diagnosis, and to assess correlation between orbits MRI and OCT. MATERIALS AND METHODS: We retrospectively studied 37 patients, who presented to our Emergency Department with an ON first episode from January 2015 to January 2017. Patients underwent immediately a complete neuro-ophthalmological evaluation, blood test, CSF analysis. MRI of brain, orbits, cervical spine was executed within 7 days from ON onset. Brain MRI was classified as: normal, non-specific, suspected demyelination, lesions with dissemination in space and time. Optic nerves findings were localized in three sites (intra-orbital, canalicular and chiasmal) and classified as: normal, STIR- alteration, altered contrast enhancement. Patients underwent neuro-ophthalmological follow-up and MRI at 6 months to assess VO (complete recovery, partial recovery, deficit persistence). Another follow-up at 1 year was performed to identify MS or clinically isolated syndrome (CIS). RESULTS: 64.8% patients received a diagnosis of MS; 35% of CIS. Lesions of the optic nerve were found in 65.8%. We observed statistically significant correlation between brain MRI pattern and diagnosis and between lesions number and diagnosis. We observed a statistically significant correlation between orbital MRI pattern and optical coherence tomography (OCT) results. MRI brain findings correlate with development of MS. MRI brain features and lesions number can predict the risk of MS conversion.


Assuntos
Encéfalo/diagnóstico por imagem , Imagem por Ressonância Magnética , Esclerose Múltipla/diagnóstico por imagem , Neurite Óptica/diagnóstico por imagem , Doença Aguda , Adulto , Técnicas de Diagnóstico Oftalmológico , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/etiologia , Nervo Óptico/diagnóstico por imagem , Neurite Óptica/tratamento farmacológico , Estudos Retrospectivos , Estatísticas não Paramétricas , Esteroides/uso terapêutico , Fatores de Tempo , Tomografia de Coerência Óptica , Acuidade Visual , Adulto Jovem
18.
Int J Comput Assist Radiol Surg ; 14(9): 1601-1610, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31420832

RESUMO

PURPOSE: Intravitreal injection is among the most frequent treatment strategies for chronic ophthalmic diseases. The last decade has seen a serious increase in the number of intravitreal injections, and with it, adverse effects and drawbacks. To tackle these problems, medical assistive devices for robotized injections have been suggested and are projected to enhance delivery mechanisms for a new generation of pharmacological solutions. In this paper, we present a method aimed at improving the safety characteristics of upcoming robotic systems. Our vision-based method uses a combination of 2D OCT data, numerical simulation and machine learning to classify the range of the force applied by an injection needle on the sclera. METHODS: We design a neural network to classify force ranges from optical coherence tomography (OCT) images of the sclera directly. To avoid the need for large real data sets, the network is trained on images of simulated deformed sclera. This simulation is based on a finite element method, and the model is parameterized using a Bayesian filter applied to observations of the deformation in OCT images. RESULTS: We validate our approach on real OCT data collected on five ex vivo porcine eyes using a robotically guided needle. The thorough parameterization of the simulations leads to a very good agreement between the virtually generated samples used to train the network and the real OCT acquisitions. Results show that the applied force range on real data can be predicted with 93% accuracy. CONCLUSIONS: Through a simulation-trained neural network, our approach estimates the force range applied by a robotically guided needle on the sclera based solely on a single OCT slice of the deformed sclera. Being real-time, this solution can be integrated in the control loop of the system, permitting the prompt withdrawal of the needle for safety reasons.


Assuntos
Técnicas de Diagnóstico Oftalmológico , Procedimentos Cirúrgicos Robóticos , Esclera/diagnóstico por imagem , Tomografia de Coerência Óptica , Animais , Teorema de Bayes , Simulação por Computador , Humanos , Processamento de Imagem Assistida por Computador , Injeções Intravítreas , Aprendizado de Máquina , Fenômenos Mecânicos , Modelos Teóricos , Reprodutibilidade dos Testes , Suínos
19.
Acta Clin Croat ; 58(1): 63-71, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31363327

RESUMO

The aim was to determine feasibility and reliability of noninvasive tear break-up time (NIBUT) assessment using handheld lipid layer examination instrument, and to compare it with standard tear break-up time (TBUT) test. Fifty patients were enrolled, 31 with and 19 without dry eye symptoms. Schein questionnaire was used to assess dry eye symptoms. During examination, three NIBUT measurements were performed on each eye using handheld instrument, followed by three TBUT measurements. Receiver operating characteristic curves, sensitivity, specificity and logistic regression analysis were generated. Median NIBUT values were significantly shorter in dry eye symptom group than in control group in all three measurements (9, 8 and 8 s vs. 21, 22 and 21 s; p<0.001). TBUT values showed no significant difference between the groups in the first measurement (p=0.053), but the values were significantly shorter in dry eye symptom group in second and third measurements (p=0.020). The cutoff value to distinguish patients with symptoms of dry eye from control group was 12 seconds for NIBUT and 8 seconds for TBUT, with NIBUT having significantly higher sensitivity, specificity, area under the receiver operating characteristic curve and positive predictive value. NIBUT, measured by handheld lipid layer examination instrument, was superior to TBUT in detecting dry eye.


Assuntos
Técnicas de Diagnóstico Oftalmológico/instrumentação , Síndromes do Olho Seco/diagnóstico , Metabolismo dos Lipídeos/fisiologia , Lágrimas/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Inquéritos e Questionários
20.
Acta Clin Croat ; 58(1): 87-94, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31363329

RESUMO

The aim of the study was to assess biometric factor aberrations and differences among groups of eyes with cataract and pseudoexfoliative syndrome, cataract and pseudoexfoliative glaucoma, and cataract and primary open-angle glaucoma (POAG), and to determine biometric factors of the eye specific for the group of glaucomatous patients with pseudoexfoliative syndrome by use of optical low-coherence reflectometry. This retrospective study included 72 patients, and the study sample of 102 eyes was divided into the following three groups according to diagnosis: 29 eyes with pseudoexfoliative syndrome and cataract; 36 eyes with POAG and cataract; and 37 eyes with pseudoexfoliative glaucoma and cataract. Data on biometric measurements (central corneal thickness, pupillary diameter, anterior chamber depth, lens thickness, axial length, retinal thickness, astigmatism and white-to-white) obtained by use of optical low-coherence reflectometry on a Lenstar LS 900® (Haag-Streit International) were collected and analyzed by thorough survey of medical documentation of patients scheduled for cataract surgery at Department of Ophthalmology, Sveti Duh University Hospital in Zagreb, Croatia. Comparative analysis of the groups yielded statistically significant differences in central corneal thickness (F2/99=7.066; p=0.001) and lens thickness (F2/96=5.133; p=0.008). The group of eyes diagnosed with pseudoexfoliative glaucoma and cataract had a significantly thinner cornea as compared with the other two groups and a significantly thicker lens as compared with the group of eyes with POAG and cataract. In conclusion, optical low-coherence reflectometry revealed differences in biometric factors among the three groups of eyes, with a statistically significantly thinner cornea and thicker lens in the group of glaucomatous patients with pseudoexfoliative syndrome.


Assuntos
Biometria/métodos , Catarata/diagnóstico , Glaucoma/diagnóstico , Tomografia de Coerência Óptica/métodos , Idoso , Croácia , Técnicas de Diagnóstico Oftalmológico , Feminino , Humanos , Cristalino/patologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Retina/patologia , Estudos Retrospectivos
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