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McElhinney K, McGrath R, Holohan R, Idrees Z. Twelve-month analysis of emergency argon laser retinopexy in an Irish tertiary hospital. Ir J Med Sci 2024; 193:1653-1657. [PMID: 37874504 DOI: 10.1007/s11845-023-03549-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Retinal tears occur as a result of traction at sites of retinal and vitreous adhesion-this allows retrohyaloid fluid into the subretinal space. Prompt management is required to prevent progression to rhegmatogenous retinal detachment (RRD). AIMS To identify the post-procedural outcomes following treatment of retinal tears with laser retinopexy in an emergency setting. METHODS Retrospective review of all patients who underwent emergency slit-lamp laser retinopexy between January and December 2021 in Cork University Hospital, an Irish tertiary referral centre. RESULTS A total of 87 patients were identified-mean age of 60 ± 12 years and 54% female. Follow-up ranged from 1 week to 11 months. Pre-disposing risk factors were identified-myopia (37%), recent trauma (2%), and RRD family history (5%). All patients had slit-lamp mounted laser-retinopexy performed in the eye-casualty. 63 patients (72%) had a superior break, 66 patients (76%) had a horse-shoe retinal tear, and 21 patients (24%) had a retinal hole. Associated findings included lattice degeneration (26%), sub-retinal fluid (55%), and vitreous haemorrhage (33%). Fourteen patients (16%) required multiple slit-lamp laser retinopexies while 18 patients (21%) required intervention by a vitreo-retinal surgeon including indirect-laser retinopexy (3%), cryotherapy (11%), and pars-plana vitrectomy (6%). At the most recent follow-up, all the patients had anatomically attached retinas. CONCLUSION A notable proportion of patients (21%) undergoing emergency laser retinopexy required further intervention. Patients with anteriorly located retinal tears would benefit from an early discussion with a vitreo-retinal surgeon. Departmental training in laser retinopexy and retinal tear management is recommended as part of ongoing quality improvement.
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Affiliation(s)
- Kealan McElhinney
- Department of Ophthalmology, Cork University Hospital, Cork, Ireland.
| | - Robert McGrath
- Department of Ophthalmology, Cork University Hospital, Cork, Ireland
| | - Rory Holohan
- Department of Ophthalmology, Cork University Hospital, Cork, Ireland
| | - Zubair Idrees
- Department of Ophthalmology, Cork University Hospital, Cork, Ireland
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2
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Christ M, Habra O, Monnin K, Vallotton K, Sznitman R, Wolf S, Zinkernagel M, Márquez Neila P. Deep Learning-Based Automated Detection of Retinal Breaks and Detachments on Fundus Photography. Transl Vis Sci Technol 2024; 13:1. [PMID: 38564203 PMCID: PMC10996975 DOI: 10.1167/tvst.13.4.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 02/18/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose The purpose of this study was to develop a deep learning algorithm, to detect retinal breaks and retinal detachments on ultra-widefield fundus (UWF) optos images using artificial intelligence (AI). Methods Optomap UWF images of the database were annotated to four groups by two retina specialists: (1) retinal breaks without detachment, (2) retinal breaks with retinal detachment, (3) retinal detachment without visible retinal breaks, and (4) a combination of groups 1 to 3. The fundus image data set was split into a training set and an independent test set following an 80% to 20% ratio. Image preprocessing methods were applied. An EfficientNet classification model was trained with the training set and evaluated with the test set. Results A total of 2489 UWF images were included into the dataset, resulting in a training set size of 2008 UWF images and a test set size of 481 images. The classification models achieved an area under the receiver operating characteristic curve (AUC) on the testing set of 0.975 regarding lesion detection, an AUC of 0.972 for retinal detachment and an AUC of 0.913 for retinal breaks. Conclusions A deep learning system to detect retinal breaks and retinal detachment using UWF images is feasible and has a good specificity. This is relevant for clinical routine as there can be a high rate of missed breaks in clinics. Future clinical studies will be necessary to evaluate the cost-effectiveness of applying such an algorithm as an automated auxiliary tool in a large practices or tertiary referral centers. Translational Relevance This study demonstrates the relevance of applying AI in diagnosing peripheral retinal breaks in clinical routine in UWF fundus images.
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Affiliation(s)
- Merlin Christ
- Department of Ophthalmology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Oussama Habra
- Department of Ophthalmology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Killian Monnin
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Kevin Vallotton
- Department of Ophthalmology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Raphael Sznitman
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Sebastian Wolf
- Department of Ophthalmology, Inselspital, Bern University Hospital, Bern, Switzerland
- Bern Photographic Reading Center, Department of Ophthalmology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Martin Zinkernagel
- Department of Ophthalmology, Inselspital, Bern University Hospital, Bern, Switzerland
- Bern Photographic Reading Center, Department of Ophthalmology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Pablo Márquez Neila
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
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Lucente A, Taloni A, Scorcia V, Giannaccare G. Longitudinal Observation of Two Giant Peripheral Atrophic Retinal Holes Left Untreated. Ophthalmic Surg Lasers Imaging Retina 2024; 55:176-178. [PMID: 38270565 DOI: 10.3928/23258160-20240105-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
In this report, two rare cases of large atrophic peripheral retinal holes are described. Both patients presented during a routine visit without reporting any ocular symptoms. The holes did not exhibit significant risk factors for progression to rhegmatogenous retinal detachment: No signs of posterior vitreous detachment, vitreoretinal tractions, or retinal degeneration were visible. For such asymptomatic cases, international guidelines recommend a strict follow-up schedule; however, the unusual size of the holes raised significant concerns about the management of these retinal breaks. The advantages and disadvantages of laser photo-coagulation treatment were discussed, ultimately favoring a watch-and-wait strategy. [Ophthalmic Surg Lasers Imaging Retina 2024;55:176-178.].
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Wu T, Ju L, Fu X, Wang B, Ge Z, Liu Y. Deep Learning Detection of Early Retinal Peripheral Degeneration From Ultra-Widefield Fundus Photographs of Asymptomatic Young Adult (17-19 Years) Candidates to Airforce Cadets. Transl Vis Sci Technol 2024; 13:1. [PMID: 38300623 PMCID: PMC10851781 DOI: 10.1167/tvst.13.2.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/27/2023] [Indexed: 02/02/2024] Open
Abstract
Purpose Artificial intelligence (AI)-assisted ultra-widefield (UWF) fundus photographic interpretation is beneficial to improve the screening of fundus abnormalities. Therefore we constructed an AI machine-learning approach and performed preliminary training and validation. Methods We proposed a two-stage deep learning-based framework to detect early retinal peripheral degeneration using UWF images from the Chinese Air Force cadets' medical selection between February 2016 and June 2022. We developed a detection model for the localization of optic disc and macula, which are used to find the peripheral areas. Then we developed six classification models for the screening of various retinal cases. We also compared our proposed framework with two baseline models reported in the literature. The performance of the screening models was evaluated by area under the receiver operating curve (AUC) with 95% confidence interval. Results A total of 3911 UWF fundus images were used to develop the deep learning model. The external validation included 760 UWF fundus images. The results of comparison study revealed that our proposed framework achieved competitive performance compared to existing baselines while also demonstrating significantly faster inference time. The developed classification models achieved an average AUC of 0.879 on six different retinal cases in the external validation dataset. Conclusions Our two-stage deep learning-based framework improved the machine learning efficiency of the AI model for fundus images with high resolution and many interference factors by maximizing the retention of valid information and compressing the image file size. Translational Relevance This machine learning model may become a new paradigm for developing UWF fundus photography AI-assisted diagnosis.
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Affiliation(s)
- Tengyun Wu
- Air Force Medical Center of Chinese PLA, Beijing, China
| | - Lie Ju
- Beijing Airdoc Technology Co. Ltd., Beijing, China
- Faculty of engineering, Monash University, Clayton, Australia
| | - Xuefei Fu
- Beijing Airdoc Technology Co. Ltd., Beijing, China
| | - Bin Wang
- Beijing Airdoc Technology Co. Ltd., Beijing, China
| | - Zongyuan Ge
- Beijing Airdoc Technology Co. Ltd., Beijing, China
- Faculty of engineering, Monash University, Clayton, Australia
| | - Yong Liu
- Air Force Medical Center of Chinese PLA, Beijing, China
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Morris RE, Kuhn F, West MR, Richardson C. Re: Wallsh et al.: Fellow-eye retinal detachment risk as stratified by hyaloid status on OCT (Ophthalmology. 2023;130:624-630). Ophthalmology 2023; 130:e44-e45. [PMID: 37737810 DOI: 10.1016/j.ophtha.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/12/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023] Open
Affiliation(s)
- Robert E Morris
- Retina Specialists of Alabama LLC, Birmingham, Alabama; Helen Keller Foundation for Research and Education, Birmingham, Alabama; Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Ferenc Kuhn
- Retina Specialists of Alabama LLC, Birmingham, Alabama; Department of Ophthalmology, University of Pecs Medical School, Pecs, Hungary; Helen Keller Foundation for Research and Education, Birmingham, Alabama
| | - Matthew R West
- Retina Specialists of Alabama LLC, Birmingham, Alabama; Helen Keller Foundation for Research and Education, Birmingham, Alabama; Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Cole Richardson
- Retina Specialists of Alabama LLC, Birmingham, Alabama; Retina Specialists of Mississippi, LLC, Hattiesburg, Mississippi; Helen Keller Foundation for Research and Education, Birmingham, Alabama; Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama
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Kalaw FGP, Tavakoli K, Baxter SL. Evaluation of Publications from the American Academy of Ophthalmology: A 5-Year Analysis of Ophthalmology Literature. OPHTHALMOLOGY SCIENCE 2023; 3:100395. [PMID: 38025157 PMCID: PMC10630667 DOI: 10.1016/j.xops.2023.100395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/21/2023] [Accepted: 09/05/2023] [Indexed: 12/01/2023]
Abstract
Objective To analyze recent publications in Ophthalmology, the journal of the American Academy of Ophthalmology. Design Retrospective review of published articles. Participants No human participants were involved in the study. Methods Articles published in Ophthalmology from January 2018 to December 2022 were reviewed and analyzed. Main Outcome Measures Research and review articles were included and analyzed per the following: total number of published articles based on related subspecialty area, level of evidence using the modified Oxford level of evidence, number of citations, number of listed authors, gender of the corresponding author, country of affiliation of the corresponding and contributing author(s), and involvement of consortium(s), group(s), or committee(s). Results A total of 965 articles were included. The mean (standard deviation) number of authors per article was 8.6 (5.7) and the majority of corresponding authors were male (665, 70.7%). The greatest number of published articles were related to retina (296, 30.7%) followed by glaucoma (172, 17.8%). The greatest number of Preferred Practice Pattern guidelines were also related to retina (7/24, 29.1%), followed by cornea/dry eye syndrome/external disease (6/24, 25%). Retina (77) had the most level 1 evidence, glaucoma (30) for level 2 evidence, and retina for levels 3 (69) and 4 (65). There were 223 articles contributed by consortia/groups/committees, with most from retina (73, 32.7%) followed by glaucoma (40, 17.9%). The mean number of citations per subspecialty article was highest in retina (45.8/article), followed by uveitis (31.7/article). The United States had the greatest number of affiliated corresponding authors (544, 56.4%), followed by the United Kingdom (68, 7.0%). There were 357 (37.0%) articles with coauthors affiliated outside the corresponding author's country of affiliation, although with a downward trend over the most recent 5-year period. There has been an increasing trend in the number of authors and consortia/group/committee involvement in publications. Conclusions Although team science and collaborations have increased recently, ongoing efforts to diversify individuals, groups, and subspecialties may be needed. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Fritz Gerald P. Kalaw
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California
| | - Kiana Tavakoli
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California
| | - Sally L. Baxter
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California
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Morano MJ, Khan MA, Zhang Q, Halfpenny CP, Wisner DM, Sharpe J, Li A, Tomaiuolo M, Haller JA, Hyman L, Ho AC. Incidence and Risk Factors for Retinal Detachment and Retinal Tear after Cataract Surgery: IRIS® Registry (Intelligent Research in Sight) Analysis. OPHTHALMOLOGY SCIENCE 2023; 3:100314. [PMID: 37274012 PMCID: PMC10239011 DOI: 10.1016/j.xops.2023.100314] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/28/2023] [Accepted: 04/12/2023] [Indexed: 06/06/2023]
Abstract
Objective To report the incidence of and evaluate demographic, ocular comorbidities, and intraoperative factors for rhegmatogenous retinal detachment (RRD) and retinal tear (RT) after cataract surgery in the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight). Design Retrospective cohort study. Participants Patients aged ≥ 40 years who underwent cataract surgery between 2014 and 2017. Methods Multivariable logistic regression was used to evaluate demographic, comorbidity, and intraoperative factors associated with RRD and RT after cataract surgery. Main Outcome Measures Incidence and risk factors for RRD or RT within 1 year of cataract surgery. Results Of the 3 177 195 eyes of 1 983 712 patients included, 6690 (0.21%) developed RRD and 5489 (0.17%) developed RT without RRD within 1 year after cataract surgery. Multivariable logistic regression odds ratios (ORs) showed increased risk of RRD and RT, respectively, among men (OR 3.15; 95% confidence interval [CI], 2.99-3.32; P < 0.001 and 1.79; 95% CI, 1.70-1.89; P < 0.001), and younger ages compared with patients aged > 70, peaking at age 40 to 50 for RRD (8.61; 95% CI, 7.74-9.58; P < 0.001) and age 50 to 60 for RT (2.74; 95% CI, 2.52-2.98; P < 0.001). Increased odds of RRD were observed for procedure eyes with lattice degeneration (LD) (10.53; 95% CI, 9.82-11.28; P < 0.001), hypermature cataract (1.61; 95% CI, 1.06-2.45; P = 0.03), complex cataract surgery (1.52; 95% CI, 1.4-1.66; P < 0.001), posterior vitreous detachment (PVD) (1.24; 95% CI, 1.15-1.34; P < 0.001), and high myopia (1.2; 95% CI, 1.14-1.27; P < 0.001). Lattice degeneration conferred the highest odds of RT (43.86; 95% CI, 41.39-46.49; P < 0.001). Conclusion In the IRIS Registry, RRD occurs in approximately 1 in 500 cataract surgeries in patients aged > 40 years within 1 year of surgery. The presence of LD conferred the highest odds for RRD and RT after surgery. Additional risk factors for RRD included male gender, younger age, hypermature cataract, PVD, and high myopia. These data may be useful during the informed consent process for cataract surgery and help identify patients at a higher risk of retinal complications. Financial Disclosures The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
| | - M. Ali Khan
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania
- Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Qiang Zhang
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania
- Wills Eye Hospital, Philadelphia, Pennsylvania
- Vickie and Jack Farber Vision Research Center at Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Colleen P. Halfpenny
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania
- Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Douglas M. Wisner
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania
- Wills Eye Hospital, Philadelphia, Pennsylvania
| | - James Sharpe
- Wills Eye Hospital, Philadelphia, Pennsylvania
- Vickie and Jack Farber Vision Research Center at Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Alexander Li
- Wills Eye Hospital, Philadelphia, Pennsylvania
- Vickie and Jack Farber Vision Research Center at Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Maurizio Tomaiuolo
- Wills Eye Hospital, Philadelphia, Pennsylvania
- Vickie and Jack Farber Vision Research Center at Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Julia A. Haller
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania
- Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Leslie Hyman
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania
- Wills Eye Hospital, Philadelphia, Pennsylvania
- Vickie and Jack Farber Vision Research Center at Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Allen C. Ho
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania
- Wills Eye Hospital, Philadelphia, Pennsylvania
| | - IRIS Registry Analytic Center Consortium
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania
- Wills Eye Hospital, Philadelphia, Pennsylvania
- Vickie and Jack Farber Vision Research Center at Wills Eye Hospital, Philadelphia, Pennsylvania
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8
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Vofo BN, Yosef YB, Tiosano L, Levy J, Khateb S, Chowers I. Visualizing Vitreous Traction by Biomicroscopy versus OCT. Ophthalmol Retina 2023; 7:1116-1117. [PMID: 37673398 DOI: 10.1016/j.oret.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/23/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Brice N Vofo
- Department of Ophthalmology, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yair B Yosef
- Department of Ophthalmology, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Liran Tiosano
- Department of Ophthalmology, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jaime Levy
- Department of Ophthalmology, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Samer Khateb
- Department of Ophthalmology, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Itay Chowers
- Department of Ophthalmology, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
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Lin AC, Kalaw FGP, Schönbach EM, Song D, Koretz Z, Walker E, Breazzano MP, Scott NL, Borooah S, Ferreyra H, Spencer DB, Goldbaum MH, Nudleman ED, Freeman WR, Toomey CB. The Sensitivity of Ultra-Widefield Fundus Photography Versus Scleral Depressed Examination for Detection of Retinal Horseshoe Tears. Am J Ophthalmol 2023; 255:155-160. [PMID: 37468086 DOI: 10.1016/j.ajo.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE Ultra-widefield (UWF) imaging is commonly used in ophthalmology in tandem with scleral depressed examinations (SDE) to evaluate peripheral retinal disease. Because of the increased reliance on this technology in tele-ophthalmology, it is critical to evaluate its efficacy for detecting the peripheral retina when performed in isolation. Therefore, we sought to evaluate UWF imaging sensitivity in detecting retinal horseshoe tears (HSTs). STUDY DESIGN Retrospective clinical validity and reliability study. METHODS A single-institutional retrospective analysis was performed on patients at the Shiley Eye Institute, University of California, San Diego. Patients with HSTs seen on SDE who underwent treatment with laser were included in the study. A total of 140 patients with HSTs in the right and/or left eyes met the inclusion criteria. Those with concomitant ruptured globes, retinal detachments, and vitreous hemorrhages were excluded. A total of 123 patients with 135 HSTs were included in the final analysis. The primary outcome was the number of HSTs detected by UWF imaging. A secondary outcome was HST location. Sensitivity was measured with respect to HST location, and statistical significance was calculated by Fisher exact testing. RESULTS A total of 69 (51.1%) HSTs were visualized on UWF images and 66 (48.9%) were not visualized. The sensitivity of UWF imaging in capturing HSTs was 7 of 41 (17.1%), 8 of 25 (32.0%), 7 of 14 (50.0%), and 47 of 55 (85.5%) for the superior, inferior, nasal, and temporal quadrants, respectively. Sensitivities between HST visibility and location were statistically significant (P < .001). CONCLUSIONS Nearly half of HSTs were missed by UWF imaging. This study demonstrates that UWF imaging alone is not sufficiently sensitive to exclude the presence of HSTs.
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Affiliation(s)
- Andrew C Lin
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA
| | - Fritz Gerald P Kalaw
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA; Division of Ophthalmology Informatics and Data Science (F.G.P.K.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA
| | - Etienne M Schönbach
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA
| | - Delu Song
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA
| | - Zachary Koretz
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA
| | - Evan Walker
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA
| | - Mark P Breazzano
- Retina-Vitreous Surgeons of Central New York (M.P.B.), Liverpool, New York, USA; Department of Ophthalmology & Visual Sciences (M.P.B.), SUNY Upstate Medical University, Syracuse, New York, USA
| | - Nathan L Scott
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA
| | - Shyamanga Borooah
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA
| | - Henry Ferreyra
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA
| | - Doran B Spencer
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA
| | - Michael H Goldbaum
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA
| | - Eric D Nudleman
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA
| | - William R Freeman
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA
| | - Christopher B Toomey
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA; Glycobiology Research and Training Center (C.B.T.), University of California, San Diego, La Jolla, California, USA..
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10
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Choi S, Goduni L, Wald KJ. Clinical Outcomes of Symptomatic Horseshoe Tears After Laser Retinopexy. JOURNAL OF VITREORETINAL DISEASES 2023; 7:290-292. [PMID: 37927320 PMCID: PMC10621698 DOI: 10.1177/24741264231171822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Purpose: To determine the clinical course of patients treated for acute symptomatic horseshoe retinal tears (HSTs). Methods: A retrospective chart review was performed of patients presenting between January 2014 and December 2021 with acute onset of floaters and/or flashes who were found to have horseshoe retinal tear HRT(s) without retinal detachment (RD). Patients were included if they had at least 3 months of follow-up. Exclusion criteria were a rhegmatogenous RD (RRD) at initial presentation, asymptomatic HST(s), operculated hole, atrophic hole, retinal dialysis, history of trauma, or previous retinal surgery. Charts were reviewed for subsequent new HST(s), progression to RRD, and development of epiretinal membrane (ERM). Characteristics, including age, sex, eye laterality, phakic status, high myopia, lattice degeneration, and vitreous hemorrhage (VH) at initial presentation, were also noted. The main outcome measures were the percentage and timing of subsequent new HST(s), progression to RRD, and development of ERM. Results: The study included 216 eyes (199 patients). The mean age was 60.4 years. Of the eyes, 27.3% had lattice degeneration and 6.5% high myopia. At presentation, 25.9% of eyes had a VH. Twenty-seven eyes (12.5%) experienced new tear(s); 63.0% occurred between 1 month and 3 months. Progression to RRD occurred in 15 eyes (6.9%); 53.3% occurred within 3 months. On multivariate logistic regression, VH was a significant risk factor (odds ratio, 6.48; P = .002) for progression to new HST(s) or RRD. Conclusions: Eyes treated for acute symptomatic HSTs require ongoing follow-up. Although new retinal tears and progression to RRD tends to occur within 3 months, these events can occur later.
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Affiliation(s)
- Stephanie Choi
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
| | | | - Kenneth J. Wald
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
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11
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Ramamurthy S, Raval V, Ali H, Tyagi M, Narayanan R, Reddy R, Das AV. GIANT RETINAL TEAR DETACHMENT: Clinical Presentation and Treatment Outcomes in 396 Patients. Retina 2023; 43:784-792. [PMID: 36728871 DOI: 10.1097/iae.0000000000003720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To study etiology, clinical presentation, anatomical, and functional outcomes of patients with giant retinal tear detachment at a tertiary eye institute. METHODS Retrospective, consecutive case series of 396 patients (396 eyes) who underwent surgery were reviewed. Factors affecting the final anatomical and functional success were determined. RESULTS Mean age was 37 years (range; 1-79 years), and 86% (n = 339) of the subjects were men. Trauma (21%) and high myopia (11%) were predisposing risk factors. Two hundred and seventy-seven eyes (70%) had giant retinal tear configuration of >180° and <270°, associated with partial retinal detachment in 282 (71%) eyes and macular detachment in 262 (66%) eyes. Primary surgery included pars plana vitrectomy (n = 240, 61%), pars plana vitrectomy with encirclage band (n = 152, 38%), or scleral buckle (n = 4, 1%). The mean follow-up duration was 15 months (median, 8.4 months; range, 3-83 months). Anatomical success after initial surgery was 64% (255 eyes), which improved to 78% (308 eyes) after undergoing a second vitreoretinal procedure for recurrent retinal detachment (53 eyes). Median visual acuity improved from 20/1,500 preoperatively to 20/400 at final follow-up ( P = 0.01), and 15% of eyes achieved postoperative visual acuity of 20/60 or better. Factors associated with poor anatomical success included age <16 years ( P = 0.005) and presenting visual acuity 20/400 or less ( P = 0.001). CONCLUSION Trauma and myopia constituted the major risk factors for giant retinal tear detachment in our series. Surgery for giant retinal tear detachment managed with pars plana vitrectomy with or without encirclage band and silicone oil tamponade had good anatomical and favorable visual outcomes at last follow-up.
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Affiliation(s)
- Srishti Ramamurthy
- Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Vishal Raval
- Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Hasnat Ali
- Center for Biostatistics and Epidemiology, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Mudit Tyagi
- Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Raja Narayanan
- Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rajeev Reddy
- Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Anthony Vipin Das
- Department of eyeSmart EMR and AEye, L V Prasad Eye Institute, Hyderabad, Telangana, India; and
- Indian Health Outcomes, Public Health and Economics Research Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
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12
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Jonas JB, Spaide RF, Ostrin LA, Logan NS, Flitcroft I, Panda-Jonas S. IMI-Nonpathological Human Ocular Tissue Changes With Axial Myopia. Invest Ophthalmol Vis Sci 2023; 64:5. [PMID: 37126358 PMCID: PMC10153585 DOI: 10.1167/iovs.64.6.5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Purpose To describe nonpathological myopia-related characteristics of the human eye. Methods Based on histomorphometric and clinical studies, qualitative and quantitative findings associated with myopic axial elongation are presented. Results In axial myopia, the eye changes from a spherical shape to a prolate ellipsoid, photoreceptor, and retinal pigment epithelium cell density and total retinal thickness decrease, most marked in the retroequatorial region, followed by the equator. The choroid and sclera are thin, most markedly at the posterior pole and least markedly at the ora serrata. The sclera undergoes alterations in fibroblast activity, changes in extracellular matrix content, and remodeling. Bruch's membrane (BM) thickness is unrelated to axial length, although the BM volume increases. In moderate myopia, the BM opening shifts, usually toward the fovea, leading to the BM overhanging into the nasal intrapapillary compartment. Subsequently, the BM is absent in the temporal region (such as parapapillary gamma zone), the optic disc takes on a vertically oval shape, the fovea-optic disc distance elongates without macular BM elongation, the angle kappa reduces, and the papillomacular retinal vessels and nerve fibers straighten and stretch. In high myopia, the BM opening and the optic disc enlarge, the lamina cribrosa, the peripapillary scleral flange (such as parapapillary delta zone) and the peripapillary choroidal border tissue lengthen and thin, and a circular gamma and delta zone develop. Conclusions A thorough characterization of ocular changes in nonpathological myopia are of importance to better understand the mechanisms of myopic axial elongation, pathological structural changes, and psychophysical sequelae of myopia on visual function.
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Affiliation(s)
- Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Richard F Spaide
- Vitreous, Retina, Macula Consultants of New York, New York, New York, United States
| | - Lisa A Ostrin
- College of Optometry, University of Houston, Houston, Texas, United States
| | - Nicola S Logan
- School of Optometry, Aston University, Birmingham, United Kingdom
| | - Ian Flitcroft
- Centre for Eye Research, School of Physics and Clinical and Optometric Sciences, Technological University Dublin, Dublin, Ireland
- Department of Ophthalmology, Children's Health Ireland at Temple Street Hospital, Dublin, Ireland
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13
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Rao AV, Shah AR, Nguyen VT, Pearce W, Wong TP, Brown DM, Wykoff CC, Patel SB. USE OF OPTICAL COHERENCE TOMOGRAPHY IN DETECTING RETINAL TEARS IN ACUTE, SYMPTOMATIC POSTERIOR VITREOUS DETACHMENT. Retina 2023; 43:802-807. [PMID: 36728866 DOI: 10.1097/iae.0000000000003718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/11/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE To evaluate the association of posterior vitreous opacities (PVOs) on optical coherence tomography with retinal tears identified on examination in patients with acute, symptomatic posterior vitreous detachment (PVD). METHODS Data were retrospectively collected from the medical records of 388 patients with acute, symptomatic PVD between January 1, 2021, and June 30, 2021. Included patients had received a primary diagnosis of PVD and presented with flashes and/or floaters. Optical coherence tomography scans were reviewed by two separate readers for the presence of PVOs. The primary outcome was the presence of retinal tear on fundus photograph and on examination. RESULTS Of 388 patients who presented with acute PVD symptoms, 90 (23.2%) were found to have a retinal tear on dilated fundus examination. Among these patients, 78 (86.7%) were found to have PVOs on optical coherence tomography. Statistical analysis demonstrated a significant relationship between the presence of PVOs and retinal tear ( P < 0.01). The sensitivity and specificity of this finding was 86.7% and 72.5%, respectively. Further analysis included area under the curve from receiver operating characteristic curve which was found to be 0.80. CONCLUSION The presence of PVOs on optical coherence tomography is suggestive of a retinal tear in patients with acute, symptomatic PVD.
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Affiliation(s)
- Aishwarya V Rao
- John P. and Kathrine G. McGovern Medical School, the University of Texas Health Science Center at Houston, Houston, TX; Retina Consultants of Texas, Retina Consultants of America, Houston, TX; and Blanton Eye Institute, Houston Methodist Hospital, Houston, TX
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14
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Tang YW, Ji J, Lin JW, Wang J, Wang Y, Liu Z, Hu Z, Yang JF, Ng TK, Zhang M, Pang CP, Cen LP. Automatic Detection of Peripheral Retinal Lesions From Ultrawide-Field Fundus Images Using Deep Learning. Asia Pac J Ophthalmol (Phila) 2023; 12:284-292. [PMID: 36912572 DOI: 10.1097/apo.0000000000000599] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/19/2022] [Indexed: 03/14/2023] Open
Abstract
PURPOSE To establish a multilabel-based deep learning (DL) algorithm for automatic detection and categorization of clinically significant peripheral retinal lesions using ultrawide-field fundus images. METHODS A total of 5958 ultrawide-field fundus images from 3740 patients were randomly split into a training set, validation set, and test set. A multilabel classifier was developed to detect rhegmatogenous retinal detachment, cystic retinal tuft, lattice degeneration, and retinal breaks. Referral decision was automatically generated based on the results of each disease class. t -distributed stochastic neighbor embedding heatmaps were used to visualize the features extracted by the neural networks. Gradient-weighted class activation mapping and guided backpropagation heatmaps were generated to investigate the image locations for decision-making by the DL models. The performance of the classifier(s) was evaluated by sensitivity, specificity, accuracy, F 1 score, area under receiver operating characteristic curve (AUROC) with 95% CI, and area under the precision-recall curve. RESULTS In the test set, all categories achieved a sensitivity of 0.836-0.918, a specificity of 0.858-0.989, an accuracy of 0.854-0.977, an F 1 score of 0.400-0.931, an AUROC of 0.9205-0.9882, and an area under the precision-recall curve of 0.6723-0.9745. The referral decisions achieved an AUROC of 0.9758 (95% CI= 0.9648-0.9869). The multilabel classifier had significantly better performance in cystic retinal tuft detection than the binary classifier (AUROC= 0.9781 vs 0.6112, P < 0.001). The model showed comparable performance with human experts. CONCLUSIONS This new DL model of a multilabel classifier is capable of automatic, accurate, and early detection of clinically significant peripheral retinal lesions with various sample sizes. It can be applied in peripheral retinal screening in clinics.
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Affiliation(s)
- Yi-Wen Tang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Jie Ji
- Network and Information Center, Shantou University, Shantou, Guangdong, China
| | - Jian-Wei Lin
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Ji Wang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Yun Wang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Zibo Liu
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Zhanchi Hu
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Jian-Feng Yang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Tsz Kin Ng
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
- Shantou University Medical College, Shantou, Guangdong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Mingzhi Zhang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Chi Pui Pang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Ling-Ping Cen
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
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15
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Vangipuram G, Li C, Li S, Liu L, Harrison LD, Lum F, Shah GK. Timing of Delayed Retinal Pathology in Patients Presenting with Acute Posterior Vitreous Detachment in the IRIS® Registry (Intelligent Research in Sight). Ophthalmol Retina 2023:S2468-6530(23)00154-9. [PMID: 37080486 DOI: 10.1016/j.oret.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE To determine the timing to delayed retinal pathology in eyes presenting with acute posterior vitreous detachment (PVD). DESIGN Retrospective database study. SUBJECTS Patients in the IRIS registry found to have acute posterior vitreous detachment based on International Classification of Diseases (ICD), Ninth and Tenth Revision, codes were followed. METHODS Patients coded to have a PVD from 2013 to 2018 along with CPT coding of extended ophthalmoscopy were included. Ocular baseline characteristics included visual acuity, lens status, presence or absence of vitreous hemorrhage, myopia, lattice degeneration and sub-specialty training of the treating physician. MAIN OUTCOME MEASURES Timing (days) to delayed retinal break or detachment RESULTS: A total of 434,046 eyes met inclusion/exclusion criteria and 10,518 eyes (2.42%) presented with a delayed retinal break or detachment after initial PVD. The median time to retinal break and detachment after initial PVD was 42 (range 1-365) days and 51 (range 1-365) days, respectively. Eyes with vitreous hemorrhage (HR: 9.30, 95% CI [8.50-10.2], history of RB/RD in the fellow eye (HR: 3.91, 95% CI [3.64-4.20]), lattice degeneration (HR: 2.61, 95% CI [2.35-2.90]), and myopia (HR: 1.42, 95% CI [1.33-1.53]) were found to be at a higher risk of developing delayed break or detachment. CONCLUSIONS Follow up examination after initial PVD is necessary to diagnose delayed or missed retinal pathology. In eyes with no initial pathology, providers should consider repeat examination at least once within six weeks, and within 1 month for eyes with higher risk features.
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Affiliation(s)
| | - Charles Li
- American Academy of Ophthalmology, San Francisco, California
| | - Siying Li
- American Academy of Ophthalmology, San Francisco, California
| | - Lynn Liu
- American Academy of Ophthalmology, San Francisco, California
| | | | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California
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Jindachomthong KK, Cabral H, Subramanian ML, Ness S, Siegel NH, Chhablani J, Hsu SX, Chen X. Incidence and Risk Factors for Delayed Retinal Tears after an Acute, Symptomatic Posterior Vitreous Detachment. Ophthalmol Retina 2023; 7:318-324. [PMID: 36307014 DOI: 10.1016/j.oret.2022.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 04/24/2023]
Abstract
PURPOSE To determine the long-term incidence of and risk factors for delayed retinal tears after acute, symptomatic posterior vitreous detachment (PVD) without concurrent retinal tears. DESIGN Retrospective, observational case series. SUBJECTS Patients diagnosed with an acute, symptomatic PVD without concurrent retinal tears at a tertiary eye center between 2013 and 2018. METHODS This is a retrospective, consecutive, and observational case series. Acute and symptomatic PVD was defined as experiencing flashes or floaters for 1 month or less at the time of diagnosis. Patients with a retinal tear or detachment at or before the time of diagnosis were not included. The occurrence and timing of subsequent retinal tears after initial PVD diagnosis were recorded. The age, sex, race, refractive error, lens status, lattice degeneration status, and type of physician (retina specialist vs. nonretina specialist) who saw the patient were also recorded. MAIN OUTCOME MEASURES Time to the development of a delayed retinal tear. RESULTS A total of 389 eyes from 389 patients had acute and symptomatic PVDs without concurrent retinal tears or detachments at diagnosis. Kaplan-Meier analysis showed that 7.39% of eyes developed delayed retinal tears by 6.24 years after initial PVD diagnosis. Of these tears, 50% occurred within 4.63 months of PVD diagnosis, and 63.46% occurred within 1 year of PVD diagnosis. Cox-Mantel log-rank analysis showed that those who were younger (age < 60 years), myopic, or had lattice degeneration were more likely to develop tears. A multivariate Cox proportional-hazards models controlling for other significant risk factors supported lattice degeneration as a likely risk factor for delayed retinal tear. CONCLUSIONS This study demonstrates that 7.39% of patients with acute, symptomatic PVD without concurrent retinal tears develop delayed retinal tears by 6.24 years after PVD diagnosis, with many developing tears well after a typical 6-week follow-up time for PVD. Lattice degeneration is a significant risk factor for delayed tears. These findings can guide clinicians in establishing optimal follow-up protocols for patients with acute, symptomatic PVD. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Manju L Subramanian
- Boston University School of Medicine, Boston, Massachusetts; Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
| | - Steven Ness
- Boston University School of Medicine, Boston, Massachusetts; Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
| | - Nicole H Siegel
- Boston University School of Medicine, Boston, Massachusetts; Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts
| | - Jay Chhablani
- Department of Ophthalmology, UPMC Eye Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Samuel X Hsu
- Boston University School of Medicine, Boston, Massachusetts
| | - Xuejing Chen
- Boston University School of Medicine, Boston, Massachusetts; Department of Ophthalmology, Boston Medical Center, Boston, Massachusetts.
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Wallsh JO, Langevin ST, Kumar A, Huz J, Falk NS, Bhatnagar P. Fellow-Eye Retinal Detachment Risk as Stratified by Hyaloid Status on OCT. Ophthalmology 2023; 130:624-630. [PMID: 36773761 DOI: 10.1016/j.ophtha.2023.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
PURPOSE To evaluate the risk of a rhegmatogenous retinal detachment (RRD) in the fellow eye using posterior hyaloid status as determined by OCT at the time of initial RRD. DESIGN Retrospective chart review. PARTICIPANTS Patients with a diagnosis of RRD. METHODS Posterior hyaloid status-presence or absence of a posterior vitreous detachment (PVD)-in both eyes at the time of initial RRD was determined by OCT imaging. Baseline characteristics, including lattice degeneration, refractive error, prior ocular laser procedures, lens status, and family history of RRD, were recorded. MAIN OUTCOME MEASURES The main outcome measures were the development of fellow-eye RRD and the time to fellow-eye RRD. In addition, OCT imaging was used in those fellow eyes with a visible posterior hyaloid to document whether a PVD developed during follow-up and time to such an event. RESULTS A total of 1049 patients with an RRD were followed up for an average of 5.7 ± 0.3 years. Overall, 153 patients (14.6%) received a diagnosis of bilateral sequential RRD during this follow-up period. OCT images were available for 582 fellow eyes; PVD was noted in 229 fellow eyes (39.3%), and an attached hyaloid was noted in 353 fellow eyes (60.7%). An RRD occurred in 7 fellow eyes (3.1%) with a PVD at presentation. Within the cohort of fellow eyes with an attached hyaloid, 28 eyes (7.9%) demonstrated an RRD during follow-up; however, when evaluating only those in which a PVD developed during follow-up, 23.7% of such eyes were found to have an RRD as well. At the time of PVD development in the fellow eye, an additional 21 eyes (17.8%) were noted to have a retinal tear that was treated without progression to RRD. CONCLUSIONS OCT imaging of the fellow eye at the time of presentation with an RRD offers a significant amount of information regarding risk stratification for RRD in this eye. Patients noted to have a completely detached posterior hyaloid are at a significantly lower risk of RRD than those with a visible posterior hyaloid, who need to be monitored closely at the time of PVD development. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Josh O Wallsh
- Retina Consultants PLLC, Slingerlands, New York; Albany Medical College, Department of Ophthalmology, Albany, New York
| | - Spencer T Langevin
- Retina Consultants PLLC, Slingerlands, New York; Albany Medical College, Department of Ophthalmology, Albany, New York
| | - Aman Kumar
- Albany Medical College, Department of Ophthalmology, Albany, New York
| | - Jonathan Huz
- Retina Consultants PLLC, Slingerlands, New York; Albany Medical College, Department of Ophthalmology, Albany, New York
| | - Naomi S Falk
- Retina Consultants PLLC, Slingerlands, New York; Albany Medical College, Department of Ophthalmology, Albany, New York
| | - Pawan Bhatnagar
- Retina Consultants PLLC, Slingerlands, New York; Albany Medical College, Department of Ophthalmology, Albany, New York.
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Bertram B, Feltgen N, Hattenbach LO, Helbig H, Hoerauf H, Kreutzer T, Lommatzsch A, Ostrowski A, Priglinger S, Wolf A. [Risk factors and prophylaxis of rhegmatogenous retinal detachment in adults : S1 guidelines of the German Society of Ophthalmology (DOG), the Retinological Society (RG) and the German Professional Association of Ophthalmologists (BVA). Version: 5 May 2022]. DIE OPHTHALMOLOGIE 2023; 120:38-43. [PMID: 36520163 DOI: 10.1007/s00347-022-01775-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 06/17/2023]
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19
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Shaimova VA, Kuchkildina SK, Islamova GR, Arslanov GM, Kravchenko TG, Askaeva AA. [Age-related changes in human vitreous]. Vestn Oftalmol 2023; 139:106-111. [PMID: 37379116 DOI: 10.17116/oftalma2023139031106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
There are two main age-related changes that can occur in the vitreous body of healthy individuals throughout life: liquefaction (synchesis) and aggregation of collagen fibrils into dense bundles (syneresis). Progressive age-related degradation leads to posterior vitreous detachment (PVD). At present many classifications of PVD exist, in which authors relied either on the morphological features, or on the differences in pathogenesis before and after widespread use of OCT. The course of PVD can be either normal or anomalous. Physiological PVD induced by age-related vitreous changes progresses in specific stages. The review emphasizes that PVD can occur initially not only in the central zone of the retina, but also on the periphery with further spread to the posterior pole. Anomalous PVD can lead to various negative effects on the retina, as well as on the vitreous as a result of traction in the area of vitreoretinal interface.
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Affiliation(s)
- V A Shaimova
- Academy of Postgraduate Education of the Federal Scientific and Clinical Center of Specialized Types of Medical Care and Medical Technologies, Moscow, Russia
- OOO Center Zreniya, Chelyabinsk, Russia
| | | | | | - G M Arslanov
- Eye Microsurgery Clinic Schastliviy Vzglyad, Saint Petersburg, Russia
| | - T G Kravchenko
- Multiprofile Center for Laser Medicine, Chelyabinsk, Russia
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20
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Taevere MR, Kryl LA, Doga AV. [Horseshoe retinal tear: factors that determine the risk of developing rhegmatogenous retinal detachment]. Vestn Oftalmol 2023; 139:20-25. [PMID: 37638568 DOI: 10.17116/oftalma202313904120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Horseshoe (flap) retinal tears are the leading cause of rhegmatogenous retinal detachment (RRD). Identification of the most significant predictors of RRD in patients with a horseshoe tear will enable the development of an optimal treatment strategy. PURPOSE This study aimed to determine the main risk factors for RRD development based on the analysis of the condition of vitreoretinal interface in the area of horseshoe tears, both isolated and those that resulted in retinal detachment. MATERIAL AND METHODS A total of 88 patients with horseshoe retinal tears (43 patients with RRD due to the horseshoe tear and 45 with isolated horseshoe tears) were included in the study. All patients underwent wide-field multispectral laser scanning and optical coherence tomography to determine the shape of the horseshoe tear and the extent of vitreoretinal adhesion (VRA). Cluster analysis was used to differentiate horseshoe tears by shape. Spearman's correlation analysis was used to identify the relationship between the shape of the horseshoe tear and localization of VRA. RESULTS Spearman's correlation analysis revealed a strong negative correlation between the length-to-width ratio of the horseshoe tear and the extent of VRA. Cluster analysis helped determine four shapes of horseshoe tears, each corresponding to a certain localization of VRA. Analysis of RRD risk, depending on the characteristics of the horseshoe tear, showed that the most significant risk factor for the development of RRD is the presence of a horseshoe tear with width greater than its length, which is characterized by a larger VRA area. CONCLUSION The study established that the larger the horseshoe tear width and the smaller its length, the larger the VRA area and, consequently, the higher the risk of RRD development. Horseshoe retinal tears with a length-to-width ratio of less than 1/1 are the most dangerous in terms of RRD risk, which is important to consider when selecting the treatment tactics.
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Affiliation(s)
- M R Taevere
- S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Moscow, Russia
- Hadassah Medical Moscow - Skolkovo Innovation Center, Moscow, Russia
| | - L A Kryl
- S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Moscow, Russia
| | - A V Doga
- S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Moscow, Russia
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Automated Detection of Posterior Vitreous Detachment on OCT Using Computer Vision and Deep Learning Algorithms. OPHTHALMOLOGY SCIENCE 2022; 3:100254. [PMID: 36691594 PMCID: PMC9860346 DOI: 10.1016/j.xops.2022.100254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
Objective To develop automated algorithms for the detection of posterior vitreous detachment (PVD) using OCT imaging. Design Evaluation of a diagnostic test or technology. Subjects Overall, 42 385 consecutive OCT images (865 volumetric OCT scans) obtained with Heidelberg Spectralis from 865 eyes from 464 patients at an academic retina clinic between October 2020 and December 2021 were retrospectively reviewed. Methods We developed a customized computer vision algorithm based on image filtering and edge detection to detect the posterior vitreous cortex for the determination of PVD status. A second deep learning (DL) image classification model based on convolutional neural networks and ResNet-50 architecture was also trained to identify PVD status from OCT images. The training dataset consisted of 674 OCT volume scans (33 026 OCT images), while the validation testing set consisted of 73 OCT volume scans (3577 OCT images). Overall, 118 OCT volume scans (5782 OCT images) were used as a separate external testing dataset. Main Outcome Measures Accuracy, sensitivity, specificity, F1-scores, and area under the receiver operator characteristic curves (AUROCs) were measured to assess the performance of the automated algorithms. Results Both the customized computer vision algorithm and DL model results were largely in agreement with the PVD status labeled by trained graders. The DL approach achieved an accuracy of 90.7% and an F1-score of 0.932 with a sensitivity of 100% and a specificity of 74.5% for PVD detection from an OCT volume scan. The AUROC was 89% at the image level and 96% at the volume level for the DL model. The customized computer vision algorithm attained an accuracy of 89.5% and an F1-score of 0.912 with a sensitivity of 91.9% and a specificity of 86.1% on the same task. Conclusions Both the computer vision algorithm and the DL model applied on OCT imaging enabled reliable detection of PVD status, demonstrating the potential for OCT-based automated PVD status classification to assist with vitreoretinal surgical planning. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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22
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Karasu B, Kesim E, Kaskal M, Celebi ARC. Efficacy of topical dexamethasone eye drops in preventing ocular inflammation and cystoid macular edema following uncomplicated cataract surgery with or without injection of a single dose perioperative subtenon triamcinolone acetonide. Cutan Ocul Toxicol 2022; 41:310-317. [DOI: 10.1080/15569527.2022.2136193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Buğra Karasu
- Department of Ophthalmology, Tuzla State Hospital, Istanbul, Turkey
| | - Enes Kesim
- Department of Ophthalmology, Tuzla State Hospital, Istanbul, Turkey
| | - Mert Kaskal
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ali Rıza Cenk Celebi
- School of Medicine, Department of Ophthalmology, Acibadem University, Istanbul, Turkey
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23
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Li H, Chen L, Wu M, Zheng B. Spectral-domain optical coherence tomography characteristics of cystic retinal tuft. BMC Ophthalmol 2022; 22:412. [PMID: 36307802 PMCID: PMC9615242 DOI: 10.1186/s12886-022-02636-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/10/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Objective
To investigate the characteristics of cystic retinal tufts (CRTs) with 55° widefield spectral-domain optical coherence tomography.
Methods
This was a retrospective study. All subjects underwent a complete ocular examination, ultra-widefield (UWF) pseudocolor fundus photography and Spectral domain optical coherence tomography (SD-OCT) with a 55° widefield lens. The SD-OCT characteristics were analyzed in subjects with CRT.
Results
Twenty-six eyes of 25 subjects were scanned and 29 CRTs were analyzed for SD-OCT characteristics. On SD-OCT images, the CRTs exhibited hyperreflective irregular elevated lesions with internal hyporeflective cystoid cavities. Normal layers of the neuroepithelium could not be distinguished. The mean diameter of CRTs was 1022 microns (range, 117–3711 microns; standard deviation, 815 microns). There was vitreoretinal traction at the apex of CRTs. Among them, retinal tears in 24.14% (7/29), suspected retinal tears in 27.59% (8/29), and shallow neuroepithelium detachment in 31.03% (9/29).
Conclusions
The widefield SD-OCT imaging can provide detailed cross-sectional anatomic information of CRT and may guide clinical treatment.
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24
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Shen BY, Salman AR, Shah SM, Hassan MB, Alniemi S, Goyal DG, Barkmeier AJ. Clinical Outcomes Following Implementation of a Formalized "Flashes and Floaters" Emergency Department Triage Protocol. Am J Ophthalmol 2022; 242:125-130. [PMID: 35750217 DOI: 10.1016/j.ajo.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/31/2022] [Accepted: 06/09/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To report outcomes of patients presenting to the emergency department (ED) with new-onset visual flashes and/or floaters following implementation of a formalized triage protocol allowing eligible patients to be discharged for prompt outpatient ophthalmic examination. DESIGN Retrospective consecutive case series. METHODS Patient characteristics, protocol eligibility, and clinical outcomes were recorded for adult patients triaged within a formal "flashes and floaters" protocol at a single academic emergency department. RESULTS 457 patients presented for 471 unique ED encounters with a chief complaint of visual flashes and/or floaters between October 2014 and May 2018. 61% of patient encounters (287/471) met protocol criteria for prompt outpatient ophthalmic examination, of whom 94% (269/287) were examined within 48 hours. Final diagnoses of protocol-eligible patients were posterior vitreous detachment only (73%, 197/269), retinal break(s) (10%, 26/269), migraine (5%, 14/269), and no cause or new cause found (10%, 27/269). No protocol-eligible patients had retinal detachment or diagnoses requiring emergent diagnostic or therapeutic care (0%, 95% confidence interval 0-1.1%). Final diagnoses following 175 encounters not meeting criteria for deferred examination included posterior vitreous detachment only (25%, 43/175), retinal break(s) (19%, 33/175), macula-involving retinal detachment (13%, 22/175), macula-sparing retinal detachment (11%, 19/175), retinal arterial occlusion (2%, 3/175), and stroke (0.6%, 1/175). Cohen's kappa for agreement on protocol eligibility between the ED physician and ophthalmologist was 0.85. CONCLUSIONS A formalized emergency department "flashes and floaters" triage protocol may help identify patients for whom prompt outpatient ophthalmic examination may be more safely considered.
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Affiliation(s)
- Bailey Y Shen
- Mayo Clinic Department of Ophthalmology, 200 First Street SW, Rochester, MN 55905; Loma Linda University Eye Institute, 11370 Anderson Street, Suite 1800, Loma Linda, CA 92354
| | - Ali R Salman
- Mayo Clinic Department of Ophthalmology, 200 First Street SW, Rochester, MN 55905
| | - Saumya M Shah
- Mayo Clinic Department of Ophthalmology, 200 First Street SW, Rochester, MN 55905
| | - Mohamed B Hassan
- Mayo Clinic Department of Ophthalmology, 200 First Street SW, Rochester, MN 55905; Physicians Eye Clinic, 2101 Westown Parkway, West Des Moines, IA 50265
| | - Saba Alniemi
- Mayo Clinic Department of Ophthalmology, 200 First Street SW, Rochester, MN 55905; Carle Foundation Hospital, 611 W Park Street, Urbana, IL 61801
| | - Deepi G Goyal
- Mayo Clinic Department of Emergency Medicine, 200 First Street SW, Rochester, MN 55902
| | - Andrew J Barkmeier
- Mayo Clinic Department of Ophthalmology, 200 First Street SW, Rochester, MN 55905.
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25
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Packer M. Evaluation of the EVO/EVO+ Sphere and Toric Visian ICL: Six Month Results from the United States Food and Drug Administration Clinical Trial. Clin Ophthalmol 2022; 16:1541-1553. [PMID: 35645557 PMCID: PMC9132105 DOI: 10.2147/opth.s369467] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/13/2022] [Indexed: 12/29/2022] Open
Abstract
Purpose To evaluate the safety and effectiveness of Collamer posterior chamber phakic refractive lenses with a central port design (EVO and EVO+ Sphere and Toric Visian ICLs) for correction of moderate-to-high myopia with or without astigmatism. Patients and Methods Six-month results of a multicenter clinical trial performed under United States FDA Investigational Device Exemption. Subjects 21 through 45 years of age with myopia ranging from -3.00 D to -20.00 D and astigmatism up to 4.00 D underwent implantation of EVO or EVO+ Sphere or Toric Visian ICLs. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction, intraocular pressure (IOP), endothelial cell density, and adverse events were evaluated over 6 months. Results This clinical trial enrolled 629 eyes of 327 subjects with mean age 35.6 ± 5.09 years. Mean preoperative spherical equivalent (SE) measured -7.62 ± 2.75 D (range: -3.00 to -15.62 D). At 6 months, mean SE was -0.079 ± 0.33 D, with 90.5% within ± 0.50 D of target and 98.9% within ±1.00 D of target. Mean postoperative UDVA and CDVA were -0.059 ± 0.10 logMAR and -0.13 ± 0.08 logMAR, respectively. 52.3% of eyes gained lines of CDVA. Efficacy and safety indices were 1.06 and 1.24, respectively. No eye experienced pupillary block, required peripheral iridotomy or iridectomy, developed anterior subcapsular cataract or had elevated IOP due to angle narrowing or pigment dispersion. Mean endothelial cell density declined by 2.3%. Conclusion EVO ICL lenses demonstrated accuracy of refractive correction and achievement of high levels of UDVA. This clinical trial confirmed that the central port design of EVO and EVO+ Sphere and Toric Visian ICL lenses functions effectively to allow physiologic flow of aqueous humor, thus eliminating the requirement for preoperative peripheral iridotomies. The results of this clinical trial resulted in FDA approval on March 25, 2022.
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Affiliation(s)
- Mark Packer
- Packer Research Associates, Boulder, CO, USA
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26
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Driban M, Chhablani J. Clinical findings in acute posterior vitreous detachment. Graefes Arch Clin Exp Ophthalmol 2022; 260:3465-3469. [PMID: 35622141 DOI: 10.1007/s00417-022-05708-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/13/2022] [Accepted: 05/06/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To analyze the typical presentation of acute posterior vitreous detachment (PVD), including demographics and prevalence of various treatable findings in the same and fellow eye. METHODS Retrospective analysis of medical records from 2346 patients with acute PVD. Descriptive statistics were generated on age, sex, contact date, visual acuity, and slit lamp, and fundoscopy findings. Multivariate regressions were used to generate odds ratios with 95% confidence intervals (CI) to quantify associations between variables. RESULTS A total of 4692 eyes from 2346 patients were analyzed. Most patients were female (60.5%) with an average age of 62.8 years old. Overall, 605 patients (25.8%) had any additional ocular finding on fundus exam, including pigmentation (N = 184, 7.8%), lattice degeneration (N = 158, 6.7%), tear (N = 131, 5.6%), and hole (N = 131, 5.2%). Unilateral retinal detachment was present in 26 patients (1.1%), and these patients demonstrated a similar rate (26.9%) of additional ocular findings compared to the entire sample size. Female sex (OR 1.21, 95% CI 1.03-1.43, p = 0.020) was independently associated with presentation during spring or summer. CONCLUSION Acute PVD is associated with a number of risk factors and peripheral lesions. These findings may be useful in treating and predicting the course and development of PVD.
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Affiliation(s)
- Matthew Driban
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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27
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Cheung R, Ly A, Katalinic P, Coroneo MT, Chang A, Kalloniatis M, Madigan MC, Nivison-Smith L. Visualisation of peripheral retinal degenerations and anomalies with ocular imaging. Semin Ophthalmol 2022; 37:554-582. [DOI: 10.1080/08820538.2022.2039222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Rene Cheung
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Angelica Ly
- Centre for Eye Health, University of New South Wales, Sydney, Australia
| | - Paula Katalinic
- Centre for Eye Health, University of New South Wales, Sydney, Australia
| | - Minas Theodore Coroneo
- Department of Ophthalmology, Prince of Wales Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, Australia
| | - Andrew Chang
- Sydney Institute of Vision Science, Sydney, Australia
- Save Sight Institute, The University of Sydney, Sydney, Australia
| | - Michael Kalloniatis
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
- Centre for Eye Health, University of New South Wales, Sydney, Australia
| | - Michele C. Madigan
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
- Save Sight Institute, The University of Sydney, Sydney, Australia
| | - Lisa Nivison-Smith
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
- Centre for Eye Health, University of New South Wales, Sydney, Australia
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28
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Patel SN, Lee C, Cui D, Wingert AM, Zhou S, Scott IU. Association of staffing with Incidence of delayed retinal break or detachment after posterior vitreous detachment in a resident urgent care clinic. Graefes Arch Clin Exp Ophthalmol 2021; 260:791-798. [PMID: 34661735 DOI: 10.1007/s00417-021-05437-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/26/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To compare the incidence rate of delayed retinal break or detachment after diagnosis of acute, symptomatic posterior vitreous detachment (PVD) in a resident-run urgent care clinic (UCC) when staffed by a retina attending, non-retina ophthalmology attending, optometrist, or ophthalmology resident only. METHODS Retrospective consecutive case series. Of the 594 patients with acute, symptomatic PVD evaluated in the UCC at Penn State Eye Center between 1/1/2016 and 10/10/2019, 454 were included in the study; 140 were excluded because they were diagnosed with a retinal break or detachment on presentation to the UCC, had media opacity precluding examination, or had no follow-up within one year. Demographics, presenting examination findings, and type of staffing were recorded; subsequent visits up to 1 year were analyzed for presence of delayed retinal break or detachment. RESULTS Among 491 eyes of 454 patients with a mean follow-up of 147 days, ten delayed breaks (10/491, 2.0%) and three delayed detachments (3/491, 0.6%) were discovered. Incidence rates of delayed breaks and detachments were 1.8% (5/282) and 0.7% (2/282), respectively, in the retina attending group, 1.0% (1/105) and 1.0% (1/105) in the non-retina ophthalmology attending group, 4.7% (3/64) and 0% (0/64) in the optometrist group, and 2.5% (1/40) and 0% (0/40) in the ophthalmology resident only group. There was no statistically significant difference in the incidence of delayed break or detachment among the staffing groups (P = 0.7312), but this study was underpowered to detect a statistically significant difference among staffing groups. Patients with a delayed break or detachment were more likely to have lattice degeneration (P = 0.0265) or a history of retinal break in the contralateral eye (P = 0.0014), and most eyes (10 [76.9%]) with a delayed break or detachment were left eyes (P = 0.0466). CONCLUSIONS The overall rate of delayed retinal break or detachment in the current study is similar to previously published rates among retinal physician and retinal fellow examiners. Although no statistically significant difference among staffing groups in the incidence rates of delayed retinal tears or detachments was identified in the study, it is important to note that the optometry and ophthalmology resident only groups had higher incidence rates of delayed retinal breaks than did the retina and non-retina ophthalmology attending groups, and this may be clinically important. Larger cohort studies would be needed in order to have the power to detect statistically significant differences among staffing groups. Varied staffing for acute, symptomatic PVD may assist with resource allocation in similar settings.
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Affiliation(s)
- Saagar N Patel
- Department of Ophthalmology, Penn State College of Medicine, 500 University Drive, HU19, Hershey, PA, 17033-0850, USA
| | - Charles Lee
- Penn State College of Medicine, Hershey, PA, USA
| | - David Cui
- Penn State College of Medicine, Hershey, PA, USA
| | | | - Shouhao Zhou
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Ingrid U Scott
- Department of Ophthalmology, Penn State College of Medicine, 500 University Drive, HU19, Hershey, PA, 17033-0850, USA. .,Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
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Vangipuram G, Zhu A, Dang S, Blinder KJ, Shah GK. Vitrectomy vs. Combined Vitrectomy and Scleral Buckle for Repair of Primary Rhegmatogenous Retinal Detachment with Vitreous Hemorrhage. Ophthalmol Retina 2021; 6:228-233. [PMID: 34628067 DOI: 10.1016/j.oret.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/01/2021] [Accepted: 10/01/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare pars plana vitrectomy (PPV) to PPV with scleral buckle (PPV/SB) for repair of primary rhegmatogenous retinal detachment (RRD) with associated vitreous hemorrhage (VH). DESIGN Retrospective, observational study. SUBJECTS Patients with RRD and associated VH who underwent PPV or PPV/SB from January 1, 2010 through August 31, 2020 were analyzed. METHODS, INTERVENTION, OR TESTING We performed a single-institution, retrospective, observational study of 224 eyes with RRD and VH at the time of detachment. We excluded eyes with less than 6 months of follow up, prior history of retinal detachment repair with vitrectomy or scleral buckle, VH that resolved before surgical intervention, tractional or combined tractional and rhegmatogenous detachment. MAIN OUTCOME MEASURES Single surgery anatomic success (SSAS) at 6 months, defined as no recurrent retinal detachment requiring surgical intervention. RESULTS PPV and PPV/SB were performed on 138 eyes (62%) and 85 eyes (38%), respectively. The mean age was 61.9 years in PPV patients and 60.2 years in PPV/SB patients. Single-surgery anatomic success was achieved in 107 of 138 (77.5%) eyes that underwent PPV and in 78 of 85 (91.7%) eyes that underwent PPV/SB. The difference in SSAS between types of treatment was significant (p = 0.006). Mean visual acuity improvement in the PPV/SB group was 0.54 logMAR units greater than the PPV group (p = 0.126). The incidence of postoperative PVR in the PPV/SB group (11.7%) was lower than in the PPV group (19.5%) (p = 0.128). The rate of repeat PPV for non-RD reasons was similar for both groups (p = 0.437). Final reattachment status was achieved in 137 of 138 and 84 of 85 eyes in the PPV and PPV/SB groups, respectively. Final visual acuity improvement was significantly better in eyes with PPV/SB compared to PPV alone (logMAR 2.12 vs 1.26; p=0.011). CONCLUSIONS In RRD with VH patients, SSAS was superior in patients treated with PPV/SB compared with PPV alone. Although not significantly different, the PPV/SB group had better visual outcomes and a lower postoperative PVR rate.
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Affiliation(s)
| | - Alan Zhu
- Washington University, St. Louis, MO
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30
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Abstract
Retinal detachments are a potentially sight-threatening ophthalmic emergency that may result in significant, irreversible vision loss. The risk of developing retinal detachment increases with advancing age, myopia and trauma. Pre-existing retinal degenerations can precipitate a pre-detachment symptomatic period of photopsia or floaters, allowing clinicians to intervene early and prevent detachments. Novel imaging techniques, such as spectral-domain optical coherence tomography, and well-established topographic modalities, such as B scan, can help to elucidate the type of detachment and any underlying causes, and help with surgical management. The overarching goal of treatment is to identify and seal all retinal holes, relieve vitreoretinal traction and prevent further recurrence. Prompt prophylactic retinopexy of retinal holes and tears is crucial in preventing retinal detachment, the main treatments of which are pars plana vitrectomy, tamponading agents and silicone scleral buckle.
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Affiliation(s)
- Ahmed Ibrar
- Ophthalmology Department, Great Western Hospital, Swindon, UK
| | - Maghsoudlou Panayiotis
- Ophthalmology Department, Great Western Hospital, Swindon, UK.,Department of Stem Cells and Regenerative Medicine, University College London, London, UK
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Ramovecchi P, Salati C, Zeppieri M. Spontaneous posterior vitreous detachment: A glance at the current literature. World J Exp Med 2021; 11:30-36. [PMID: 34141604 PMCID: PMC8188834 DOI: 10.5493/wjem.v11.i3.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/14/2021] [Accepted: 05/21/2021] [Indexed: 02/06/2023] Open
Abstract
Spontaneous posterior vitreous detachment (PVD) is a common age-related condition in which prevalence tends to increase with age. Acute PVD can cause the onset of symptoms that include visual disturbances, myodesopsia and photopsia. The goal of this short review was to provide a quick glance at the important factors related to PVD based on current literature in this field, which includes incidence, symptoms, diagnosis, risk factors, and education for patients with acute symptoms, and treatments. The take home message is that an ophthalmic examination at the onset of symptoms is of utmost importance, considering that irreversible sight-threatening complications can be prevented if diagnosed and treated promptly.
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Affiliation(s)
- Paola Ramovecchi
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
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32
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Bradford CA, Melson AT. Ocular Complaints, Disease, and Emergencies in the General Medical Setting. Med Clin North Am 2021; 105:409-423. [PMID: 33926638 DOI: 10.1016/j.mcna.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Primary care physicians see nearly half of all clinical visits, and 2% to 3% of those are for eye complaints. Taking a good ocular history is essential to establishing the diagnosis. Patient complaints fall into several categories including visual change, redness, and pain. Primary care physicians can screen for patients at risk of vision loss from glaucoma, diabetes, and toxic medication and ensure that patients have appropriate eye evaluations. Examination techniques such as direct ophthalmoscopy, evaluation of the red reflex, eversion of the upper lid, checking pupillary response, and using fluorescein to stain the cornea are helpful in evaluating patients' ocular complaints.
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Affiliation(s)
- Cynthia A Bradford
- Department of Ophthalmology, University of Oklahoma, College of Medicine, Dean A. McGee Eye Institute, 608 Stanton L. Young Boulevard, Oklahoma City, OK 73104, USA.
| | - Andrew T Melson
- Department of Ophthalmology, University of Oklahoma, College of Medicine, Dean A. McGee Eye Institute, 608 Stanton L. Young Boulevard, Oklahoma City, OK 73104, USA
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Development of a deep-learning system for detection of lattice degeneration, retinal breaks, and retinal detachment in tessellated eyes using ultra-wide-field fundus images: a pilot study. Graefes Arch Clin Exp Ophthalmol 2021; 259:2225-2234. [PMID: 33538890 DOI: 10.1007/s00417-021-05105-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 01/10/2021] [Accepted: 01/26/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To investigate the detection of lattice degeneration, retinal breaks, and retinal detachment in tessellated eyes using ultra-wide-field fundus imaging system (Optos) with convolutional neural network technology. METHODS This study included 1500 Optos color images for tessellated fundus confirmation and peripheral retinal lesion (lattice degeneration, retinal breaks, and retinal detachment) assessment. Three retinal specialists evaluated all images and proposed the reference standard when an agreement was achieved. Then, 722 images were used to train and verify a combined deep-learning system of 3 optimal binary classification models trained using seResNext50 algorithm with 2 preprocessing methods (original resizing and cropping), and a test set of 189 images were applied to verify the performance compared to the reference standard. RESULTS With optimal preprocessing approach (original resizing method for lattice degeneration and retinal detachment, cropping method for retinal breaks), the combined deep-learning system exhibited an area under curve of 0.888, 0.953, and 1.000 for detection of lattice degeneration, retinal breaks, and retinal detachment respectively in tessellated eyes. The referral accuracy of this system was 79.8% compared to the reference standard. CONCLUSION A deep-learning system is feasible to detect lattice degeneration, retinal breaks, and retinal detachment in tessellated eyes using ultra-wide-field images. And this system may be considered for screening and telemedicine.
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Deng X, Tanumiharjo S, Chen Q, Li S, Lin H, He Y, Jiang J, Zhang J. Myopic retinal changes screening: comparison of sensitivity and specificity among 15 combinations of ultrawide field scanning laser ophthalmoscopy images. Ophthalmic Res 2021; 64:1029-1036. [PMID: 33401267 DOI: 10.1159/000514176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 01/02/2021] [Indexed: 11/19/2022]
Abstract
AIMS To investigate the evaluation indices (diagnostic test accuracy and agreement) of 15 combinations of ultrawide field scanning laser ophthalmoscopy (UWF SLO) images in myopic retinal changes (MRC) screening to determine the combination of imaging that yields the highest evaluation indices in screening MRC. METHODS This is a retrospective study of UWF SLO images obtained from myopes and were analyzed by two retinal specialists independently. 5-field UWF SLO images that included the posterior (B), superior (S), inferior (I), nasal (N) and temporal (T) regions were obtained for analysis and its results used as a reference standard. The evaluation indices of different combinations comprising of one to four fields of the retina were compared to determine the abilities of each combinations screen for MRC. RESULTS UWF SLO images obtained from 823 myopic patients (1646 eyes) were included for the study. Sensitivities ranged from 50.0% to 98.9% (95% confidence interval (CI), 43.8-99.7%); the combinations of B+S+I (97.3%; 95% CI, 94.4-98.8%), B+T+S+I (98.5%; 95% CI, 95.9-99.5%), and B+S+N+I (98.9%; 95% CI, 96.4-99.7%) ranked highest. Furthermore, the combinations of B+S+I, B+T+S+I and B+S+N+I also revealed the highest accuracy (97.7%; 95% CI, 95.1-100.0%, 98.6%; 95% CI, 96.7-100.0%, 98.8%; 95% CI, 96.9-100.0%) and agreement (Kappa = 0.968, 0.980 and 0.980). For the various combinations, specificities were all higher than 99.5% (95% CI, 99.3-100.0%). CONCLUSION In our study, screening combinations of B+S+I, B+T+S+I and B+S+N+I stand out with high-performing optimal evaluation indices. However, when time is limited, B+S+I may be more applicable in primary screening of MRC.
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Affiliation(s)
- Xuan Deng
- Aier School of Ophthalmology, Central South University, Changsha, China
| | - Silvia Tanumiharjo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | | | - Shengnan Li
- Aier School of Ophthalmology, Central South University, Changsha, China
| | - Huimin Lin
- Guangzhou Aier Eye Hospital, Guangzhou, China
| | - Yanqiong He
- Guangzhou Aier Eye Hospital, Guangzhou, China
| | - Junyi Jiang
- Aier Eye Institute, Aier Eye Hospital Group, Changsha, China
| | - Jinglin Zhang
- Aier School of Ophthalmology, Central South University, Changsha, China
- Guangzhou Aier Eye Hospital, Guangzhou, China
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Jarocki A, Durrani A, Zhou Y, Miller JML. On-Call Examinations for Acute Onset of Flashes, Floaters, or Curtain by Junior Ophthalmology Residents: Outcomes, Safety, and Resource Use. Ophthalmol Retina 2020; 5:330-336. [PMID: 32795660 DOI: 10.1016/j.oret.2020.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine whether an on-call system serviced by junior residents can safely triage patients with symptoms concerning for posterior vitreous detachment, retinal tear, and retinal detachment. DESIGN Quality improvement study structured as a prospective cohort study. PARTICIPANTS All symptomatic patients seen in 2017 by an on-call junior resident were followed up (257 patients). Those with follow-up within 6 months of initial presentation (228 patients, 246 unique encounters) were included. METHODS We prospectively tracked all symptomatic patients seen on-call by a junior resident in 2017 at a major academic medical center. MAIN OUTCOME MEASURES Incidence and predictors of true retinal tears or detachments, false-positive tears or detachments, false-negative tears or detachments, and resource use. RESULTS Of 246 symptomatic encounters, 83 (33.7%) had a perceived retinal tear or detachment. Residents used B-scan ultrasonography in a high number of encounters (41.0%). Ten (4.1%) false-positive tears or detachments were identified, with the presence of intraretinal hemmorhage predicting a false-positive examination (adjusted odds ratio, 3.86; 95% confidence interval, 1.1-13.5). Thirteen (5.3%) false-negative tears and no false-negative detachments were identified. Eleven (84.6%) false-negative tears underwent follow-up within days based on high-risk characteristics, and no false-negative tears progressed to detachment at follow-up. Measures of resource use included an in-person confirmation of examination findings by the senior resident or fellow in 59 encounters (24.0%) and shorter follow-up times to a retina rather than a nonretina clinic for 52 of 151 patients who showed no pathologic features on initial examination. CONCLUSIONS Junior residents can safely provide on-call triage of patients with symptoms concerning for a posterior vitreous detachment, retinal tear, or retinal detachment. The system requires moderate resource use, including occasional confirmatory examinations by a second physician and shorter follow-up times to retina clinic for high-risk patients.
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Affiliation(s)
| | - Asad Durrani
- Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - Yunshu Zhou
- Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | - Jason M L Miller
- Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan.
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