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Jo JJ, Pasquale LR. Recent developments of telemedicine in glaucoma. Curr Opin Ophthalmol 2024; 35:116-123. [PMID: 38295153 DOI: 10.1097/icu.0000000000001019] [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: 02/02/2024]
Abstract
PURPOSE OF REVIEW Telemedicine has an increasingly significant role in the fields of ophthalmology and glaucoma. This review covers recent advancements in the development and optimization of teleglaucoma techniques and applications. RECENT FINDINGS Glaucoma monitoring and diagnosis via remote tonometry, perimetry, and fundus imaging have become a possibility based on recent developments. Many applications work in combination with smart devices, virtual reality, and artificial intelligence and have been tested in patient populations against conventional "reference-standard" measurement tools, demonstrating promising results. Of note, there is still much progress to be made in teleglaucoma and telemedicine at large, such as accessibility to internet, broadband, and smart devices, application affordability, and reimbursement for remote services. However, continued development and optimization of these applications suggest that the implementation of remote monitoring will be a mainstay for glaucoma patient care. SUMMARY Especially since the beginning of the COVID-19 pandemic, remote patient care has taken on an important role in medicine and ophthalmology. Remote versions of tonometry, perimetry, and fundus imaging may allow for a more patient-centered and accessible future for glaucoma care.
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Affiliation(s)
- Jason J Jo
- Department of Medical Education
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Louis R Pasquale
- Department of Medical Education
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Mastropasqua L, Agnifili L, Brescia L, Figus M, Posarelli C, Oddone F, Giammaria S, Sacchi M, Pavan M, Innocenti DD, Olivotto V, Sensi SL, Mastropasqua R. A deep learning approach to investigate the filtration bleb functionality after glaucoma surgery: a preliminary study. Graefes Arch Clin Exp Ophthalmol 2024; 262:149-160. [PMID: 37530849 PMCID: PMC10805808 DOI: 10.1007/s00417-023-06170-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/30/2023] [Accepted: 07/10/2023] [Indexed: 08/03/2023] Open
Abstract
PURPOSE To distinguish functioning from failed filtration blebs (FBs) implementing a deep learning (DL) model on slit-lamp images. METHODS Retrospective, cross-sectional, multicenter study for development and validation of an artificial intelligence classification algorithm. The dataset consisted of 119 post-trabeculectomy FB images of whom we were aware of the surgical outcome. The ground truth labels were annotated and images splitted into three outcome classes: complete (C) or qualified success (Q), and failure (F). Images were prepared implementing various data cleaning and data transformations techniques. A set of DL models were trained using different ResNet architectures as the backbone. Transfer and ensemble learning were then applied to obtain a final combined model. Accuracy, sensitivity, specificity, area under the ROC curve, and area under the precision-recall curve were calculated to evaluate the final model. Kappa coefficient and P value on the accuracy measure were used to prove the statistical significance level. RESULTS The DL approach reached good results in unraveling FB functionality. Overall, the model accuracy reached a score of 74%, with a sensitivity of 74% and a specificity of 87%. The area under the ROC curve was 0.8, whereas the area under the precision-recall curve was 0.74. The P value was equal to 0.00307, and the Kappa coefficient was 0.58. CONCLUSIONS All considered metrics supported that the final DL model was able to discriminate functioning from failed FBs, with good accuracy. This approach could support clinicians in the patients' management after glaucoma surgery in absence of adjunctive clinical data.
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Affiliation(s)
- Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Ageing Science, University "G. D'Annunzio" of Chieti-Pescara, Via Dei Vestini Snc, 66100, Chieti, Italy
| | - Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Ageing Science, University "G. D'Annunzio" of Chieti-Pescara, Via Dei Vestini Snc, 66100, Chieti, Italy.
| | - Lorenza Brescia
- Ophthalmology Clinic, Department of Medicine and Ageing Science, University "G. D'Annunzio" of Chieti-Pescara, Via Dei Vestini Snc, 66100, Chieti, Italy
| | - Michele Figus
- Ophthalmology Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Chiara Posarelli
- Ophthalmology Unit, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | | | - Sara Giammaria
- IRCCS Fondazione Bietti, Via Livenza, 3, 00198, Rome, Italy
| | - Matteo Sacchi
- University Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy
| | - Marco Pavan
- Datamantix S.R.L. Artificial Intelligence Company, Via Paolo Sarpi, 14/15, 33100, Udine, Italy
| | - Dante Degli Innocenti
- Datamantix S.R.L. Artificial Intelligence Company, Via Paolo Sarpi, 14/15, 33100, Udine, Italy
| | - Valentina Olivotto
- Datamantix S.R.L. Artificial Intelligence Company, Via Paolo Sarpi, 14/15, 33100, Udine, Italy
| | - Stefano L Sensi
- Department of Neuroscience, Imaging and Clinical Sciences (DNISC), "G. d'Annunzio" University of Chieti-Pescara, Via Dei Vestini 31, 66100, Chieti, Italy
| | - Rodolfo Mastropasqua
- Department of Neuroscience, Imaging and Clinical Sciences (DNISC), "G. d'Annunzio" University of Chieti-Pescara, Via Dei Vestini 31, 66100, Chieti, Italy
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McLaughlin DE, Savatovsky EJ, O’Brien RC, Vanner EA, Munshi HK, Pham AH, Grajewski AL. Reliability of Visual Field Testing in a Telehealth Setting Using a Head-Mounted Device: A Pilot Study. J Glaucoma 2024; 33:15-23. [PMID: 37647317 PMCID: PMC10713003 DOI: 10.1097/ijg.0000000000002290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 07/16/2023] [Indexed: 09/01/2023]
Abstract
PRCIS Monitoring visual fields (VFs) through virtual reality devices proved to have good inter-test and test-retest reliability, as well as easy usability, when self-administered by individuals with and without VF defects in a remote setting. PURPOSE To assess the reliability of remote, self-administered VF monitoring using a virtual reality VF (VRVF) device in individuals without ocular disease and with stable VF defects. MATERIALS AND METHODS Individuals without ocular disease and with stable defects were recruited. All participants had a baseline standard automated perimetry (SAP) test. Participants tested remotely on a VRVF device for 4 weeks (examinations V 1 , V 2 , V 3 , and V 4 ), with the last 3 unassisted. The mean sensitivities of VRVF results were compared with each other and to SAP results for reliability. RESULTS A total of 42 eyes from 21 participants were tested on the VRVF device. Participants tested consistently although external factors impacted outcomes. VRVF results were in reasonable agreement with the baseline SAP. Examinations performed by the cohort with stable defects evinced better agreement with SAP examinations (V2, P = 0.79; V3, P = 0.39; V4, P = 0.35) than those reported by the cohort without ocular disease (V2, P = 0.02; V3, P = 0.15; V4, P = 0.22), where the null hypothesis is that the instruments agree. Fixation losses were high and variable in VRVF examinations compared with those of SAP, particularly in certain test takers. Participants considered the device comfortable and easy to use. CONCLUSIONS Self-administered, remote VF tests on a VRVF device showed satisfactory test-retest reliability, good inter-test agreement with SAP, and acceptability by its users. External factors may impact at-home testing and age and visual impairment may hinder fixation. Future studies to expand the sample size and understand inconsistencies in fixation losses are recommended.
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Wu JH, Varkhedi V, Saseendrakumar BR, Acuff K, Weinreb RN, Baxter SL. Social and Health Care Utilization Factors Associated With Ophthalmic Visit Nonadherence in Glaucoma: An All of Us Study. J Glaucoma 2023; 32:1029-1037. [PMID: 37671531 PMCID: PMC10840877 DOI: 10.1097/ijg.0000000000002300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/09/2023] [Indexed: 09/07/2023]
Abstract
PRCIS In a diverse nationwide cohort, lower education and income levels, cost saving on medications, fewer past-year medical/specialist visits, and concerns regarding dissimilarity with health care providers were risk factors for ophthalmic visit nonadherence among glaucoma patients. PURPOSE The purpose of this study was to characterize social and health care utilization factors associated with nonadherence with ophthalmic visits among patients with glaucoma. MATERIALS AND METHODS Glaucoma patients in the All of Us database who completed the Healthcare Access and Utilization Survey were included and categorized into "visit" and "nonvisit" groups based on visit adherence, defined by self-reported past-year encounters with eyecare providers (yes/no). Data regarding potential factors affecting ophthalmic visit adherence, including past-year medical visits, inabilities to afford health care, and self-reported reasons for delayed care, were extracted. χ 2 tests and logistic regression were used to compare the 2 groups. Odds ratios (ORs) of visit adherence were analyzed for potential risk factors. RESULTS Of 5739 glaucoma patients, 861 (15%) were in the nonvisit group. More participants in the visit group reported past-year general doctor/specialist visits (94%/65%; vs. nonvisit group: 89%/49.3%; P <0.05). The nonvisit group reported greater difficulty in affording medical care and learning about medical conditions, and higher rates of delayed/missed health care access for various concerns ( P <0.05). Older age (OR=1.02, 1.01-1.03), higher education (OR=1.25, 1.13-1.40), and income level (OR=1.06, 1.01-1.11), not employed for wages (OR=1.28, 1.08-1.53), and higher health care utilization in general medical/specialist visits (ORs range:1.08-1.90) were associated with visit adherence ( P <0.05). Visit nonadherence was associated with cost saving on medication (OR=0.62, 0.40-0.97) and delaying/avoiding seeing health care providers because of dissimilarity (OR=0.84, 0.71-0.99) ( P <0.05). CONCLUSIONS This study builds on prior literature by identifying potentially modifiable factors associated with visit nonadherence and underutilization of eyecare in glaucoma. These may inform strategies to improve real-world ophthalmic visit adherence and identify patients who might benefit from additional support.
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Affiliation(s)
- Jo-Hsuan Wu
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, United States
| | - Varsha Varkhedi
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Bharanidharan Radha Saseendrakumar
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Kaela Acuff
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Robert N. Weinreb
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, United States
| | - 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
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, United States
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Liu H, Ying S, Kamat S, Tukel C, Serle J, Fallar R, Tai TYT, Chadha N. The Role of Telemedicine in Glaucoma Care Triggered by the SARS-CoV-2 Pandemic: A Qualitative Study. Clin Ophthalmol 2023; 17:2251-2266. [PMID: 37575208 PMCID: PMC10422957 DOI: 10.2147/opth.s418502] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/28/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose To explore and report on how glaucoma care was impacted by the SARS-CoV-2 pandemic (COVID-19) in New York City (NYC) with a specific emphasis on the role of telemedicine. Patients and Methods This was a qualitative, cross-sectional study that engaged glaucoma clinicians in semi-structured interviews to elicit perspectives on telemedicine and patient care experiences during the pandemic. Interview responses were coded and analyzed thematically. Results Twenty clinicians participated. Mean participant age was 48.8 ± 12.3 years, and the mean number of years in practice post-glaucoma fellowship was 17.5 ± 12.4 years. Four main themes pertinent to the role of telemedicine triggered by the COVID-19 pandemic were identified: (1) The Need to Ensure Patient and Staff Safety Drove Telemedicine Uptake; (2) Telemedicine Allowed Providers to Address Subjective Complaints; (3) Telemedicine was Discontinued Due To Concerns of Compromised Patient Safety and Measurement Inaccuracy; (4) Technological Advances are Needed for Continued Telemedicine Usage and Uptake in Glaucoma Care. The interviews suggested that telemedicine usage dropped markedly within just a few months during the pandemic, and for most physicians interviewed, telemedicine is no longer part of their clinical practice. Several clinicians reported optimism towards future implementation of telemedicine as the technology develops. Conclusion This study identified 4 themes outlining the uptake, application, discontinuation and overall perspectives on telemedicine by glaucoma clinicians. The role of telemedicine, as triggered by the COVID-19 pandemic, may have lasting implications for patient safety, continuity of care, and glaucoma care delivery beyond this public health crisis.
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Affiliation(s)
- Helen Liu
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stephanie Ying
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samir Kamat
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Connor Tukel
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Janet Serle
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Ophthalmology, New York Eye and Ear Infirmary, New York, NY, USA
| | - Robert Fallar
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tak Yee Tania Tai
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Ophthalmology, New York Eye and Ear Infirmary, New York, NY, USA
| | - Nisha Chadha
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Ophthalmology, New York Eye and Ear Infirmary, New York, NY, USA
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Chahal R, Jindal A, Parmar UPS, Singh RB, Bhartiya S, Ichhpujani P. Lifestyle Measures for Glaucoma Patients: An Objective Social Media Content Analysis. J Curr Glaucoma Pract 2023; 17:141-148. [PMID: 37920374 PMCID: PMC10618604 DOI: 10.5005/jp-journals-10078-1412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/08/2023] [Indexed: 11/04/2023] Open
Abstract
Aim In this study, we analyze the content quality and characteristics of the most viewed search results on various internet platforms related to lifestyle measures for patients with glaucoma. Materials and methods In this internet-based cross-sectional study, we used search keywords "glaucoma," "lifestyle," "glaucoma," and "exercise" on the most popular internet platforms-Google, Facebook, YouTube, and Reddit. The top 30 Google searches about each of the keyword combinations were identified. We also assessed the first 30 videos on YouTube and Facebook Watch, the first 30 Reddit posts and the first 30 Google images about each of the keyword combinations. The quality of content from the platforms was evaluated by three independent reviewers using the well-established Sandvik score, Health on Net (HON) code, and risk score for different uploaders. The quality of content regarding lifestyle measures in glaucoma uploaded by healthcare professionals (HCPs) was further evaluated. Results The established criteria resulted in 48 websites from the Google search engine, 22 videos from YouTube, 37 posts from Reddit, and 28 videos from Facebook Watch, which were included in the final analysis. The mean Sandvik scores were 11.14 ± 1.8 (Google webpages), 10.4 ± 2.19 (YouTube videos), 10.54 ± 2.21 (Facebook Watch), and 4.24 ± 1.18 (Reddit). The mean risk scores were 0.22 ± 0.68 (YouTube videos), 0.18 ± 0.47 (Facebook Watch), and 0.11 ± 0.31 (Reddit). The mean HON code scores were 5.45 ± 1.62 (YouTube), 6.55 ± 1.44 (Google webpages), 5.29 ± 1.04 (Facebook Watch), and 8.27 ± 3.05 (Reddit). The content uploaded by HCPs was primarily from ophthalmologists and had significantly (p < 0.05) higher content quality scores. The majority of the content recommended aerobic exercise as a lifestyle measure in patients with glaucoma as an adjuvant to medical and surgical management. Conclusion The majority of the content regarding lifestyle measures in glaucoma was uploaded by HCPs and had medically accurate and well-referenced information, especially on Google and YouTube. Clinical significance Primary care physicians and ophthalmologists can reliably use social media content to guide recently diagnosed patients about the requisite lifestyle measures. How to cite this article Chahal R, Jindal A, Parmar UPS, et al. Lifestyle Measures for Glaucoma Patients: An Objective Social Media Content Analysis. J Curr Glaucoma Pract 2023;17(3):141-148.
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Affiliation(s)
- Rutvi Chahal
- Department of Ophthalmology, Government Medical College & Hospital, Chandigarh, India
| | - Ankush Jindal
- Department of Ophthalmology, Government Medical College & Hospital, Chandigarh, India
| | | | - Rohan Bir Singh
- Department of Ophthalmology, Fortis Memorial Research Institute, Gurugram, Haryana, India
| | - Shibal Bhartiya
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Parul Ichhpujani
- Department of Ophthalmology, Government Medical College & Hospital, Chandigarh, India
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Lee YF, Chay J, Husain R, Wong TT, Ho CL, Lamoureux EL, Chew ACY. Three-year Outcomes of an Expanded Asynchronous Virtual Glaucoma Clinic in Singapore. Asia Pac J Ophthalmol (Phila) 2023; 12:364-369. [PMID: 37523427 DOI: 10.1097/apo.0000000000000620] [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: 03/09/2023] [Accepted: 05/11/2023] [Indexed: 08/02/2023] Open
Abstract
PURPOSE Virtual glaucoma clinics can help increase health care capacity, easing the disease burden of glaucoma. This study assesses the safety, rate of glaucoma progression, time efficiency, and cost-savings of our expanded Glaucoma Observation Clinic (GLOC) at the Singapore National Eye Centre over 3 years. METHODS All patients seen at GLOC between July 2018 and June 2021 were included. Visual acuity, intraocular pressure, and visual fields or optic nerve head imaging were recorded, followed by a virtual review of the data by an ophthalmologist. An objective review of the management of 100 patients was conducted by 2 senior consultants independently as a safety audit. Patient outcomes including the rate of instability (due to worsening of clinical parameters necessitating a conventional clinic visit), glaucoma progression, the consultation review time efficiency, and cost-savings of GLOC were measured. RESULTS Of 3458 patients, 16% had glaucoma, and the others had risk factors for glaucoma. The safety audit demonstrated a 95% interobserver agreement. The rate of instability was 14.6%, of which true progression was observed in 3.12%. The time taken for a glaucoma specialist to review a GLOC patient was 5.75±0.75 minutes compared with 13.7±2.3 minutes in a conventional clinic. The per capita manpower cost per GLOC patient per visit was $36.77 compared with $65.62 in the conventional clinic. This translates to a cost-saving of $280.65 over the lifetime of a hypothetical patient. CONCLUSIONS Our expanded virtual glaucoma clinic is a safe, time-efficient, and cost-effective model with low rates of glaucoma progression, which could allow for significant health care capacity expansion.
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Affiliation(s)
- Yi Fang Lee
- Glaucoma Service, Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
- Duke-NUS Medical School, Singapore
| | - Junxing Chay
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Rahat Husain
- Glaucoma Service, Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
- Duke-NUS Medical School, Singapore
| | - Tina T Wong
- Glaucoma Service, Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
- Duke-NUS Medical School, Singapore
| | - Ching Lin Ho
- Glaucoma Service, Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
- Duke-NUS Medical School, Singapore
| | - Ecosse L Lamoureux
- Glaucoma Service, Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
- Duke-NUS Medical School, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Annabel C Y Chew
- Glaucoma Service, Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
- Duke-NUS Medical School, Singapore
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Sohail M, Hirji SH, Liebmann JM, Glass LD, Blumberg DM. Remote Contrast Sensitivity Testing Seems to Correlate With the Degree of Glaucomatous Macular Damage. J Glaucoma 2023; 32:533-539. [PMID: 36897654 DOI: 10.1097/ijg.0000000000002205] [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: 10/17/2022] [Accepted: 02/18/2023] [Indexed: 03/11/2023]
Abstract
PRCIS Remote contrast sensitivity (CS) testing through a free downloadable home test correlates with glaucomatous macular damage measured by 10-2 visual field (VF) testing. PURPOSE To assess the feasibility and validity of home CS monitoring as a measure of glaucomatous damage using a free downloadable smartphone application. METHODS Twenty-six participants were asked to remotely use the Berkeley Contrast Squares (BCS) application, a free downloadable tool that records the user's CS for varying degrees of visual acuity. An instructional video detailing how to download and use the application was sent to the participants. Subjects were asked to send logarithmic CS results with a minimum 8-week test-retest window, and test-retest reliability was measured. Results were validated against office-based CS testing that was collected within the previous 6 months. Validity analysis was also carried out to determine whether CS as measured by BCS is a good predictor of 10-2 and 24-2 VF mean deviation (MD). RESULTS There was a high BCS test-retest reliability with an intraclass correlation coefficient score of 0.91 and a significant correlation between repeat test results and baseline test scores (Pearson, 0.86, P < 0.0001). There was significant agreement between unilateral CS scores as measured by BCS and office-based CS testing ( b = 0.94, P < 0.0001, 95% CI: 0.61 to 1.27). Unilateral CS as measured by BCS was significantly associated with 10-2 VF MD ( r2 = 0.27, P = 0.006, 95% CI: 3.7 to 20.6), but not with 24-2 VF MD ( P = 0.151). CONCLUSION This study suggests that a free, rapid home CS test correlates with glaucomatous macular damage as measured by 10-2 VF.
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Affiliation(s)
- Marium Sohail
- Columbia University Vagelos College of Physicians and Surgeons New York, NY
| | - Sitara H Hirji
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Lora D Glass
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
| | - Dana M Blumberg
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
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Díez-Álvarez L, Beltrán-Agullo L, Loscos J, Pazos M, Ponte-Zúñiga B, Pinazo-Durán MD, Giménez-Gómez R, Ussa F, Pinilla LM, Jaumandreu L, Rebolleda G, Muñoz-Negrete FJ. Advanced glaucoma. Clinical practice guideline. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:18-39. [PMID: 36088247 DOI: 10.1016/j.oftale.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/24/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To present an update clinical practice guideline that serve as a guide for the detection, evaluation and treatment of adults patients with advanced glaucoma. METHODS After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR 2 (Assessment of Multiple systematic Rewiews) and Cochrane "Risk of bias" tools by at least two reviewers, recommendations were formulated following the Scottish Intercollegiate methodology. Guideline Network (SIGN). RESULTS Recommendations with their corresponding levels of evidence that may be useful in the diagnosis, monitoring and treatment of adults patients with advanced glaucoma. CONCLUSIONS Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of advanced glaucoma.
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Affiliation(s)
- L Díez-Álvarez
- Departamento de Oftalmología, Hospital Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain.
| | | | - J Loscos
- Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Servicio de Oftalmología, Hospital Universitari Germans Trias i Pujol, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - M Pazos
- Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Institut Clínic d'Oftalmologia, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - B Ponte-Zúñiga
- Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Servicio de Oftalmología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - M D Pinazo-Durán
- Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Unidad Investigación Oftalmológica Santiago Grisolía/FISABIO; Unidad de Oftalmobiología Celular y Molecular, Universidad de Valencia, Valencia, Spain
| | - R Giménez-Gómez
- Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Servicio de Oftalmología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - F Ussa
- Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain; Department of Ophthalmology, The James Cook University Hospital, Middlesbrough, United Kingdom
| | - L M Pinilla
- Institut Català de la Retina (ICR), Barcelona, Spain
| | - L Jaumandreu
- Departamento de Oftalmología, Hospital Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Department of Ophthalmology, The James Cook University Hospital, Middlesbrough, United Kingdom
| | - G Rebolleda
- Departamento de Oftalmología, Hospital Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain
| | - F J Muñoz-Negrete
- Departamento de Oftalmología, Hospital Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain
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10
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Coan LJ, Williams BM, Krishna Adithya V, Upadhyaya S, Alkafri A, Czanner S, Venkatesh R, Willoughby CE, Kavitha S, Czanner G. Automatic detection of glaucoma via fundus imaging and artificial intelligence: A review. Surv Ophthalmol 2023; 68:17-41. [PMID: 35985360 DOI: 10.1016/j.survophthal.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 02/01/2023]
Abstract
Glaucoma is a leading cause of irreversible vision impairment globally, and cases are continuously rising worldwide. Early detection is crucial, allowing timely intervention that can prevent further visual field loss. To detect glaucoma an examination of the optic nerve head via fundus imaging can be performed, at the center of which is the assessment of the optic cup and disc boundaries. Fundus imaging is noninvasive and low-cost; however, image examination relies on subjective, time-consuming, and costly expert assessments. A timely question to ask is: "Can artificial intelligence mimic glaucoma assessments made by experts?" Specifically, can artificial intelligence automatically find the boundaries of the optic cup and disc (providing a so-called segmented fundus image) and then use the segmented image to identify glaucoma with high accuracy? We conducted a comprehensive review on artificial intelligence-enabled glaucoma detection frameworks that produce and use segmented fundus images and summarized the advantages and disadvantages of such frameworks. We identified 36 relevant papers from 2011 to 2021 and 2 main approaches: 1) logical rule-based frameworks, based on a set of rules; and 2) machine learning/statistical modeling-based frameworks. We critically evaluated the state-of-art of the 2 approaches, identified gaps in the literature and pointed at areas for future research.
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Affiliation(s)
- Lauren J Coan
- School of Computer Science and Mathematics, Liverpool John Moores University, UK.
| | - Bryan M Williams
- School of Computing and Communications, Lancaster University, UK
| | | | - Swati Upadhyaya
- Department of Glaucoma, Aravind Eye Hospital, Pondicherry, India
| | - Ala Alkafri
- School of Computing, Engineering & Digital Technologies, Teesside University, UK
| | - Silvester Czanner
- School of Computer Science and Mathematics, Liverpool John Moores University, UK; Faculty of Informatics and Information Technologies, Slovak University of Technology, Slovakia
| | - Rengaraj Venkatesh
- Department of Glaucoma and Chief Medical Officer, Aravind Eye Hospital, Pondicherry, India
| | | | | | - Gabriela Czanner
- School of Computer Science and Mathematics, Liverpool John Moores University, UK; Faculty of Informatics and Information Technologies, Slovak University of Technology, Slovakia
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11
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Chow SC, Lam PY, Choy BNK. Patient-centred care in ophthalmology: current practices, effectiveness and challenges. Graefes Arch Clin Exp Ophthalmol 2022; 260:3149-3159. [PMID: 35445876 DOI: 10.1007/s00417-022-05666-x] [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: 01/17/2022] [Revised: 03/16/2022] [Accepted: 04/08/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To summarise different patient-centred care approaches that can be used in ophthalmology and review their effectiveness. METHODS An Entrez Pubmed search on publications concerning different patient-centred care was performed on September 7, 2021. Articles on animal research, non-English language and review articles were excluded after manually screening by two authors. RESULTS A total of 16 articles were reviewed after curation by the authors for relevance. Patient-centred care has advantages in improving disease knowledge, enhancing doctor-patient communications and improving mental well-being of patients. Various methods including intensive patient education, patient-centred communication techniques during consultations, personal disease records, education programme for caregivers, on-site ocular care for residential care home resident and shared medical appointments can be used to enhance patient-centred care. CONCLUSIONS Current strategies in patient-centred care in ophthalmology were found to be useful. However, they have not been widely practised and more studies would be required generate an evidence-based recommendation for future use.
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Affiliation(s)
- Shing Chuen Chow
- LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Pun Yuet Lam
- LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Bonnie Nga Kwan Choy
- Department of Ophthalmology, LKS Faculty of Medicine, The University of Hong Kong, Room 301, Block B, Cyberport 4, Cyberport, Hong Kong, Hong Kong.
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12
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Abstract
PURPOSE OF REVIEW The current article reviews enhancements to the delivery of glaucoma care that developed in response to the coronavirus disease 19 (COVID-19) pandemic and are likely to persist beyond its resolution. RECENT FINDINGS Literature from the review period (2020-2021) includes reports highlighting contributions of the ophthalmology community to global health during the pandemic. Glaucoma practices worldwide have instituted more robust infection control measures to mitigate severe acute respiratory syndrome coronavirus 2 transmission in the outpatient setting, and many of these modifications will endure in the post-COVID era. Operational adjustments have led to the provision of more efficient glaucoma care. A hybrid care model involving technician-based diagnostic testing and subsequent virtual consultation with a glaucoma specialist has evolved as a useful adjunct to traditional face-to-face encounters with patients. SUMMARY Glaucoma specialists, patients, and staff have adapted to a 'new normal' of glaucoma care delivery during the COVID-19 pandemic. Although innovation has propelled several improvements to glaucoma care during this global health crisis, significant barriers to more widespread implementation of teleglaucoma still exist. Whether, and in what capacity, the pandemic has permanently altered glaucoma practice patterns remains to be seen.
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Affiliation(s)
- Kateki Vinod
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai and New York Eye and Ear Infirmary of Mount Sinai, New York, New York USA
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13
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Thainimit S, Chaipayom P, Sa-arnwong N, Gansawat D, Petchyim S, Pongrujikorn S. Robotic process automation support in telemedicine: Glaucoma screening usage case. INFORMATICS IN MEDICINE UNLOCKED 2022. [DOI: 10.1016/j.imu.2022.101001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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14
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Chitungo I, Mhango M, Mbunge E, Dzobo M, Musuka G, Dzinamarira T. Utility of telemedicine in sub-Saharan Africa during the COVID-19 pandemic. A rapid review. HUMAN BEHAVIOR AND EMERGING TECHNOLOGIES 2021; 3:843-853. [PMID: 34901772 PMCID: PMC8653215 DOI: 10.1002/hbe2.297] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/01/2021] [Indexed: 12/23/2022]
Abstract
Telemedicine is the use of technology to achieve remote care. This review looks at the utility of telemedicine during the pandemic, period March 2020 to February 2021. Eleven articles met inclusion criteria. There was moderate use of telemedicine in sub‐Sahara Africa during the pandemic, however, there were also some limitations. Benefits of telemedicine include continuing medical service provision, connecting relatives with loved ones in quarantine, education, and awareness of mental health issues, and toxicovigilance and infection control. Challenges to the implementation of telemedicine on the continent were lack of supporting telemedicine framework and policies, digital barriers, and patient and healthcare personnel biases. To address these challenges, this article proposes the development of policy frameworks that fosters telemedicine use by all stakeholders, including medical insurance organizations, the introduction of telemedicine training of medical workers, educational awareness programs for the public, and improvement of digital platforms access and affordability.
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Affiliation(s)
- Itai Chitungo
- Department of Laboratory Diagnostics and Investigative Science, Faculty of Medicine and Health Sciences University of Zimbabwe Harare Zimbabwe
| | - Malizgani Mhango
- School of Public Health University of Western Cape Cape Town South Africa
| | - Elliot Mbunge
- Department of Computer Science, Faculty of Science and Engineering University of Eswatini (formerly Swaziland) Kwaluseni Eswatini
| | - Mathias Dzobo
- Department of Laboratory Diagnostics and Investigative Science, Faculty of Medicine and Health Sciences University of Zimbabwe Harare Zimbabwe
| | | | - Tafadzwa Dzinamarira
- ICAP at Columbia University Harare Zimbabwe.,School of Health Systems & Public Health University of Pretoria Pretoria South Africa
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15
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Abstract
Purpose of Review The field of teleglaucoma has expanded rapidly in recent years with several large-scale teleglaucoma screening programs in existence throughout the world. Additionally, teleglaucoma programs for use in disease management are under study. The limited access to care that resulted from the COVID-19 pandemic highlighted the need for expansion of such programs. This article reviews the literature on teleglaucoma for screening and management of glaucoma, discussing considerations for incorporating teleglaucoma into clinical practice. Recent Findings Teleglaucoma screening reduces the rate of false-positive referrals and can accurately screen at-risk populations with accuracy similar to in-person screening. The use of teleglaucoma for the management of glaucoma shows promise for low-risk patients with early disease. Furthermore, teleglaucoma is cost-effective and reduces travel burden for patients resulting in high patient satisfaction. Summary Teleglaucoma offers potential for improving access to glaucoma care, reducing the burden on patients and health care systems.
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